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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Words Mean Things

Published February 19, 2016 5:06 PM by Dillon Stickle

ANAHEIM, CA -- Language, both verbal and non-verbal, are important tools in the therapist-client relationship. In a lecture called "Words Mean Things: How Communication Impacts Clinical Results" given by Kevin Lulofs-MacPherson, PT, DPT, OCS, Larry Benz, PT, DPT, OCS, MBA, and Tim Flynn, PT, PhD, we learned the value of language and how it can affect the outcomes of a therapist's client.

The speakers went through things like verbal and non-verbal layers of communication. We learned that patient satisfacion is tied to social talk, direct eye contact, body language, physical contact, close interpersonal distance, less time on a chart, and not frowning. They said that distancing behaviors in the therapist leads to poor functional outcomes for the patient.

An interesting take was that of anxiety in the patient. If a patient is given an angry expression, it results in an avoidance tendency; however, studies show that if the patient is given an overly happy expression, the outcome is often the same as when they're given an angry expression. The speakers questioned whether PTs need to start "toning down" their approach to communicating with patients.

One of the speakers went over "thinking traps," one being the use of abstract words. The more abstract a word, the heavier the load on your brain. Another "trap" was the idea that PTs are empathetic by nature. They said that PTs actually need to learn and condition their empathy -- "it's like a muscle." It was suggested that if you do not like the word "empathy" then to think of it as curiosity.

In this session, PTs were challenged to reconsider their role in the "therapeutic alliance," which is the relationship between the healthcare professional and the client. Should they continue looking at an iPad while their client looks around, not really paying attention to the session? Or should the therapist offer the patient a look at the iPad as well, so that there is a "shared object of attention"? I think after today, most PTs would consider the latter to result in the best patient outcomes.


This is something that I have recognized throughout my DPT program, specifically during my clinical rotations. It isn't something you may realize until you encounter a situation. Our words, as health care professionals, can have a great impact on our patients and their outcomes. A particular incident I encountered was a patient with MRI confirmed bulging discs. This particular patient had it set in their mind that PT couldn't do anything for them surgery was the only option. Even after explaining the research and the ways that PT could help, she still couldn't get over the fact of what her MRI was showing and what her physician told her. We have to be careful with our words and take into account the impact that these words will have on our patients.

Richard April 16, 2018 2:03 PM

I find this topic to be something of interest especially being a student on my last clinical rotation. Part of the reason I was drawn to the field of physical therapy was the platform it gives to cultivate relationships. While I consider myself optimistic and compassionate for all people and their recovery, I never considered my presentation of this as a potential barrier to a therapeutic alliance. Another take away from this excerpt is the shared object of attention. Sometimes I catch myself conversing with another health care professional about a patient while the patient is in the room but acting as if they were not present instead of allowing the patient to have a sense of control of their care. In my experience, sometimes the patient is the last to know about their own health status which has a negative impact on their rehabilitation potential. Therefore, engaging patients in their own care and to being present both physically and mentally, where they are, can prevent negative implications.

Morgan, Physical Therapy - Student January 21, 2017 4:43 PM

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