As we enter the new millennium, we are faced with new challenges of how to provide clinical services to culturally and linguistically diverse populations. Thus, the role of culture and the treatment of stuttering must be examined on a case by case basis.
In order for clinicians to competently provide services to a person who stutters, they need be aware of and sensitive to many issues. Some of these issues are; 1) changes in multicultural populations; 2) variations of language-learning environments in which many multicultural children are being reared; 3) effects of poverty on many multicultural children; 4) the speech-language pathologists role and responsibility regarding clinical assessment and therapeutic management (Adler, 1993).
The continued growth of multicultural populations in the United States will necessitate an increase of awareness and sensitivity on the part of our profession. Thus, requiring changes in our traditional assessment and treatment practices with people who stutter. Moreover, differences in race, gender, ethnicity, and socioeconomic status require an understanding of a variety of mores, behaviors, and linguistic patterns which may be demonstrated by culturally and linguistically diverse populations (Adler, 1990).
A culturally competent clinician is sensitive to issues related to culture, race, gender, sexual orientation, and social class. However, cultural competence is more than simply acquiring knowledge about ethnic-racial groups. It is a very complex combination of knowledge, attitudes, and skills (Lipson, Dibble & Minarik, 1998).
What is Culture?
Culture defined by Adler (1993) is any group of people who share a common history and a set of relatively common behaviors and/or communication patterns. Taylor (1986) refers to culture as a set of perceptions, technologies, and survival systems used by members of a specific group to ensure the acquisition and perpetuation of what they consider to be a high quality of life. Culture is arbitrary and changeable. It is learned and exists at different levels of conscious awareness. Culture is also a double-edged sword, on one hand social groups live together because of shared values, beliefs, and practices. Within groups we see disharmony because of judgments of ones own values, beliefs and practices.
Cultural Influences on Communication Styles
Multicultural considerations in the assessment and treatment of stuttering are not new. Primarily because of areas in which culture influences communication styles. Verbal and nonverbal communication styles are major factors to be considered during the assessment and treatment process. Rules for eye contact, proxemics, and silence as a communication style are some of the nonverbal behaviors to be considered. Verbal communication styles may involve laughter as a communication device, appropriate topics of communication, when and how to interrupt, and use of humor.
Cultural Considerations in the Treatment of Stuttering
Inevitably speech clinicians will come in contact with clients from various cultural backgrounds that differ from that of the clinician. The assessment of stuttering is an ongoing process and many factors addressed during the assessment need to become part of the treatment process. Thus, it is imperative that most of the areas listed be addressed (Lipson, Dibble, and Minarik, 1998).
Where is the client from? If an immigrant, how long have they resided in this country?
What is the clients ethnic affiliation?
Who are the supporters of the client: family, friends, extended family members?
Does the client live in an ethnic community?
What is the clients first language for speaking and reading?
Does the client speak and/or read a second language?
How would you describe and characterize the nonverbal communication style of the client?
How would you describe and characterize the verbal communication style of the client?
What is the clients religion, and what role does it play in daily activities?
What is the clients social economic status?
What are the health and illness beliefs and practices of the family?
What are the customs and beliefs involving birth, illness, and disorders?
With the answers to the questions above and taking into account dysfluency types, frequency of dysfluencies, physiologic correlates of dysfluencies, attitudes, and awareness, hopefully the clinician will be able to develop an effective culture-independent treatment plan.
Clinical Implications of Cultural Differences in Stuttering
Source: W.R. Leith, "Treating the Stutterer with Atypical Cultural Influences," in K. St. Louis (ed.), The Atypical Stutterer (New York: Academic Press, 1988), pp. 30-32. Reprinted with permission.
Clinicians must be cognizant of the following considerations with service delivery to multicultural stuttering populations. Cole (1989) identified several issues that could possibly affect the service delivery process when multicultural populations are involved. These issues are:
It is necessary that we, as clinicians, view each treatment session being subject to cultural rules of both the client and the clinician. Therefore, keeping in mind that because of cultural and linguistic differences, clients may respond differently to standard types of stuttering treatment because of their cultural and language backgrounds. If the assumption is made that there are similarities between client and clinician, rather than recognizing differences, this could lead to cultural conflicts during clinical encounters.
Clinicians should recognize that learning about multicultural populations is an on-going process involving constant reassessment and revisions of ideas, awareness, and greater sensitivity to cultural diversity. It appears to be of critical importance that we find ways of continuing to learn from various multicultural populations to understand the patterns of people that govern face-to-face relations, and to prepare clinicians to function within cultural systems that are foreign but no longer incomprehensible.
Adler, S. (1990). Multicultural clients: Implications for the SLP. Language, Speech, and Hearing Services In Schools, 21, 135-139.
Adler, S. (1993). Multicultural communication skills in the classroom. Boston:Allyn and Bacon.
Cole, L. (1989). E. Pluribus Pluribus: Multicultural imperatives for the 1990Ős and beyond. Asha, 31(9), 65-70.
Leith, W.R., (1988), Treating the stutterer with atypical cultural influences. In St. Louis, The atypical stutterer, 9-33. New York: Academic Press.
Lipson, Dibble, and Minarik (1998). Culture and nursing care: A pocket guide. San Francisco: School of Nursing, University of California San Francisco Nursing Press.
Taylor, O. (1986). Treatment of communication disorders in culturally and linguistically diverse populations. San Diego: College-Hill Press.