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From: Pat Roberts
Date: 03 Oct 2010
Time: 21:31:13 -0500
Remote Name: 74.198.12.4
You describe an interesting pattern. I see 2 separate issues in your question: one about culture and one about bilingualism. To keep each reply relatively short, this post will focus only on culture. It is impossible to make a statement about culture that would apply very widely. Time since immigration (measured in months, in years, or in generations), the prevailing values in the two cultures.... there are so many factors. So the short answer to your question “how important are cultural factors?” is “I don’t know. No one does.” My experience is that most people recognise when a clinician is trying to help them and with some good will on both sides, cultural differences are usually less important than some writers who specialise in the field of cultural studies make it seem. On the other hand, there are some situations where culturally based behaviours are very important and misunderstandings occur that have a real impact on treatment: time/punctuality, payment, who makes decisions in the family, forms of reinforcement that may be appropriate or inappropriate, different status of girls vs boys, views on stuttering itself... These misunderstandings and differences occur when the clinician and client are from the same culture too. It is important to remember that! But they are more likely when the two parties involved are from different cultures. When these occur, some families would be comfortable raising them. For example, asking "why do you .... it seems odd/inappropriate to ask me to talk to strangers (in transfer activities in a shopping centre or a set of phone calls) .... is there another way to do this?". But many families (and children) would never raise these issues overtly with a clinician. Families/clients may find culturally based behaviours interesting but not very important (as in “my SLP dresses strangely but he/she is really helping me with my speech) OR they may chose to ignore the cultural differences in order to get needed and appreciated help with the stuttering (as in “he/she always seems to be in a hurry/talks too loud or does ___ and I don’t like that” or “my SLP was rude (did something that in my family/culture/former country is seen as rude) but maybe he/she didn’t mean to be, and I’m going to just get on with the therapy”), OR they may decide to seek treatment elsewhere. One really important question for places where there are many immigrants is how many people never seek assessment or treatment because of what they see as cultural differences or obstacles? If you work in a school system, this is more or less a moot issue. But for clinics where people self-refer or must ask their physician to refer them, it seems important. The strongest evidence for how cultural factors can influence treatment completion and treatment outcomes is an anecdotal report (students out there: where do anecdotal reports rank in the levels of evidence chart from your research methods courses?) by Waheed Kahn who worked in one of Canada’s largest hospitals, in our largest city with groups of very recent immigrants from very far away. More studies on the real impact of cultural factors in SLP (not just fluency disorders) are needed. If anyone knows of another study that reports data (not just speculations) on how cultural sensitivity affects stuttering assessments or treatment, I hope they will post the references here. Waheed Khan, N. (1998). Fluency therapy with multilingual clients. In E.C. Healey & H.F.M Peters (Eds.). Second world congress on fluency disorders: Proceedings (pp. 195-199). Nijmegen: Nijmegen University Press.