The mode of client participation we refer to as ‘accommodation’ is enacted by clients in whom the contestants’ adversarial framing efforts have comparable degrees of emotional resonance. Although different forms of ambivalence may lead to accommodation, in each, clients experience some degree of anger and pride as evoked by the movement’s framing efforts, yet also some degree of fear and shame as evoked by the profession’s framing efforts.

We argue that accommodation is enacted by clients who feel very angry at the profession for breaching its duty, yet also equally fearful of relying on the movement’s alternative project to address their needs. By accommodation, we mean that clients seek to incrementally improve established arrangements. Clients experiencing this configuration of emotional resonance are attached to the movement as a collective actor but mistrust its experiential knowledge to address their needs. We call this form of ambivalence towards the movement ‘attachment yet mistrust’. It leads clients to see deviance from the profession’s prescriptions as a righteous imperative, yet nonetheless remain engaged with established arrangements and work to incrementally improve them. Enacting accommodation in this way allows clients to reconcile contradictory inclinations towards the movement. This configuration of emotional resonance is illustrated in Figure 4a.

Exemplifying this form of ambivalence towards the movement, which leads clients to enact accommodation, are adherents to the patient partnership movement, which gained a foothold across healthcare systems in recent decades. Mobilized by a latent anger at healthcare professions and their practices, which they see as paternalistic and exclusionary, members of patient groups including hemophiliacs, people living with HIV/AIDS, cancer survivors, mental health advocates, and others, are demanding to be included in the design, governance, evaluation of, and research about health care ( Citation: Maurer, Dardess & al., 2019 Maurer, M., Dardess, P. & Rouse, T. (2019). Patient and family engagement in the United States: A social movement from patient to advocate to partner.. InPomey, M., Denis, J. & Dumez, V. (Eds.), Patient Engagement: How Patient-provider Partnerships Transform Healthcare Organizations.. Springer International Publishing. Retrieved from https://link.springer.com/10.1007/978-3-030-14101-1 ; Citation: Jouet, Flora & al., 2010 Jouet, E., Flora, L. & Las Vergnas, O. (2010). Construction et reconnaissance des savoirs expérientiels des patients. Pratiques de Formation - Analyses, 2010(58-59). olivier_lv. Retrieved from https://hal.science/hal-00645113 ) .

By enacting accommodation, adherents to the patient partnership movement seek to work from inside established arrangements, collaborating with members of incumbent professions to incrementally improve their practices. This stance, more ‘reformist’ than ‘revolutionary’, suggests that, despite their anger at healthcare professions, patient partners nonetheless maintain some trust in professions’ expert knowledge. Their fear of relying solely on peer-driven, alternative arrangements to address their needs leads them to seek collaboration with healthcare professions and advocate for the valorization and inclusion of their experiential knowledge of illness and care as a way to address the shortcomings of established healthcare arrangements ( Citation: Boivin, Dumez & al., 2018 Boivin, A., Dumez, V., Fancott, C. & L’Espérance, A. (2018). Growing a Healthy Ecosystem for Patient and Citizen Partnerships. Healthcare Quarterly, 21(SP). 73–77. https://doi.org/10.12927/hcq.2018.25634 ; Citation: Epstein, 2007 Epstein, S. (2007). Inclusion: the politics of difference in medical research. University of Chicago Press. ) .

We argue that accommodation is also pursued by clients experiencing another form of ambivalence. They are clients who feel very proud of supporting the movement’s alternative project, yet equally ashamed of deviating from the profession’s prescriptions. Clients experiencing this emotional resonance trust the movement’s experiential knowledge to address their needs but remain detached from it as a collective actor because they see deviance from the profession’s prescriptions as morally flawed and/or self-degrading. We call this form of ambivalence towards the movement ‘trust yet detachment’. These clients see the movement’s experiential knowledge as more relevant, safer, and more reliable than the profession’s expert knowledge, yet they remain engaged with the profession’s established arrangements and work towards incrementally improving them from inside because they do not want to be seen as deviant. Enacting accommodation allows them to reconcile these contradictory inclinations towards the movement. This configuration of emotional resonance is illustrated in Figure 4b.

Illustrating the ‘trust yet detachment’ form of ambivalence towards the movement, which leads clients to enact the accommodation mode of participation in jurisdictional contestation, are HIV/AIDS activists. ( Citation: Gould, 2009 Gould, D. (2009). Moving politics: emotion and act up’s fight against AIDS. The University of Chicago Press. ) , p24] describes the ambivalence experienced in their struggle with the medical profession as a mix of “contradictory feeling states, including shame about homosexuality along with gay pride, as well as a desire for social acceptance along with repulsion from a society that oppresses sexual minorities.” She notes how the ambivalence of activists, who feel proud of the movement’s change project but ashamed of being seen to support it and labeled as deviant, leads them to work for incremental change while trying not to ‘rock the boat’ and risk marginalization from mainstream arrangements ( Citation: Gould, 2009 Gould, D. (2009). Moving politics: emotion and act up’s fight against AIDS. The University of Chicago Press. ) . In different ways, both the ‘trust yet detachment’ and ‘attachment yet mistrust’ forms of ambivalence towards the movement involve in individual clients a desire to challenge prevailing arrangements that is tempered by a concern for keeping their place within them.