The Steinhoff Saga Management review - University of Stellenbosch Business School

July – December 2018

Using existential leadership coaching in a medical partnership

leadership coaching

Eric David Spencer and Dr Ruth Albertyn

  • OCT 2018
  • Tags Insights, Coaching, existential leadership
22 minutes to read


Eric David Spencer and Dr Ruth Albertyn

Leading in a partnership with no corporate hierarchy

How can leadership be developed in a dynamic partnership context where the usual corporate or public institutional rules of hierarchy and power do not apply?

When specialist physicians partner in private practice, do they perceive each other as leaders equally? Are some seen as subordinate to others? Do they function as teams, or do only some take the lead?

This case study explored the use of existential leadership coaching in a private medical partnership of specialist physicians. The unique context of physician partnerships calls for alternative approaches to leadership development. Applying the tenets of existentialism to coaching for leadership development involves reflecting upon oneself in a given context, relatedness to others, and aligning choices towards purpose.

Leadership in a medical partnership, as in any organisation, involves situational choices that rely on the interactions and relationships with others in the context. One possible developmental mechanism for such a context is that of leadership coaching. Coaching interventions have been described as individualised processes that involve working with personal meaning, allowing individuals to reflect on the way they see themselves engaging in the world, and the way they make meaning in their situations. If approached from the philosophical perspective of existentialism, coaching interventions can focus on individual choice as an exercise of free will in an interrelated world. Existential coaching can provide physicians as leaders with time for reflection, as well as a chance to “unplug” from their busy lives and find a quiet internal environment in which to consider the best way to lead and contribute to their organisation.

Applying the tenets of existentialism to coaching for leadership development involves reflecting upon oneself in a given context, relatedness to others, and aligning choices towards purpose.

Existentialism applied to leadership coaching

A number of existential philosophical assumptions underpinned the coaching of the physicians: all humans are unique; free will exists; humans choose for themselves; inquiry is intrinsic to being human; understanding of reality is constructed and de- or reconstructed; humans are shaped through potentialities and possibilities within contexts and situations; situations in turn require interaction and dialogue with others; and humans further choose to become themselves/create themselves through such encounters and dialogues.

Existentialism holds that by being conscious, individuals are free within the constraints of their wider context, as long as they are able to envisage alternative worldviews and alternatives to the situations in which they find themselves. It is argued that realisation and reflection through a process of coaching in a partnership context can bring a change in the construction of the self and relationships with others, and the organisation as a whole. Existentialism provides an argument that if, while engaged in self-reflection, individuals discover aspects of themselves that are not pleasant, they will reorient their attention towards uncovering past unpleasant events in an attempt to solve the problem. If, however, in self-refection they recall pleasant things, they are more likely to self-reflect constructively and enhance their self-worth. Thus, existentialism, with its tenet of self as construct, provides a means for self-improvement through conscious choice.

In a private partnership, unlike in a public institution or corporate entity, hierarchy and power are not fixed but are relative and negotiable within the collective.

Relatedness in context and the link to leadership

In a private partnership, unlike in a public institution or corporate entity, hierarchy and power are not fixed but are relative and negotiable within the collective. Recent thinking on leadership has a number of implications for such a context. Some researchers refer to leadership as a social activity that involves engagement with the world, and consider it a collective resource, not an individual property, because it involves a symbiotic relationship between leaders and the given context. Other researchers say leadership calls for a collaborative understanding of others and a commitment to motivate rather than control. Leadership is therefore about encouraging colleagues to contribute towards improvement; it is about building relations with others. Leadership needs to embrace new forms of leading that recognise and build on the contributions of all members of a group – an inclusive approach rather than self-aggrandisement. Collaboration and connectivity are essential components of leadership in a partnership.

Through relating to others, we come to encounter and test our surroundings and ourselves, and begin to form shared meaning. It is mainly through dialogue that we relate to others. Consensus building is another critical tenet of a humanistic approach to leadership. Therefore, a holistic perspective approach is called for in a partnership that gives others the opportunity to see their contributions to the organisation within a context. Leaders are only leaders through their relatedness to others. Leadership is thus a result of perceptions from others. Only through awareness of self and others can one develop leadership, and this is especially so in the case of partnerships.

Coaching with perceptions and choice

Viewed from the perspective of existential philosophy, and considering the implications of leadership and relatedness in the context, working with perceptions and choice becomes valuable in the coaching conversation. Leadership has been said to be a process of being perceived by others as a leader, and studies suggest that leaders should indeed understand how they are perceived by others. Such awareness has been shown to be beneficial to leaders, and the encouragement of leader self-reflection has been linked to increased skills that positively affect others.

Humans exist in particular situations and contexts. Our identities are ever-forming in response to these situations and contexts, and we are ever-choosing our situations and contexts. In the process of becoming, we are influenced by our surroundings and others, and we construct our realities as we encounter others and form our truths and biases.

Leadership empowerment has been said to arise when one is perceived to be effective, when the work being undertaken is meaningful, and when one believes one has the power to make decisions and a positive contribution. Trust enables one to be empowered for one’s own development, and being more involved in an organisation can enhance a sense of ownership.

