For decades, Vygotsky’s (Reference Vygotsky, van der Veer and Valsiner1994, p. 208) principle of double stimulation was mainly understood as just another name for mediation by tools and signs, enhancing the performance of the learner or problem solver in experimental contexts and classroom interventions. Analyses of the occurrence and functioning of double stimulation in mundane work activities began to appear only after 2015. The turning point was Sannino’s (Reference Sannino2015) groundbreaking paper in which Vygotsky’s principle of double stimulation as the foundational mechanism of volitional action and agency was carefully reconstructed, systematized, and modeled. Understanding double stimulation as a principle of the formation of will and agency is of great importance for work activities and organizations facing transformations.
Transformations in work require volitional actions. The aim of this chapter is to analyze the process of double stimulation in a mundane work activity facing transformations. I aim at uncovering how volitional change actions emerge and take shape in such processes of double stimulation in the wild, and how they lead to attempts at concept formation. Thus, the question motivating this chapter is: What are the key characteristics of double stimulation and what is its role in concept formation in an everyday work activity facing transformations?
Sannino’s model of the phase structure of double stimulation (Figure 3.1 in this book) points out that full-blown processes of double stimulation are triggered by a conflict of motives. In work activities, such conflicts of motives are typically intensified when novel practices and instruments are introduced and implemented. In such situations, the participants of the activity commonly struggle between resisting and embracing the novel possibilities. Resistance often comes from fear of additional work and new competence demands; embracing often comes from visions of enriched and more meaningful work. Furthermore, such conflicts of motives typically surface in interactions between key actors in the work activity, for example between practitioners and clients, between managers and workers, or between practitioners representing different domains of expertise and responsibility. In such interactions, the conflict of motives typically appears in two forms, namely as external tension between the intentions and aspirations of the two actors, and as internal tension between the colliding motives of each individual actor.
I call these conflictual interactions at work critical encounters. In order to understand double stimulation in mundane work, we need to identify and analyze critical encounters. To accomplish this, I will present and test a conceptual model of a critical encounter. This model should be seen as complementary to the foundational model of the phases of double stimulation proposed by Sannino (Figure 3.1). The model presented here is more specific, aimed at integrating the formation of agentic action and concept formation in critical encounters.
Double stimulation is accomplished by making use of an artifact as a second stimulus in a conflictual situation. When one looks for occurrences of double stimulation in everyday work, the uses of artifacts are therefore a main clue to follow. This is why much of the following analysis will focus on different uses of artifacts and the consequences of these uses in critical encounters.
I will seek answers to the question formulated above with the help of data from the municipal home care services of the city of Helsinki in Finland. The data consist of videotaped home care visits, understood as critical encounters. In such a visit, the home care worker and the elderly client faced the challenge of implementing a new instrument called the mobility agreement, aimed at integrating regular mobility exercises into the daily routines of the client (see Chapter 5). The introduction and implementation of this instrument may be seen as an effort at the collective formation of a new concept of sustainable mobility.
In the next section, I will introduce the model of the critical encounter and its constituent theoretical concepts to be used in the analysis. After that, I will describe the research setting and data, as well as the methods of analysis. The actual data analysis begins with a section that gives an overview of the ways artifacts were used in the critical encounters included in the present analysis. In the subsequent sections, I will first analyze two cases of predominantly restrictive uses of artifacts in critical encounters, and then two cases of predominantly expansive uses of artifacts in critical encounters. In the final section, I will summarize the findings and present an overall interpretation of the characteristics of double stimulation and concept formation in everyday work contexts.
6.1 Theoretical Framework
A critical encounter is an event in which two or more relevant actors come together to deal with a problem that represents a shared object and at the same time a conflict of motives. In such a critical encounter, there is both complementarity and tension between the actors. To resolve the problem, the actors may use mediating artifacts to take volitional action and to try and conceptualize the situation. In this sense, critical encounters are generic sites of learning, understood as formation of transformative agency and functional concepts. A general model of an ideal-typical critical encounter is depicted in Figure 6.1.
While composed of factors discussed in the literature, the model depicted in Figure 6.1 as a whole is a novel synthesis aimed at understanding how volitional actions and conceptualization efforts emerge in organizational encounters driven by conflicts of motives. The model should be read from bottom up, as if climbing a Christmas tree. However, as a critical encounter is not a linear event, one should expect various iterations and back-and-forth movements, thus the two-headed arrows in Figure 6.1.
Figure 6.1 depicts two actors (actor 1 and actor 2) facing a problem that is relevant for both of them (target). In other words, the starting point of the model is resolutely interactional. The actors are characterized by the notions of “need state” and “anticipatory directionality.” The notion of need state comes from the work of Bratus and Lishin (Reference Bratus and Lishin1983). According to these authors, a need state is a state in which “a person desires (sometimes very passionately) something he himself does not know and cannot clearly describe”; thus, “these states have only potential, possible, hypothetical, but by no means rigorously fixed objects” (p. 43). The need state is often expressed in the form of wishes and search actions.
The notion of anticipatory directionality comes from the work of Fogel (Reference Fogel1993). He points out that already infants show intentionality but “direction is not a static initial condition, not an executive giving orders that guide action, it is a fluid part of a dynamic perception-action system” (pp. 124–125).
The target of the two actors refers to the more or less explicitly expressed purpose of the encounter. Behind the target, there is a less explicit set of issues that may be characterized as a boundary problem. This notion stems from Star and Griesemer’s (Reference Star and Griesemer1989) work on boundary objects and our own work on boundary crossing and modes of collaboration (Engeström, Engeström, & Kärkkäinen, Reference Engeström, Engeström and Kärkkäinen1995; Engeström et al., Reference Engeström, Kajamaa, Lahtinen and Sannino2015). A boundary problem is a problem space that concerns at least two parties with qualitatively different positions and perspectives. Initially the parties typically see the problem in very different terms. The challenge is to turn the initially diffuse problem into a jointly workable shared object (Leont’ev, Reference Leont’ev1978; Engeström, Reference Engeström1995b). The object gives purpose, direction, and motivational force to the activity and its constituent actions.
