Saunders, B, Chew-Graham, CA, Sowden, G, Cooke, K, Walker-Bone, K, Madan, I, Parsons, V, Linaker, CH and Wynne-Jones, G (2023) Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. 136345932211484 - 136345932211484. ISSN 1363-4593

[thumbnail of 13634593221148446.pdf]
13634593221148446.pdf - Published Version
Available under License Creative Commons Attribution.

Download (186kB) | Preview


<jats:p> Work participation is known to benefit people’s overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person’s perspective; positively evaluating their personal qualities and prior actions; reflecting individuals’ views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW’s individual goals and agendas. This led to VSWs putting in considerable interactional ‘work’ to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial. </jats:p>

Item Type: Article
Additional Information: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (
Uncontrolled Keywords: theme-oriented discourse analysis therapeutic support work absence
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 03 May 2023 07:54
Last Modified: 03 May 2023 07:54

Actions (login required)

View Item
View Item