Applying a leadership coaching intervention in a partnership, which works with perceptions and choice, has the potential to raise the awareness of partners about how perceptions influence their choices, and how they can choose to be more empowered to contribute more to their organisation as leaders.

Leadership needs to embrace new forms of leading that recognise and build on the contributions of all members of a group – an inclusive approach rather than self-aggrandisement.

How was this study conducted?

The aim of the study was to explore, in a qualitative case study, how existential coaching conversations that focus on perceptions and choice might facilitate a leader’s awareness of how she or he could contribute to leadership development in a partnership. To gather data, four individual structured coaching sessions of one hour each were conducted with four purposively selected specialist physicians over a period of eight weeks.

The coaching conversations, which were central to the research process, were conducted through the application of the coach’s five-phase existential coaching model: focus, own perceptions, alternative perceptions, imagined perceptions of others, and choice.

Multiple sources of data were collected during this study. Prior to and after the coaching intervention, data in the form of reflective questions were collected from participants in their own words. During and after each session, note-taking using index cards were completed by participants in their own writing. Furthermore, note-taking and participant observations made by the coach/researcher were collected as data and captured in the researcher’s journal. Data collection commenced prior to the start of the coaching sessions using eight guided reflective questions to be completed in a written format. These questions spoke to the existential nature of the inquiry using existential vocabulary to describe perceptions concerned with being, meaning, freedom, anxiety, purpose and choice. The following questions were included:

Q1: What does it mean to be a leader?

Q2: What is the purpose of having leaders?

Q3: What characteristics and values should leaders possess?

Q4: How should leaders relate to others?

Q5: What anxieties (stresses) can result (in you and others) from a lack of leadership?

Q6: What characteristics or values for leadership do you personally possess?

Q7: How could you contribute more to the organisation as a leader?

Q8: What personal choices could you freely make to develop as a leader?

Directly before their first coaching conversation, each participant was requested to respond in writing to the eight pre-coaching reflective research questions. The written format was selected rather than interviews in order to establish the boundary between the verbal coaching conversation and the written data collection. During the conversations and at the conclusion of each of the first three conversations, participants were also asked to write down any matters deemed important to them on index cards. This included any thoughts clarified, any new ideas, new revelations, things they would like to remember, quotes from the conversations or summative words about the conversation. Immediately after the fourth coaching conversation, the participants were requested (not earlier known to them) to respond in writing to the identical set of guided reflective research questions in the same manner as at the start of the process. It was deemed important to document the participants’ perceptions at the end of the process in a consistent way for the data to be as credible and consistent as possible. The written data was analysed using thematic content analysis to identify themes.

Findings and discussion

The argument of this article is that working with perceptions of leadership in existential coaching conversations, and particularly the process of imagining the perceptions of others, can provide a mechanism for specialist physicians in a partnership to realise how they can contribute to leadership development in their organisation. The study’s findings are underpinned by the following assertions:

  • Partnerships are voluntary collectives, and thus leadership contribution therein is unique and a matter of individual free choice.
  • The process of trying to imagine the perceptions of others provided the greatest learnings/realisations in the context of the study.
  • Choices for contributions and hence leadership development can perhaps be made through conscious consideration of “the other”.
  • Purpose and meaning may also be discovered in such an imaginative, reflective and conscious process.

Collaboration and connectivity are essential components of leadership in a partnership.

Unique leaders in the partnership context

When explaining their own and subsequently alternative perceptions of leadership, the participants initially offered lists of characteristics and values that apparently mattered most to each of them. As the conversations progressed, questions of the meaning and purpose of leadership, as well as the underlying meaning and purpose of their individual lives, their responsibilities and obligations, and futures, were discussed. Themes that emerged during the review of the data included the concepts of self and self-awareness as related by the participants, their stated identities and backgrounds as influences on their perceptions of leadership, and leadership purpose and styles. It was clear from the conversations that the participants saw each leader as unique and were aware of the self in leadership. However, their use of self-dialogue and their degrees of self-awareness varied.

The participants chose to draw on their identities and backgrounds as influences on their perceptions of leadership.

The data from the conversations lends support to the existentialist and constructivist views that we are influenced in life and that we can choose how we respond to these influences. The study, although limited in a specific context, supports the concept of self, identities and worldviews that are unique to every individual and his or her personal learning journey, and how exploring these influences are part of the quest to know oneself. It was noted that the views expressed also support the view that leadership is an individual person-based, self-affirming construct. Partnerships are constructed by unique individuals, and leadership in such a context is also unique.

The imagined perceptions of others

The phases of the coaching conversations about imagining others’ perceptions, and especially others’ perceptions of the participants themselves as leaders, were usually more contemplative, serious-toned and introspective. Most of their uncertainties and extended thinking pauses occurred when considering others’ perceptions. These phases of the conversations often stalled or even came to a complete halt for a time. It was also noted that body language, gestures and facial expressions were often nervous or strained. Alternatively, there were bursts of embarrassed laughter. Participants began to fiddle with objects at their disposal, kneading their hands, breaking eye contact and looking around the room or out of the window. Hands scratched heads, rubbed chins or caressed thighs. All four participants expressed at one time or another that the process of imagining the perceptions of others was the most challenging part of the conversations for them.