In a critical encounter, the emerging object is characterized by a conflict of motives. This notion comes from the work of Vygotsky (Reference Vygotsky and Rieber1997; also Vasilyuk, Reference Vasilyuk1988; Sannino, Reference Sannino2008). In organizations and work activities, conflicts of motives are rooted in historically accumulated systemic contradictions, for example between new types of demands from clients and existing limited instruments and rules of production. In other words, the very target is in itself contradictory and generates conflicting motives.
The notion of volitional action comes from Vygotsky’s (Reference Vygotsky, Rieber and Carton1987a, Reference Vygotsky and Rieber1997) work. Having to overcome an obstacle, to resolve and break out of a paralyzing conflict of motives, is what makes an action truly volitional. Understood this way, a volitional action is always also a change action, an action that transforms the situation and gives it a new meaning. In this perspective, volitional action is the core of transformative agency, defined as breaking away from the given frame of action and taking an initiative to transform it. Transformative agency goes beyond conventional notions of agency in that it stems from encounters with and examination of disturbances, conflicts, and contradictions in the collective activity and leads to envisioning and implementing new possibilities. Transformative agency goes beyond the individual as it seeks possibilities for collective change efforts. It also goes beyond situational here-and-now actions as it emerges and evolves over time, often through complex debates and stepwise enactments that engender crystallizations of a vision to be implemented (Engeström & Sannino, Reference Engeström and Sannino2013; Haapasaari, Engeström, & Kerosuo, Reference Haapasaari, Engeström and Kerosuo2014).
Volitional actions are performed with the help of mediating artifacts. I use the notion of mediating artifact in the dynamic sense worked out by Vygotsky (Reference Vygotsky and Rieber1997) and Sannino (Reference Sannino2015) in their accounts of double stimulation. Initially, the mediating artifact appears as an ambiguous second stimulus that is grabbed by the actor faced with a first stimulus which contains a paralyzing conflict of motives (i.e., the target, as explained above). The ambiguous second stimulus can be something deliberately introduced into the situation by an interlocutor, or it can be something taken up by the actor on the basis of his or her repertoire of artifacts and representations, or even opportunistically picked up from the available environment. In any case, the second stimuli typically stem from or are seen as meaningful against the background of the source domains available to actors in terms of their institutional, professional, and educational experiences (Nersessian, Reference Nersessian2008). The second stimulus may also be something quasi-accidentally discovered in the material environment as an objet trouvé.Footnote 1 When the actors invest the second stimulus with actionable meaning, the artifact becomes a sign that the actors can use to guide and empower their actions.
A conceptualization effort is some type of an articulation of a general idea or characteristic that has integrative potential for establishing a perspective for a solution to the problem or conflict of motives. Conceptualization efforts may take place by means of sketching possibilities, putting forward suggestions, making commitments, formulating definitions, agreements or decisions, and proposing names or integrative symbols. Conceptualization efforts are typically partial contributions toward the development and formulation of a functional concept in the making. When viewed as nodes in a texture woven over time by multiple actors, conceptualization efforts can be seen as significant steps in collective concept formation.
Notice that the model presented in Figure 6.1 assumes that volitional actions typically precede and pave the way for conceptualization efforts. However, this is not meant to be a fixed universal order. Collective concept formation can also proceed with the name of the concept in the lead, so that practical actions gradually “fill” an initially rather intuitive term with conceptual content (see Chapter 8 for a full treatment of this topic).
What is the relationship of the model of the critical encounter displayed in Figure 6.1 and Sannino’s model of the phases of double stimulation, reproduced in Figure 3.1 in this book? As I see it, the phase structure of Sannino’s model opens up and explains what actually happens in the interplay between the target (1st stimulus), the mediating artifacts (2nd stimuli), and the volitional actions, schematically interconnected in the center of Figure 6.1. A conflict of motives as the starting point of double stimulation and transformative action is the most important common denominator between Figure 6.1 and the model developed by Sannino. Perhaps the upper part of the model suggested in Figure 6.1 can be used to enrich the understanding of the implementing apparatus in Sannino’s model.
6.2 Setting and Data
The data of this study were collected in home care visits conducted by home care workers of the municipal home care services of the city of Helsinki in Finland. As explained in Chapter 5, the new mobility agreement was developed to promote the clients’ mobility by means of exercises embedded in the daily chores at home. The contents of the mobility agreement were to be negotiated between the home care worker and the client, and the result was recorded in the client’s care plan.
The implementation of the mobility agreement requires a serious revision of the standard script of home care visits. The clients of home care are commonly viewed as passive objects of care who do not actively make initiatives or express agency. Also the clients contribute to this mode of working in that they often expect that home care services are given to them in a ready-made form rather than produced together between the home care worker and the client. This means that along with enthusiasm, the implementation of the mobility agreement has also been met with widespread avoidance or passive resistance.
The data of this study consist of twenty-six home care visits conducted and videotaped in the years 2008 to 2011. These were regular visits conducted by regular home care workers to whom the given clients were assigned. Besides the standard tasks, in these visits the home care workers had the task of promoting and enacting the implementation of the mobility agreement. A member of our research team videotaped the visits. The visits lasted between 45 and 90 minutes. The verbal interactions in the home care visits were transcribed, with descriptions of physical actions taken by the participants in the course of the visit.
From among the twenty-six home care visits, I have selected four visits for detailed analysis (the criteria for the selection are explained in the next section). Three of these clients were female and one male.
6.3 Methods of Analysis
The data were analyzed in five steps. As the first step, my research group (Jaana Nummijoki, Anu Kajamaa, and myself) analyzed each home care visit with the help of the model of the critical encounter (Figure 6.1). This means that we went through the transcript and identified the segments in the transcript that represented each component of the model, using as criteria the characterizations of the components presented above in the theoretical framework. This way we filled the components with excerpts from the transcript of the visit. When the information was not expressed verbally but only by means of physical actions and gestures (e.g., grabbing or pointing at a physical object to be used as a mediating artifact), we described the action in our own words and gave the corresponding line numbers from the transcript. In some cases, the source domain component of the model could not be filled with a specific utterance from the transcript but had to be filled with a summarizing characterization formulated by the researchers. Problems in the identification of contents for each component were systematically discussed and resolved between the researchers. This first step of the analysis generated twenty-six graphic models filled with excerpts and information found in the corresponding transcripts and videos.
