Work Type




Faculty Advisor

Danny McMillian, Jennifer Hastings




Title: Defending the Art of Physical Therapy: Expanding Inquiry and Crafting Culture in Support of Therapeutic Alliance

Authors: Nicole Brun-Cottan1, SPT, Danny McMillian PT DSc.1, Jennifer Hastings, PT PhD. ,NCS.1

Affiliations 1. School of Physical Therapy, University of Puget Sound, Tacoma WA, USA.

Theory/Body: The successful practice of physical therapy within the biopsychosocial construct requires a professional culture that places value on the interpersonal relationships that foster healing and the face time required to build those relationships. The unfortunate truth is that pressures on current practice are not facilitating this dynamic approach. The drive for increased productivity, cost effectiveness and ultimately, profit, are changing the landscape in which we practice. For-profit entities are placing an emphasis on data-driven practice patterns and tying reimbursement to performance on standardized outcomes measures. The data that drives these models is often not informed by physical therapists, and changes are being imposed by payers without adequate regard for the impact on quality of life for both patients and practitioners. This phenomenon is fueled by an overemphasis on quantitative research in evidence based medicine and an under-appreciation of clinical expertise and patient values. This imbalance undermines the holistic, patient-centered approach that has been the basis for physical therapy since its inception.

In this paper an argument is presented that we are losing the art of practicing physical therapy. Authors suggests that in order to preserve defining characteristics of the profession, there is an urgent need to redirect our research agenda and PT education with a focus on the study of contextual and psycho-social factors that influence treatment outcomes. Recent research findings indicate that the effect of therapeutic alliance may be as important to outcomes as the chosen intervention. The authors suggest that excellence in DPT education must incorporate education addressing the vital importance of therapeutic alliance and also include training in the skills for developing such unique intentional relationships.


1.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. Physical Therapy. 2010;90(8):1099-1110. doi:10.2522/ptj.20090245.

2.Kayes NM, McPherson KM. Human technologies in rehabilitation: “Who” and “How” we are with our clients. Disability & Rehabilitation. 2012;34(22):1907-1911 5p. doi:10.3109/09638288.2012.670044.

3. Rosin T. Fee-for-service vs. value-based care: 6 points of debate raised by health policy experts.


University of Puget Sound