By Melissa M. Sweetman, PhD, OTD, OTR/L

In recent years, emotional intelligence has become a widely recognized concept associated with successful leadership. This concept could scarcely be better suited than for the clinical care professions operating within healthcare. It is especially among the rehabilitation disciplines, where interpersonal communication is vital not only for instructing care, but for engendering trust and rapport between therapists and their client-caregiver stakeholders. Likewise, emotional intelligence is an asset for rehab managers in optimizing communication and cooperation between themselves and a diverse group of staff members.

Contemporary scholars have discovered that it is no longer sufficient for a leader to possess cognitive intelligence and job skills alone, but that emotional intelligence is also a requisite characteristic.1 Emotional intelligence significantly impacts relationships between leaders and followers, and guides actions that foster successful work climates. In a clinical setting, we are all leaders. If we are managers we lead our staff, but our jobs as therapists require that we lead our clients through the process of rehabilitation every day. Possessing strong emotional intelligence skills will pave the pathway for developing beneficial relationships with others, thereby enabling leadership excellence.

Emotional Intelligence Defined

Emotional intelligence is a set of four primary skills, each with its own set of specific competencies.2 The four primary skills that comprise emotional intelligence are self-awareness, self-management, relationship management, and social awareness. Competencies that fall within these categories include, but are not limited to, self-confidence, self-control, transparency, optimism, empathy, inspiration, influence, and conflict management. Essentially, emotional intelligence is the ability for one to recognize both his/her own and others’ emotions, and understand how those emotions can affect behavior.

Goleman et al presented the argument that emotional intelligence is a primal aspect of leadership: “It is both the original and the most important act of leadership.”2 From the beginning of time, humans have relied upon a leader for guidance in times of uncertainty, challenge, or when work needs to be done. How that leader manages his/her emotions sets the emotional tone for the entire group. Because emotions often drive behavior, it is critical that the foundational aspect (the primal aspect) of leadership be emotional in nature. Many researchers, including Goleman et al, have examined this concept.2 Research proves that a leader’s emotional tone sets the emotional tone of his/her followers, and that when the tone is optimistic and enthusiastic, productivity, creativity, and efficiency are enhanced.3

Recently, therapists have faced many changes in how clinics and practices operate due to healthcare reform, with more likely to come. These changes and difficult situations can be scary. It is vitally important that as rehab managers, we recognize and acknowledge the emotions our staff might be experiencing as we navigate these challenging times. Choosing to present the changes with an optimistic tone in positive and creative ways is scientifically proven to ease the transitions and increase the acceptance of those changes.3

Relationship Management

Managing the relationships between people within an organization is a critical factor for success.4 Some key considerations include ensuring a good fit between the worker and the organization, fulfillment of human needs through the organization, and understanding how to best motivate the valuable assets of the workers. Research shows that the human capital within an organization can be the major factor that determines how successfully an organization achieves its strategic mission. When there is ideal alignment between an organization and the human resources that support it, the organization “can develop sources of competitive advantage that are valuable, rare, inimitable, and non-substitutable.”4

For rehab professionals, emotional intelligence plays a large role in the ability to establish strong interpersonal relationships. Face-to-face, hands-on work with client and patient populations is a hallmark of physical and occupational therapy, which makes the importance of those interpersonal relationships self-evident. To effectively engage in a variety of situations, one must be able to recognize his/her own emotions as well as those of clients, caregivers, colleagues, and a range of healthcare workers. Stein and Book asserted that to begin building strong interpersonal relationships, one must become cognizant of the social environment in which he/she is operating, improve verbal and non-verbal communication skills, and gain comfort speaking to a large group of people.1 A common thread among each of these strategies is that of emotional intelligence—especially emotional self-awareness and empathy.

