A Physical Therapist Who Swears: A Case Series
Keywords:physical therapy, swearing, therapeutic alliance, professionalism, communication
Objective: Swearing deserves attention in the physical therapy setting due to its potential positive psychological, physiological, and social effects. The purpose of this case series is to describe 2 cases in which a physical therapist swears in the clinical setting and its effect on therapeutic alliance.
Patients: Case 1 is a 19-year-old male treated for a hamstring strain, and case 2 is a 23-year-old male treated post-operatively for anterior cruciate ligament reconstruction. The physical therapist utilized social swearing in the clinic with the goal of motivating the patient and enhancing the social connection with the patient, to improve therapeutic alliance.
Results: The patient in case 1 reported a decrease in therapeutic alliance after the physical therapist began swearing during physical therapy treatments, whereas the patient in case 2 reported an increase in therapeutic alliance. Both patients disagreed that physical therapist swearing is unprofessional and disagreed that swearing is offensive, and both patients agreed physical therapists should be able to swear around their patients.
Conclusion: Physical therapist swearing may have positive and negative influences in the clinic setting and may not be considered unprofessional. These are, to our knowledge, the first published cases of a physical therapist swearing in the clinical setting.
Swearing produces positive effects that cannot be achieved with any other forms of language. Quite simply, swearing is powerful and deserves attention in the physical therapy setting. Swearing can lead to tighter human bonds, thereby enhancing the social connection between a patient and a physical therapist. This case series describes 2 cases where a physical therapist swears with patients in the clinical setting and its effect on their social connection. While swearing increased the social connection in 1 case, it decreased it in the other case. None of the patients thought that physical therapist swearing was unprofessional, and both patients believe physical therapists should be able to swear around their patients. The results of these cases indicate that physical therapist swearing can have positive and negative influences in the clinic. More studies are needed to help determine when, how, and if to swear in the physical therapy setting.
Stewart M, Loftus S. Sticks and stones: the impact of language in musculoskeletal rehabilitation. J Orthop Sports Phys Ther 2018; 48: 519–522. https://doi.org/10.2519/jospt.2018.0610 DOI: https://doi.org/10.2519/jospt.2018.0610
Puentedura EJ, Louw A. A neuroscience approach to managing athletes with low back pain. Phys Ther Sport 2012; 13: 123–133. https://doi.org/10.1016/j.ptsp.2011.12.001 DOI: https://doi.org/10.1016/j.ptsp.2011.12.001
Beers Fägersten K. Who’s swearing now? The social aspects of conversational swearing. Newcastle: Cambridge Scholars Publishing; 2012.
Cavazza N, Guidetti M. Swearing in political discourse: why vulgarity works. J Lang Soc Psychol 2014; 33: 537–547. https://doi.org/10.1177/0261927X14533198 DOI: https://doi.org/10.1177/0261927X14533198
Johnson DI, Lewis N. Perceptions of swearing in the work setting: an expectancy violations theory perspective. Commun Rep 2010; 23: 106–118. https://doi.org/10.1080/08934215.2010.511401 DOI: https://doi.org/10.1080/08934215.2010.511401
Green R, Gregory R, Mason R. Professional distance and social work: stretching the elastic? Aust Soc Work 2007; 59: 449–461. https://doi.org/10.1080/03124070600986010 DOI: https://doi.org/10.1080/03124070600986010
Vingerhoets AJJM, Bylsma LM, de Vlam C. Swearing: a biopsychosocial perspective. Psych Top 2013; 22: 287–304.
McLeod L. Swearing in the “tradie” environment as a tool for solidarity. Griffith Work Pap Pragmat Intercult Commun 2011; 4: 1–10.
Wachtel PL. Therapeutic communication: knowing what to say when. 2nd ed. New York, NY: The Guilford Press; 2011.
DuFrene DD, Lehman CM. Persuasive appeal for clean language. Bus Commun Q 2002; 65: 48–55. https://doi.org/10.1177/108056990206500105 DOI: https://doi.org/10.1177/108056990206500105
Wah L. Profanity in the workplace. Manage Rev 1999; 88: 8.
