Equality and reciprocity within EBL therapy.

Naam Studentnummer Sectie Universiteit Begeleiders Datum van inleveren

Nick Leunissen s4084306 Orthopedagogiek: Gezin & Gedrag Radboud Universiteit Nijmegen Sonja van Veen-Graafstal en Maarten Wijnants 20-07-2012

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Equality and reciprocity within EBL therapy.

Nick Leunissen

Radboud Universiteit Nijmegen, 2012

In this research, with the help of an AB-design, the role of the aspects

‘equality’ and ‘reciprocity’ is investigated within the method of Emerging

Body Language (EBL). EBL is a methodical, dynamical approach in the

practice of helping and supporting children and adolescents that contributes

handgrips in the case of severe problems in the areas of communication,

attachment and contact. The main question under investigation is whether

aspects of ‘reciprocity’ and ‘equality’ in a relationship have a positive

influence on the problematic behaviour of the client. This is done by

analysing the qualitative and quantitative changes the client has made as a

result of the EBL intervention. The student’s observations and videotapes

from the baseline period are compared to the observations and videotapes

from the intervention period. It can be concluded that the client made great

observable, positive changes, mainly concerning the most addressed

intervention goal.

Equality and reciprocity are important aspects in every relationship. Equality means that two people

have a similar role within a relationship and that there’s a balanced initiative. When a relationship is

equal, there’s also a matter of reciprocity. This means that there’s mutual influence, action and

dependence between the two people. What aspects play a part in the emergence of equality and

reciprocity?

For both aspects to be present in a relationship, there has to be a certain kind of synchrony

present. William Condon studied interactional processes and was interested in synchrony between

people (Condon, 1974). He discovered two different kinds of synchrony in communicating

individuals. ‘Self-synchrony’ refers to the integrated behaviour of the individual in which

correspondence can be demonstrated. ‘Interactional synchrony’ designates a similar correspondence

between change in sound elements in the speech of a speaker and points of change in movement

configurations shown by the listener. Both kinds of synchrony are not detectable at normal

communication speed and take place out of the awareness of the individuals engaged. Condon

(1975) therefore states: “Communication is like a dance, with everyone engaged in intricated and

shared movements across many subtle dimensions, yet all strangely oblivious that they are doing so.”

Both kinds of synchrony are very important in the emergence of equality and reciprocity within a

relationship.

In the exact sciences like physics, synchrony is also studied. Christiaan Huygens discovered

two pendulum clocks ‘falling into synchrony’ when hung on the same wall (Spoor & Swift, 2000). The

waves of vibration that both pendulum clocks produce will go through the wall and influence each

other’s rhythm. This way, Huygens discovered that pulsing and ticking items tend to go in each

other’s rhythms, or fall into synchrony. This was the first known reference to the phenomenon of

‘entrainment’; a concept of two or more self-maintained oscillators lock together in frequency and

phase. Subsequently, Leisman (1990) made the comparison between pulsing and ticking items that

fall into synchrony on one side and human beings on the other side. Leisman showed that interacting

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people tend to fall into synchrony as well. The respiration and the rhythm of eye movements and

heartbeat of two people will move in one direction and synchronize during interaction. Entrainment

therefore is an important factor in the emergence of equality and reciprocity within a relationship.

A healthy, equal and reciprocal relationship can arise when there’s a healthy form of

attachment. John Bowlby described attachment as a ‘deep and enduring emotional bond that

connects one person to another across time and space’ (Bowlby, 1988). He believed that the earliest

bonds formed by children with their caregivers, especially in the first nine months, have a

tremendous impact that continues throughout life. The central theme of the attachment theory is

that mothers who are available and responsive to their infant’s needs, establish a sense of security in

their children; a secure base for the child to explore the world. Children who don’t form secure

attachments in early life have a higher risk of developing severe disorders like oppositional-defiant

disorder, conduct disorder or post-traumatic stress disorder. Konrad Lorenz discovered a process

called ‘imprinting’, which proves the existence of a biological attachment mechanism in young geese.

Right after hatching, young geese follow the first moving ‘thing’ they see, which results in them

thinking this ‘thing’ is their mother (Vicedo, 2009). Lorenz observed that at a certain critical stage

soon after hatching, the young geese learn to follow the parent. Imprinting involves visual and

auditory stimuli from the parent object; these elicit a following response in the young geese that

affects their subsequent adult behaviour. With this discovery, Lorenz proved that it isn’t so much the

representation of the mother that is biologically pre-programmed in the geese, but an attachment

mechanism (Vicedo, 2009). In his studies, Lorenz also began to focus on human behaviour and he

discovered that certain facial features and physical proportions are different in children than in

adults. In children, the head is quite large in comparison to the rest of the body and they mostly have

big, round eyes, a small, short nose and chubby cheeks. All these features evoke feelings of

tenderness in adults and the need to protect and nurture. Lorenz believes that maternal care is a

matter of instincts, as is the behaviour of an infant towards its mother. Lorenz’s thinking about

animal behaviour and his views about the human psyche were deeply connected and he stated that

“even in humans, social behaviour in particular is largely determined by instincts.” The pre-

programmed attachment mechanism that is also present in humans, results in babies synchronizing

with their environment and adults wanting to synchronize with their babies and protect and nurture

them (Condon, 1975).

Besides synchronization, mutual influence is an important aspect in communication and

relation. Colwyn Trevarthen discovered that very young infants are competent partners in social

interaction, who have latent sociability and intentionality (Trevarthen, 1979). Trevarthen’s view of

early interaction is that infants are doing more than automatically responding to the behaviour of

others. He stated that infants are born with the motivation to engage in social interaction and

primitive communication with people. In order to communicate, infants must be able to adapt or fit

subjective control of the subjectivity of others. This is called ‘intersubjectivity’ and it’s the shared,

reciprocal experience between the parent and child, whereby the experience of each is having an

impact on the experience of the other. For example, children experience themselves being loved,

valued and clever whenever their parents experience them as manifesting those characteristics.

Intersubjectivity emerges from attunement, shared emotion, shared attention and shared intention.

This is very similar to the mindset of Daniel Stern and his vision on early parent-child communication.

Stern described the development of five interrelated ‘senses of self’. These ‘senses of self’ develop

over the lifespan, but make significant developmental strides during sensitive periods, mainly in the

first two years of life (Stern, 1985). The mother and other primary attachment figures play a critical

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role in helping the infant with this developmental process. The ‘sense of self’ exists before there’s

any self-consciousness and language involved and it forms the primary organizing principle of human

development. The first stage is the ‘sense of an emergent self’, in which the main focus is on physical

care. It covers the first two months after birth and a sense of organisation begins to develop. There’s

also a lot of social interaction between parent and child, for example touching the baby, rocking the

baby, or singing and talking to the baby. The baby reacts by looking, staring, smiling or crying. From

the parents behaviour can be deduced that they consider the baby to be a social being with its own

subjective experience. The second stage is the ‘sense of core self’ and it covers the period between

two and seven months of age. In this stage, the social smile emerges and joint attention and

vocalizations of the baby are focused on another person. It’s the most exclusive social period in the

baby’s life and the fascination is mainly focused on the other. There’s also a clear preference for the

human face. The parents use baby faces, baby language and talk slowly to the baby, in high pitch,

loud voices. This way, the parents help the baby with the discovery of a certain consistency. Both

language and body language are characterized by themes and patterns in which variations can occur.

