Intercultural Differences in Clinical Interviews

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Intercultural Differences in Clinical Interviews

• Jackie Guendouzi, Ph.D.
• Communications Sciences Disorders
• Southeastern Louisiana University
• Mandy J. Williams, Ph.D., CCC-SLP.
• Communications Sciences Disorders
• The University of South Dakota

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Variables affecting interactions

• Social Distance who you are talking to, how
  well you know them, etc.
• Power Relations doctor versus patient, judge
  versus defendant, etc.
• Speaker Goals what is the speaker trying to
  achieve (institutional, clinical, personal,
  interactional etc. (may shift throughout
  interview)
• Culture what is deemed appropriate within ones
  own culture
• FACE Threat of Speech Act how much of an
  imposition (or threat) is what I am about to say
  to the listener.

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Speaker alignments

• What are we aligning to in our presentation of
  self?
• Are our contributions to a conversation guided by
  instrumental goals, or identity goals?
• We are usually aware of our own cultural norms
  about how to handle these issues but this can be
  a problem in intercultural interactions.

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Interactional Factors Impacting Therapy Outcomes

• Client
• Age
• Gender
• Awareness of condition
• Attitude to therapy
• Beliefs about outcomes
• Relationship with therapist
• Culture
• Goals
• Instrumental
• Interpersonal
• Identity
• Immediate factors
• Mood
• Health
• Fatigue level

• Clinician
• Age
• Gender
• Knowledge of disorder
• Interactional skills
• Beliefs about efficacy of therapy
• Scope of practice
• Relationship with client
• Culture
• Goals
• Instrumental
• Interpersonal
• Identity
• Immediate factors
• Mood
• Health

Interactional space

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Issues at stake in clinical interviews

• Goals
• Clinicians instrumental goals to get accurate
  information (long uninterrupted speech sample),
  to establish rapport, to give advice
• Clients instrumental goals to get help, to get
  a diagnosis, to get treament (to fix it)

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Identity goals

• Identity goals are likely to be more salient in
  intercultural contexts.
• The variable of culture plays a greater role in
  influencing interlocutors behaviors in
  interactions. Face issues may be more pronounced
  in certain cultures.
• Chinese culture has a more structured system of
  interactional moves in relation to impression
  management (Scollon Scollon, 1998), and a
  listener may agree with a speaker or say what
  they perceive the interlocutor wishes to hear in
  order to maintain Face.

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• Attitudes to stuttering in China
• Sheree Reese - Associate Professor and clinic
  director in the Speech Pathology Program, at Kean
  University in New Jersey
• Carried out interviews with people in China about
  attitudes and perceptions of stuttering.

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• Author Would being a stutterer affect a person's
  ability to get a job?
• L Certainly, because people wouldn't think they
  were intelligent.
• Author But their intelligence is not a problem
• L. Yes, but there are too many healthy people
  without jobs.
• Author But stutterers are healthy, they just
  have trouble speaking sometimes.
• L. Maybe they could get jobs like sewing that
  don't require thinking.
• Author But stutterers can think okay
• L. But even if the employers know that they can
  think, they would not want to listen to them.

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Background

• Dr Yu - 42
• Chinese
• General surgeon in China
• Came to USA to continue his medical career
  specializing in Cardio-thoracic surgery
• Stuttered since childhood.
• Stutters in L1 and L2
• Due to time constraints the focus is on
• Non- verbal behaviors
• Issues of identity

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Non-verbal

• In 35 minute interview for diagnostic purposes
  with 2 student clinicians and a Ph.D., CCC-SLP
  supervisor (with expertise in fluency).
• Despite the fact that students were attempting to
  ask client questions he only made fleeting
  eye-contact with student clinicians 10 times and
  only when directed by supervisor.
• Deferred to the supervisor when elaborating on
  his answers.
• Eye contact was maintained with supervisor so the
  lack of eye contact with students was not
  attributed to the lack of EC typically associated
  with fluency issues.

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• Non-verbal behaviors with supervisor
• Body turned towards supervisor
• Shoulders relaxed
• Maintained lengthier eye contact
• More animated
• Used laughter more
• Smiled frequently
• More hand gestures

• Non-verbal behaviors with student-clinicians
• Fleeting glance
• No maintained eye-contact
• Face expression less animated than with
  supervisor
• Folded arms
• Closed posture
• Appeared more tense through body
• Only turned head slightly not body
• Didnt smile

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Identity

• Given Chinese attitudes to stuttering how Dr Yu
  accounted for his stuttering was of interest.
• Dr Yu portrayed his stuttering as a verbal
  habit that he had picked up from another child.

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• Example
• uh (.) well you know (.) th -the stuttering had
  nothing to do with career I choose (.) and (.) uh
  (.) however I think the beginning of my
  stuttering is from (.) mhm (.) sometimes my
  primary school (.) one of my class mates was
  stuttering and I try to mimic him (.) I mimic him
  a lot and (.) uh (.) and then I become a little
  bit stuttering (.) and uh then somehow I theres
  a one thing that was reinforced (.)

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• you know by my family member and my friends
  because (.) oh youre stuttering (.) stuttering
  (.) stop it! Stop it! And uh at that time I
  really do not have any concept of a stuttering
  (.) and in my mind I dont have that (.) but the
  concept was reinforced by them and I become
  nervous (.) and every time when I speak I become
  nervous because they always reminded me Im
  stuttering (.) I was stuttering

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Questions

• Does Dr Yu downplay the negative impact of his
  stuttering?
• Given the comment that stuttering can limit
  career choices University entrance etc., (in
  China candidates are interviewed) may lead Dr Yu
  to minimize the effects his stuttering has played
  
• So are we getting accurate information??

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Questions

• Were the very noticeable differences in his
  non-verbal behaviors
• (1) a result of cultural differences?
• (2) related to status differences (culture of
  the medical model)?
• (3) an interaction between both?

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Questions arising

• What were Clinicians thoughts prior to
  evaluation?
• How successful was the interview?
• Did culture interfere? How do intercultural
  differences in pragmatic variables affect a
  clinical interaction?
• Do these differences impact the accuracy of
  information the clinician receives?
• To what extent are our students prepared for
  dealing with all these aspects of cultural
  difference?
• College courses often give global societal or
  cultural differences not micro level pragmatic
  differences or attitudes to specific disorders
  such as stuttering

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