Interactional patterns between staff and clients with borderline to mild intellectual disabilities

Background Client-centred models of care imply that clients should have a collaborative relationship with staff providing support. This study investigates whether dialogues between staff and clients in naturally occurring contexts reflect this collaborative ideal. Methods Nineteen staff members video recorded a social interaction with one of their clients. The topic of the interaction concerned an aspect of their support needs. The recordings were transcribed and analysed using the Initiative Response Analysis designed by Linell et al. Results Staff were more dominant than clients, albeit the level of asymmetry in the dialogues was relatively small. However, a different pattern of turns was used by staff and clients. Staff asked more direct questions and sometimes neglected meaningful client contributions. Clients, on the other hand, provided more extended turns in response to staff members' questions, thereby helping to maintain the dialogue. However, in a notable minority of communicative turns, the clients failed to link with the staff member's contribution. Conclusions The interactional patterns found in this study suggest that staff and clients can face difficulties establishing collaborative dialogues on shared topics. Future research should take account of what staff and clients want to achieve in dialogues, along with the nature of their non-verbal communication