The four theoretical frameworks reviewed here are relevant to the conceptualisation of EL: pragmeme theory, integrative pragmatics, frame theory and elasticity theory. They are adopted as a guide through the research of EL in the present study. They all focus on pragmatic meanings grounded in context and complement each other for the benefit of this study. Pragmeme theory states that a pragmeme refers to a situation or an act that captures the goal of the situation, e.g., online healthcare information dissemination. This study expects that there should be regular patterns or protocols of EL use. The EL pragmeme can be realised in different situations, which can be manifested, according to the integrative pragmatics, through the pragmatic behaviours of online website writers and the evaluations of observers. The two focuses highlighted in integrative pragmatics are empirical evidence and the importance of observers’ participation (metapragmatics), both of which are adopted in this study. Frame theory guides the reader through the investigation of the participants’ perceptions of and attitudes towards the use of EL in this study.

Both psychology and medicine insist on the ‘right’ way to speak and increasingly attempt to control the language both clinicians and other stakeholders use. Such guides range from article suggestions of replacing certain words to more comprehensive and formal guides of how to communicate (e.g. the guide of the BPS’ Clinical Psychology Division’s Guidelines on Language). In this chapter we explore constructions of language and clinical communication in clinical language guides. Methodologically, our study is anchored in the constructionist view of discourse, taking a qualitative critical discourse studies perspective on the data. Our argument is twofold. First, we argue that the guides represent language and linguistic communication as outside any context, either situational or societal. Second, as the guides focus solely on lexical material, ignoring the grammatical form, they ignore a significant aspect of the communicative interaction. Analysing interactional clinical data, we argue against such assumptions. We end the chapter by making a point of the futility of clinical language guides, stressing the negotiability of clinical communication.