The facial expressions of the parents are very exaggerated, long lasting and emerge slowly. These

activities make the baby and the parent recognize each other. Between the seventh and fifteenth

month of age, the ‘sense of subjective self’ develops and it gets obvious for the environment that the

baby wants and is able to communicate. This is indicated by gestures, posture, actions and

vocalizations. A baby is able to share intentions, for example when the mother has something in her

hands that the baby wants. The baby will reach, grab, make noise and look back and forth between

the mother’s face and the object. This behaviour implies that the child ‘knows’ that his mother can

understand its intentions and is also able to meet the baby’s conditions. The intention becomes a

shared experience. In this period, the child gets to understand the intersubjectivity between child

and parent and is able to apply it. The child discovers that another person can also have feelings,

thoughts and intentions. It discovers that there can be communicated about these thoughts, also

without words. When the child masters these qualities, he is able to ‘read’ the mental state of a

person, to match and to attune. The fourth stage is ‘sense of verbal self’ and it starts from the

fifteenth month. In this period, the child becomes more aware that language is a medium for

organizing perceptual experiences and experiencing intersubjectivity. Language enables the

possibility to share experiences in a different way than through more direct ways that were already

available in the child. The fifth and last stage is the ‘sense of narrative self’. This period starts from

around the third year of life and mainly includes the ability to ‘talk about’ (meta) in comparison with

just naming objects and situations around us. All different stages of the ‘sense of self’ keep existing

and growing next to each other, during someone’s entire lifetime (Stern, 2004). Stern states that the

existence of a ‘sense of self’ implies that there automatically is a ‘sense of other’ (Bosman, 2010). In

the period the ‘sense of a core self’ develops, the ‘sense of self’ starts to distinguish from the ‘sense

of other’. The essential difference between the ‘sense of self’ and the ‘sense of other’, is that all

experiences of ‘the other’ are just slightly different than the baby’s own experiences. There’s no

absolute similarity; every experience is partly structurally similar and contains variations every time.

Because parents do it slightly different every time, the baby can’t identify with itself. After all, only

their own actions lead to almost entirely predictable reactions, while actions of the other rarely lead

to completely predictable behaviour. At a certain point in the development of the ‘sense of a core

self’, babies can turn their head towards the source of sound. This way, the parent who is nearby the

baby will evoke a ‘sense of other’ by looking at, talking to and touching the baby. The baby is able to

move body parts similarly and in a rhythmic pattern. Parents will synchronize with the baby and take

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rhythmic breaks, while adjusting their facial expressions and voice tone. The baby is also able to

synchronize with its parents, for example by displaying powerful gestures when a parent sets up a

sudden, loud voice. The baby and parent start together, finish together and changes in direction and

speed are also similar. Stern observed this strategy and his findings were structured in an

intervention method.

When a child’s development doesn’t proceed in a normative way, negative consequences can

arise for the child itself and for the environment. A child doesn’t get the opportunity to develop

certain skills, what makes it more difficult to cope with the outside world. The child has never

learned how to communicate properly or how to maintain a relationship. This can lead to

behavioural or cognitive problems within the child that can become more pervasive when they’re not

addressed properly. Emerging Body Language (EBL) is a therapeutic treatment that is based on the

majority of the aspects and essences of all different theories mentioned above. The main goal of EBL

is the development, the recovery or the improvement of the so called ‘Interaction structures’ a child

usually develops in the first five years of life (Rutten-Saris, 1990). An ‘Interaction structure’ is a very

clearly defined form of interaction. The first form that most babies usually learn in the first months of

their life is the interaction structure ‘Attunement’. The form is simple in nature and defined as ‘in

each other’s rhythm, shortly doing the same thing, with rhythmic breaks’. For example, when a baby

makes smacking sounds, most parents also make this sound (vocalizing) in the same rhythm

(Bosman, 2008). The following form is ‘Alternation’ and it’s defined as ‘doing the same thing one

shortly after the other, in each other’s rhythm, with rhythmic breaks’. For example, when a baby

laughs, most parents follow by smiling at the baby and support this smile with language (motherese)

in the same rhythm (Bosman, 2008). The subsequent ‘Interaction structures’ are respectively

‘Exchange’, ‘Play dialogue’ and ‘Verbal identity (Task/Theme)’. These interaction structures form a

personal profile and structure that we use engaging contacts during the rest of our lives. Interaction

is very important within EBL and it’s defined as any form of mutual influence that wittingly or

unwittingly leads to a behavioural change in the people involved (Marinussen, 2009). A baby is born

with a broad range of abilities to communicate with the environment (Verdult, 2009). Emotions that

the baby experiences are expressed by the body, for example through facial expressions, voice,

posture, awareness and body movements. To give meaning to these expressions, it’s important that

the expressions are followed by a reaction (Kozima & Michalowski 2009). This is how interaction

emerges. The equality and reciprocity of the mutual influence causes the ‘Interaction structures’ and

the ‘self’, as defined by Stern, to develop. The development of the ‘Interaction structures’ and of

Stern’s ‘Sense of self’ is related to each other (see Table 1). EBL states that equality and reciprocity

within a relation and the strategy of synchronization contribute to a solid attachment, a healthy

development of the ‘self’, a good intersubjectivity and a decent attunement.

When the ‘Self’ and the ‘Interactional structures’ don’t develop in a normative way, this can lead to

behavioural problems. A skill that has to be developed in one of the lower layers (especially Layer A)

is essential in the development of higher interactional structures and the skills that have to be

acquired in these structures (Adema, 2011). The certain sensitive periods in which the skills of a

specific interactional structure can be acquired, aren’t always properly addressed or exploited by the

child’s environment. This results in children from who is expected that they possess certain skills,

gained at a young age, but in reality these skills are absent. The absence of these skills can conduct in

a deficient acquisition of certain higher level skills and lead to a defective approach of the

environment. The children can’t cope with their environment and don’t know how to do this

correctly, because they’ve never learned. These children keep ‘bumping into walls’ and aren’t

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understood by their environment. This leads to problems within the child that are also expressed in

its behaviour. Subsequently, treatments address the problematic behaviour that causes trouble to

the environment and that’s observable by the naked eye. But in reality, the behaviour is caused by a

lack of skills in lower layers of the ‘Interaction structures’. So treatments should address the skills

that the children haven’t learned at an early age and which cause the problematic behaviour at an

older age. With ‘filling in these gaps’ at lower levels, children gain the skills to cope with their

environment in a better way, which also results in a reduction of the problematic behaviour. In other

words, you have to attack the problem at the roots.

Table 1 Overview of the EBL ‘Interaction structures’ and development of ‘Self’

EBL-layers Interaction structures (Rutten-Saris, 1990, 2001, 2002)

‘Sense of Self’ (Stern,

1985/2000)

Layer A – Attunement In each other’s rhythm, shortly doing the

same thing, with rhythmic breaks

Sense of an emergent self

Layer B – Alternation From A in each other’s rhythm, doing the

same thing one after the other, with

rhythmic breaks

Sense of core self

Layer C – Exchange From AB during the alternation, adding a

small, appropriate variation

Sense of subjective self

Layer D – Play dialogue From ABC playing with the expectations

resulting from the familiar exchange

Sense of verbal self

Layer E – Task / Theme From ABCD performing an assigned task

and applying a theme

Sense of narrative self

To address the problematic behaviour and to straighten the disturbed development, the EBL method

states that the therapist has to establish a reciprocal and equal relationship with the client and work

with the principles of synchronization of rhythm and movement. This is mainly expressed in the

constant invitation to the client to improve the ‘Interaction structures’ from within and not

necessarily to teach the client something. By evoking certain movements in the client (by inviting)

instead of enforcing it (by punishing), the behaviour and the ‘Interaction structure’ becomes

something of the client’s own (Adema, 2011). In most treatments, the focus is on the observable

problem behaviour and the so called ‘if.. then’ way of thinking, which are both not compatible with

the EBL principles. In EBL, it isn’t about the cause–effect relation and actions of individual people, but

about the interaction and relation between different people. An EBL-intervention is therefore not

aiming at the observable problem behaviour, but the underlying ‘Interactional structures’ and the

way in which the client interacts with the environment.

In many remedial or psychological treatment settings, the supervisor is the subject and the

client the object of treatment. The influence that the supervisor exercises on the client is often

greater than the impact the client exerts on the supervisor. This is referred to as an unequal

interaction, with the subject and object roles of the supervisor and the client alternating each other.

A key assumption in EBL is that there should be a subject-subject relationship between client and

supervisor, because the dynamic thinking presupposes equivalent reciprocity. This assumption by

Rutten-Saris (1990) also has an emancipatory character. Rutten-Saris considers any form of ‘being in

the world’ as equivalent without having equal skills. In other words, every person, with or without

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‘disabilities’ deserves the same amount of respect. Concluding; the main question that is researched

in this survey, following the set out theory, is if the aspects of ‘reciprocity’ and ‘equality’ in a

therapeutic relationship between a client and a supervisor have a positive influence on aspects of the

problematic behaviour of the client.