Researchers in this field do believe that leadership coaching has the potential to generate new understanding and to challenge the values and attitudes of leaders. They believe that knowing oneself is accomplished by also investigating the other, and that we create our perceptions of ourselves via the social world.

Choices for contributions

Themes that dominated the conversations about leadership in the specific context were physicians as leaders; structure and role demarcation; and power and profit. All four participants introduced the matter of physicians as business leaders, even though it was not in response to any specific question, indicating that it was a matter of concern to them. The participants acknowledged that they were trained as doctors, not as business leaders.

The participants were not sure whether they should be running the business or not, or whether they should even be considered leaders. For the most part, there was an acceptance of de facto leadership, and a feeling that they should at least be partly running the business. It was a moot point. They also acknowledged that playing a leadership role in the business, or not, was a matter of choice.

As the conversations progressed, the participants moved from speaking of choice as merely a concept and to specifying how they would choose to contribute to the organisation.

According to the participants, the process of imagining the perceptions of others was the most challenging part of the conversations.

Purpose and meaning

The coaching conversations, in addition to leading to tangible choices being expressed, also saw the participants grapple with deeper questions of purpose and meaning in their lives, and how this related to leadership in the organisation. For instance, overall sustained financial success did not seem, according to the participants, to equate entirely to levels of satisfaction. Three of the four participants expressed concerns that they were perhaps not caring enough. Two could be said to be suffering from a form of existential guilt for, according to them, not caring enough for others and giving back to others. It was interesting to note that caring and a lack of caring appeared to be major factors for the participants, as were concerns around their business profits.

The use of existentialist vocabularies naturally emerged and increased during the coaching process. It was noted that the older participants used more existential language in their discussions, and also indicated choices that were more aligned to meaning than to organisational tangibles. The younger participants, on the other hand, expressed more tangible and more operationally related contributions. Whether this was as a result of age, experience or other factors is not known. The participants began to speak of internal struggles and battles, guilt and shame and matters of individual consciousness. The later conversations particularly saw an increase in such dialogue, and what appeared to be a deeper search for meaning by all four participants.

Evidence from the study speaks to the four assertions stated earlier. The limited application of existential leadership coaching in the unique context of a particular medical partnership illustrates that leadership is merely a figment of the collective imagination that only really lives in relationships with colleagues and their perceptions of each other. Leadership coaching involves an acceptance of relational and social constructivist features of leadership processes and acknowledgement of the potential for growth and development, challenge and change.

This small exploratory study lends support to the views of those researchers who believe that leaders should examine the meaning of leadership in their own lives and contexts, and ask why and for what purpose and on whose behalf leadership should be developed. This calls for a relook at the way leading and following are understood. Therefore, a holistic leadership development perspective approach is called for that provides leaders with opportunities to see their contributions to their organisation in context.

Finding a better way to lead together

Existential leadership coaching can help to address the leadership development needs in a unique partnership context.

Existentialist philosophy was applied as a theoretical base to a coaching intervention, and the findings support the philosophy’s tenets in that the participants acknowledged themselves as unique individuals with an ability to choose. The study was concerned with a particular model of dialogue: one in which a leadership coach conversed with a limited number of specialists who already exist in a specific leadership situation and context. The existential coaching conversations facilitated self-awareness with regard to leadership issues and contributions in their specific context. Their relatedness to others clearly informed their perceptions. The process, conducted within a safe space, also brought to the surface personal battles, frustrations and struggles. Participants indicated choices for pragmatic operational contributions and personal developmental choices.

According to the participants, the process of imagining the perceptions of others was the most challenging part of the conversations. When the participants were encouraged, however, their imaginings allowed them a space to think carefully, and an opportunity to change their perceptions more markedly. These imaginings resulted in new insights and changed perceptions, which led to tangible choices for action.

The study indicated that through a process of structured conversations the participants were able to identify those areas where they can develop and assert themselves, and where they can more actively contribute to the partnership collective and the success of the organisation.

The identification of their developmental areas could then lead to a refocus and further conversations to address specific developmental objectives. This process can be applied in leadership development in partnerships where usual hierarchies do not exist and where leading, or not, is a matter of choice within the context.

In essence, working with perceptions of leadership in existential coaching conversations can provide a mechanism for members of a partnership to find greater purpose, and to choose how they can contribute better to leadership development in their collective. Also, the process of imagining the perceptions of fellow partners can unlock the identification of and choice for developmental actions and contributions to the collective. Leadership coaching, therefore, has the potential to generate new understanding and to challenge the values and attitudes of leaders.

  • Read the original article here: Spencer, E. D., & Albertyn, R. (2018). Existential leadership coaching in a medical partnership. Leadership in Health Services.
  • Dr Ruth Albertyn lectures in Research Methodology at the University of Stellenbosch Business School.
  • Mr Eric David Spencer is a PhD student at the University of Stellenbosch Business School.

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