Emotional self-awareness is not only having an understanding of one’s own emotions, but also an understanding of how others perceive those emotions. Showry and Manasa eloquently reminded readers that they can learn a great deal about themselves through their interactions with others: “We get the reflection of ourselves through the human mirrors, from their opinions, responses and reactions.”5 Take some time to reflect on this quote. Does your team seem resistant to your advice and directives? Does your team seem fearful or angry all the time? What is the general mood of the department? Setting aside all pride, examine your actions and the emotions you display at work. Do you think your team is mirroring your attitude?

Aside from self-deception, fear of how others will react sometimes creates a barrier to developing emotional self-awareness. Foley-Lewis opined that more often than not, team members are pleased and demonstrate positive reactions when they notice a change in the leader’s ability (for the better) to recognize and express emotions.6


Understanding and Applying Emotional Self-Awareness

Before one can be comfortable expressing emotions in the workplace, one has to develop a strong sense of emotional self-awareness. Stein and Book defined emotional self-awareness as “the ability to recognize your feelings, differentiate between them, know why you are feeling these feelings, and recognize the impact your feelings have on others around you.”1

Fortunately, all of the skills that comprise emotional intelligence can be honed and strengthened. The key to developing emotional self-awareness is through reflection and introspection.5 It is important that while exploring one’s deepest feelings, honesty and candor must be present. Steiner warned that it is easy to fall into the trap of self-deception, which paints an inaccurate picture of one’s own emotions and emotional reactions, which in turn leads to a negative impact on the ability to communicate with and engage with others.7 We can be our own harshest critics, but we can also be blind to the reality of others’ perceptions of us. Showry and Manasa stated, “While inaccurate negative perceptions about self drive people into depression, overly bloated positive perceptions result in unhealthy pride or arrogance or deception which is detrimental to the wellbeing of self, others and organizational effectiveness.”5

When one possesses emotional self-awareness, he/she is able to fully comprehend how emotions influence every situation and human beings’ responses to them. Creating a strong sense of emotional self-awareness is indeed a crucial skill for leaders to possess as it opens the door for developing strong relationships with others. Take some time at the end of each day to reflect. How did you feel throughout the day? Were there particular situations that caused certain emotions to arise? How did you react to challenges? Were there certain times of day that your mood seemed to be better or worse? Asking yourself these types of questions at the end of each work day can guide a reflective process that leads to insight into your emotional self-awareness.

Steiner believed that a lack of emotional self-awareness can limit one’s ability to form productive relationships with others.7 Furthermore, when people lack self-awareness, they are more likely to place blame for failures on others rather than recognizing their own roles and responsibilities for the outcome of the situation.7 It is a common cliché that leaders attribute all success to their team, but take all the blame upon themselves when failures occur. However, when a manager possesses little to no emotional intelligence, the opposite can be true. To build strong relationships, one must learn to temper and leverage emotional responses to elicit appropriate actions by others. Is it your natural tendency to immediately think of all the potential negative outcomes when presented with change? How might your team respond if you chose, instead, to focus on the potential opportunities?

Interpersonal Relationships, Empathy, and Social Responsibility

Aside from emotional self-awareness, other emotional intelligence skills also come into play with relationship management. For example, the skills within Stein and Book’s interpersonal realm of developing interpersonal relationships, empathy, and social responsibility are important factors to consider.1 Stein and Book asserted that interpersonal relationships need to be mutually beneficial for optimal success.1 For this to occur, both parties must be in touch with their own desires and needs as well as with those of the other person. Additionally, one must be able to understand the other person’s perspective empathetically, and must feel a desire to contribute to the well-being of the group as a whole. Menaker concurred with the importance of empathetically understanding the perspectives of others as a way of strengthening relationships.8

Empathy is a skill that can have a significant impact on the probability of a successful outcome of a difficult situation. According to Stein and Book, “Empathy is simply a skill that allows you to see and experience the world from another person’s perspective.”1 It is important to note that empathy does not require that one agree with the other person. Stein and Book made a clear distinction between the concepts of sympathy and empathy.1 Sympathy is when one expresses his or her own personal feelings about the situation or other person; whereas, empathy is when one expresses his or her understanding of what the other person may be feeling about the situation. According to Stein and Book, empathy has a much more significant impact on the outcomes of the conversation than sympathy may.1

As managers, we are faced with situations requiring empathy every day. Do you have a young mom on your team whose child is frequently sick, causing her to miss work? Do you have a clinician who is often late to work because her elderly parent with Alzheimer’s disease lives with her and morning routines are particularly tough? Taking the time to put yourself in their shoes so that you can gain some understanding of the situation from their point of view will help you empathetically problem-solve ways to achieve the mission and objectives of your department while being sensitive to your employees’ needs.