Method

Participants. ― The subject was a dyad of a client and a student. The client was a 17-year old Dutch

male. At the time of the study, he lived in an intensive treatment group at an institution with

orthopedagogic expertise situated in the southern part of the Netherlands. All of the clients in this

group were between 15 and 18 years of age and were diagnosed with a mild intellectual disability,

possibly combined with serious behavioural and/or psychiatric disorders. The client had a Turkish

father and a Dutch mother. He had never met his father and had a disturbed relationship with his

mother. The client was born with FAS (Fetal Alcohol Syndrome), which means he was born addicted.

From the age of one he was under the protection of child protective services and placed in a foster

home. The client was diagnosed with a reactive attachment disorder, Attention Deficit Hyperactivity

Disorder, Oppositional Defiant Disorder, Tourette syndrome and a developmental disorder in

adolescence (Psychodiagnostic research by GZ-psychologist, July 2000). He functioned at a below

average level of intelligence and had a fluctuating IQ, last determined at 83 (WAIS-III, October 2011).

The client experienced problems within the primary support group, problems related to the social

environment and educational problems.

The student was a 22-year old Dutch male. He was a third-year student Pedagogy and

Educational Sciences at the Radboud University Nijmegen. The treatment and research was part of

the course Clinical Practicum: Emerging Body Language. The student and the client were matched

based on the EBL expert’s opinions and their confidence in a solid connection between the two

participants.

Material. ―Every meeting was documented by a Canon PowerShot A590IS camera with video

recording option. It had eight megapixels and a four times optical zoom. The raw footage was stored

on a two gigabytes SD-card. Eventually, there was a selection of six clips made out of the raw footage

of 15 clips. The selected clips were analysed with The Observer XT 10.5 (Noldus, 2009). The Observer

is event logging software for the collection, analysis, and presentation of observational data. It was

used for analysing the dialogue between client and student, to obtain insight in the relation and

adaption between the two participants.

Procedure. ―This study was an n=1 study with AB-design. The AB-design was a two phase design

consisted of a no-intervention baseline phase (A) and an intervention phase (B). The client was

selected for participation in the EBL treatment by an expert in EBL, because of the client’s long and

unsuccessful history with treatments and therapies. It was thought that a different approach was

necessary to have a positive effect on the client’s development.

The client and the student had met 21 times during the period between October 2011 and

June 2012. Due to the client’s internship, the day that the weekly meeting was held varied from time

to time in the period of contact. The client and student undertook various activities during the

meetings, for instance playing soccer, videogames, snooker or swimming. The baseline period started

at the end of October and lasted until the beginning of February and consisted of nine meetings that

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lasted approximately one hour each. The main goal of this period was establishing equivalence

between client and student, by the student adopting a brother role and supporting low threshold

contact. During the baseline period, the student attended two courses about the theory and

background of the EBL treatment. The intervention period started in the beginning of February and

continued until mid-June and consisted of twelve meetings, all lasted about one to three hours.

There were also supervision- and peer sessions at the Radboud University. In the supervision

sessions, the contact with the client and possible difficulties, all based on videotaped material, were

discussed among four students and two EBL experts. In the peer sessions, one student could put

his/her problem up for discussion to the entire group.

Out of the raw footage, six clips were selected of ten minutes each; three baseline clips and

three intervention clips. The clips and timeframes were selected on intelligibility, audibility, quality

of sound, speech and image and no interruptions during the ten minutes. The six clips were delivered

to two peer students for scoring. This was done to secure the independence of the scoring and to

enhance the reliability and validity of the data. The students scored the interaction between student

and client with the help of The Observer XT 10.5 (Noldus, 2009).

Linell. ― Linell’s IR-analysis is a method of analysing dialogues, which measures dominance within a

conversation (Linell, Gustavsson & Juvonen, 1988). The unit of analysis is the turn, which can include

an initiative or a response. Each turn of the dialogue under analysis is assigned to a particular turn

category. Linell distinguishes 18 categories and two non-categories (see Appendix A). The distinction

between features is based on six aspects (Linell, Gustavsson & Juvonen, 1988). These aspects are the

basic distinction between initiative and response, the strength of initiatives: strong (explicitly)

soliciting or demanding versus weakly interactive (asserting or submissive), adequacy of responses:

adequate (accepted) versus inadequate, the scope of (retroactive) links: local versus nonlocal, the

focality of (retroactive and local) links: focal versus nonfocal and alter- or self-linked response (linking

up with the interlocutor’s preceding turn versus speaker’s own preceding turn). With the 20

categories, all spoken parts in a dialogue can be coded. In this research, 16 of the Linell codes had

been used for indicating strings of words in the conversations between student and client.

Reliability. ― Interrater reliability is a measure used to examine the agreement between observers

on the analysis of the clips. The statistical measure of interrater reliability is Cohen’s Kappa1, which

ranges from zero to one. In Kappa, large numbers mean better reliability and values near or less than

zero suggest that agreement is attributable to chance alone. The second baseline clip had a Kappa of

0.64, which means there was a substantial agreement between the observers. The third baseline clip

had a Kappa of 0.65, which also means that there was a substantial agreement between the

observers. The intra-rater reliability is calculated to examine the agreement between the basic

observers. The Kappa was 0.68, which means there was a substantial agreement between the two

observers.

1 With modifiers on and a one second time window difference

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Validity. ― Within the dynamic system theory, the emphasis is on mutual influence, inner processes,

reciprocity and not setting final goals for treatment (Verhofstadt-Denève, van Geert & Vyt, 2003).

The assumption according to the treatment EBL, is that when one particular part of a system starts

changing, the whole system will start to change. This principle’s consisted with the principles of the

dynamic system theory. The principles of Linell connect with the EBL-theory. The IR-analysis can be

used for designing interventions or evaluating results. It provides hard evidence about the balance in

a conversation, the rhythm and the attunement. These’re all aspects an EBL treatment targets.

IR-measures. ― In this research, both qualitative analysis and quantitative analysis were used. The

qualitative analysis mainly focused on observable behavioural changes in movement, rhythm and

attunement to themselves, another person and the environment. The quantitative analysis was

expressed in quantitative dominance (who talks the most seconds during a conversation),

interactional dominance (Linell) and CRQA (who leads, who follows).

There’re three different kinds of dominance that can be distinguished; purely quantitative

dominance, topical dominance and interactional dominance (Linell, Gustavsson & Juvonen, 1988).

Purely quantitative dominance is simply a matter of amount of speech produced. He who is

dominant is the one who says the most words or talks most of the time. Topical dominance could be

understood in terms of introduction of new content words (referents, concepts). He who dominates

would then be the one who tries to put the most content into the socially shared world of discourse,

he who initiates the most topics and subtopics. Interactional dominance has to do with the

communicative actions, initiatives and responses taken by the interlocutors. The dominant party is

the one who manages to direct and control the other party´s actions to the greatest extent and who

also avoids being directed and controlled in his own interactive behaviour. In this paper our interest

will be focussed on interactional dominance. The main expectation of the study is to see a pattern

change in the intervention, compared to the baseline.

With help of the 18 Linell categories, the IR-index, the IR-difference and the different Linell

coefficients can be calculated (see Appendix A). The IR-index is a measurement for dominance, the

IR-difference shows the degree of asymmetry and the coefficients are used to refer to the

contribution of either of the interlocutors (Linell, Gustavsson & Juvonen, 1988). Measurements

regarding the IR-analysis are expressed in frequencies and percentages. Besides the scoring of the

dialogue, the documentation of body movements and behaviour was also required. Every 30 seconds

a short summarizing sentence was put down to describe what kind of movement and behaviour was

seen in the clip. Next to dominance, the attunement and rhythm of the conversation had been

analysed for a proper image of the characteristics. The dialogue had to be attuned and through

scoring it had to be examined if the student and the client acted and talked in the same rhythm.

