This is the first in what will likely be an ongoing series of posts relating to communication standards and diversity within the field of speech-language pathology.

The Diversity Dilemma

The lack of diversity within our profession is a well-known issue for SLPs and AuDs. In my experience, though, the general public is pretty unaware of how extremely homogenous this field is.

For reference, as of 2010:

  • 95.9% of ASHA-certified speech-language pathologists in the United States were female
  • 89.1% of ASHA members were white

Also, while I couldn't find any statistics on this, my personal estimation is that we are similarly imbalanced with regard to being mostly neurotypical and middle- or upper-middle class. (And, full disclosure, I fall into all of these categories.)

ASHA is making pretty concerted efforts to recruit more gender and racial diversity into the profession, but it's going to take some time to even out these representations. For the purposes of this post, I'm interested in exploring how our current homogenous state is influencing our culture and beliefs about "communication".

Communication is cultural

What defines "good communication" varies wildly depending on where in the world you go, who you're speaking with, and why you're speaking to them. In some cultures, maintaining eye contact is equated with respect; in other cultures, it's a sign of disrespect. Some cultures value loud, physically dynamic modes of speaking; others value quiet, reserved manners.

While it's relatively easy to appreciate that "good communication" means different things in Italy and Japan, understanding that different subcultures within our own macro-culture have equally different-but-valid ways of communication is a challenging, even offensive, idea for many people. African-American English (AAE) is perhaps the best example of this in the United States. Despite being a full-fledged, complex, rule-governed dialect (syntax, morphology, phonology), it continues to be thought of as characterized by "bad grammar" and "incorrect pronunciation". In the United States, General American English (GAE) is perceived as the "best" or most "correct" way to speak English (a belief which no doubt would amuse a British person).

Beyond accent

Communication culture varies among subgroups in aspects far more subtle than accent and dialect (grammar, slang, etc.). Different macro- and micro-cultures have different levels of tolerance for displays of emotion, or direct/indirect communication styles. In American white-collar culture, regulation and suppression of emotions is highly valued compared to blue-collar environments. Measured, eloquent and nuanced language is the lingua franca of the Western business world.

Does this mean this is the best way to communicate? Of course, the answer is: it depends. If you want to work on Wall Street, yes, you're probably going to have to learn this micro-culture dialect and style to fit in. If you want to be an artist, a teacher, a physical trainer, or a doctor, this isn't necessarily the style for you.

When in Rome, one must do as the Romans.

"On Wednesdays, we wear pink" animated gif from the film Mean Girls

Clinically significant

So far, so good. Obvious stuff. As SLPs, we are sensitive to cultural communication differences. We're on the same page.

Of course we are on the same page. We literally speak the same language. We are almost all educated, white, middle-class ladies, who consciously and subconsciously carry educated, white, middle-class lady values, including values about speech and communication.

Now, as professional experts, we are trained to account for cultural variation when conceptualizing "good communication". We know about eye contact in Korean culture and adjust our therapy goals accordingly, to reflect our clients' values and not our own.

But what about our fellow SLPs?

Says who?

There is an oft-repeated moralism in our field that "SLPs should model good communication," which I generally agree with. The problem is, because the vast majority of us hail from the same communication culture, our interprofessional conception of "good communication" can easily be more culturally-defined than clinically-defined.

"Love ya" animated gif from the film Mean Girls

For example, if an SLP (or SLP student) were to do the following in a client session, how would it likely be perceived by fellow SLPs or graduate supervisors?

  • Saying "I axed you a question"
  • Swearing in front of a client
  • Speaking with a noticeable lisp
  • Stuttering openly with secondary behaviors

The first two are examples of dialectal communication styles. The second two are examples of organically-based communication differences. [Future posts in this series will discuss the issue of neurodiverse SLPs and their communication "abilities/disabilities" in greater depth.]

When I entered graduate school seven years ago, all incoming students were required to undergo a speech and language screening. I "passed"; I'm not sure what would have happened if I "failed"...or what that may have implied about my ability to succeed in this profession.

Questions for the queen bees

The goal here is not to suggest that the items in the above list, or their implied alternatives, deserve to be considered "good" or "bad", "acceptable" or "unacceptable". Rather, I'd simply hope we can observe our gut reactions to these hypotheticals, then question why we react that way. A given communication behavior may not be our preferred behavior, but does that mean it is bad or ineffective? (To be blunt: is it "unprofessional" because it's not how non-disabled WASPy women talk?)

Why does this matter? Because "communicating effectively" is a required to obtain and maintain our CCCs.

“Communicate effectively, recognizing the needs, values, preferred mode of communication, and cultural/linguistic background of the client/patient, family, caregivers, and relevant others.”

— Standard V-B.3.a., 2014 Speech-Language Pathology Certification Standards

ASHA doesn't define what it means to "communicate effectively" (or ineffectively). Can an SLP with a lisp, non-standard accent, stutter, or "overly direct" communication style be effective? More importantly, who among us decides whether or not an SLP is communicating effectively?

We consider ourselves the experts, with the expert judgment. But, on what are we basing our judgments?