As the second step, we identified five overall profiles among the twenty-six home care visits. The categorization of the overall profiles was based (a) on the extent to which the visit followed the standard script (which excluded mobility exercises) or went beyond it (to include mobility exercises), and (b) on the extent to which the home care worker expressed a pessimistic future-orientation (assuming that the client’s condition will get worse) or an optimistic future-orientation (envisioning and planning future improvements).
As the third step, we selected a number of components of the model to be categorized and quantified. These components included (a) types of use of artifacts, (b) types of volitional action, and (c) types of conceptualization effort. Starting from each identified use of an artifact, we traced the volitional action and the possible conceptualization efforts connected to it.
As the fourth step, based on the outcomes of step 3, we distinguished between two broad dimensions in the use of artifacts in the critical encounters. The first dimension is restrictive vs. expansive use of an artifact. This refers to the fact that in some cases an artifact was used to avoid going beyond the standard script (restrictive use), whereas in other cases even the same artifact could be used to facilitate and support going beyond the standard script (expansive use). The second dimension is incidental vs. planned use of an artifact. This refers to the fact that in some cases an artifact was introduced in an ad hoc or improvisational manner (incidental use), whereas in other cases the artifact was introduced on the basis of a plan made before the encounter (planned use). By planned use, I refer to an explicit mentioning of the artifact in the written care plan or an explicit reference to the planned use of the artifact in the transcribed talk of the participants.
The integration of the findings produced in step 2, step 3, and step 4 generated a number of tables that summarize the overall characteristics of the twenty-six critical encounters. These tables are presented in the next section.
Finally, as the fifth step I selected four home care visits to represent the different fields that emerged from the combination of the two dichotomous dimensions identified in step 4. These four cases will be discussed in detail in their own sections.
6.4 Uses of Artifacts in Critical Encounters: An Overview
I identified five overall profiles in the twenty-six home care visits. These are summarized in Table 6.1.
Table 6.1 Five profiles of home care visits
| Relationship to standard script | Future-orientation | F | % |
|---|---|---|---|
| 1. The encounter follows the standard script | Worker operates on the standard assumption that the client’s condition will get worse, tries to keep up the standard script as long as the client is on his/her own feet | 6 | 23 |
| 2. Worker allows client to take novel action without engaging herself | Worker lets the client talk and dream about the future but stays out of it herself | 4 | 15 |
| 3. Worker joins novel action initiated by client | Worker begins to conditionally consider possible changes in the standard script | 5 | 19 |
| 4. Worker instructs client to take novel action, leaves implementation to others | Worker obliges client and other practitioners to make changes | 6 | 23 |
| 5. Worker and client initiate and implement novel action together | Worker and client envision and plan changes jointly | 5 | 19 |
| Total | 26 | 100 |
From the point of view of understanding double stimulation, the uses of artifacts in the encounters are of crucial importance. Home care workers and clients introduced and used six kinds of artifacts in the visits, namely (1) furniture and domestic objects, (2) food and/or the microwave oven, (3) medications and medicine dispensers, (4) blood pressure meters, (5) movement-supporting devices, and (6) the mobility agreement and the associated mobility exercise booklet. These artifacts were used both restrictively, to avoid engaging in the implementation of the mobility agreement, and expansively, to initiate and support actions of implementing the mobility agreement. These findings are summarized in Table 6.2.
Table 6.2 Types of restrictive and expansive artifact use in different profiles of the home care visitsFootnote *
| Profile of encounter | Artifacts used restrictively | Artifacts used expansively | |||||
|---|---|---|---|---|---|---|---|
| Furniture, domestic objects | Food, micro-wave oven | Medications, dispensers | Blood pressure meter | Furniture, domestic objects | Movement-supporting devices | Mobility agreement | |
| 1. The encounter follows the standard script | - | - | 1 | 2 | 1 | 2 | 2 |
| 2. Worker allows client to take novel action without engaging herself | 1 | - | 1 | 1 | 2 | 1 | 2 |
| 3. Worker joins novel action initiated by client | - | - | 1 | 1 | - | 1 | 4 |
| 4. Worker instructs client to take novel action, leaves implementation to others | - | 1 | - | 1 | 3 | 3 | 6 |
| 5. Worker and client initiate and implement novel action together | - | - | - | - | 3 | 1 | 4 |
| Total | 1 (4%) | 1 (4%) | 3 (12%) | 5 (19%) | 9 (35%) | 8 (31%) | 18 (69%) |
* Note: 26 encounters = 100%; multiple different artifacts may have been used in one encounter.
Table 6.2 shows that artifacts were used expansively in encounters representing all the five profiles. Instances of expansive use of artifacts were found even in encounters which overall followed the standard script (profile 1). These were typically cases in which one of the participants initiated an expansive use of an artifact but was discouraged or stopped by the other participant, resulting in a quick return to the standard script. On the other hand, in the encounters in which the worker and the client initiated and implemented novel mobility-oriented actions together (profile 5), restrictive uses of artifacts were not found at all.
Furthermore, Table 6.2 shows that even the very same artifact (furniture and domestic objects) may be used either restrictively or expansively. The mobility agreement was expansively used in seventeen visits (65 percent of the encounters), the highest frequency among all the types of artifact use in the data. This indicates that the mobility agreement may indeed have served effectively as a support for double stimulation and concept formation in home care.
I also distinguished between incidental or ad hoc uses of artifacts and planned uses of artifacts in the encounters. Table 6.3 summarizes the distribution of artifact uses between these two types according to the profile of the encounter. Notice that the overall number of artifact uses is here higher than in Table 6.2. This is due to the fact that there were three cases in which an artifact was first introduced in an ad hoc incidental manner but then connected to the care plan or plan of implementing the mobility agreement. In these cases, the artifact use was coded as both incidental and planned.
