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Interactional Differences Is Gender a Barrier to Therapy

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					  Gender as a factor in
therapeutic interactions


            Jackie Guendouzi
            Hunter Manasco
            Morgan Weihing
             Paul Dagenais

   Speech Pathology & Audiology
      University of South Alabama
Questions about therapeutic interactions


         how do we do good therapy?

      what is a good interactional style?

   what do we actually teach students about
               interactional style?

       does gender make a difference?
Stereotypes of Male clinicians
Opposing the Stereotypes
Current study
Examined the impact of one particular dimension,
  gender.

Clinician gender was hypothesized to be a factor
  that would produce differences in:
       the client’s responsiveness and performance
       the communicative style of the clinicians.
Gender and interactional styles.
Research on gender styles considerable e.g. ,

       Coates, J. 1996
       Eckert & McConnell-Ginet, 2003
       Fishman, 1975
       Holmes & Meyerhoff, 2002
       Guendouzi, 1998; 2001; 2004; 2005
       Maltz & Borker, 1982
       Tannen, 1990
       Zimmerman & West, 1975
Communicative Features Associated with Gender
Men                           Women
• interrupt more              • better listeners
• topic-shift more directly   • more sympathetic
• use less tag questions      • tag questions
• more direct                 • more minimal responses
• less hedges                 • ask more personal details
• turn-take more formally     • offer similar stories
• use less small-talk         • less assertive
• dominate conversations      • shared conversational
• less minimal responses        floor
Men                                   Women
• talk to give information or        • talk about people rather
  to report.                           than things.
• talk about things rather           • talk to get information-
  than people.                         connect, or gain rapport.
• convey facts not detail.           • convey feelings and detail.
• goal oriented                      • are relationship oriented
• focus on solving                   • focus on cooperation.
  problems.                          • women feel talk builds,
• competitive for                      maintains, & strengthens
  conversational floor                 relationships.
• lack sentimentality,               • talk is nurturing emotional
                                       expression, empathy and
       Tonkovish and Slater (2004)     support.
Factors impacting therapy outcomes
Clinician                                            Client
Age
                                                     Age
Gender
                                                     Gender
Knowledge of disorder
                                                     Awareness of condition
Interactional skills
                                                     Attitude to therapy
Beliefs about efficacy of therapy
                                                     Beliefs about outcomes
Scope of practice
                                                     Relationship with therapist
Relationship with client

Goals                                                Goals
                                                     Instrumental
Instrumental                   Interactional space   Interpersonal
Interpersonal
                                                     Identity
Identity

Immediate factors                                    Immediate factors
                                                     Mood
Mood
                                                     Health
Health
                                                     Fatigue level
Time constraints
                                                     Anxiety
Fatique level
Environment
Variables before therapy              Variables within therapy

•   Age of participants
                                      •   Employment of gestures
•   Gender of participants            •   Non-verbal behaviors
                                      •   Proxemics (use of space) &
•   Perception of communicative           time
    competence
                                      •   Topic management
•   Perception of participant roles   •   Use of small-talk
    (Goffman,1982)                    •   Use of speech acts
                                                      - requests
•   Perception of therapy
                                                      - commands
                                      •   Use of materials
                                      •   Therapeutic routines
Method
16 clinical therapy sessions with a male client who had
  aphasia were videotaped.

•   8 sessions were conducted with a female student
    clinician
•   8 sessions were conducted with a male student clinician.
•   Clinical supervisor’s judgment of clinicians’ performance.
•   Analyzed separately by two Ph.D. graduate students
    (one male one female)
•   Analyzed by PI
•   Input of clients’ wife
Areas analyses focused on:

       Therapy
       Proxemics
       Gestures
       Eye Gaze
       Communicative Control
       Laugh/smile
       Small talk
Analysis (PI)
Male clinician                 Female clinician
• style did reflect gender     • Non-verbal behavior very
  literature and some social     different
  stereotypes                  • Small talk
• Less small talk              • Personal details
• More rigid body-language     • Gave client more time
• Closer to client –           • Prepared to allow client
  controlled space more          time to do task
• More rigid turn-taking       • Laughed more
• Task oriented                • Appeared more focused
                                 on client as person than
                                  task
Male researcher
         (commenting on male clinician)
Therapy:       Good use of strategies by MC to facilitate
               communication.

