EQ for PTs: How to Be an Emotionally Intelligent Clinician

“There are four components of emotional intelligence...I think you are deficient in three of those four. Listen, you don’t develop it out of the womb, it’s something you gain over life, and I’m not talking down to you.” That’s what recent Bachelorette contestant Bennett Jordan said to Noah Erb as he condescendingly gifted him the book On Emotional Intelligence, a Harvard Business Review collection of articles addressing the subject. After observing the many ways Bennett repeatedly mishandled relationship conflicts on the show—including this interaction—I’d advise that he hang on to his copy and give it another read.

Bennett does deserve a bit of credit in one area: emotional intelligence isn’t necessarily something we are born with, but rather a competency we can develop. You certainly don’t need to be a diehard reality TV fan to have heard the term emotional intelligence (EI)—also known as emotional quotient (EQ). The concept of EI first came to light in mid-1900s literature, but it was largely popularized by science journalist Daniel Goleman in his 1995 book, Emotional Intelligence: Why It Can Matter More Than IQ. Since then, many business organizations have realized the importance of EI in their hiring, training, and company culture.

Emotional intelligence is more than being likeable and empathetic.

According to Goleman, EI comprises twelve competencies within four key domains:

1. self-awareness,
2. self-management,
3. social awareness, and
4. relationship management.

Essentially, someone skilled in emotional intelligence has the ability to identify, understand, manage, and communicate their emotions in a positive, meaningful way. EI also encompasses the capacity to recognize and empathize with the emotions of others. While we tend to think of EI as focusing mainly on traits like empathy and self-control, Goleman notes that other components—such as an ability to manage conflict—are just as essential, yet often overlooked.

For instance, influence and conflict management are two of the twelve EI competencies that aren’t always top of mind. Individuals skilled in conflict management can navigate complex emotions while bringing sensitive topics to the surface. Furthermore, their proclivity to influence others motivates them to have difficult conversations and work through challenges with peers, subordinates, or even their own leaders.

Emotional intelligence is an important skill for rehab therapy clinicians.

We know having a well-rounded EI skill set is important for all humans who interact with others, but how do clinicians specifically benefit? As you might assume, research has shown a correlation between healthcare professionals skilled in EI and the patient outcomes those clinicians achieve. In one study, higher EI levels among nurses positively and statistically significantly related to higher patient satisfaction scores. The authors concluded that the nurses skilled in EI effectively communicated with their patients, helped boost patient morale, and—by clearly understanding their patients’ emotions and concerns—cared for them using individualized approaches. Let’s discuss a couple more specific areas where research has demonstrated a positive relationship between EI and clinical practice outcomes.

Chronic Pain Cases

One group greatly served by the EI capacity of physical therapists is the population of patients who experience chronic pain. Multiple studies have shown significant relationships between therapeutic alliance and patient outcomes. Therapeutic alliance encompasses the overall relationship between therapist and patient. This includes the agreement on patient goals and interventions, and it is predicated on mutual trust and enhanced by the EI skills of the therapist. A study by Ferriera et al revealed that positive therapeutic alliance was associated with improved outcomes for patients with chronic low back pain. Strong therapeutic alliance was also shown to positively impact factors like patient function, disability, and treatment effectiveness.

A randomized controlled trial by Fuentes et al showed a clear dose-response effect between enhanced therapeutic alliance and improved pain outcomes. Just as EI pioneer Daniel Goleman cleared up some commonly-held misconceptions about EI, these study authors noted that therapeutic alliance goes beyond therapist-patient communication—stressing that it includes warmth, support, and a sense of collaboration. They underscored the stark difference between merely interacting with a client and meaningfully engaging with them—and this engagement is what serves to enhance the relationship. Strikingly, the paper reported that in terms of pain modulation, therapeutic alliance appeared to have as much influence as the physical intervention used. 

Malpractice Claims

Many clinicians are interested in the influence of EI on malpractice lawsuits. In 2019, Dr. Daniel Shouhed and colleagues published a review of the association between EI and medical malpractice claims. They note that certain characteristics of physicians—including those pertaining to EI—were among the most important factors in the lawsuits they reviewed, and that a minority of providers generated the majority of lawsuits. In fact, according to one report, 1% of physicians accounted for 32% of lawsuits! The physicians involved in lawsuits shared many common traits: they were identified as being poor listeners, showing disrespect, and failing to return phone calls. In other noted instances, physicians failed to discuss the effect of a medical problem with the patient or refrained from soliciting the patient’s opinion concerning their treatment. 