Table 6.3 Types of incidental and planned artifact use in different profiles of the home care visits
| Profile of encounter | Incidental uses of artifacts | Planned uses of artifacts | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Furniture, domestic objects | Food, micro-wave oven | Medications, dispensers | Blood pressure meter | Movement-supporting devices | Mobility agreement | Furniture, domestic objects | Food, micro-wave oven | Medications, dispensers | Blood pressure meter | Movement-supporting devices | Mobility agreement | |
| 1. The encounter follows the standard script | 1 | 2 | 1 | 1 | 2 | |||||||
| 2. Worker allows client to take novel action without engaging herself | 5 | 1 | 1 | 1 | 1 | 2 | ||||||
| 3. Worker joins novel action initiated by client | 1 | 1 | 1 | 4 | ||||||||
| 4. Worker instructs client to take novel action, leaves implementation to others | 1 | 3 | 1 | 3 | 6 | |||||||
| 5. Worker and client initiate and implement novel action together | 1 | 3 | 1 | 4 | ||||||||
| Total | 7 | 1 | - | - | - | 1 | 7 | - | 3 | 4 | 7 | 18 |
Table 6.3 shows that incidental uses of artifacts were relatively infrequent in the encounters; they appeared nine times which represents 35 percent of the visits and 19 percent of the artifact uses in the data. The fact that planned uses of artifacts were more frequent in the data does not mean that the artifacts were used in strict accordance with a plan. There were in fact two competing plans influencing the actions of the participants: the standard script and the new implementation plan of the mobility agreement. The standard script, explicated in the care plan, may, for example, have required that the home care worker measures the blood pressure of the client. However, it does not say how this artifact use is supposed to affect the competing plan of implementing the mobility agreement. Thus, the home care worker and the client may have used the planned blood pressure measurement either restrictively, to avoid mobility issues, or expansively, to activate the client to move.
What was the relationship between artifact uses and volitional actions in the encounters? Starting from each artifact use, I traced the possible mobility-oriented volitional action connected to it. I found five types of volitional action in the data, namely (1) client’s one-sided expressions of will, (2) home care worker’s instructions or encouragements to the client, (3) expressions of joint commitment to implement novel actions, (4) novel mobility-oriented physical actions by the client, and (5) jointly accomplished novel mobility-oriented physical actions. These volitional actions, taken by one or both participants, could precede or follow the introduction of the artifact. These findings are summarized in Table 6.4.
Table 6.4 Types of volitional action connected to restrictive and expansive uses of artifacts
| Type of mobility-oriented volitional action | Artifacts used restrictively | Artifacts used expansively | |||||
|---|---|---|---|---|---|---|---|
| Furniture, domestic objects | Food, micro-wave oven | Medications, dispensers | Blood pressure meter | Furniture, domestic objects | Movement-supporting devices | Mobility agreement | |
| 1. Client’s one-sided expression of will | 1 | - | 1 | 3 | 1 | 1 | 4 |
| 2. Worker’s instruction or encouragement | - | - | - | - | 2 | 3 | 8 |
| 3. Joint commitment | - | - | - | - | 1 | 1 | 2 |
| 4. Client’s novel physical action | - | 1 | 2 | 1 | 3 | 2 | 1 |
| 5. Joint novel physical action | - | - | - | 1 | 2 | 1 | 3 |
| Total | 1 (4%) | 1 (4%) | 3 (12%) | 5 (19%) | 9 (35%) | 8 (31%) | 18 (69%) |
As Table 6.4 indicates, I found a volitional action connected to each use of an artifact. When artifacts were used restrictively, to protect the standard script, these uses typically followed a mobility-oriented volitional action initiated by the client. Thus, in ten cases, the client’s one-sided expressions of will or the client’s novel physical actions (e.g., attempts to start mobility exercises) were met with and extinguished by means of restrictive uses of artifacts by the home care worker. This typically happened by simply ignoring the client’s movement-oriented initiative and shifting the focus of interaction back to the standard script by starting to take the blood pressure, dispense medications, or arrange for the client’s meal.
When artifacts were used expansively, these uses typically preceded or coincided with the volitional action initiated by one or both parties. In six cases, the client’s one-sided expressions of will were triggered by or amplified with expansive uses of artifacts. Before or simultaneously with expressing his or her will by words, the client would typically point at, verbally refer to, or physically take hold of a specific artifact, such as a piece of furniture, a walker, or the exercise booklet associated with the mobility agreement. The same artifacts were in similar ways expansively used to enhance and support the home care worker’s instructions and encouragements, joint commitments to novel mobility-oriented actions, and actual taking of novel physical actions. It is specifically in these thirty-four cases of expansive uses of artifacts in support of mobility-oriented volitional actions that one expects to see processes of double stimulation and conceptualization to unfold.
An examination of Table 6.4 makes clear the vulnerable and fragile nature of novel volitional actions in critical encounters. Nearly 23 percent of the volitional actions were extinguished by means of restrictive uses of artifacts. Material artifacts seem to have been very effective tools for such restrictive and reactive safeguarding of the standard script. The home care worker did not necessarily have to verbally reject the client’s initiative; it was enough to shift the focus of attention and action to the blood pressure meter, medications, or food. On the other hand, about 77 percent of the volitional actions were taken with the help of expansively used artifacts. This points to the emancipatory and proactive potential of artifacts in the formation of volitional actions.
I also examined the relationship between artifact uses and conceptualization efforts. In the data, five substantive types of mobility-oriented conceptualization efforts were identified, namely conceptualizing mobility as (1) moving outside the physical boundaries of home, (2) regularity of mobility exercises, (3) conducting movement together with a home care worker or some significant other, (4) standing up from the chair as a key exercise, and (5) integrating mobility exercises into daily chores. These five types of conceptualization efforts correspond closely to the components of the emerging concept of sustainable mobility found in Chapter 5. The findings on the relationship between artifact uses and conceptualization efforts are summarized in Table 6.5.