Cross-recurrence quantification analysis (CRQA) is a non-linear method that quantifies how

two observed data series unfold over time and it measures patterns of recurrent behaviour

(Shockley, Butwill, Zbilut & Webber, 2002). CRQA produces measures reflecting coordination, such as

how often two data series have similar values or reflect similar system states (called recurrence rate).

An important part of the analysis is looking for balance in the system. With regards to this aspects, it

was analysed who started a conversation most of the time and in what way this changed during the

intervention period.

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Results

This section is organized by five topics: (a) a short diagnostic image of the client, (b) a survey of the

interventions that are worked on, (c) the hypotheses of the expected outcomes, (d) qualitative

results, (e) quantitative results and an overall conclusion.

EBL-diagnosis. ― The client is a 17-year old boy, who has several pervasive disorders in attachment

and development. In the beginning of his life, he was separated from his biological mother and

unable to develop a safe and convenient attachment mechanism. He functions at a below average

level of intelligence. Based on the EBL-theory, he mainly has shortcomings in Layer A (attunement).

He’s fairly attuned to himself and to another, but can’t integrate these two into ‘we’. The client

knows what he wants and is able to transfer this to another person. He’s able to express his own

feelings and finds it difficult to take a partner into account when he plays soccer or holds a

conversation. He will kick the ball very hard, so that his partner can’t kick it back, or he doesn’t ask

questions to his interlocutor during a conversation. Because of his shortcomings in Layer A, higher

layer qualities are not (fully) developed.

Interventions.

- The most important goal is to make the client more aware of undertaking an activity together (as

‘we’), by teaching him how to integrate ‘I’, ‘you’ and ‘we’. This goal is addressed in different ways, for

example verbally and physically. The client and the student go sporting together, in a way that

they’re dependent on each other. When the client passes the ball very hard to the student, the client

notices that the student isn’t able to pass the ball back to him correctly. The goal’s also addressed by

trying to let the client take more initiative, so that the conversations become more balanced. This is

done by the student telling personal stories and then taking a pause, instead of asking questions. A

space is created for the client to take initiative, so that he can bring up new subjects of conversation

or ask the student personal questions, without being explicitly told to do so.

- Another intervention goal is to invite the client to use less obscene language. Every time the client

uses an obscene word in front of the student, there’s a standard reaction from the student.

Whenever the client says; “What a bunch of retards!” the student reacts with “What a bunch of

retards, what a bunch of difficult people, those people I can’t get along with so well.” This provides

the client with an alternative for the obscene language and doesn’t address him in a punitive way.

- The intervention also targets putting messages in perspective, so that the client understands the

moral of the message and doesn’t deform and/or enlarges the message and then spreads it around.

If this happens in front of the student, he asks the client to sit down with him. The student then asks

the client to repeat the original message. If the client can’t properly do this, the student does it for

him. This way, the client experiences the difference between the original and the deformed message,

without being addressed punitive.

- The last goal the client and student work on, is to improve the awareness of the concepts ‘turns’

and ‘taking turns’, so that the client can participate in a conversation without interrupting his

interlocutor. It occurs that the client contributes something during a dialogue while his interlocutor is

talking, by interrupting him, or simply talking through him. Whenever this happens, the student gives

a standard reaction by saying: “Oh, were you thinking about that?” and then say: “Then I will think

along with you. Do you want to think along with me then in a moment?”

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Expected outcomes.

- The client has difficulties with integrating ‘I’, ‘you’ and ‘we’ in different sorts of situations. After the

intervention period, the client has to notice his interlocutor more during a conversation. He shows

this by taking more initiative, in terms of initiating new topics of conversation and asking the student

more personal questions. This will also result in the client talking more during the dialogue and a

decrease in the moments of silence. During sports games, the client will take his partner more into

account by considering him when he passes or throws the ball. The client will pass or throw the ball,

so that the student and the client have the same amount of possession during a game.

- Besides that, the client will use less obscene language in comparison with the baseline period. He

can have a ten minute conversation without cursing.

- The client can also tell a message that is communicated to him in exactly the same form to other

people, without any enlargements or deformations.

- Also the client interrupts his interlocutor less in comparison with the baseline period. The client can

have a five minute conversation, without interrupting his interlocutor.

Qualitative results.

- The intervention aims at training the client to integrate ‘I’, ‘you’ and ‘we’. During the baseline

period, the dialogue between student and client is patterned in a distinct way. In the intervention

period, the student stops asking questions and the client begins to take initiative. There’re more

periods of silence during the conversations, the client begins to ask personal questions and he

initiates subjects of conversation. This leads to more balanced conversations between client and

student. The implementation of the sporting aspect is very successful as well. From the beginning,

the client picks up the games very quickly. He carries the tasks out greatly, even when the bar is

raised and the exercises become more difficult. For example, passing a ball against the wall and to

the partner, or only throwing with your left arm. The client doesn’t realize that the variations are put

in deliberately and considers everything to be part of the game.

- In the intervention period, both the student and the client are comfortable being in each other’s

presence and they have a relaxed posture. Their tone of speaking is calm, they have a lot of moments

of mutual laughter and the client seems less aware of the student-client relation than in the baseline

period. The student and the client are more attuned in the intervention period, because they talk in

the same rhythm, pitch and volume the majority of the time. They have a lot of moments in which

they sit in identical body postures or make body movements in the same rhythm during a

conversation, without deliberately acting on this.

- There is little to no change in the behaviour that’s targeted by the other interventions. The amount

of obscene language the client uses stays the same in the intervention period. He can have moods in

which he curses constantly, or he curses during conversations. This is the same for the interruption of

his interlocutor. The client can talk right through a turn of the student and start about a whole

different subject. The client also keeps retelling messages that are told to him in an emphasized and

enlarged way. All three behaviours remain the same in terms of expression and frequency. The only

time there’s visible improvement, is when the client is explicitly confronted with the standardised

manner of reaction as described in the intervention. The emphasis that’s put on the main goal, might

lead to less attention spent on the other intervention goals. Also, the behaviour that the other goals

focus on doesn’t occur very frequently. Therefore, the moments that it does occur have to be

addressed more consequently.

12

Quantitative results.

- In the baseline period, the client is talking more than the student (see Fig. 1). In the intervention

period, the distribution is more even than in the baseline period and the student is talking the most.

The increase in the student’s talking can be explained by the intervention, in which he changes his

input from asking questions to telling personal stories. This takes more time, which leads to the

student talking more in the intervention period.

- In the baseline period, the student is clearly more dominant in the conversation than the client (see

Table 3). In the intervention period, the dominance is more equal and the client is even a bit more

dominant than the student. The intervention targets the increase of the client’s dominance. The

client has to take more initiative to make the conversation more equal and balanced.

- In the baseline period, the client gives more expanded responses than the student (see Fig. 2). In

the intervention period, they both give the same amount expanded responses. The intervention aims

for the client to take more initiative. An expanded response is usually given as a reaction to a

question. The increase in expanded responses of the student means that the client asks more

questions the student can respond to.

- In the baseline period, there’re slightly more turns of the client that lack new initiative than of the

student (see Fig. 3). The difference remains small in the intervention period, but now the student has

more turns that lack initiative. The student’s turns that lack initiative increase and the client’s turns

decrease in the intervention period. This is caused by the intervention, which consisted of the

student taking less initiative and allowing silences from the client and the client taking more

initiative.

- The student makes more abrupt topic shifts than the client in the baseline period (see Fig. 4). In the

intervention period, the student makes almost no abrupt topic shifts and the client’s part decreases

as well. The intervention addresses the abrupt topic shifts of the student, because he omits

questions to the client and there will be a silence instead of an abrupt topic shift.

- In the baseline period, the client avoids to link up with the main content more than the student (see

Fig. 5). In the intervention period, this becomes more equal because the student avoids linking up a

lot more and the contribution of the client stays the same. The intervention is to make the

conversations more balanced and the student adjusts himself to the client. He doesn’t work harder

for the course of the dialogue, which makes the dialogue more balanced and equal.

- In the baseline period, the student takes strong initiatives significantly more than the client (see Fig.

