A Critical Physical Therapy Skill-set for the 21st Century

There is a growing consensus that the days of patriarchal and guru approaches to medicine and therapy are no longer acceptable. And while they still may be practiced, they are still as ineffective as ever in creating a caring connection with your patient.  What’s the alternative?  Peter and many other leaders have stated that a coaching approach to leadership is the critical leadership skill-set for the 21st Century. I think a coaching approach to health-care, and PT in particular, is just as critical and big part of the answer.

Why? Because coaching at is core is focused on the client or in this case, the patient. Coaching is about asking instead of telling. It’s about partnering in a thought-provoking and creative process that inspires the person to maximize their potential.  Isn’t that what we, as therapists, are about in the first place? 

A physical therapist taking a coaching approach to his or her patient includes: 044 Balance2

  • Discovering, clarifying, and aligning with what the patient wants to achieve
  • Encouraging patient self-discovery
  • Eliciting patient-generated solutions and strategies when possible
  • Holding the patient responsible and accountable

The tenets above are almost verbatim from the International Coaching Federation (ICF) definition of coaching; I simply substituted the word “patient” for “client”. They are also the same ones I use when coaching executive and professional clients, including Confluent Health’s team leaders (who are beyond outstanding….a big shout out to all of them reading this post!).  Because these same tenets provide the foundation for The Four Habits Model of medical interviewing, some therapists will be familiar with them; unfortunately, too few are.

A coaching approach to care helps patients dramatically improve their outlook on work and life, while improving their ability to lead themselves well and maximize their outcome potential. It also helps create a quality connection and rapport. The other benefit for both therapist and patient is that minimizes and often eliminates dependency. In the words of my good friend and colleague Daphne Scott and the language of Conscious Leadership, “it’s about both parties taking 100% responsibility, no more and no less.”

If a coaching approach to patient care is simple (and it obviously is) and effective, then why don’t more therapists and health-care providers adopt it wholesale…..or at least use it from time to time?

I personally think one of the biggest reasons a coaching approach to patient care isn’t used is because it runs counter to our nature; we simply like to tell people what we know and what to do. If you doubt that, just hangout with a kindergartner for a about 5 minutes (either a chronological kindergartner or a functional one, makes no difference). And that leads to a central truth: just because something is simple doesn’t mean it’s easy to do. You have to work at it if you want to become skilled at taking a coaching approach to caring for your patients.

No need for finger pointing here. Instead, self-reflection is in order. And with that in mind I’d like to ask you a question: How often would you say you use a coaching approach or even elements of a coaching approach in your patient care?  If you disagree that a coaching approach to patient care is a foundational part of creating high-quality connections and maximizing patient oriented outcomes, what model or approach would you advocate?

Please leave a comment, I’d love to hear your thoughts and know how it’s going for you.


5 responses to “A Critical Physical Therapy Skill-set for the 21st Century

  1. John says:

    Totally agree!!

  2. Damien Howell says:

    I am intrigued with the concept of “Motivational Interviewing” as described by William Miller, and have been exploring incorporating the concepts into patient care and Physical Therapy team process improvement. I am excited when it works and frustrated when it doesn’t seem to work. I have not succeeded at evoking/eliciting from peer Physical Therapists their thoughts and ideas on how to improve the effectiveness of the service that we provide. I see a need for identifying Physical Therapists who are skilled at Motivational Interviewing and Coaching abilities who are willing to be mentors.

  3. Robert Wainner says:


    Although developed and use for use with addicts, it has broad application and have been quite effective in a number of areas and with many populations.

    Here is an excellent resource:

    Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing)
    by William R. Miller, Stephen Rollnick $45.02


  4. Laurie says:

    I have had to have physical therapy many time throughout my life and I have had good physical therapists and not so good physical therapists. The ones that I preferred made sure to be nice, explain everything and show me the exercises have me do them there – but give me assignments to take home and hold me accountable. The physical therapist needs to make sure that the patient understands what will happen if they don’t follow through with their exercises and shouldn’t just not care. Great information, thanks for sharing!

  5. John Mahoney says:

    Thank you for talking about the importance of making sure the physical therapist is clear and aligned with what the patient wants. It makes sense that this can help the patient be more confident and more willing to do what the therapists suggest. It is important to remember that hiring someone who knows what they’re doing can make the difference in your recovery.

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