Table 6.5 Types of conceptualization efforts connected to restrictive and expansive uses of artifactsFootnote *
| Type of conceptualization effort | restrictive uses of artifacts | expansive uses of artifacts | |||||
|---|---|---|---|---|---|---|---|
| Furniture, domestic objects | Food, micro-wave oven | Medications, dispensers | Blood pressure meter | Furniture, domestic objects | Movement-supporting devices | Mobility agreement | |
| 1. Moving out beyond the home | - | - | 1 | 3 | 4 | 3 | 7 |
| 2. Regularity of movement | 1 | - | - | - | 2 | 5 | 7 |
| 3. Conducting movement together | - | - | - | - | - | 2 | 3 |
| 4. Standing up from the chair or bed | 1 | 1 | 3 | 3 | 4 | 3 | 12 |
| 5. Integrating movement into daily chores | - | 1 | - | - | 4 | - | 3 |
| Total | 2 (8%) | 2 (8%) | 4 (15%) | 6 (23%) | 14 (54%) | 13 (50%) | 32 (123%) |
* Note: 26 encounters = 100%; multiple different conceptualization efforts may have been made in one encounter.
Table 6.5 shows that 81 percent of the mobility-oriented conceptualization efforts were made with the help of artifacts used expansively. In particular, expansive uses of the mobility agreement and its exercise booklet triggered a large number of mobility-oriented conceptualization efforts. Thirty-two such conceptualization efforts were made, on average nearly two conceptualization efforts per use of this artifact. By far the most frequent type of conceptualization effort (accounting for 40 percent of all the conceptualization efforts) was that of standing up from the chair. This finding supports the argument presented in Chapter 5 that standing up from the chair is actually the germ cell action of the emerging new concept of sustainable mobility.
I will now turn to analyze selected encounters in some detail. The first two are encounters in which artifacts were used predominantly restrictively. The other two are encounters in which artifacts were used predominantly expansively. The first two cases allow me to examine how double stimulation is prevented or interrupted. The latter two cases allow me to examine the unfolding of double stimulation and conceptualization efforts in the mundane work activity of home care for the elderly.
6.5 Restrictive Uses of Artifacts: Two Cases
My first case is an encounter in which the client was a man born in 1926. He moved a little but experienced his movement as deteriorated. The visit lasted forty minutes, and the transcript of the visit contains 226 turns of talk.
The boundary problem appeared very differently to the client and to the home care worker. The home care worker thought that the client was in a fairly good condition and only needed some help. The client felt unfit and helpless (turns 87 to 90).
87Home care worker: You are in good enough condition so that you did not get…
88Client: In good condition, me!?
89Home care worker: …onto the list of the home care physician. Yes.
90Client: You cannot say I am in good condition, a decrepit old man like me.
The client felt that he was impaired in his movement: “It’s just that walking, it has deteriorated so much lately” (turn 139). However, the client had the desire to move and to develop his ability to move. The client drew on the everyday experience of being unfit and helpless, yet wanting to live a normal life (the client’s source domain). The home care worker drew on the rules and operating procedures of home care (the home care worker’s source domain).
The home care worker first focused on distributing the client’s medication into small boxes and measured his blood sugar level. Then her focus shifted to taking the client to the shower, which according to her was her main objective of the visit. In other words, the home care worker carried out the standard script of a home care visit.
A conflict of motives first emerged when the home care worker told the client to go to shower: “Now, there’d be the shower!” (turn 99). The client’s explicit expectation was that he can exercise his mobility during the home care visit. He was not interested in going to the shower; instead, he took up issues of walking.
141Client: To which direction should I walk? Towards there?
142Home care worker: Into the shower!
143Client: But do not you want to watch how I walk?
The client wanted to show to the home care worker how he walks with the help of a walker. The home care worker gave in. This resulted in the volitional action of the client walking to the kitchen, now actually encouraged by the home care worker. After this, the home care worker returned to the standard script by taking up and discussing issues of blood sugar level, dietary guidelines, and the client’s eating habits.
The client then initiated a significant shift toward mobility issues. The client had a wheelchair, but he tried to avoid using it. He experienced getting up from a red armchair as a useful mobility exercise, but it was challenging for him and he wanted to discuss this with the home care worker.
204Client: It is the kind of a chair that one must struggle a bit to get out of it.
205Home care worker: Yes, it is a bit lower.
…
207Client: It is a good one, yes! I did not ever avoid it [the chair] either. At the beginning when the chair arrived, I thought that I cannot get in there.
I interpret this as the client’s one-sided expression of will with the help of an expansive use of an artifact, namely the armchair (Table 6.4), taken up in an incidental way (Table 6.3). The client introduced the armchair into the interaction as a potential second stimulus that could be employed as a means to push forward his volitional action to move. The armchair embodied in itself the conflict of motives (resting vs. exercising). In the client’s own words (turn 204), the armchair invited “struggle,” obviously not just physical but volitional as well.
This volitional action of the client was thwarted as the home care worker reacted by shifting the discussion to the external characteristics of the chair.
208Home care worker: Yes, it is a fine chair.
…
210Client: It is so…
211Home care worker: Colorful, you like colors.
I interpret this as a restrictive use of the artifact by the home care worker (Table 6.4). The meaning of the armchair as a potential instrument of will and emancipatory action was turned into that of an object of passive aesthetic admiration. In other words, the red armchair was in this encounter used first expansively and then restrictively.
In spite of the client’s thwarted attempt at double stimulation with the help of the armchair, the encounter generated fragmentary conceptualization efforts of the types “Regularity of movement” and “Standing up from the chair” (Table 6.5). This testifies to the contradictory and nondeterministic character of the critical encounter. We seldom see entirely pure examples of any given overall profile of the encounter. There are practically always ruptures and deviations from the dominant pattern.
In the second case, the client was a woman born in 1922. The client walked with the help of a walker or a walking stick. Her arm had been operated on recently. The visit lasted nine minutes and forty-six seconds. The transcript of the visit contains 124 turns of talk.