6). In the intervention period, the percentages move closer together. The client even takes slightly

more strong initiatives than the student. The intervention includes that the student takes less

initiative, so the client gets the space to increase his initiative and the conversation becomes more

balanced.

- The CRQA outcome shows that the student is more dominant in the baseline period conversations.

Dominance in CRQA means leading the conversation, or in other words, who will bring the system

into movement. In Linell, dominance means taking the strongest initiatives. Taking an initiative in

CRQA stands for starting to talk and in Linell it stands for asking a question or starting a new topic. In

the beginning it takes the client almost 29 seconds to react to the initiative of the student. The 29

second time lag decreases in the rest of the baseline period. The time lag is caused by the student

asking the client a lot of questions. After the time lag, the client starts to talk. In the beginning of the

intervention period, the client is more dominant and takes the initiative. In the rest of the

intervention period, the student is more dominant again and the client responses to this initiative in

30 seconds and later in 14 seconds. The time lag in the second and third intervention clip is caused by

13

the student and client mutually talking and the student withdrawing himself from this situation the

first. The time lag is the time that goes by before recurrent behaviour occurs again, in this case the

client also being silent after the student stops talking. This way the student leads the conversation,

because he’s the first one to take an initiative, namely he steps out of the mutual talking. The time

lag of 30 and 14 seconds indicates the client talking by himself for this amount of time. After the 30

or 14 seconds he stops talking and the student starts to talk, there’s a moment of silence or they

mutually talk. The different interpretation of the figures in baseline and intervention can be

explained by the implementation of the intervention. In the baseline, there’s an interview style, in

which the time lag stands for the amount of time the student needs to ask a question. In the

intervention period, the student starts sharing and the client responds to this. He doesn’t wait until

the student finishes talking, so there’s mutual talking. The client reacts very different throughout the

periods. The fluctuations go from reacting very slowly, to reacting very fast, to even taking the lead

and back to reacting very slowly again. This can be because of the different ways the student

approaches the client throughout the baseline and intervention or because of the client’s fluctuating

mood.

Over-all can be concluded that the implementation of the interventions has led to great results. The

client takes more initiative, in terms of initiating new topics and asking more personal questions,

there’s less difference in dominance between the student and the client and the conversations have

become more balanced on all fronts. This means that the client is better able to undertake an activity

as ‘we’, in which he can involve other people and reckon with them in games and conversations. The

client and student seem comfortable being in each other’s presence and more attuned in the

intervention period. They’ve mainly been sitting in identical body postures and make body

movements in the same rhythm without deliberately acting on this. The student has stopped asking

questions and there’re more periods of silence during the conversations. However, there’s no change

in the amount of obscene language the client uses, the awareness of the concepts ‘turns’ and ‘taking

turns’ and putting messages in perspective.

Discussion

In this study, an answer to the question if the aspects of ‘reciprocity’ and ‘equality’ have a positive

influence on aspects of the problematic behaviour of the client in a therapeutic relationship between

a client and a supervisor was sought. This was done by making a qualitative analysis of a client–

student dyad, under the supervision of EBL experts, with the use of observations and EBL-video

analysis. Based on the analysis can be concluded that the EBL method caused clear, positive

qualitative changes. Although it’s always difficult to attribute change to an intervention (Bouter, van

Dongen & Zielhuis, 2005), with a large amount of certainty can be stated that the EBL intervention

played a significant role in the observed changes.

Through targeting specific areas, like physical and verbal, the EBL intervention focused on

making the client more aware of undertaking an activity together and taking more initiative within a

conversation. The client’s problematic behaviour includes that he doesn’t take a lot of initiative

within a conversation, he doesn’t bring up new topics and he undertakes activities as ‘you’ or ‘me’

instead of as ‘we’. The client showed great progress in these areas and demonstrated skills that

weren’t visible prior to the intervention. The client took more initiative, in terms of initiating new

topics and asking more personal questions, there was less difference in dominance between the

14

student and the client, the conversations became more balanced on all fronts and activities were

undertaken more as ‘we’ by the client. The staff of the client’s life group didn’t observe these

positive changes and said the client acted the same as before the intervention. The EBL experts that

work at the institution did observe a positive change in the client, mainly in the way he addressed

people and the polite manner in which he had conversations with adults. It has to be noted that

there were also areas targeted through the EBL intervention that didn’t show progress. This applies

to the goals of inviting the client to use less obscene language, putting messages in perspective so

that the client doesn’t deform and/or enlarges the message and improving the awareness of the

concepts ‘turns’ and ‘taking turns’, so that the client can participate in a conversation without

interrupting his interlocutor. From EBL point of view, this can be explained by two arguments. On

one side the emphasis that was put on the main goal, might have led to spending too little time on

the implementation of the other three intervention goals. On the other side, the behaviour that the

other goals focussed on didn’t occur very frequently. So the moments that it did occur had to be

addressed very consequently, what didn’t happen. Therefore, the intervention wasn’t well

conducted, what led to few results in these goals.

Some of the changes that have been made are visible with the naked eye. But to identify

these changes in a scientific way, a different kind of analysis is needed. That’s why a Linell analysis

was made, to conceive quantitative results as well. With these results, an answer can be provided to

the question if there’s a change in the verbal interaction between client and student after

implementation of the EBL intervention. In the quantitative results, clear changes can be observed in

the verbal interaction. The changes are mostly in line with the goals that were set for

implementation. For example, the client took more initiatives, the client became more dominant and

the differences between client and student decreased; the conversation became more balanced. The

client’s problem behaviour includes that he doesn’t take a lot of initiative within a conversation. He is

fairly attuned to himself and to another person, but can’t integrate these two into ‘we’. The Linell

analysis shows that the difference between client and student in the taking of initiative, giving

expanded responses, making abrupt topic shifts, giving turns that lack initiative and avoiding to link

up with the main content decreased. In other words, the client and student became more

synchronized, which made the dialogue more balanced. Making the dialogue more balanced also

meant that the client had to take more initiative and be more dominant in the intervention period,

compared to the baseline. The Linell analysis shows that both of the conditions have been met. In the

intervention period, the initiative of the client not only increased, but the client even took more

initiative than the student. The client was also more dominant than the student in the intervention

period. Because the difference in dominance between client and student was very small in the

intervention period, the conversation was more balanced.

It can be concluded, that the intervention goals that have been addressed properly led to

great results. The question that arises from this conclusion is what makes the EBL method so

effective. Is it the great importance of ‘reciprocity’ and ‘equality’ within the relation of the student

and the client, or are there other aspects that led to these changes. In the introduction, important

aspects of EBL such as ‘interaction’, ‘relation’, ‘attunement’, ‘equality’ and ‘reciprocity’ were already

mentioned. To comply with precisely these EBL principles, various studies found convincing motives.

For example, van Baaren, Holland, Kawakami and van Knippenberg (2004) performed an experiment

where the subject and test leader sat at a table. The subject was asked to give his opinion about ten

advertisements. The test leader copied the body orientation (for example bending forward) and the

position of the arms and legs of half the subjects. The test leader didn’t copy anything from the other

15

half of the subjects. As soon as the subject had finished the task, the test leader announced that

there was still another task to follow. For this task, the test leader had to pick up material from

another room. After the test, the leader would leave the room for 30 seconds and return with a stack

of paper with six pens on top. While the test leader walked past the subject, she ‘accidentally’

dropped the pens. When the subject would not pick the pens up within ten seconds, the test leader

would do this herself. In the first group, in which the test leader attuned to the subjects, 100% of the

subjects picked up the pens. In the second group, in which the test leader didn’t attune to the

subjects, only 33% of the subjects picked up the pens. This suggests that attuning to a partner, in this

example through a form of mirroring, leads to more prosocial behaviour. In mirroring, a person

consciously duplicates the movement another person makes a few seconds later. This is not the

same as attunement, in which a person in a subconscious, natural way moves in the same rhythm of

another person. But because of the identical body postures, it can create a feeling of attunement

between test leader and subject, what also leads to the subject showing more prosocial behaviour. A

second experiment of van Baaren et al. (2004) was structured in the same way, only now a second

test leader was added. After the first task was completed, the test leader announced that another

test leader would bring in the second task. The first test leader would leave the room, after which the

other test leader would enter the room. While the new test leader walked past the subject, she

would also ‘accidentally’ drop the pens. In the group in which there was attunement during the first

test, 84% of the subjects picked up the pens. In the group in which there was no attunement, only

