Taking a stance about the inner lives of patients with intellectual disabilities: uncertainty as an interactional resource in Discovery Awareness meetings

Staff working with people who have intellectual disabilities and mental health problems and/or challenging behaviour face the difficulty of interpreting and inferring meaning from behaviours that may be difficult to interpret. Understanding the behaviour of this group is fundamental to the provision of appropriate support and the development of relational aspects of care. However, staff generally attribute meaning without reflecting upon or communicating to others why they interpret behaviour in a particular way. Methods which support staff to reflect on patient's behaviour, and their interpretations of it, are therefore critical to providing good support. This article examines staff interactions in such a method; Discovery Awareness (DA). Drawing on video recordings of six 90-min DA sessions that took place in two Assessment and Treatment units, we use conversation analysis to examine how staff discuss and interpret patient behaviour(s) in both first position (where they offer an initial interpretation) and second position (i.e. as a response to, in opposition to, or in agreement with, a stance expressed by another staff member). This article demonstrates that staff use uncertainty as an interactional resource to navigate their epistemic rights to interpret the meaning of patients' behaviour and interactions. We conclude that, while other kinds of healthcare meetings seek to develop a shared conclusion or single way forward, DA meetings create a space that engenders epistemic modesty and reflective discussion between staff that does not seek to resolve uncertainty.