Through the encounter, the home care worker demonstrated that she did not trust the client’s ability to move without support devices and much caution: “Yes, take that cane or the walker, you see otherwise it’s a bit unstable.” (turn 110).
The client, on the other hand, expressed that she was feeling good and needed more exercises. This clash between the desire to move and concern for safety was the conflict of motives in this case.
The client’s mobility was reduced, but in the morning of the visit, she had succeeded in walking twenty-two times around the table, which was her new record. The home care worker started the visit in a directive manner, focusing on the standard script with a biomedical emphasis.
1Home care worker: Well, Linda, take off that coat so I will first measure your blood pressure. How are you feeling nowadays?
2Client: Well, quite acceptable, actually pretty good.
3Home care worker: Yes. Has your arm been hurting?
4Client: The arm is bothering me now. Last night…
5Home care worker: Yes.
6Client: …it troubled me quite a bit.
7Home care worker: Just sit down.
8Client: But I did not want to take the extra pain killer.
9Home care worker: Yes. You could a little bit, so that you would not have to go so many times around that table with the walker, if that makes it hurt more.
10Client: Well.
11Home care worker: Like I said the last time, go just 10 times. 20 times is quite a lot.
12Client: Yes, well this is now the record.
13Home care worker: How many is it usually?
14Client: Well, 12 or so.
15Home care worker: So!
16Client: Now I did 22.
17Home care worker: Yes. Now be still and do not talk, so I set this meter [sets the blood pressure meter on the client’s arm].
The client’s initiative to take up her new record of walking laps around the table may be interpreted as a move toward activating the count as an expansive artifact and second stimulus for volitional actions aimed at increased mobility. The home care worker turned the meaning of counting into the opposite: reduce the number of laps in order to avoid pain (turns 9 and 11). When the client mentioned her record of 22 laps (turn 16), the home care worker interrupted this line of discourse by means of setting the blood pressure meter on the client’s arm (turn 17). I see this as a restrictive use of an artifact which thwarted the client’s one-sided expression of will (Table 6.3).
The same pattern was repeated a little later in the encounter. The client began to talk about the improvement in the condition of her legs, indicating her readiness to extend the walking exercises.
42Client: They [the legs] are so good that I am having a wonderful time.
44Client: Yes.
45Home care worker: So be quiet during this [starts the measuring of blood pressure].
Figure 6.2 presents a summary of the components of the critical encounter in Case 2.
The figure shows that no clear conceptualization efforts emerged in this visit. The standard script dominated the interaction, and the mobility exercises taken up were strictly limited to the execution of previously agreed-upon procedures. In other words, the competing mobility-oriented script was incorporated into the dominant standard script as a technical addition, a subordinate sub-script, rather than as a reconceptualization that would require and support transformative agency in and between the actors. The volitional action of the client that deviated from this merged script (turns 12 to 16: counting of laps around the table) was effectively thwarted by a restrictive use of the blood pressure meter.
The counting of laps was part of the client’s mobility agreement and thus fell into the category of planned use of artifacts (Table 6.3). Notice that the client’s initiative of counting the laps as a potential second stimulus is analogous to Vygotsky’s accounts of counting to three as a second stimulus in enhancing one’s own volitional action. Vygotsky’s examples of counting one, two, three as an auxiliary stimulus concern the volitional actions of getting up in the morning and taking one’s medicine (Vygotsky Reference Vygotsky, Rieber and Carton1987a, pp. 357–358) and diving into the water (Vygotsky Reference Vygotsky and Rieber1997, pp. 211–212). The function of counting as a second stimulus was somewhat more complex in Case 2. As turns 12 to 16 in the transcript show, the client was using counting as a long-term developmental monitoring and control instrument, not merely as a situational instrument for accomplishing a single difficult action.
6.6 Expansive Uses of Artifacts: Two Cases
In the third case, the client was a woman born in 1922. The client felt that her mobility had deteriorated and due to dizziness she did not dare to walk alone outside her home. The client had a mobility agreement according to which her mobility was systematically supported by means of taking the trash out together with the visiting home care worker. The encounter lasted 50 minutes and the transcript contains 332 turns of talk.
The conflict of motives in this case was not manifested as an external clash or discoordination between the client and the home care worker, as both were committed to implementing the new script of the mobility agreement. The conflict of motives was manifested by both actors as an internal tension between the desire to move independently and the concern for safety.
18Home care worker: Yes, it always frightens you a bit, the falling down. Are you going to go and take it [the trash out] without the walker?
19Client: I am not going to take it.
…
23Client: I could take that stick, that walking stick.
79Home care worker: So you lean a little bit on the wall for support. Here there would be sufficient space also to walk with the walker, or with that walking stick if you prefer it, so that it is with you all the time.
80Client: I do not like to walk with either one. I would rather walk without any aids, but that does not work.
The client and the home care worker took the trash out together (Figure 6.3).
After that, the client and the home care worker had a lengthy conversation about the client’s life and care. Toward the end of the visit, the home care worker took up the taking out of the trash.
253Home care worker: Yes, and then there is the taking out of the trash bag every time the home care visits you. Do you at least in that situation go out and move? Each time when home care visits, do you take out the trash bag with them?
254Client: No, I do not. They have taken it themselves.
255Home care worker: Oh really. Somebody has taken it out for you?
256Client: Yes.
257Home care worker: Well, well.
258Client: Many of them have taken it out. The other day I accidentally asked a young guy who brought me the food, I asked if he would take out the trash bags. He said that it is not their job. It might not be, indeed.
259Home care worker: No, it is not their job, they just take care of the meals.
260Client: I said sorry about that.
261Home care worker: But it would be good for you to always go with them to take them [the trash bags] out. It does not take a long time…
262Client: Yes, I have taken it occasionally, then some relative may come to visit and ask if I have any trash. I say look around if there is any.
263Home care worker: Well, if you have not had, at times we have agreed that we will not go and take out just one newspaper. But it would be good to keep it regular, so that even if the home care worker offers to take out [the trash bag], you just say that let us go together.