48% of the subjects picked up the pens. This shows that more prosocial behaviour caused by

attunement is not limited to those who attune to the person. It indicates that the effect of

attunement is not the result of ‘something special’ in the relationship between the subject and the

test leader, but that attunement can change the way in which people interact with their

environment. This is also evident in the observations of the EBL experts, who experienced a positive

change in the client, mainly in the way he addressed people and the polite manner in which he had

conversations with adults. These were situations that the student, who implemented the

interventions, wasn’t present himself. Attunement is the result of a reciprocal and equal relationship;

these are both vital aspects for the presence of attunement. This means that whenever a treatment

is trying to accomplish attunement in the interest of addressing problematic behaviour, this can’t be

done without prioritizing the aspects ‘equality’ and ‘reciprocity’. This results in the therapist having

to focus on the relationship between client and therapist, instead of addressing the problem

behaviour directly. Because most treatments consist of the direct addressing of problem behaviour,

this would mean that a drastic shift has to be made in the manner in which is looked upon the entire

concept of ‘treatment’ and the way in which problem behaviour has to be addressed.

There’re also limitations to this study. It’s a study conducted by one student, focused on one

client. Also, the implementation of EBL principles in the student-client contact in the baseline period

had to be absent. Therefore, the difference between baseline and intervention period indicated the

change that had been made due to the EBL method. Because of the introduction with the theory

behind the EBL principles, the baseline period was entered with a different mindset than it would

have been started with, was there no existing EBL knowledge. That’s why the interaction in the

baseline period could already have been influenced by the theory behind EBL and the matter that

was thought during part one of the EBL course. The student could have used some of the acquired

knowledge subconsciously in the baseline contact with the client. Another limitation is that

movement and body language is only analysed in a qualitative way and not in a quantitative. All the

statements about posture and movement were based on observations. Therefore, the conclusions

16

can’t be supported by hard evidence in the form of, for example, Linell results. Of about 1800

minutes of contact, only 60 minutes of video footage was included in the Linell analysis. This means

that only three per cent of the contact is included in the analysis. The quantitative results are

therefore only based on a fragment of the contact between client and student. Besides that, there

hasn’t been an operational definition of the concepts ‘reciprocity’ and ‘equality’. Therefore it’s very

hard to check, based on qualitative and quantitative analysis, what part these concepts have played

in the EBL treatment. There can be more general conclusion drawn, because both concepts are

important aspects within the whole EBL theory. A fair part of the progression can be assigned to the

role of ‘reciprocity’ and ‘equality’ within the relationship, because EBL states that these concepts are

essential for the treatment. It’s hard to define what role the different aspects of EBL treatment

individually have and what aspects lead to the results that other treatments can’t achieve. Is it the

role of ‘equality’, or ‘reciprocity’? Is it the general concept of ‘working in the relation’ and

‘attunement’? Or is it the combination of all of the different aspects?

Through the intervention, attachment, interaction structure and the development of ‘self’

were also addressed. This was done by focusing mainly on an equal, reciprocal relationship between

student and client. Because of the equality and reciprocity in the relationship, the client showed

progress in these areas. He began to share personal stories, was sincerely interested in the student’s

life and wanted to help with the arrangement of activities that could be undertaken by student and

client together. The areas were not specifically addressed, but were worked on because of the

equality, reciprocity and synchronization the student provoked in relationship with the client. This

led to conversations being more balanced and therefore more equal. Also, a space was created for

the client to take initiative. The client began to take more initiative and the relation became more

reciprocal. This meant that there was progression in the problem behaviour, the lack of initiative and

undertaking activities as ‘you’ and ‘I’.

Overall, people who first come in contact with the EBL method see that something happens

with the client due to EBL. However, this conclusion is often overshadowed by a sense of vagueness

that’s created by the somewhat poetic sounding EBL terms as ‘attunement’ and ‘reciprocity’

(Koreman, 2008) and by the ignorance of the underlying EBL mechanisms. Research, of for example

van Baaren et al. (2004), shows that in EBL there’s no ‘black box effect’. Studies demonstrate that the

principles of attunement, synchrony, reciprocity and equality, which can be explained by different

fields of research, play a central role in the development of human behaviour, both in terms of

movement, as in the field of communication and social skills. EBL is a method that works with these

principles, what makes EBL easily accessible, versatile and relatively easy to generalize. Obviously,

there’s an EBL expert needed who can determine, based on EBL-(video) diagnostics, where the gaps

of the client are. Also, an EBL therapist, expert in the principles of EBL, can derive more from the

interactions with the client than a random person. But movement is natural behaviour, what

basically makes everyone capable of inserting this behaviour to enable development in another

person.

17

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Vignet

Dossier and observational data. ― The client is a 17-year old boy who functions at a below average

level of intelligence and has a fluctuating IQ (WAIS-III (2011): TIQ 83, VIQ 81, PIQ 87). The client is

diagnosed with a reactive attachment disorder, Attention Deficit Hyperactivity Disorder; Combined

hyperactive-impulsive and inattentive subtype, Oppositional Defiant Disorder, Tourette syndrome

and a developmental disorder in adolescence (Psychodiagnostic research by GZ-psychologist, July

2000). The client suffers from Fetal Alcohol Syndrome, which means that he was born addicted. He’s

in need of intensive one-on-one guidance and he can’t follow a day program by himself. The client

can get very worked up, also in his head. If the staff doesn’t respond to this, the situation can

escalate within minutes. The client will start picking a fight, screaming or act verbally or physically

aggressive towards staff and peers. The client can only focus on a topic for about ten minutes, which

makes his learning process very slow. He has serious difficulties in understanding social interaction

and is able to make jokes at very inappropriate times. He doesn’t have strong friendships and mainly

bonds with groups of people that are older than him and related to drugs, alcohol and criminality. If

the client doesn’t get what he wants, he can start throwing objects or use obscene language. In a

conversation, the client takes little initiative. He mainly shares his own stories and talks about his

own experiences. The client is easily influenced and doesn’t question people he looks up to, which

leads to him getting in trouble with authorities. For example, when an older boy with fancy clothes

tells him it’s okay to sell drugs or to get in a fight, he will do this without consideration. This could

lead to the client getting in trouble with the police. He easily acts on his impulses, which makes his

behaviour unpredictable for the staff. He attaches great value to status, clothing and musical

preference. The client often has muscle contractions in his face, mainly twitching his eyelids and

raising his upper lip. He’s in need of clear, strict rules and a solid structure within his living situation.

EBL-intervention. ― The client’s problems in the EBL interaction structure are mainly in Layer A

(‘Attunement’). He’s able to attune reasonably to himself and to another person. The client is unable

to integrate the ‘I’ and ‘you’ into ‘we’. He doesn’t realize how to undertake an activity as ‘we’,

instead of as ‘you’ and ‘I’. This is possibly one of the causes of the problems in the field of

oppositional-defiant behaviour, aggressive behaviour and lack of empathy. Within a conversation,

the client isn’t reciprocal, because he doesn’t know how to do this. He isn’t always well attuned to his

environment. For example, he can use obscene language in formal situations or while walking

through town. During interactions, the client hardly shows own initiatives and variations. Besides the

problems in Layer A, the client also experiences trouble within Layer B (‘Alternation’). This expresses

itself within a conversation, by the client not knowing when he can speak and when he has to listen.

He can talk right through his interlocutor’s turn, because he has to say or know something and

directly acts on that. The client isn’t well aware of the concept of alternation.

Description of the filmed meetings. ― In this part, the content of the six clips that are recorded

during the meetings between client and student are described. The first three clips are part of the

baseline period, in which the student didn’t use an intervention. The last three clips are part of the

intervention period, in which the student implemented the EBL-intervention.