We also face situations requiring empathy with our clients and their caregivers. Experiencing and adjusting to a new illness, injury, or condition is often an emotional and stressful process. Our clients and their caregivers may not possess strong emotional intelligence skills and may have difficulty processing those emotions. Have you ever had a client’s family get angry during an intervention or interdisciplinary meeting? Have you ever observed a client and their family having a disagreement related to the plan of care or discharge plan? Has a client ever refused your treatment or become emotional during a session? Understanding that these actions are most likely stemming from emotions, a clinician or manager with strong emotional intelligence skills can not only mitigate the difficult situations, but can also help guide the client and their caregiver through more effective ways of expressing the emotion.

Social Awareness

Social awareness is the skill of identifying and understanding other people’s emotions.9 It also involves the ability to understand the viewpoint of other people. This ability to consider others’ perspectives is akin to the concept of perspective-taking that is a prominent component of conflict management. Perspective-taking is the act of truly trying to understand the situation from the other party’s perspective. Conflict is not resolved by simply acknowledging it; conflicting parties must be willing to identify potential solutions. Expressing emotions is an important factor in this process. How one handles emotion can have a significant impact on the resolution of the conflict. If social awareness is present, it opens the door for this type of conflict-resolving communication to occur.1

Social awareness also involves paying close attention to the body language of others. Because leadership focuses on the interactions with others, how one “reads” the body language, explicit and implied verbal messages, emotions, and behaviors of both him/herself and others will significantly influence the working relationship between the leader and follower.

Bradberry and Greaves suggested that one must practice learning to read body language.9 They encouraged readers to begin scanning other people from head to toe, tuning in to subtleties such as facial expressions, vocal tone, eye contact (or lack thereof), posture, gestures, and stance. Becoming proficient at reading body language can help one discern whether someone’s words are genuine, or whether more is being “said” between the lines through nonverbal communication.

Once a leader has the ability to read the emotions of others, he/she can begin to establish a state of emotional synchronicity with followers. Such a state is referred to as resonance.2 Resonant leaders possess a high level of emotional intelligence and facilitate a sense of harmony among the team. Studies have proven that resonant leadership leads to improved worker health, improved job satisfaction, higher levels of organizational commitment, decreased levels of emotional exhaustion, and decreased intent to seek employment elsewhere.10,11 Conversely, a leader’s behavior can also lead to dissonance in the workplace. Dissonant environments are teemed with distress, crisis, volatility, unrest, negativity, and lack of teamwork.2 The particular approach a leader chooses has a significant impact on whether the outcome is resonance or dissonance. Goleman et al presented six distinct leadership styles that may be used interchangeably depending on the situation and the followers’ needs.2 Four of these styles primarily result in resonance, whereas two of these styles easily result in dissonance if not used skillfully and appropriately.

The visionary style of leadership promotes a shared vision among the team and is best used when clear direction is needed to move the team forward. The coaching style focuses on enabling the employee to reach personal goals that align with organizational goals. The affiliative style focuses on team relationships and facilitates motivation and teamwork during stressful times. Using the democratic style, a leader seeks to gain input from team members during decision-making processes, which leads to organizational commitment and loyalty. The pacesetting and commanding styles must be used with caution. These two styles are those that may lead to dissonance if used improperly. Pacesetting is used to maximize productivity and the attainment of fast-paced, ambitious goals. It works best when the team is already highly motivated and just needs that extra push to achieve more than they imagined possible. The commanding style is ideally used in a crisis situation and provides clear direction which, when used appropriately, can allay fears.2 Each of the resonant styles of leadership that Goleman et al set forth rely upon emotional intelligence, but specifically on social awareness.2 As a rehabilitation manager, it is important that you understand not only the needs of the situation, but also the needs and emotions of the team so that you can select the approach that best fits.


