Practitioners mark behavior as inadequately accounted for. "It's still not quite clear to me" implies pain alone doesn't explain inactivity. This subtly challenges the inevitability of patient's limitations. It creates space for alternative explanations.

State University of New York at Binghamton

- Normalization Devices
- Hypothetical Treatment Directions
- Insufficient Explanation Framing
- Agency Attribution
- Hedging and Distancing

Practitioner Challenge Strategies: Techniques for encouraging behavioral change without direct confrontation

- Script Formulations
- Breach Narratives
- Insufficient Explanation Framing
- Agency-Accountability Link

Accountability Work: Managing responsibility and moral identity

Lester, J. N. (Ed.). (2021). Discursive Psychology and Disability. Palgrave Studies in Discursive Psychology. Springer Nature Switzerland AG.

Reference For: Discursive Psychology and Disability

Practitioners use "just" to minimize perceived difficulty. "Just go do it" suggests activity is ordinary and achievable. This implies patient could and should be able to perform the action. It challenges the self-evidence of disability claims.

Normalization Devices

Suggesting "moving does no harm" proposes behavioral change. Hypothetical framing tests patient openness to psychosocial approach. It implies current inactivity isn't medically necessary. This positions change as possible and desirable.

Hypothetical Treatment Directions

Insufficient Explanation Framing

Using "you lie down" versus "you have to lie down" matters. Active voice positions patient as choosing their actions. This makes accountability and responsibility relevant to the interaction. It opens possibility for different choices in future.

Agency Attribution

Tentative language protects practitioners from direct confrontation. "Suppose we would say" creates hypothetical distance. Institutional "we" deflects personal accountability for challenging patient. Manages delicacy of questioning patient's account.

Hedging and Distancing

Attributing agency makes past actions accountable. If you choose to lie down, why did you choose inactivity? This provokes defensive responses from patients. Conversations spiral into frustrating circular patterns.

Agency-Accountability Link

Patients use "if-then" structures to present actions as inevitable. "If pain is bad, then I must lie down" frames behavior as forced. This minimizes personal accountability for decreased activity. The pain, not the patient, determines the action.

Script Formulations

Calling in sick described as exception to normal conduct. Establishes baseline of good work ethic and responsibility. Prevents inference of malingering or lack of motivation. Positions patient as reluctantly disabled, not willingly inactive.

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