Humans communicate by using codes, which are the vehicles for the transmission of meaning. Codes exhibit many properties; they are culturally defined and governed by rules. The many types of codes—verbal, nonverbal, paralanguage, and discourse (Cooley, 1983; Gudykunst, 1983)—can be formal or informal, and the rules for using them may change depending on the contexts in which they are used.
Different cultures use different codes to transmit meaning, and different rules may apply depending on different contexts. Acknowledging these explicit and implicit rules does not mean knowing how to use them appropriately across cultures. Clinicians need to be aware of these many codes and contexts in developing the cultural and social intelligence needed to apply these implicit rules.
Our language is one of the most important codes in transmitting meaning. People from the same cultural group may share the same or similar languages. When people travel, they bring their codes with them. Over time, the patterns of these linguistic codes change and may become difficult to decipher. Those who are exposed to many languages may switch and mix codes. Others may have different levels of proficiency in the languages they use.
In the United States, many people grew up with several different "Englishes." In an article titled "Mother Tongue," bestselling novelist Amy Tan, a Chinese-American, described these forms of Englishes: "I began to write stories using all the Englishes I grew up with: the English I spoke to my mother, which for lack of a better term might be described as simple; the English she used with me, which for lack of a better term might be described as broken; my translation of her Chinese, which could certainly be described as watered-down; and what I imagine to be her translation of her Chinese if she could speak in perfect English, her internal language, and for that sought to preserve the essence, but neither an English nor a Chinese structure. I wanted to capture what language ability tests can never reveal: her intent, her passion, her imagery, the rhythms of her speech and the nature of her thoughts" (Tan, 2003, pp. 256-257).
Not only do we have to learn to decode the verbal linguistic codes, we also need to decode such non-verbal messages as facial expressions, gazing, postures, proximity, and gestures. Different cultures have different interpretations of these nonverbal codes. Furthermore, we have to decode the meanings hidden in the tone of an expression. For example, in the United States, the word "okay" can be expressed in a high tone with energy, denoting emphasis and enthusiasm; that same word can be expressed with a low tone and a lack of energy, denoting a lack of support or willingness.
In Japan, however, the same word, reflecting the same level of energy, may not have the same meaning. Paralinguistic features including pitch, stress, loudness, rhythm, and cadence are sometimes more powerful in transmitting meanings and linguistic features. Many Americans say that when they hear two Cantonese speakers talk, they think they are arguing. This is due to the Americans' lack of familiarity with the tonal language and the mannerism in which discourse is conducted.
The cultural/linguistic differences present challenges for individuals who work with linguistically and culturally diverse populations. Many Cantonese find it curious that in an upscale restaurant, people from Western cultures engaged in conversation speak soft and low. One can hear the clinking of the silverware. In the Japanese culture, slurping the udon soup from a bowl is a normal behavior, as is burping. In some cultures, slurping noodle soup indicates enjoyment and burping is a form of praise for the hostess, indicating the food served was delicious (see sidebar on page 9 for other types of codes).
All human encounters are embedded in sociocultural contexts, which carry codes that vary from the very informal to the most formal. Buying something from a roadside vendor is considered very informal, while being received by the Queen of Sweden is considered very formal. All contexts must be interpreted according to the specific social and cultural norms. For example, one cannot say to the queen "How are you doing?" nor ask her "How is everything?" On the other hand, saying to the vendor, "How is business?" would be perfectly acceptable. In most interactions with people from China, asking someone his or her age is fairly common and one would expect to get an answer. This same question cannot be asked in a social setting in the United States.
Being able to read the context and decode the message is essential for successful cross-cultural communication. Not knowing what to say to whom may lead to a cultural faux pas. The expression "I put my foot in my mouth" conveys that the person said something inappropriate and has committed a social/cultural faux pas. Thus the "foot-in-mouth syndrome" means a person knows the conversational rules and violates them.
Orestroem (1983) gives the following characteristic features of American conversation:
- Private rather than public
- Casual and spontaneous (planning and production are more or less simultaneous)
- Not institutionalized (informal setting; turn order, length, aim, and topic are not specified in advance)
- Focuses on the interaction (facts are not always central)
- Free to introduce new topics
- Frequent use of "tag questions" (isn't it) and "intimacy signals" (you know)
- Frequent use of "listener responses" (mm, yes, that's right)
In clinical encounters, clinicians must be aware of the sociocultural contexts in which we interact and must learn to be more sensitive to multiple contexts in their daily encounters.
