Among its many benefits, telepractice has enabled speech-language pathologists (SLPs) to connect to clients across geographical boundaries. This has opened the door for many culturally and linguistically diverse clients previously underserved to benefit from top-quality speech therapy.
However, this giant step forward is accompanied by a new challenge. SLPs delivering therapy via telepractice to diverse populations must become sensitive to the cultural considerations of their culturally diverse clients. Roughly one-third of the U.S. population belongs to an ethnic or racial minority group. Nearly 14 percent of Americans, the highest percentage in history, are now foreign-born.
The Mandate for Cultural Sensitivity
There is nearly unanimous agreement in the field of healthcare that an individual's cultural sensitivities must be treated as a critical factor. The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity, states, "Substantive data from consumer and family self-reports, ethnic match, and ethnic-specific services outcome studies suggest that tailoring services to the specific needs of these [ethnic] groups will improve utilization and outcomes" (U.S. Department of Health and Human Services 2001, p. 36).
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), obligated clinicians to understand how cultural differences impact the therapist-client relationship. These understandings and sensitivities must be applied in other therapies and forms of care as well.
Telepractice that is Culturally Sensitive
Telepractice that is culturally sensitive takes into account the SLP's knowledge and understanding of the client's background, ethnicity, and system of beliefs. Once the SLP is aware of the cultural differences, she is in a position to respect and accommodate differences in attitudes, values, and opinions of various types of people and different cultures.
Cultural sensitivity has another benefit - the acquisition of cultural competence. Cultural competence is the capacity to understand one's own cultural bias and its influence on the client-therapist relationship. Grounded in this understanding, the therapist is poised to respond to another's culture more accurately, making the treatment more effective.
There are two components involved in meeting the needs of diverse clients: (1) knowing how to interact and work with people from different cultures and (2) understanding the particular culture of the client (Jezewski and Sotnik 2001). In other words, being a culturally competent clinician is very similar to being a caring, responsible clinician who ignores first impressions and stereotypes and instead treats clients with respect.
Like the rest of us, therapists often believe that their social values are the norm, and therefore typical of all cultures. American culture differs from most other cultures in several ways. The first step in understanding another’s culture is to have a full grasp of the tenets of the Anglo-American culture of the United States.
When seen in contrast to much of the rest of the world, Anglo-American culture in general is competitive, materialistic, has a heavy emphasis on accomplishment, and has its orientation on the future. Most people in the United States experience a fast-paced life split between family and work. It is often compartmentalized and deemphasizes community and spirituality.
Getting a bit More Nuanced
The cardinal rule in avoiding the temptation to stereotype is to remember that each client is an individual. Every culture has its complexities and is therefore not easy to reduce to a formula or exact description. It may be something as seemingly innocuous as an observation that is highly accurate regarding a large group of people, but misleading and hurtful when applied to an individual.
It must be remembered that culture is only the point of orientation when attempting to understand an individual's values, wishes, and perceptions. How neatly aligned any given individual is with the current values of his/her culture is dependent on many factors such as how integrated that person has become into U.S. society, socioeconomic status, and education.
Culturally Diverse Worldviews:
Holistic worldview. Many cultures, among them Native-American and Asian cultures, have a holistic view of the world. They comprehend all of nature, the animal kingdom, the heavens, and the spiritual world as an integrated whole.
Communication styles. Communication problems between client and therapist and cultural misunderstandings may prevent people of different cultures from accessing therapy altogether, or lead to a compromised experience.
Multidimensional learning styles. American culture emphasizes learning through reading and teaching, focusing on reasoned facts. Other cultures place heavy emphasis on their oral tradition. Learning often comes through parables and stories that interweave emotion and narrative.
Issues Impacting the Therapist-Client Relationship:
- Authority and Boundaries. Clients who come from other cultures usually perceive the therapist as the authority. This may create more of a natural distance between the client and the therapist.
Respect and dignity. American culture is more informal regarding how people are addressed. Treating others in a friendly way is considered to be respectful. This is in stark contrast to other cultures, especially where people have been oppressed, where formality and honor are considered paramount in importance. In these cultures, informality is tantamount to disrespect and rudeness.
Attitudes regarding therapists. There are considerable differences across cultures regarding how comfortable people feel about accepting professional help. For some individuals, the family or the extended family is where problems are handled.
Want to Know More?
You have an excellent opportunity for a more in-depth exploration of this increasingly relevant topic given by Lesley Edwards Gaither, MA, CCC-SLP at the upcoming 2019 ASHA Convention at the Orange County Convention Center in Orlando, Florida, November 21-23. The session entitled, "A Pilot Study of Speech-Language Pathologists' Use of Telepractice with Culturally Diverse Students" will be held on Thursday, Nov 21, 11:30 AM-12:00 PM in CC/231A.
Lesley Edwards-Gaither has over seven years of experience performing telepractice and is currently pursuing a Ph.D. at Howard University in Washington, D. C. Her research interests include the delivery of telepractice services to culturally diverse populations and the application of educational technology to the field of speech-language pathology.
The session will review a pilot study designed to explore the clinical knowledge, concerns, activities, and materials used by SLPs providing treatment to culturally diverse students via telepractice. While you are there, please visit us at the Global Teletherapy Booth #1452.