Using expletives to enhance therapeutic outcomes: A case report
Background
Swearing deserves attention in the physical therapy setting due to its potential positive effects on pain, physical performance, and therapeutic alliance. The purpose of this case report is to describe the strategic use of swearing in the clinical setting.
Case Presentation
A 44-year-old female completed an episode of physical therapy after undergoing patellofemoral arthroplasty. Swearing was formally included into the plan of care, and the patient swore out loud during the most challenging and painful interventions.
Results
The patient reported that repeating a swear word was funny, distracted the patient, and made the patient feel more confident. The patient and physical therapist self-reported a strong therapeutic alliance.
Conclusion
There is evidence repeating a swear word out loud can strengthen the therapeutic alliance, improve physical performance, and decrease pain. This is, to our knowledge, the first report of a patient swearing during an episode of physical therapy care.
1. Stewart M, Loftus S. Sticks and stones: The impact of language in musculoskeletal rehabilitation. I Orthop Sports Phys Ther. 2018;48(7):519-522. doi:10.2519/jospt.2018.0610
2. Puentedura EJ, Louw A. A neuroscience approach to managing athletes with low back pain. Phys Ther Sport. 2012;13(3):123-133. doi:10.1016/j.ptsp.2011.12.001
3. Beers Fagersten K. Who's Swearing Now? The Social Aspects of Conversational Swearing. Cambridge Scholars Publishing; 2012.
4. The associated press profanity study. Ipsos Public Affairs. https://www.ipsos.com/sites/default/files/news%20and%20polls/2006-03/mr060328-2.pdf. Published 2006.
5. 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(4):404-421. doi:10.1080/13642537.2021.2001025
6. Stapleton Karyn, Beers Fagersten Kristy, Stephens Richard, Loveday Catherine. The power of swearing: What we know and what we don't. Lingua. 2022;277:103406. doi:10.1016/j.lingua.2022.103406
7. Vingerhoets AJJM, Bylsma LM, de Vlam C. Swearing: A Biopsychosocial Perspective. Psych Top. 2013;22(2):287-304.
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(8):1099-1110. doi:10.2522/ptj.20090245
9. Washmuth NB, Stephens R. Frankly, we do give a damn: Improving patient outcomes with swearing. Arch Physiother. 2022;12(1). doi:10.1186/s40945-022-00131-8
10. Stephens R, Atkins J, Kingston A. Swearing as a response to pain. Neuroreport. 2009;20(12):1056-1060. doi:10.1097/wnr.0b013e32832e64b1
11. Stephens R, Umland C. Swearing as a response to pain-effect of daily swearing frequency. J Pain. 2011;12(12):1274-1281. doi:10.1016/j.jpain.2011.09.004
12. Stephens R, Robertson O. Swearing as a response to pain: Assessing hypoalgesic effects of novel “swear” words. Front Psychol. 2020;11:723. doi:10.3389/fpsyg.2020.00723
13. Robertson O, Robinson SJ, Stephens R. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants. Scand J Pain. 2017;17(1):267-272. doi:10.1016/j.sjpain.2017.07.014
14. Hostetter AB, Rascon-Powell DK. F@#k pain! The effect of taboo language and gesture on the experience of pain. Psychol Rep. Published online September 8, 2022:003329412211257. doi:10.1177/00332941221125776
15. Stephens R, Spierer DK, Katehis E. Effect of swearing on strength and power performance. Psychol Sport Exerc. 2018;35:111-117. doi:10.1016/j.psychspor t.2017.11.014
16. 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(2):305-318. doi:10.1177/17470218221082657
17. Trummer G, Stephens R, Washmuth NB. A Physical Therapist Who Swears: A Case Series. J Rehabil Med- Clin Commun. 2023;6(10277). doi:10.2340/jrmcc.v6.10277
18. Jensen MP, Miller L, Fisher LD. Assessent of pain during medical procedures: A comparison of three scales. Clin J Pain. 1998;14(4):343-349. doi:10.1097/00002508-199812000-00012
19. Mehta SP, Fulton A, Quach C, Thistle M, Toledo C, Evans NA. Measurement properties of the lower extremity functional scale: A systematic review. J Orthop Sports Phys Ther. 2016;46(3):200-216. doi:10.2519/jospt.2016.6165
20. Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. F.A. Davis; 2016.
21. Pisanu G, Rosso F, Bertolo C, et al. Patellofemoral arthroplasty: Current concepts and review of the literature. Joints. 2017;5(4):237-245. doi:10.1055/s-0037-1606618
22. Stapleton K. Swearing and perceptions of the speaker: A discursive approach. J Pragmat. 2020;170:381-395. doi:10.1016/j.pragma.2020.09.001
23. Stepien KA, Baernstein A. Educating for empathy. J Gen Intern Med. 2006;21(5):524-530. doi:10.1111/j.1525-1497.2006.00443.x
24. Fuentes J, Armijo-Olivo S, Funabashi M, 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;94(4):477-489. doi:10.2522/pt j.20130118
25. Horvath AO, Del Re AC, Flückiger C, Symonds D. Alliance in individual psychotherapy. Psychotherapy. 2011;48(1):9-16. doi:10.1037/a0022186
26. Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. J Consult Clin Psychol. 2000;68(3):438-450. doi:10.1037/0022-006 x.68.3.438
27. Luborsky L, Barber JP, Siqueland L, Johnson S, Najavits LM, Frank A, Daley D. The revised helping alliance questionnaire: Psychometric properties. J Psychother Pract Res. 1996;5:260-271.