Section One
Module 2: Groups, Identities, Dimensions, and 16 Questions
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How do our groups and our individual characteristics shape our perceptions?
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After working with the material in this module, readers will be able to
explain the importance to client-centered, culturally and individually appropriate speech-language pathology of the notion that groups and individuals have characteristics that fall along multiple dynamic and intersecting continua
explain six continua along which groups of people vary, from Hofstede (e.g., 2011) and colleagues’ work
explain Morgan’s (1996) model of multiple intersecting individual continua of identity
use the 16 Questions matrix to evaluate different people’s approaches to a clinical situation
combine the notions of continua for groups, continua for people, and interactions among characteristics to develop initial descriptions of culturally influenced professional situations
Many frameworks or models can help us think about how cultures and identities influence our work as speech-language pathologists. This module describes three such frameworks, all of which we will use throughout this website.
Groups of People: Dimensions and Tendencies
One way to think about the influence of culture and cultures on speech-language pathology is to consider how groups of people form and function.
Try thinking about some of the groups of people to which you have belonged, or that have shaped your journey through your life (Module 1).
You might have been part of one or more family groups, one or more work groups, a neighborhood, a religious or community organization, some friend groups, a sports team, or a book club.
If you are working on or have already earned your master’s degree, you probably are or were part of a speech-language pathology department or a graduate-school cohort.
In each of these examples, the people in the group shared at least some beliefs and behaviors (see Box 1.1 in Module 1). The people in your book club differed from each other, for instance, but they had in common that they all read books and talked about books. Similarly, the members of a sports team are all different people, but they have in common that they value spending their time playing a particular game.
One basic principle from the science of anthropology extends these ideas. Classical anthropology teaches us that any relatively permanent group of people not only must share some individual beliefs and individual behaviors but also must agree on some shared solutions to the basic problems that face all human beings. Anthropologists focus on many types of such problems, beginning with the most basic: Human beings need food, so any group of human beings who are going to live together for any period of time need a shared solution to the problem of how to have food. Possible solutions range from “Each of us is responsible for finding and preparing our own food” to “A specific subgroup of people will find and prepare the food for everyone else” to “Each week a different person will find and prepare all the food for the entire group,” among many others. Any of these solutions can work, but they only work for the whole group if everyone has agreed to the same solution.
This notion, that a functional group of people must have some shared solutions to the universal concerns that group will face, given that each set of possible solutions exists as a continuum of multiple options, also forms the heart of sociology, education, management theory, and organizational psychology, among many other areas of human inquiry and practice. One particularly influential model of group functioning, as we begin to think about cultures and identities in speech-language pathology, was developed over the course of several decades by Hofstede and colleagues from their study of multiple international datasets (see Hofstede, 2011, for a retrospective explanation of their work). Hofstede’s model is especially useful, and has been incorporated into resources provided for speech-language pathologists by the American Speech-Language-Hearing Association, for three reasons:
because his work was based on factor analyses of large datasets;
because of his emphasis that groups can exist anywhere along the length of the dimensions he identified; and
because of his related emphases that the members of any group will cluster around a subset of the full range of possible options on any dimension and that groups themselves can have tendencies or characteristics.
Let’s address each of these reasons in turn.
Factor analysis is a set of statistical procedures intended to identify sets of variables that co-vary, or that tend to “travel together.” The goal of a factor analysis is to identify the relatively few broader constructs (factors) that underlie, explain, or can predict a relatively larger set of more detailed variables. To return to the anthropologist’s example of food: If a society’s solution to feeding its members is that one of the adults in each family will take on this responsibility for everyone in that family, then the details that this adult can be seen to plan meals, visit food stores, cook food, and serve food are all explained by the one larger factor that this adult is responsible for feeding the family. This solution (that one of the adults in each family will feed everyone in that family) also controls how the community and its families then deal with second-order issues, such as who will be seen in the food stores, who has time for a job outside the house or for artistic pursuits because someone else is shopping and cooking for them, and so on.
From their analyses of international datasets, Hofstede and his colleagues identified several broad constructs, or factors, that helped to explain many of the similarities and differences about workers in different countries. As they explained (Hofstede, 2011), data-based descriptions of group functioning have many advantages over theory-based proposals or presumptions about group functioning. In addition, and as our second important point, Hofstede and colleagues also emphasized that each construct exists as a dimension, or as a continuum that allows for a wide range of possible solutions to the question posed by that construct. Just as anthropologists have identified relatively few basic problems (food, water, shelter), each of which has an almost infinite number of possible solutions, Hofstede’s work identified relatively few basic issues for groups, each of which also has an almost infinite number of solutions.
The descriptions in Box 2.1 draw on Hofstede’s (2011) retrospective description of the first four dimensions, and two later dimensions, developed by his team. I have renamed some of the dimensions and added examples. As you read Box 2.1, think about the different groups you have belonged to and where those groups fell along each of the six continua.
Box 2.1. Six Continuous Dimensions Along Which Groups of People Will Vary, Based on the Work of Hofstede and Colleagues
Distribution of Power
The group will fall somewhere between having completely distributed power (everyone is equal; all decisions are made by consensus) to having completely undistributed power (there is one strong leader and/or several layers of subgroups; the group accepts that some members have more power and some members have less power).
Certainty and Structure
A group’s values, preferences, routines, and approaches will fall somewhere between highly structured, fixed, or repetitive (seeking certainty) to highly creative, flexible, or unstructured (seeking novelty).