264Client: That is right, yes.
265Home care worker: So you get to go out a little.
The exchange was important in that the trash bag triggered a critical examination of the actual practice in relation to the mutually accepted mobility agreement. The critique concerned both the home care workers and the client who had failed to implement the regularity principle of the agreement. The new second stimulus was jointly constructed around the trash bag as a clear decision: “even if the home care worker offers to take out [the trash bag], you just say that let us go together” (turn 263). This volitional action of joint commitment was grounded in the preceding joint physical action of actually taking out the trash bag together (Table 6.3).
In terms of double stimulation, this case represents the phase of the real conflict of stimuli in Sannino’s (Reference Sannino2015) model. In the negotiation of the client’s mobility agreement, the trash bag had been constructed as a second stimulus for prompting the volitional action of going out regularly. However, when a home care worker actually visited the client and the real conflict of stimuli occurred (i.e., a conflict between the stimulus of the home care worker offering to take out the trash alone and the auxiliary stimulus of the trash bag as a sign for initiating a volitional action of mobility), the closure was often not reached and the actors resorted to the standard script of doing for rather than doing together with the client.
The events in this encounter demonstrate that the construction and functioning of double stimulation can be a lengthy iterative process in which the initially created second stimulus has to be revitalized by means of reflection and reformulation. The trash bag was initially used in an expansive way when the mobility agreement was created, but it needed to be rediscovered and refilled with meaning to ensure its functioning in real conflicts of stimuli.
In Case 3 the conceptualization efforts included moving out beyond the home, conducting movement together, and integrating movement into daily chores (Table 6.5). However, the most important conceptualization effort focused on the regularity of movement as a crucial principle of sustainable mobility: “Yes, and then there is the taking out of the trash bag every time the home care visits you. … Each time when home care visits, do you take out the trash bag with them?” (Turn 253). “But it would be good to keep it regular …” (Turn 263).
In the fourth case, the client was a woman born in 1933. She felt that her condition was relatively poor, whereas the home care worker saw her condition in more positive terms. The client took care of smaller daily chores but needed help in bigger tasks. The client had a mobility agreement. The visit was focused on the assessment of the implementation of the agreement as well as on further planning and introduction of useful mobility exercises. The visit lasted slightly under 20 minutes, and the transcript contains 96 turns of talk.
As in Case 3, both actors in this case were committed to the implementation of the mobility agreement. The entire visit was carried out according to the new script. The conflict of motives in this case appeared quite subtly between the home care worker’s optimistic and somewhat directive push for active movement and the client’s more pessimistic perspective which made her a rather passive partner in the assessment, planning, and testing of exercises during the encounter.
16Home care worker: …So are there better days and worse days [in handling laundry]?
17Client: Not really. They are all bad ones. I cannot get the sheets straight.
32Client: I cannot get the cord [of the washing machine] plugged into the wall.
33Home care worker: Yes.
34Client: It is so high that I cannot reach it.
35Home care worker: Yes.
36Client: [inaudible]
37Home care worker: Yes, yes. But when someone plugs in the washing machine cord, you can then make it work yourself. Good!
The mobility agreement itself, with its detailed regular exercises, was constructed as a second stimulus meant to support the client’s volitional actions to maintain and develop her mobility. In this visit, the functioning of this designed double stimulation was examined and pushed forward.
62Home care worker: Well, right. Now that you have made this Mobility Agreement, you have agreed with your family caregiverFootnote 2 that you will try to take care of washing clothes, washing dishes and cooking yourself also in the future. Isn’t that so? […] You did not agree to conduct other exercises besides these everyday chores?
63Client: No.
64Home care worker: Right. So this is based on the idea that we will not wash dishes for you. Is that so?
65Client: Yes.
The home care worker asked the client to test whether she could stand up from the chair five times. The client was able to complete the exercise two times. The home care worker then introduced the exercise booklet to the client.
75Home care worker: […] Did you discuss with Sarah [another home care worker] these exercise programs [shows the exercise booklet included in the Mobility Agreement]?
76Client: No, we did not.
77Home care worker: The idea of these is that we try to repeat on a daily basis these exercises, and that way to maintain and improve your mobility. Are you interested in this?
78Client: Yes, I am interested. But I cannot carry out all of them.
79Home care worker: Yes, and probably it would not be wise either. And it is by no means a good idea to start doing them alone. But would you be ready to add a few of these [into your Mobility Agreement]? So that when you have a good day and you feel energetic, we will do a few of these to improve your balance and the strength of your arms.
The home care worker and the client proceeded to test physically some of the other exercises. At the end of this, the home care worker asked whether the client would like to keep the exercise booklet.
89Home care worker: Would you like me to leave this [the exercise booklet] with you?
90Client: Yes.
91Home care worker: Well, I leave this with you, so you can study it yourself. But this contains also these [exercises] which ask you to stand and move your feet, do not do them yet at this point because your balance may not hold. These can be taken into your program later, these in which you do not really lean on anything. […]
In this encounter, the mobility agreement as a second stimulus was revisited, assessed, amended, and tested in volitional physical actions. The previously constructed written agreement was now extended to include the printed exercise booklet that the client could use at her own convenience. All this reinforces the observation made above in Case 3: In work activities, double stimulation can be a lengthy iterative process in which the initially created second stimulus has to be revitalized by means of reflection and reformulation.
The home care worker made a focused effort at conceptualizing the idea of the mobility agreement practice. However, the effort was made in the form of a monologue.
91Home care worker: […] And now you of course wonder what this is and what is the purpose of all this. The purpose is to try and maintain your mobility, perhaps even improve it a bit, but above all so that you can live in your own home as long as you want, and get by in your own home. Of course we would wash your dishes faster, but the point is to maintain the mobility and control of your own hands.
The encounter included more specific conceptualization efforts of mobility as regularity of movement, as conducting movement together, as standing up from the chair, and as integrating movement into daily chores (Table 6.5). Again, these conceptualization efforts were mainly made explicit by the home care worker.