Codes Within Contexts
The interpretation of the codes depends on the particular contexts. A polite nod, smile, or response of "yes" may simply be an acknowledgement that our client has heard the message. It may not signify agreement with the comments. As an example, an SLP working in a large California school district recalled an IEP meeting in which both Hmong parents were present. During the presentation of the case, they nodded their heads frequently. But when the SLP asked the parents to sign the document, the father refused. When probed, the parents indicated that they were following the report by nodding, but they did not agree with the recommendation of the SLP and could not sign an agreement.
Another example illustrates an SLP's ability to interpret the sociocultural context when making a home visit to a Hmong family to ask the parents to read to their children and assist with homework. Although she did not know that Hmong is a preliterate society and many Hmong do not have literacy skills, she was sensitive to the environment and to contextual cues. She entered the apartment and noticed that there were no newspapers, books, or magazines. She even went into the bathroom and noticed no reading materials. She then asked a number of critical questions and learned that the parents did not know how to read or write in English but could speak some English. Instead of asking the parents to read to their children, she suggested that they read together and with the help of a volunteer who was a retired teacher. Being sensitive to the context made it possible for the SLP to build the bridge of communication and achieve clinical goals.
Karl Albrecht (2006) defines social intelligence as the ability to get along well with others while winning their cooperation. It is a combination of sensitivity to the needs and interests of others with an attitude of consideration and skills for interacting successfully with people in any social context; it includes being able to decode the messages in context and respond appropriately. He described five dimensions of social intelligence: situational awareness, presence, authenticity, clarity, and empathy. An SLP should assess one's social intelligence and further develop social intelligence in order to work competently in our multicultural society.
Conversational Rules and Discourse
In a multicultural society, people come into contact with others from various cultures, and an initial encounter may be marked by uneasiness. People do not know what to say or what not to say. They are hesitant about making comments for fear of making the other person uncomfortable. The composition of discourse—silence, interruptions, turn-taking, the organization of talk, choice of dialect, code-mixing, and code-switching—are all part of the complex system of using codes. In addition, the rules of conversational pragmatics are different among cultures.
For example, in the Japanese culture, there is a hierarchy in seating arrangements and rules about who should speak and who should not. Nancy Masterson Sakamoto (1995) described the rules of Japanese conversation as similar to bowling—one person has the floor and he will be the one to talk. On the contrary, she felt that the American rule is more like a tennis game in which the players hit the ball back and forth and there is an exchange. These rules are learned through experience.
Earley and Mosakowski (2004), in their Harvard Business Review article, "Cultural Intelligence," discussed a bank ad that shows a grasshopper with this message: "USA—Pest. China—Pet. Northern Thailand—Appetizer." Cultural intelligence is an aptitude and skill related to emotional intelligence. They define cultural intelligence as an outsider's seemingly natural ability to interpret someone's unfamiliar and ambiguous gestures the way that person's compatriots would.
The three sources of cultural intelligence are head, body, and heart (Earley and Mosakowski, 2004). Being able to diagnose your cultural intelligence is the first step in self-understanding. It helps to understand whether you are (Earley and Mosakowski, 2004) a "provincial" who works well with people of similar background but runs into trouble when venturing farther afield; an "analyst" who relies on intuition rather than on systematic learning style; an "ambassador" who is confident, but with the humility to know what you do not know and how to avoid underestimating cultural differences; a "mimic" who has a high degree of control over his behaviors; or a "chameleon" who possesses high levels of all three components and achieves results with skills and perspective. Earley and Mosakowski provide six steps for developing cultural intelligence (see sidebar at left).
Developing cross-cultural competence requires education and training, personal engagement, and life-long experience (Cheng, 2004; Cheng 2006; Nidhi, Ribera et al., 2005). The diagram on p. 32 offers a model for developing cultural and social competence that integrates the key attributes—positive attitude, acumen, and aptitude (heart, head, and hand)—at the core of these competencies (Cheng, 2007). Gaining knowledge about the cultures, communication codes, and situational contexts is the key to success in clinical practice.