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patronizing. Reassurance involves elucidation of the patient's beliefs about their illness (beliefs about cause, prognosis, and treatment) and providing education and advice that address those beliefs.

Clinicians can learn the phrases that people with MUPS find belittling and avoid them. Similarly, they can learn some phrases that “join” the clinician and patient in a collaborative dialogue. For example, most individuals with MUPS describe their distress as secondary to symptoms. It is best to adopt the patient's words and views regarding causation, no matter how faulty the clinician may think they are. Patients with MUPS understandably react negatively to physician statements such as “There's nothing physiologically wrong.” This is an unempathetic statement that runs contrary to the patient experience of physical distress. It is important to convey that the clinician believes that the patient is hurting and will work collaboratively with them to maximize functioning and quality of life. The clinician may have to prepare the patient for a shift in emphasis from a solely diagnostic and curative approach to a rehabilitative emphasis.

Collaborative goal setting. Reducing disability requires specific changes in patient behavior. It requires patients to take an active, collaborative role in their treatment. Clinician-patient collaboration and negotiation of behavioral goals will usually prove to be more rewarding than striving for elusive cures. Goals must be specific, incremental, realistic, and achievable, and they should center on observable or reportable behaviors. First and foremost, goals must be negotiated with the patient to provide the patient with a feeling of ownership of his or her goals. Productive goal-setting areas include occupational, household, or social tasks, physical activation, sleep hygiene, or medication adherence. Clinicians should shift the responsibility for change to the patient but avoid blaming the patient for his or her predicament.

Physical and role reactivation. Regular exercise in tolerable doses helps patients with MUPS discharge distress, increase stamina, and improve functioning. A physical therapist is seldom necessary to initiate reactivation strategies. Instead, activation goals can be negotiated in the primary care setting. The goal here is to start at low levels of exertion and gradually increase exercise in a stepwise fashion to build aerobic capacity and functional reserve. Patients may also need encouragement to remain gainfully employed and active in supportive relationship roles. This reduces dependence and improves morale, self-confidence, and ability to meet expectations.

Involvement of social supports. Clinicians should encourage participation of support systems in nearly all aspects of care, provided that the