Clip 1 (31-10-2011): the student and the client meet for the first time. They sit outside in the patio

and the student explains what the goal of the meetings is going to be. There’s a lot of talking during

the clip and the student mainly asks questions. The client answers in a calm, self-controlled manner

20

while he sits back in his chair. When they talk, they both make gestures in a controlled way. The

client talks about the neighbourhood he grew up in, his foster home and how he experiences living in

a treatment group. At one point, the client and student discover that they grew up very nearby and

they start talking about the area, friends they have there and people the other person may know.

They also discuss taste in music and sports.

Clip 2 (07-11-2011): the student and the client sit in the kitchen and drink a cup of soda. At first they

talk about the weekend. The chairs they sit in are turned, so that they face each other. The student

sits very calmly and the client changes his position in the chair a lot. After discussing the weekend,

they talk about the client going back to school and the internships he wants to do. During the

conversation, the client looks around and the student asks a lot of questions. There’re few silences in

the conversation and when the client listens, he plays with his hands. At one point they start talking

about the client’s music ambitions and the client starts to tell more without being asked questions.

He explains what activities he wants to undertake to become a famous rapper and the student listens

and responds.

Clip 3 (28-11-2011): the student and the client sit on the client’s bed in his bedroom. They sit next to

each other and the student asks a lot of questions. The questions are about the client’s internship

and his weekend. The client answers the questions, looks out the window most of the time and

doesn’t ask questions himself. At one point, the student leans back and leans against the wall behind

his bed. They start talking about the client’s biological mother. From this point on, the client mainly

tells stories about what he doesn’t like about his mother and how she treats him. The student

doesn’t ask questions anymore, sits turned facing the client and listens to his stories. The client also

discusses how he has to take care of himself and how he always gets in fights with his mother and

stepfather. The client speaks monotonous and softly, while he looks straight ahead.

Clip 4 (16-02-2012): the student and the client sit in the kitchen and drink a cup of tea. The student

starts to tell a story about an operation he had. The client reacts to this story and the conversation

flows naturally. The client asks the student about his opinion a new internship. They start to talk

about the client’s plans when he turns 18. They sit calmly in their chairs and talk controlled and calm.

The client wants to know more about legislations concerning living independently and working

without a diploma and asks questions about this.

Clip 5 (29-03-2012): the student and client talk about tattoos while sitting in the kitchen, drinking a

cup of soda. They both sit calmly in their chair, but the client’s chair is further away from the table

and he sits a bit slumped. The client wants to get a tattoo and asks the student’s opinion on this

matter. The client proposes a lot of different styles and wants to know what the student thinks of

them. At one point, the client looks up an image of a tattoo and he starts using his smartphone. From

this point on, he keeps the phone in his hand. The client asks about the student’s phone and they

start comparing. They hold their phones together and start comparing properties. At the end the

client asks if he can have a smoke and they both go outside.

Clip 6 (18-04-2012): the client and student sit in the client’s bedroom, on the edge of his bed. The

student starts talking about a concert he attended. The client replies with stories about his music

ambitions and his plans for building a studio. The client stands up a couple of times to point out the

measurements of some equipment he wants to buy for the studio. The client talks very enthusiastic

and rapid, while he smiles a lot. The student asks about specific plans the client has and the client

explains them. The client also asks the student if he knows some things about studios. The student

sits in the same position, very calm and unmoved, while the client is more active and changes his

position a lot.

21

Results in tables and figures. ― The results of the Linell-analysis are discussed based on the

categories used to score the conversations between client and student. To give some idea of the

percentages used, the absolute numbers of each category are presented in Table 2.

Table 2 Total Frequency of Turns per Meeting and Frequency of Turns per Category

Total number of turns

Expanded responses

Lacks new initiatives

Abrupt topic shifts

Avoids to link up with the main content

Questions or strong initiatives

Client

Baseline 1 73 17 21 2 25 6 Baseline 2 93 25 40 2 20 4 Baseline 3 119 24 33 4 58 1

Student

Baseline 1 62 12 7 7 15 23 Baseline 2 98 9 35 5 12 42

Baseline 3 80 3 29 3 1 45 Client Intervention 1 85 19 20 2 35 8 Intervention 2 75 19 17 4 20 13 Intervention 3 103 16 33 4 33 16 Student Intervention 1 117 24 36 2 41 11

Intervention 2 121 24 31 1 56 9 Intervention 3 99 17 39 1 22 18

In Figure 1 can be seen that there’s a difference in quantitative dominance (who talks the most?)

between the baseline and intervention period. In the baseline meetings, the client talked more

(average 64%) than the student (average 36%). In the intervention period, the distribution was more

even than in the baseline period. However, in the intervention period the client (average 41%) talked

less than the student (average 59%). This means that the conversations in the intervention period

were more balanced, based on the quantitative dominance. Also, there’s a complete reversal of the

distribution visible. In the baseline period, the client talks more than the student in all three meetings

and in the intervention period, the student talks more than the client in all three meetings. So the

ratio of the figure changes in the intervention period compared to the baseline period.

22

Figure 1 Quantitative dominance; number of seconds a person is talking

In Figure 2 it’s visible that the client gives more expanded responses than the student in the baseline

period (average 23% versus average 11%). The percentage is more equal in the intervention period,

because the client gave expanded responses an average of 21% of the time and the student an

average of 19%. In the baseline period, there’re big differences between client and student. In the

intervention period, the percentages are much closer together.

Figure 2 Percentage expanded responses (B-coefficient → B = balance)

It’s notable that the percentages of the turns which lack new initiatives (for example; just ‘yes’ or

‘no’) of the student and client are following somewhat the same pattern in both the baseline and the

intervention period (see Figure 3). In the baseline period, there were slightly more turns of the client

(average 33%) that lacked new initiative than turns of the student (average 28%). In the intervention

period, the difference remained small, but an average of 32% of the student’s turns lacked initiative

in comparison with an average of 26% of the client’s turns. The client’s percentage stayed about the

same from the first baseline through the last intervention, where the student’s percentage clearly

increases. This is a coupled system, where both interlocutors are dependent on each other. When

the percentage of one rises, the percentage of the other rises as well and when one drops, most of

the time the other one drops as well.

0

50

100

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450

Bs-1 Bs-2 Bs-3 Int-1 Int-2 Int-3

Client

Student

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25

30

Bs-1 Bs-2 Bs-3 Int-1 Int-2 Int-3

Client

Student

23

Figure 3 Percentage turns which lack new initiatives (E-category)

In Figure 4 is visible that the student made more abrupt topic shifts than the client (average 7%

versus average 3%) in the baseline period. In the intervention period, the student only made abrupt

topic shifts an average of 1% of the time, in comparison to an average of 4% for the client. Notable is

the development of the student’s course throughout the baseline and intervention period. He starts

at 11% and the percentage decreases to 1% in the intervention period, while the client’s percentage

rises a bit in the intervention period. However, the percentages of student and client are much closer

together in the intervention period.

Figure 4 Percentage abrupt topic shifts (F-coefficient → F = fragmentation)

In the baseline period, the client (average 35%) avoids to link up with the main content of the

previous turn more than the student (average 13%) (Figure 5). The difference is especially notable in

the third baseline meeting. In the intervention period, the percentages are more equal. The

percentage of the client remains approximately the same (average 33%) and the percentage of the

student rises up to an average of 35%. This means that in the intervention period, student and client

avoid linking up with the main content to about the same extend. The trends of the student and the

client are also similar.

0

5

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Bs-1 Bs-2 Bs-3 Int-1 Int-2 Int-3

Client

Student

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12

Bs-1 Bs-2 Bs-3 Int-1 Int-2 Int-3

Client

Student

24

Figure 5 Percentage avoid to link up with the main content (O-coefficient → O = obliqueness)

In Figure 6 is visible that the student took strong initiatives significantly more than the client (average

45% versus average 4%) in the baseline period. Notable is also the upward trend for the student and

the downward trend for the client in the baseline period. The cut-off point between baseline and

intervention period is clearly identifiable. In the intervention period, the percentages moved closer

together. The client even took slightly more strong initiatives than the student (average 14% versus

average 12%). The percentage of strong initiatives by the student drops with 33% in the intervention

period, while the client’s percentage rose with 10%. This is a coupled system, where both

interlocutors are dependent on each other. In the baseline, when one rises, the other one drops. This

makes the difference between the interlocutors increase bit by bit. In the intervention period, when

one rises, the other drops and when one drops, the other rises. The difference between the

interlocutors is much smaller in the intervention period. What’s also visible is that the student

started adjusting his own behaviour and that this action changed the whole pattern. The student

used his own behaviour as an instrument to subsequently take the client along with him and change

his behaviour.