Self-management is one’s ability to recognize his/her own emotions and hot buttons and prevent them from controlling behavior.9 It is the ability to sense when one’s emotions are rising, take the temperature of the situation, and make conscious decisions on how to act in a calm and productive manner. Emotions can have a significant impact on not only how one behaves, but also on how one interprets the behavior of others. Research has shown that parties who demonstrate positive emotions regarding a conflictual situation are more likely to view the conflict as constructive; whereas, those who view the conflict with negative emotions are more likely to view the conflict as destructive or dysfunctional.12

The ability to self-manage requires a clear understanding of what elicits an emotional response. Triggers for negative emotional responses are often called hot buttons.13 Oftentimes, emotions produced by hot buttons cause individuals to misinterpret others or make inaccurate assumptions about another person’s behavior. To prevent these negative effects, one must first introspectively assess his/her emotions and identify personal hot buttons.13 Pay close attention to your reactions to situations. What causes you to get angry or lose your temper? What causes you extreme frustration? Do particular people or situations exasperate you? Do your emotions ever control your actions? Do you ever regret something you said or did? By increasing self-awareness, one can more objectively and accurately determine whether reactions are based on emotions and biases rather than the accurate causes and motives. Learning how to cool one’s hot buttons is not always an easy process, but it will result in much-needed self-control.13

Self-management also requires emotional agility. David and Congleton define emotional agility as the ability to “approach [one’s inner experiences] in a mindful, values-driven, and productive way.”14 When one demonstrates emotional agility, he/she can quickly identify personal thoughts, feelings, and biases that lead to patterns of behavior so that he/she can act on them in a positive manner. David and Congleton assert that emotional agility can be strengthened through four processes: recognizing patterns of emotional behavior, identifying thoughts and emotions, learning to accept one’s patterns and behaviors, and feeling confident enough to act on personal values.14 As with other skills previously discussed, recognizing such patterns requires great introspection and self-awareness.


Each of the emotional intelligence components discussed above are skills that will benefit a rehabilitation leader. Fortunately, researchers and experts agree that emotional intelligence can be learned and strengthened. Zijlmans, Embregts, Gerits, Bosman, and Derksen provided emotional intelligence training to 214 healthcare facility support staff through “verbal feedback on an Emotional Intelligence Quotient-inventory profile and video-feedback on staff interacting with clients.”15 Results showed that the participants in the training program showed statistically significant gains in all areas of emotional intelligence, and that 4 months later the positive effects were still present.

Likewise, a qualitative study by Thory showed that when managers were taught emotional regulation strategies at work, they were more likely to use them throughout their work experiences.16 These studies offer hope to leaders that with the effort to learn emotional intelligence strategies, and practice them in an intentional manner, the ability to manage relationships, increase social awareness, and improve the ability to self-manage can all be attained. Reflect on the components of emotional intelligence, learn more about the topic, and share the education with your rehabilitation team. Possessing these emotional intelligence skills allows leaders to strengthen the ability to inspire, motivate, encourage, and lead their teams or clients to successful outcomes. RM

Melissa M. Sweetman, PhD, OTD, OTR/L, has been an occupational therapist for 22 years. For the majority of her career she has worked as a clinical and operational multi-state regional director in the post-acute and long-term care settings. She transitioned to the academic setting in 2012 as program director and director of the administration and practice management elective track for the Post-Professional Doctor of Occupational Therapy Program at Rocky Mountain University of Health Professions. She currently serves as the Founding Program Director of the Entry-Level Doctor of Occupational Therapy Program at Wingate University, and is president of the South Carolina Occupational Therapy Association. For more information, contact [email protected].


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