Proxemics:     MC leans forward with elbows on table. Pt posture remains
               unchanged.

Gestures:      Pt continues use of habituated gestures with communicative
               attempts. MC uses little to no gestures.

Eye Gaze:      MC uses appropriate eye gaze during therapy and pt
               reciprocates.

Com Control:   Control of communication during TX now seems to be
               shared but MC maintains authority to cut pt off when
               being nonproductive.

Feedback:      MC is now up front with not being able to understand pt’s
               communicative attempts. MC’s positive feedback is
               not over positive “Pretty good”.

Laugh/smile:   Not very much smiling and laughing past introduction.
Female researcher
               (commenting on Male clinician)
Therapy:
MC introduces himself. Treatment begins with oral motor exercises
   followed by syllable and word repetition. Mr. S performs exercises
   with relative ease, but certain sounds are more difficult for him to
   repeat. In particular, he has difficulty with some frontal sounds (e.g.
   /d/ & /t/) and voiced sounds (e.g. /p/ for /b/). MC provides auditory
   and visual cues as needed. Word recognition is targeted in a picture
   naming exercise. Mr. S is asked to point to pictures named by the
   clinician, then he is asked to match words (on note cards) to their
   corresponding picture.
This exercise is followed with MC providing spoken function words and
   Mr. S pointing to the matching object. When asked to match the
   printed function word to the object, Mr. S seems to have more
   difficulty.
Therapy is returned to word repetition using picture cards. Again, MC
   provides auditory and visual cues for sound placement.
Clinical Supervisor (male)
Who do you feel was the better clinician?
 “Female clinician was far better (pause)male
 clinician more self-conscious but I’d have to say
 the female clinician’s style was excellent”
What about achieving clinical goals?
 “(pause) hmm harder to say maybe I’m judging
 FC by style (pause) but perhaps it was male
 clinician’s individual style?”
Female research assistant
I thought FC did a better job as a clinician. She seemed
    more at ease with the client and more comfortable with
    his communication difficulties. She provided lots of cues
    and allowed time for the client to respond.
When client had difficulty with a particular item, it seemed
    like MC was a little more eager to "come back to it later".
    FC really stayed with it, even when it was difficult.
She praised his effort but was very descriptive/detailed in
    what type of response she was looking for, and she
    made the client repeat items that he had difficulty with.
    Overall, I think the FC performed best.
Male research assistant

 I think MC did a more effective job. This is basically
 because he was faster more minimized patient failure.
 From a student training perspective they need to be able
 to go very fast while at the same time maintaining low
 patient frustration and high patient success.

 I liked how he would not let the patient keep repeatedly
 trying and failing to communicate while growing more
 frustrated. FC wasn't short enough with the patient
 although she was obviously took on more of a
 counseling role.
Male research assistant
It is knowing at which point the pt's added attempts
    to communicate will be unsuccessful and cutting
    him off or redirecting.
I think FC just let him try and fail too much, which
    increased his frustration, and created a need for
    comforting that wouldn't be there if the therapist
    had minimized patient failure and maximized
    patient success.
It is a learned skill and both students needed
    refining but I have to go with MC
PI judgement
Female clinician’s style was more interactively
  engaging, there was more of a therapeutic
  relationship with client however the male
  clinician did get through his task goals more
  efficiently.

Client’s wife reported he had a better rapport with
  FC but had got on well with a previous male
  clinician.
Issues arising?
•   Male clinician’s style did match gender literature.

•   In Aphasia therapy (post maximal recovery point) are
    task goals or interactional goals more important?

•   Style of interaction seems to influence the clinical
    supervisor’s immediate judgment in assessing students.

•   Do we spend enough time looking at students
    interactional styles and their effect on outcomes.

•   Do SLP students learn enough about social interaction &
    pragmatics?
Future directions….

Qualitative research results can not generalize to whole
  population of SLP’s but they are indicative of potential
  differences in male and female clinician’s styles.

Future directions should include larger studies including
  more clinicians, although given that males currently
  comprise only 4.4% of speech-language pathologists
  (ASHA.org, 2006) this may prove a difficult task to
  coordinate.
Any Questions

				
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