This case was peculiar in that the steps of double stimulation were fairly one-sidedly led by the home care worker, leaving the actual engagement and commitment of the client somewhat in the dark. In this sense, Case 4 demonstrates a risk very different from the problems involved in cases of restrictive use of artifacts. Instead of thwarting a client’s initiatives, the home care worker may have here been pushing double stimulation and conceptualization efforts forward without making sure that both parties are sufficiently involved in them.
However, this may also be a false impression engendered by the relative scarcity of utterances on the part of the client. Having experienced a stroke some ten years earlier, the client had difficulties speaking clearly, a fact that may explain her lack of spoken discourse in the encounter. In other words, only actions in the longer run will tell to which extent also the client was engaged in double stimulation and concept formation in this case. Figure 6.4 summarizes my analysis of the critical encounter in Case 4.
6.7 Conclusion: Double Stimulation and Concept Formation in Everyday Work Contexts
The question I presented at the beginning of this chapter was: What are the key characteristics of double stimulation and what is its role in concept formation in an everyday work activity facing transformations? The findings discussed above support the assumption that critical encounters, as defined earlier in the chapter, are fruitful breeding grounds for double stimulation and concept formation efforts in work activities. Instead of automatically generating processes of double stimulation and concept formation, critical encounters seem to generate special kinds of micro-contexts in which artifacts are actively employed to deal with the challenge at hand. These micro-contexts may be described with the help of two dimensions, namely the dimension of restrictive vs. expansive use of artifacts and the dimension of incidental vs. planned use of artifacts. The four cases analyzed above may be placed in this framework as depicted in Figure 6.5.
Case 1 in Figure 6.5 moves from expansive to restrictive use of the red armchair as an incidentally introduced artifact. This demonstrates that the artifact itself does not necessarily determine how it is used. One could imagine expansive uses even for the traditional instruments of the standard script, such as the blood pressure meter. Conversely, merely making available or requiring the use of certain artifacts does not guarantee that they are used expansively, to trigger double stimulation and conceptualization efforts.
On the other hand, the findings indicate that the mobility agreement was used in many encounters in an expansive manner (Tables 6.2–6.5). As demonstrated in Case 4, when implemented systematically, the mobility agreement was potentially a powerful second stimulus. This justifies cautious optimism with regard to planned implementation of complex artifacts or instrumentalities as supportive auxiliary stimuli for transformation efforts at work. On the other hand, if such complex artifacts are one-sidedly promoted by the professionals, their actual appropriation by clients may remain questionable. For this reason, it is of crucial importance to identify and nourish client-initiated expansive uses of artifacts, such as the red armchair in Case 1 or the counting of laps in Case 2. Probably the planned and professionally initiated use of the mobility agreement succeeds best when it connects and merges with client-initiated and incidental uses of artifacts as second stimuli. To some extent, we saw this happening in Case 3 when the client surprised the home care worker by reporting that the trash bag had not been taken out together with the client as planned. The client’s report gave a new meaning to the trash bag as a second stimulus and led to a revitalization of the mobility agreement.
The findings call attention to two features of double stimulation in mundane work. The first one is the interactional nature of the generation – and inhibition – of double stimulation. The generative potential of interaction is best demonstrated by Case 3: the trash bag was truly jointly redefined as a second stimulus. The inhibiting potential of interaction is demonstrated by the thwarting of the clients’ double stimulation initiatives in Cases 1 and 2. Case 4 remains an open question in this regard.
The second feature of double stimulation evident in the findings is its longitudinal, multi-phased, and iterative nature in work activities. Already the client’s subtle attempts in Cases 1 and 2 testify to this. In Case 1, the client had obviously thought about and used the armchair as a second stimulus for some time; in Case 2, the client used counting the laps as a second stimulus that helped her follow her own development over time. In Case 3, the discovery of the trash bag allowed an iterative loop of returning to the mobility agreement so as to sharpen it up and to follow it through. In Case 4, the mobility agreement as a complex second stimulus was assessed and extended by introducing the exercise booklet.
The findings indicate that conceptualization efforts do indeed often accompany the volitional actions resulting from the expansive use of artifacts as second stimuli. These conceptualization efforts are seldom conscious attempts to fully define or explain a concept as an entity in itself (an exception may be seen in the explanation effort made by the home care worker in Case 4). The conceptualization efforts are predominantly fragmentary and focused on specific aspects of the emerging concept. In this light, conceptualization efforts in critical encounters resemble the construction of a mosaic pattern distributed in time and social space across many actors and encounters. Although seemingly modest and piecemeal, such efforts may lead to a radical sea change over time (Cole, Reference Cole1999; Hubbard, Mehan, & Stein, Reference Hubbard, Mehan and Stein2006).
The fragmentary nature of conceptualization efforts taken alone might indicate that the concept being constructed is excessively “loose” (Löwy, Reference Löwy1992), as if lacking a solid core and structure. However, as Table 6.5 shows, we found five key types of conceptualization efforts which together form a coherent set. Standing up from the chair was the most frequent among those five types, lending support to the argument presented in Chapter 5 that this may indeed be seen as the germ cell of the emerging concept of sustainable mobility.
What is the explanatory potential of the model of critical encounter (Figure 6.1) in the analysis of double stimulation and concept formation in mundane work activities? We analyzed twenty-six home care visits with the help of this model and found the model workable. The model offers a powerful way to compare different overall profiles of critical encounters and to identify important variations in the employment of artifacts in attempts to trigger or extinguish processes of double stimulation and concept formation. The novelty and strength of the model is in its holistic character. Yet, it is sufficiently detailed to allow in-depth empirical analyses.
The model was particularly helpful in capturing the interplay between the target, mediating artifacts, volitional actions, and conceptualization efforts. On the other hand, the need states and source domains may have remained as somewhat more peripheral and ambiguous – an outcome that would not be in line with the holistic idea of the model. Also, the fact that the model depicts two interacting actors is a limitation, as many critical encounters obviously involve more than two actors. It remains to be seen whether the model can be modified and extended to cope with multi-actor encounters.
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