When I was a kid, I wanted to be a therapist (I actually wanted to be the Bionic Woman, but that role was taken, so I settled on a therapist). I went to school, studied, got a master’s degree and PhD, completed all of the required licensing hours, passed the big exam, and off I went. I very quickly ended up in management and am now the CEO of Constellation Behavioral Health. How did this happen exactly? Early on, I became a student of approaches to leadership in behavioral healthcare. The more I watched, practiced, stumbled and fell, I realized leadership was about one thing: relationships. Simply put, leaders lead people and clinicians use techniques to move people. I quickly discovered that my clinical training was one of my greatest strengths in leadership in this industry. And I realized that my relationship with myself and my own ego was tantamount to supporting a healthy organization.

Think about it:  Who we are as leaders flows throughout the organization. We set the tone. We create the experience of emotional safety (or lack of it), and the freedom to speak out or be quiet. If we have integrity, the organization will be known for that. If we are reactive in a management meeting, this can define the culture of the organization from that moment forward. Our direct reports project a great deal onto us. They watch us so closely that with the simple raise of an eyebrow they will know whether we are for or against the idea they have presented. Trust me, I have seen it happen.

All of this intense focus by the team on the leader can do interesting things to the leader’s relationship with themselves. They can become self-important. They may over time stop asking for input from others and have to make the choice to create a culture of fear or of inclusion. Some become leaders, particularly in behavioral healthcare, in a context of feeling deeply insecure. Perhaps they are in recovery from addiction themselves or come from a family dynamic that may have included mental health disorders. It is natural for these life experiences to catalyze the desire to work in this field, but such leaders may not have the emotional maturity to match their level on the organizational chart.

What has naturally resulted are some very insecure leaders in this industry. And truth be told, the ego loves insecurity. The ego puffs way up to compensate for this experience of what is called “imposter syndrome” and to soothe itself in the most challenging moments. Here are some examples:

• We are given a promotion to a management role. We have no idea what we are doing and feel insecure or fearful. In response to this, we become very directive, acting the way we think a manager should act. Our direct reports bristle at the change in us.
• We quietly question our confidence in ourselves. Marketing our facilities at an industry conference filled with high level professionals, insecurity can cause us to oversell our facilities and perhaps embellish on what may already be great treatment. Others sense our overblown style and may move on. Our insecurity increases.

These are inner, and to some extent outer, experiences that we hope no one can see. We hope for grace amid our self-doubt and hope for a steep learning curve. We fail to trust that we are enough, that our team and quality of care is enough. Our ego gets in the way of our own integrity.

So how can this impact the bottom line you ask? When we engage from an ego-centered lens in leadership, we distance those around us. We quickly forget the mission-driven focus of patient-centered care. Putting our own sense of self-importance first, we can believe we have the right answers without seeking input from others. We believe that everyone except for us is replaceable and thereby undermine how the individuals on our team feel valued by us. We essentially undo the relationships that could create the team’s success. Thus, employee satisfaction will go down and employee turnover will inevitably increase. 

To take this a step further, once we have taken this ego-centered approach and our managers feel distanced from and devalued by the leader of the organization, we now have directly impacted the frontline staff and the patient. The psychological insight on this is that the patient can only be as healthy as the staff and organization is healthy. If the employees are not engaged and do not feel valued, they do not offer hope in the same way to the patient. The staff may try, but they ultimately will be limited in their ability to express belief in the recovery of the patient (which, research shows, is a significant factor in the recovery from mental health and co-occurring disorders) if their leader has failed to value, focus on, and believe in them. At this point you have lost: You have lost the team, you have lost the staff, and you have lost your ability to be effective with patients. What follows, if we remain in this ego-centered state, is that our facilities become known for poor outcomes. We lose our referral relationships, we lose our admissions stream, and we lose revenue. Try as we may, nothing will change unless we find right relationship with ourselves again.

The key words here are mission-driven. We must focus and put the patient first. Always. No matter what. We do the right things for the right reasons, again and again. We get ourselves out of the way through doing our own inner work. We overcome being the limiting factor in this dynamic. We stop focusing as much on revenue and we focus on what matters: believing in the people that can make a difference. By letting go of ego, we remember what it means to be part of a team and we catalyze both the hope and the inherent ability of our patients to recover.

I have been part of organizations that have struggled, watched the leaders methodically disintegrate and ultimately dismantle previously successful cultures and teams through their own fear of decreased revenues and, at a deeper level, their lens of ego. I have also been in behavioral healthcare organizations and senior leadership teams that have achieved great success and that have innovated in extraordinary ways. We were honest with each other and with ourselves, we had a leader who openly invited feedback and input, and we pushed ourselves to be more than we were yesterday. We felt valued, worked hard, and did not want to be anywhere else. Our patient outcomes were twice the industry standard, and our revenues were extraordinary.

Of course, the danger is in inflating the ego once success is achieved through this mission-driven focus (which is also how many once mission-driven single owner facilities start out). Be careful in this scenario. While the temptation is great to own this success as our own, it is better a success to be owned and shared by a team. Once ego takes hold of it, patient outcomes will suffer and so will our bottom lines.

Krista Gilbert, PhD, LMFT, is chief executive officer of Constellation Behavioral Health.