Stuttering and Cultural Diversity

Fluency Professionals, 

I am a second-year SLP graduate student, could you discuss how you approach coaching for openness and acceptance in families of cultures which view any “disability” as shameful? 

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Stuttering and Cultural Diversity — 2 Comments

  1. Good question, Matt! I may or may not know your name. 🙂 Thank you so much for asking a question to the professional panel. This can be a tough situation. Cultural pre-conceptions about stuttering absolutely happen, and often. No matter what we are always culturally sensitive and recognize cultural difference in the therapy room without making the person feel we are forcing our own ideals and values upon them. Here’s how I handle such a situation:

    First and foremost: the situation must be approached with active listening and an open mind. The person who stutters must first be heard- through their stories and experiences, and as the clinician we must be sure to use body language that is inviting, accepting and open when listening to this person’s beliefs and viewpoints about stuttering- even if they are far different from our own. With that being said, do know that even with counseling, some individuals will continue to embrace that cultural viewpoint and that innate viewpoint will not budge no matter how much we tell them that “stuttering is ok” or “you are enough”, and we have to be ok as clinicians if that happens too….

    Second: Once we have listened to this viewpoint with an open-mind and non-judgmental/non-bias lens, we slowly want to try to desensitize this person to their stringent viewpoints on stuttering. Multiple studies have been completed regarding stuttering and the effects of the knowledge of stuttering and possible negative stigmas have on potential stuttering treatment in given countries or cultures. Sometimes, negatives stigmas within a given culture or regional area regarding stuttering can be because of a lack of understanding of stuttering and the etiology, etc of stuttering. So to start, the person you are servicing can participate in generalized discussion regarding the nature of stuttering, what we know right now regarding stuttering etiology, the individualized stuttering experience, etc. That in itself may start to help break down some of the person’s pre-conceived ideas.- I would try to have this discussion during the initial evaluation if the person came out regarding their cultural beliefs re: stuttering and how that has an effect on their life, etc. if it is negatively effecting their life.

    Third: Given that the person who stutters is given agency regarding therapeutic goals, if the person is fluency-focused only I would kindly and professionally educate the need for the addition of a counseling component to the therapeutic journey and see if that is something the client would consider. I always say, “it is their stutter not mine- even if the clinician stutters” so a person we serve can want a therapeutic focus on fluency if they want that and we can work on fluency strategies in the therapy room if the person wants that- we have the knowledge, understanding and training to do such strategies with a person. But I would try to encourage the person with my knowledge/background to consider an approach like ACT combined with stuttering modification methods, for example, so that ideas of self-efficacy and mindfulness can be incorporated along with the speaking strategies. There is a study when this was done with “potentially promising effects”, cited here:

    Freud, D., Levy-Kardash, O., Glick, I., & Ezrati-Vinacour, R. (2020). Pilot Program Combining Acceptance and Commitment Therapy with Stuttering Modification Therapy for Adults who Stutter: A Case Report. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP), 72(4), 290–301. https://doi.org/10.1159/000501078

    Here are a couple of more article citations regarding culture and stuttering that you may enjoy:

    Al-Khaledi, M., Lincoln, M., McCabe, P., Packman, A., & Alshatti, T. (2009). The attitudes, knowledge and beliefs of Arab parents in Kuwait about stuttering. Journal of fluency disorders, 34(1), 44–59. https://doi.org/10.1016/j.jfludis.2009.02.003

    St Louis, K. O., Przepiorka, A. M., Beste-Guldborg, A., Williams, M. J., Blachnio, A., Guendouzi, J., Reichel, I. K., & Ware, M. B. (2014). Stuttering attitudes of students: Professional, intracultural, and international comparisons. Journal of fluency disorders, 39, 34–50. https://doi.org/10.1016/j.jfludis.2013.10.001

    So bottom line: tread lightly, sensitively and know that we don’t want to ever change someone’s values and culture, but at the same time, we also want to help people who stutter know that it’s ok to stutter, right- so where is that line? Also always recognize that the term “acceptance” doesn’t look the same for everyone and can be a years and years long process, regardless of stigma, cultural beliefs, etc. For some- acceptance is non-linear and for others it is. For me in my personal medical journey- some days I accept it and other days I don’t. For people who stutter- I have heard similar stories. I know some people who stutter who are very accepting of their stutter, and others who have had years of therapy and counseling and outside help other than SLP, and still don’t accept it. We have to meet the individual where they are at and be ok with that. They aren’t us. 🙂
    The advice I gave you above is how I would approach it.
    Be well, and thanks again for asking an excellent question to the professional panel.
    Thanks,
    Steff

  2. Hello!

    Thanks for asking such a great question!

    I see that Steff has given you a lot of great thoughts – so I’ll add just a few more from personal experience.

    A few years ago, I had the amazing opportunity of being able to live and work in Nagoya, Japan. For the first time in my life, I was definitely a minority and I also struggled to speak, read, and communicate in general (as my Japanese language skills were elementary at best). The experience was both eye-opening and humbling in so many ways.

    As an SLP in an international school, I was able to work with families from all over the world. And, by doing so, I learned a lot about the ways that communication challenges are viewed in so many different places. A lot of times, the views were similar to mine; a lot of times, they were completely different; and other times they fell somewhere in-between. This entire process really helped me to better understand some of my own cultural beliefs and implicit biases. I think this awareness, while difficult to swallow at times, really has made me a stronger therapist.

    It’s really important for us as clinicians to understand what we are bringing to the table in any therapeutic relationship. We often will have to set our own beliefs on what we think is ‘best’ or ‘right’ aside and meet our client and his/her family where they are in that moment. Active listening is a really, really powerful skill to help us to do so.

    I have to share that I worked with clients who stuttered while I lived abroad. Some of them felt that stuttering was okay and wanted to work toward acceptance and others did not believe stuttering was okay and had personal goals to minimize it as much as possible. In both cases, I listened, counseled, and really took the time to figure out what the client wanted out of therapy. At the end of the day, our clients are the experts on their stuttering/communication. We are simply the guides for a short time in their entire journey. Client-drive therapy can be powerful and when given the space and support, a lot of our clients and their families may begin to challenge previous viewpoints and develop their own thoughts, opinions about stuttering. This is often a very powerful process to observe!

    I hope this helps – please feel free to ask any follow-up questions you may have.

    Best of luck,
    ~Jaime