This article examines “imagined constructed thought”: speakers giving voice to the inner world of a non-present other. Drawing on 9 hours of video footage of health-care staff discussing patients with intellectual disabilities (ID) during Discovery Awareness sessions, we explored times when the staff presented a possible version of a patient’s thoughts. They used those versions to take a stance on the patient’s inner world, often as a bridge between description of objectively observable phenomena and subjective interpretation of its meaning. It also projected staff’s own stance on what the patient was thinking, both in first position descriptions and as a competitive resource in those given in second position. The findings suggest that presenting the patients’ thoughts from a first-person perspective can be a versatile way of enacting a variety of complex epistemic and empathic actions in this setting. Data are in British English.