What is creative tension? Why does it matter?

Drs. Joel C. Small and Edwin McDonald discuss the concept of creative tension and how to utilize this valuable tool to increase productivity. 

Drs. Joel C. Small and Edwin McDonald describe a powerful motivator that drives positive change

Many of us are familiar with the concept of cognitive dissonance. Described initially by Leon Festinger in 1957, the theory of cognitive dissonance proposes that humans seek psychological consistency between their current reality and their perceived ideal reality. When a gap exists between the two, psychological tension, or dissonance, occurs. The more significance and value people attribute to the perceived ideal state, the greater the tension, and the more they seek to relieve it. For example, smokers may well understand that smoking is unhealthy, and they may desire a healthy lifestyle, and yet they continue to smoke and experience psychological tension because a gap exists between their reality and their perceived ideal state. The more they value becoming a nonsmoker, the greater the degree of tension.

It has been our observation that those who are unable to close the ideal/reality gap continue to suffer psychological tension until they finally either close the gap and become nonsmokers, rationalize why smoking is acceptable, or submit to a self-limiting belief that they are simply incapable of reaching the perceived ideal state. The consequences of adopting this self-limiting belief can be significant as they live with constant frustration and loss of self-esteem.

Interestingly, this same tension can be used in a more positive and generative way. Peter Senge, author of the book The Fifth Discipline (1990), introduced the concept of creative tension as a potential aid in facilitating creativity and change. According to Senge’s theory, we create positive (creative) tension when we clearly articulate our vision and our current reality, thus making the gap between the two apparent.

Cognitive dissonance and creative tension both share a common etiology — tension created by the perceived gap between the ideal and the real. What distinguishes creative tension from chronic cognitive dissonance is the manner in which the tension is resolved.

It is our assertion that creative tension is a powerful motivator that drives positive change within organizations. It is also our belief that the following three essential elements must be present for creative tension to produce positive change.


Jim Clemmer, a renowned leadership opinion leader, once stated, “If you can’t see it, you can’t be it.” Our vision is what allows us to see a preferred future state of being. Having a compelling vision of a preferred future is essential on a personal level, but how we communicate this vision to our team is even more critical.


Unless our team finds the vision compelling, they will lack the motivation necessary to make the vision a reality. Trusting the leader and believing in an overarching organizational purpose are important when seeking team motivation.


There is perhaps no greater driving force for creative tension than people’s belief in their ability to attain the desired future state. Those that suffer from chronic cognitive dissonance do so because they either place little value in achieving their preferred future, or even more commonly, they believe that they are incapable of closing the ideal/reality gap.

Creating a team’s sense of self-efficacy requires a growth mindset on the part of the leader. Believing in the capabilities of all team members, creating a psychologically safe environment, and allowing them a degree of autonomy will empower our teams and build their confidence in their ability to accomplish any goal.

It is the doctor’s/leader’s responsibility to provide clarity of vision, an explanation of the tangible benefits of achieving the desired state, and all the resources and support that are required for the staff to be successful.

Clinical practices that harness the power of creative tension are more productive than those that fail to recognize or utilize this valuable tool. Given these three essential elements, creative tension becomes energizing because team members view the task ahead as a means to an extremely desirable future. Once they embrace a clear vision that they find desirable and compelling, and they are confident in their capabilities, there is little that will stop them from achieving the desired result. For the team, the task becomes their mission.

Besides harnessing creative tension, a practice must develop a set of core values for the practice to thrive. Read “What do we value? A critical question and a values exercise” at https://endopracticeus.com/what-do-we-value-a-critical-question-and-a-values-exercise/.

Drs. Joel C. Small and Edwin (Mac) McDonald have a total of over 75 years of dental practice experience. Both doctors are trained and certified Executive Leadership Coaches. They have joined forces to create Line of Sight Coaching, a business dedicated to helping their fellow dentists discover a better and more enjoyable way to create and lead a highly productive clinical dental practice. Through their work, clients experience a better work/life balance, find more joy in their work, and develop a strong practice culture and brand that positively impact their bottom line. To receive their free ebook, 7 Surprising Steps to Grow Your Practice Through Leadership, go to www.lineofsightcoaching.com.


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