How to Be a Culturally Responsive Speech-Language Pathologist

Human beings are most likely to rely on their implicit bias in three situations: in situations that involve ambiguous or incomplete information, in the presence of time constraints, and circumstances in which our cognitive control may be compromised—like during periods of fatigue or burnout. 

As speech-language pathologists, we’re likely to face all three of these situations on a daily basis. 

The Impact of Implicit Bias

I’m a Black SLP—one of only 3.6% in my profession.

Through this unique lens, I can see the lack of cultural representation in our field quite clearly. However, it’s not just a lack of diversity I see among professionals—it’s also a lack of diversity in the materials we use with our clients, families, and students as well. 

As an undergraduate student, I never saw a Black speech-language pathologist.

What’s more, I was told that my natural hair was unprofessional and inappropriate for the clinic. Most damagingly, I repeatedly received the message that I wouldn’t make it in this career—or even to graduate school—regardless of my qualifications.

As a graduate student clinician working with mostly Black and Latine students, I often had to use materials in therapy that looked nothing like my clients. They were forced to answer questions on assessments where they had no relevant prior experience to help them accurately answer.

It became clear to me that my students, and others like them, weren’t considered when the assessments were constructed. 

Throughout my career, I’ve witnessed first-hand how bias in standardized assessments can adversely impact students of color.

Nearly all standardized assessments are written in Mainstream American English (MAE)—meaning that any dialectal speaker is already at a severe disadvantage. Additionally, they’re often norm-referenced in mostly suburban locations, on populations that aren’t culturally or linguistically diverse. On top of that, test administrators are typically unqualified to evaluate with a responsive lens.

Why Being Culturally Responsive Matters

A simplified and relevant understanding of culture is that it encompasses the opinions, values, and expectations that are related to education and behavior. In my experience, I’ve seen many white people believe that they don’t have a culture, or even refer to their culture as “normal” or “regular.”

Everyone has a culture. If someone believes that they don’t, they’re likely part of the dominant culture—so their perspectives are regarded as the norm. This is one of many perspectives that leads to symbolic annihilation: the absence or un-representation of a group that leads to the belief that these groups are unimportant in society.

The truth is that most people don’t think about things they don’t have to think about. Being culturally responsive in speech therapy means challenging yourself to do just the opposite. I prefer the term responsiveness over “competence” or “humility,” and I’ll explain why. 

Cultural humility promotes self-awareness, acknowledges that other people’s perspectives are different, and that they still have positive value.

Cultural competence takes this a step further, promoting understanding of other cultures rather than just acknowledging the differences.

However, the word “competence” implies that there’s a threshold we should strive to achieve. 

Alas, in reality, culture can’t be reduced to a technical skill that someone can become an expert in. There’s  no level of competence you can reach that suggests you don’t need to continue your journey of learning, unlearning, and introspection. 

Cultural responsiveness encompasses both humility and competence. It requires lifelong learning and encourages awareness of all cultures, while being especially aware of the cultures in the room.

The key points to remember about cultural responsiveness are self-awareness, lifelong learning, and placing a specific understanding on the immediate identities while in therapy. And for how beneficial culturally responsive care can be, not being culturally responsive can have extremely detrimental results. It can lead to people of color not feeling accepted in therapy, and even unsure of how to succeed in therapy. 

“You can’t be what you can’t see,” is a quote that’s always stuck with me.

When our clients aren’t presented with models of success that look like them, or any representation at all, they’re less likely to engage in therapy and make progress.

I believe the most essential component to successful speech and language therapy is the relationship and rapport between provider and client. I’ve found that the best way to build this relationship and ensure that all parties are comfortable is to place a high priority on understanding your client’s background, celebrating your differences, and being responsive to their individual needs.

In our role as speech-language pathologists, one of the worst things that not being culturally responsive can lead to is misdiagnosis.

People of color are continuously misdiagnosed secondary to a dialectal difference—not a disorder. As we know, our diagnosis could impact the whole course of an individual’s life.

We can’t afford to adversely impact someone’s future because of our ignorance, or because we’re comparing them to our own set of standards and norms without taking their culture into consideration.

 

 

How to Apply Cultural Responsiveness in Practice

To catalyze your journey toward cultural responsiveness, here are five daily practices of a culturally responsive SLP:

1. Include cultural content about the histories, contributions, experiences, points of view, and concerns relevant to students and clients of diverse backgrounds.
2. Provide content in a way that is validating and meaningful.
3. Make connections with your student or client’s background knowledge. 
4. Teach the importance of respecting their own culture and identities as well as the cultures of others.
5. Use multicultural literature and materials to illustrate social and cultural contributions by various people. 

Dr. Rudine Sims Bishop’s theory, “Mirrors, Windows, and Sliding Glass Doors,” sums up one of many reasons being actively culturally responsive is a necessity for children.

She writes:

“Books are sometimes windows, offering views of worlds that may be real or imagined, familiar or strange. These windows are also sliding glass doors, and readers have only to walk through in imagination to become part of whatever world has been created or recreated by the author. When lighting conditions are just right, however, a window can also be a mirror. Literature transforms human experience and reflects it back to us, and in that reflection, we can see our own lives and experiences as part of the larger human experience. Reading, then, becomes a means of self-affirmation, and readers often seek their mirrors in books.”

The materials we use in therapy need to be representative of the world around us. When they’re not, we miss opportunities to teach children about loving and caring for themselves, as well as people who don’t look like them—a lesson that so many adults have unfortunately missed.

A major part of being culturally responsive is understanding why we think the way we do. A great place to start is the Harvard Implicit Association Test, which will help you uncover your own implicit biases.

The list of reasons why anyone, but especially speech-language pathologists, should be culturally responsive in our practice is never-ending. One aspect of this that can get tricky is parent or family interaction. All families may not be as accepting of other identities and may question the exposure. I’ve created a resource you can use as a guide for those conversations, so you can start to work through any questions or concerns families may have about this approach. 

Cultural responsiveness is a lifelong journey. I don’t expect perfection of myself or others, and neither should you.

I’ll leave you with my favorite quote: “Do what you can, where you are, with what you have.”

You have no idea how much of a difference one person can make.

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FREE DOWNLOAD: Culturally Responsive Speech Therapy Template