Figure 6 Percentage questions or other strong initiatives (S-coefficient → S = solicitation)

0

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Bs-1 Bs-2 Bs-3 Int-1 Int-2 Int-3

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Student

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Student

25

In the baseline period, the IR-index of the student (average 3.23) was higher that the IR-index of the

client (average 2.72). In the intervention period, the IR-indexes were more equal than in the baseline

period. The IR-index of the client (average 2.86) was a bit higher than the IR-index of the student

(average 2.73). In the three baseline meetings, the IR-differences were high figures (-0.65, -0.48,

-0.4), which means that the student was clearly more dominant than the client. In the intervention

meetings, the IR-differences were close to zero (0.12, 0.18, 0.08), which means that there was little

difference in dominance. In the intervention period, the student and the client became more equal

to the point that no one was clearly dominating the conversation.

Table 3 Dominance (IR-index) and Asymmetry (IR-difference)

IR-index client IR-index student IR-difference

Baseline 1 2,75 3,40 -0,65 Baseline 2 2,61 3,09 -0,48 Baseline 3 2,79 3,19 -0,40 Intervention 1 2,82 2,71 0,12 Intervention 2 2,92 2,74 0,18 Intervention 3 2,85 2,77 0,08

The CRQA-plot shows that in the baseline period, the student is more dominant than the client and

the student takes the initiative (Figure 7). The first baseline meeting, the student leads with a time

lag of 29 seconds. This means that the student starts talking and the client responds after 29

seconds. The second baseline meeting, the student leads by only four seconds. This means that the

time that the client needs to respond to the student’s initiative decreased to four seconds. The last

baseline meeting, the student leads with a time lag of three seconds. The time lags in the baseline

period are caused by the student asking the client questions and the conversation being set up as

sort of an interview.

Figure 7 Dominance and initiative in the baseline period (CRQA)

26

In the CRQA-plot of the intervention period it’s visible that the client is more dominant and leads the

conversation in the first intervention meeting (Figure 8). It takes the student over a second to

respond to the client’s initiative. The second intervention meeting, the student is more dominant

again. He leads the conversation with a time lag of 29 seconds. The third meeting, the student stays

in the leading role with a time lag of 14 seconds. In the second and third meeting of the intervention

period, student and client spend a lot of time mutually talking. The student is the first one to

withdraw himself from this situation and therefore takes the initiative. He lets the client tell his story

and stops talking. ‘Following’ in this case means continuing the talking, when the conversation starts

with mutual talking. So while the client is talking, the student was the one who took the initiative.

Figure 8 Dominance and initiative in the intervention period (CRQA)

27

Appendix A

Table 4 Linell categories

Category Explanation

a < > Turn with clear properties of both response and initiative, the retroactive part being linked to the interlocutor’s preceding turn and the proactive part involving a strong initiative.

b < ^ Turn with clear properties of initiative and response the retroactive part being linked to the interlocutor’s preceding turn and the proactive part involving a weak initiative.

c > Turn involving a strong initiative on a new and independent topic.

d ^ Turn involving a weak initiative on a new and independent topic.

e < Turn linked to the interlocutor’s adjacent turn and involving no initiating properties. The turn treated by the interlocutor as satisfying the demands of his own preceding initiative.

f ..> Turn with clear properties of both response and strong initiative, the retroactive part being linked to a specific nonadjacent turn further back in the preceding dialogue.

g ..^ Turn with clear properties of both response and weak initiative, the retroactive part being linked to a specific nonadjacent turn further back in the preceding dialogue.

h ..< Turn linked to, and treated as satisfying the demands of, a nonadjacent initiative and involving no initiating properties.

i => Turn with strong initiative linked to the speaker’s own preceding turn, typically occurs when the interlocutor’s interjacent utterance isn’t accepted as an adequate response.

j =^ Turn with weak initiative linked to the speaker’s own preceding turn, for example repetition or simple reformulation.

k < = > Turn with clear properties of both response and strong initiative, the retroactive part being linked to the speaker’s own preceding turn and clearly ignoring an interjacent initiative by the interlocutor.

l < = ^ Turn with clear properties of both response and weak initiative, the retroactive part being linked to the speaker’s own preceding turn and clearly ignoring an interjacent initiative by the interlocutor.

m : > Turn with clear properties of both response and strong initiative, the retroactive part being non-focally linked to the interlocutor’s preceding turn. The focus isn’t on the core of what the other says, but often on the function or shape of the interlocutor’s turn.

n :^ Turn with clear properties of both response and weak initiative, the retroactive part being non-focally linked to the interlocutor’s preceding turn. The focus isn’t on the core of what the other says, but often on the function or shape of the interlocutor’s turn

o - Turn linked to the interlocutor’s adjacent turn and involving no initiating properties. The turn is treated by the interlocutor as not satisfying the demands; an irrelevant or inadequate answer.

28

p -> Turn linked to the interlocutor’s preceding turn but deferring rather than in itself providing the adequate response to that turn, for example asking for repetition, confirmation or simple clarification.

q (> Turn lacking substantial content but involving an initiative to open a new topic or subgame; a kind of prepitory initiative.

r <) Turn closing the current topic or subgame and involving no further new initiatives.

x (0) Turn that doesn’t contribute to the dialogue; turnmiscarriage.

s Inaudiable item.

The 18 categories in which Linell scores can be ordered on a six point ordinal scale from the strongest

initiative with no response properties (category C) to the weakest response without any propensity

of promoting the dialogue any further (Category O) (Figure 9). This is called the IR-profile and the

median score of the conversation is the IR-index.

>

..>

:>

<=>

˄

.. ˄

: ˄

<= ˄

=>

<>

..<

(>

<)

= ˄

< ˄

->

<

-

6 5 4 3 2 1

Independent turn

and strongly

proactive

Totally dependent

turn and by no

means proactive

Figure 9 IR-Profile: de Turns Categorised on a Six-point Scale

Based on the scored turns, a couple of measures can be calculated:

- The IR-Index is the overall measure of the extent to which one dominates or is controlled during a

conversation. It’s the median of the scores on the IR Profile.

- The IR-difference displays the difference in IR-index between the interlocutors. The IR-difference

therefore shows the degree of asymmetry in a conversation.

- The B-coefficient (B = balance) is defined as the number of expanded responses (category [b]) as a

percentage of all turns in the dyad (or for a single actor).

- The S-coefficient (S = solicitation) is defined as the number of questions or other strong initiatives

(categories [a], [c], [f], [i], [k], [m]) as a percentage of all the turns in the dyad (or for a single actor).

The S-coefficient shows how often parties explicitly try to force their interlocutors into responding on

their terms.

- The F-coefficient (F = fragmentation) is defined as the number of unconnected or non-locally

connected initiatives or responses (categories [c], [d], [f], [g], [h], [q]) as a percentage of all turns in

the dyad (or for a single actor). The F-coefficient indicates how often parties perform abrupt topic

shifts, thus contributing to local incoherence or fragmentation of the discourse.

29

- The O-coefficient (O = obliqueness) is defined as the number of turns involving the features ‘:’ or ‘=’

(categories [i], [j], [k], [l], [m], [n]) in percentage of all turns in the dyad (or for a single actor). This

kind of obliqueness coefficient is designed to capture how often actors avoid linking up with the main

content of their interlocutor’s adjacent turn, in spite of the fact that their contribution in question is

locally connected.

- The E-category is the number of turns which lacks new initiatives (category [e]) as a percentage of

all turns in the dyad (or for a single actor).