Stapleton K, Beers Fägersten K, Stephens R, Loveday C. The power of swearing: what we know and what we don’t. Lingua 2022; 277: 103406. https://doi.org/10.1016/j.lingua.2022.103406 DOI: https://doi.org/10.1016/j.lingua.2022.103406
Washmuth NB, Stephens R. Frankly, we do give a damn: improving patient outcomes with swearing. Arch Physiother 2022; 12: 6. https://doi.org/10.1186/s40945-022-00131-8 DOI: https://doi.org/10.1186/s40945-022-00131-8
Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Phys Ther 2010; 90: 1099–1110. https://doi.org/10.2522/ptj.20090245 DOI: https://doi.org/10.2522/ptj.20090245
Kinney M, Seider J, Beaty AF, Coughlin K, Dyal M, Clewley D. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: a systematic review of the literature. Physiother Theory Pract 2018; 36: 886–898. https://doi.org/10.1080/09593985.2018.1516015 DOI: https://doi.org/10.1080/09593985.2018.1516015
Fuentes J, Armijio-Olivo S, Funabashi M, Miciak M, Dick B, Warren S, et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther 2014; 9: 477–789. https://doi.org/10.2522/ptj.20130118.cx DOI: https://doi.org/10.2522/ptj.20130118
Pinto RZ, Ferreira ML, Oliveira VC, Franco MR, Adams R, Maher CG, et al. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. J Physiother 2012; 58: 77–87. https://doi.org/10.1016/S1836-9553(12)70087-5 DOI: https://doi.org/10.1016/S1836-9553(12)70087-5
Baruch Y, Jenkins S. Swearing at work and permissive leadership culture: when anti-social becomes social and incivility is acceptable. Leadersh Organ Dev J 2007; 28: 492–507. https://doi.org/10.1108/01437730710780958 DOI: https://doi.org/10.1108/01437730710780958
Giffin HJ. Client’s experiences and perceptions of the therapist’s use of swear words and the resulting impact on the therapeutic alliance in the context of the therapeutic relationship. Theses, Dissertations, and Projects 2016. [cited 2022 December 28] Available from: http://scholarworks.smith.edu/theses/1696
Martin RL, Cibulka MT, Bolgla LA, Koc TA, Loudon JK, Manske RC, et al. Hamstring strain injury in athletes. J Orthop Sports Phys Ther 2022; 52: CPG1–44. https://doi.org/10.2519/jospt.2022.0301 DOI: https://doi.org/10.2519/jospt.2022.0301
Andrade R, Pereira R, van Cingel R, Staal JB, Espregueira-Mendes J. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with focus on quality appraisal (AGREE II). Br J Sports Med 2020; 54: 512–519. https://doi.org/10.1136/bjsports-2018-100310 DOI: https://doi.org/10.1136/bjsports-2018-100310
van Melick N, van Cingel REH, Brooijmans F, Neeter C, van Tienen T, Hullegie W, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016; 50: 1506–1515. https://doi.org/10.1136/bjsports-2015-095898 DOI: https://doi.org/10.1136/bjsports-2015-095898
Stephens R, Dowber H, Barrie A, Almeida S, Atkins K. Effect of swearing on strength: disinhibition as a potential mediator. Q J Exp Psychol 2022; 76. https://doi.org/10.1177/17470218221082657 DOI: https://doi.org/10.31234/osf.io/dfyc8
Mbada CE, Nonvignon J, Ajayi O, Dada OO, Awotidebe TO, Johnson OE, et al. Impact of missed appointments for outpatient physiotherapy on cost, efficiency, and patients’ recovery. Hong Kong Physiother J 2013; 31: 30–35. https://doi.org/10.1016/j.hkpj.2012.12.001 DOI: https://doi.org/10.1016/j.hkpj.2012.12.001
Peek K, Carey M, Sanson-Fisher R, Mackenzie L. Physiotherapists’ perceptions of patient adherence to prescribed self-management strategies: a cross-sectional survey of Australian physiotherapists. Disabil Rehabil 2017; 39: 1932–1938. https://doi.org/10.1080/09638288.2016.1212281 DOI: https://doi.org/10.1080/09638288.2016.1212281
Bokinskie J, Johnson P, Mahoney T. Patient no-show for outpatient physical therapy: a national survey. UNLV Theses Dissertations Prof Pap Capstones; 2015, Las Vegas.
Room J, Boulton M, Dawes H, Archer K, Barker K. Physiotherapists’ perceptions of how patient adherence and non-adherence to recommended exercise for musculoskeletal conditions affects their practice: a qualitative study. Physiotherapy 2021; 113: 107–115. https://doi.org/10.1016/j.physio.2021.06.001 DOI: https://doi.org/10.1016/j.physio.2021.06.001
Williams IL, Uebel M. On the use of profane language in psychotherapy and counseling: a brief summary of studies over the last six decades. Eur J Psychother Couns 2021; 23: 404–421. https://doi.org/10.1080/13642537.2021.2001025 DOI: https://doi.org/10.1080/13642537.2021.2001025
Babatunde F, MacDermid J, MacIntyre N. Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature. BMC Health Serv Res 2017; 17: 375. https://doi.org/10.1186/s12913-017-2311-3 DOI: https://doi.org/10.1186/s12913-017-2311-3
Luborsky L, Barber JP, Siqueland L, Johnson S, Najavits LM, Frank A, et al. The revised helping alliance questionnaire: psychometric properties. J Psychother Pract Res 1996; 5: 260–271. https://doi.org/10.1037/t07504-000 DOI: https://doi.org/10.1037/t07504-000
Jay T. The utility and ubiquity of taboo words. Perspect Psychol Sci 2009; 4: 153–161. https://doi.org/10.1111/j.1745-6924.2009.01115.x DOI: https://doi.org/10.1111/j.1745-6924.2009.01115.x
The associated press profanity study. Ipsos Public Affairs [Internet]. 2006; Available from: https://www.ipsos.com/sites/default/files/news_and_polls/2006-03/mr060328-2.pdf
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