Contrast this with physicians who were not involved in malpractice claims: these clinicians were far more likely to ask their patients’ opinions and to spend more time with those patients. The authors even noted differences in the providers’ tone of voice during interactions with patients: those with domineering and unconcerned tones were more likely to be involved in malpractice litigation. It would appear from these results that many clinicians could benefit greatly from expanding their EI capabilities.

Fostering emotional intelligence starts at the educational level.

Building on previous research on the correlation between EI and academic success in nursing and medical school students, one group of researchers published findings on a novel tool for evaluating non-cognitive traits—including EI skills—in DPT students. They argue that DPT programs would do well to seek out applicants who work well with others, show a strong ability to develop solid therapeutic alliances, and demonstrate natural leadership tendencies. Their assessment tool focuses on three domains related to EI and other non-cognitive constructs:

• adaptability,
• intuitiveness, and
• engagement.

The assessment tool showed good preliminary construct and content validity, and the researchers plan to publish further findings showing any correlation to academic and professional success in those students who completed the assessment.

You can take steps to improve your own EI skills.

Curious about your own EI or wondering how to deepen your EI skills? Dr. Ted James of Harvard Medical School suggests first reflecting on your emotions in stressful situations. Adopting a practice of mindfulness can help you develop greater self-awareness and take greater control over how you react. By recognizing your emotional responses and your triggers in tense interactions, you can lessen their hold over you and maintain more control—which in turn leads to more positive social connections. Dr. James also suggests using an EI assessment tool and seeking input from others. You can do this using either a 360-degree assessment tool (which involves soliciting feedback from colleagues or peers) or a self-assessment tool (which you can supplement by having a peer take the same test on your behalf and giving you an honest evaluation). 

There are many assessments you can use to get a read on your EI skills, but keep in mind that each test has its own limitations. Although some researchers dispute the validity of self-report measures of EI, studies have shown modest associations between EI ability and self-report measures, as well as test-retest reliability and consistency across a variety of cultures.

Available Assessment Tools

Many assessment tools are available free of charge for academic or clinical research purposes. The most extensively used assessment was also the first to be scientifically validated: the Emotional Quotient Inventory (EQ-i-2.0). EQ assesses behaviors linked to EI skills (in other words, how one’s EI cognitive skills translate into actions in real-life situations). Whereas the EQ-i-2.0 is more global, other tools break EI down into a couple of components—trait EI and ability EI. Trait EI is described as the perception and regulation of one’s own emotions, while ability EI involves a deeper understanding of emotions and the ability to use them to navigate social environments. A couple of self-report tests that measure trait EI are the Trait Emotional Intelligence Questionnaire (TEIQue) and the Wong and Law Emotional Intelligence Scale (WLEIS). The TEIQue also has a version (TEIQue 360) that allows for peer input and may be more reliable.

Some free self-assessments are available as well. While they may not be as rigorous or validated as the aforementioned assessments, they can give you a general idea of where your skills lie—and they can be fun! Here are a few to try out:

• Emotional Intelligence Test from Psychology Today
• Emotional Intelligence Quiz from the Institute for Health and Human Potential
• Emotional Intelligence Test from PsychTests

Once you have a read on your skills, you might consider checking out some EI books. A great place to start is, of course, Daniel Goleman’s original bestseller, Emotional Intelligence: Why It Can Matter More Than IQ. Goleman has since written several more books on the subject—one of which is specific to the workplace: Everyday Emotional Intelligence. This book is full of strategies for regulating emotions in difficult situations, making better decisions, and helping others on your team develop EI. Another resource, Emotional Agility—by Harvard Medical School psychologist Susan Davis—takes readers through a science-based approach to deftly navigating their thoughts, feelings, and self-talk.

While EI isn’t a novel concept, we are continuing to learn more and more about its wide-reaching implications in the therapy world—and beyond. Research has made clear that EI is invaluable to clinicians and those they serve. Take some time to reflect on your EI capacity today, and see where you may be able to develop some new skills!