Despite abundant leadership research, unknowns remain on maximizing the leader-follower dyad. Previous research has detailed the role of leadership perceptions on leader-follower relations, but it is not known how these two variables affect follower self-efficacy and its influences on employees and their organizations. Expanding upon existing research, this study investigated perceptions of leadership through employees’ implicit leadership theories (ILTs) and their relationship with quality of leader-member exchange (LMX) and follower self-efficacy. The study is supported by ILT, LMX, and self-efficacy theories. Three research questions progressively explored relationships between specific and general ILTs, quality of LMX, and self-efficacy. In this non-experimental, correlational study, healthcare workers from 8 primary-care practices completed questionnaires to measure ILTs, quality of LMX, and self-efficacy. Correlation and multiple regression tested hypotheses pertaining to the role of different types of ILTs upon LMX quality and follower self-efficacy. Results revealed a correlation between employees’ different types of ILTs and predictive utility for LMX quality. Correlation and predictive utility were also revealed for employees’ specific ILTs for antiprototypical traits and LMX-7 scores upon self-efficacy. Results suggest ineffective leaders are detrimental to the development of dyadic relationships and employees’ self-efficacy, thus supporting the importance of understanding and reconciling employees’ different types of ILTs to enhance relationships and employee self-efficacy. An understanding of ILT influence upon LMX and self-efficacy may enhance leadership practices, thereby improving organizational operations in terms of productivity and efficiency, while increasing employee and customer satisfaction and facilitating overall, positive social change.