Individualism
The group’s assumptions and emphases will range from valuing individualism (the group expects people to take care of themselves and rewards individual accomplishments) to valuing collectivism (the group exists to take care of each other and rewards accomplishments that help the group as a whole).
Gender-based Differences
Groups of human beings range from those within which each gender has its own accepted and distinct role, especially with regard to what are typically viewed as “feminine” or “masculine” emotions and actions (as in some families or religious traditions), to those within which the roles and expectations for each person are not related to their gender (as in many work groups or military units).
Stability / Orientation to Time
Groups range from emphasizing the past and present (the group values history and stability) to emphasizing the future (the group values adaptation, perseverance toward new goals, and change).
Individual Freedom
Groups range from valuing what Hofstede called “indulgence” (the importance of individuals’ freedom to seek current satisfaction) to valuing “restraint” (the importance of individuals’ refraining from pursuing immediate desires so as to increase the likelihood of attaining a later goal).
As you read about these dimensions, did you notice that you have beliefs or preferences for any of them? Everyone does! And you probably also identified the tendency or practice of some groups you have belonged to, which brings us to the third important element of considering groups in terms of multiple dimensions: the members of any group will tend to cluster around a subset of the full range of possible options on any dimension, and the group itself (separate from the individuals who comprise it) can have tendencies and characteristics as well.
Combining these last two points, we see that Hofstede and colleagues’ models emphasize that, with respect to any larger dimension or construct, any well-defined group of people will tend to demonstrate recognizable group actions that represent only part of all possible places on a much longer continuum. As one example, we might say that speech-language pathologists, as a group, probably fall together somewhere toward the “value the future” end of Hofstede’s Stability continuum. Speech-language pathologists are not all the same, but we all tend to value helping our clients to change, or working in therapy now as a way of improving our clients’ future for later. Can you think of a group whose members might cluster more toward the “value the past” end of a Stability continuum?
Student support teams in schools, and rehabilitation-unit teams in medical settings, provide another example of the value of Hofstede’s principles. With respect to the Distribution of Power continuum, for example, consider the four teams described in Box 2.2.
Box 2.2. Four hypothetical clinical teams that differ along Hofstede’s “Distribution of Power” continuum
Team 1: All members of the team, including the client and the family, listen to each other’s input and then make decisions together.
Team 2: The professional members of the team share their assessment results with the client/family; consider the client’s/family’s reactions, comments, and needs; and then help the client/family make decisions that are right for them in their contexts.
Team 3: The professionals assess the client’s and the family’s needs and then present a suggested treatment plan to the client/family.
Team 4: The professionals assess the client’s and the family’s needs and present that information to the case manager. The case manager develops a plan of action and provides it to the therapists and to the client/family.
Notice several key points about the examples from Box 2.2.
First, there are many possible positions along any continuum, including the Distribution of Power dimension. These four examples are only four of the many possibilities. Very few characteristics exists as binaries, or as a set of only two options; as Hofstede and colleagues emphasized, each of their dimensions, and most other human and group characteristics, include a wide range of many possible options.
Second, notice that each of the four options described above is at least reasonable on its face. You might prefer the very communal approach to group decision-making used by Team 1, or you might prefer having Team 4’s active, efficient case manager. Overall, however, any of the four approaches described above could be a reasonable solution to the basic problem that a work group must figure out how to make decisions.
And third, notice that the group as a whole is functioning at a particular place along Hofstede’s Distribution of Power continuum and using a system that reflects one of the many possible options along that continuum. The speech-language pathologist on Team 4 might, as an individual, believe in distributed power and the importance of involving everyone in a conversation. Team 4’s client, similarly, might believe in shared decision-making. Nevertheless, Team 4, as a team, has the group characteristic of functioning closer to the non-distributed end of the Distribution of Power continuum, regardless of those two individuals’ views. Hofstede’s dimensions remind us that groups, as groups, have traits or characteristics. The point goes beyond noting that individuals within a group can differ from each other; the point is that the group itself has characteristics.
In summary, Hofstede’s model and classic ideas from anthropology remind us of several important points about groups of people, summarized in Box 2.3.
Box 2.3. Key Points About Groups of People
The individuals in any group are not identical to each other, but to be a definable or meaningful group the individuals must have some traits, characteristics, beliefs, or behaviors in common.
To function as a group, any group of people must develop some shared solutions to some of the basic problems that group will face.
Groups of people can be described in terms of where the group falls along several defining dimensions.
Some higher-order dimensions are especially useful, as we think about groups, because they explain, predict, or control multiple more-detailed group characteristics.
The set of all possible solutions or positions along any dimension spans a wide range, but the members of any single group will tend to cluster in only one subsection of the full range of possibilities.
Any group, as a whole, can be described as having some group-level characteristics, distinct from the individual-level characteristics of its members.
Your Turn
Think about any group you have ever been part of. Depending on your background and circumstances, possible examples could include the second foster family you lived with during middle school, the crowd at last weekend’s baseball game, the religious institution you currently belong to, or your current work team. Describe that group, as a group, using each of Hofstede’s six dimensions (Box 2.1.).
When you are finished, try to identify other groups you have also been part of that functioned at different places on each of Hofstede’s continua. If you analyzed your high school drama club, which tended more toward creative uncertainty, have you also been part of a group that valued and used highly structured routines? If your current work group at the hospital has relatively few distinctions between the expectations placed on men, women, and other genders at work, have you ever been part of a group that did expect each gender to fulfill its own role?
Reflect for a moment on the range of possibilities for each dimension, and reflect for a moment on that fact that you have belonged to groups that fell at many points on each dimension. What does this recognition of your own ability to function in different groups imply for you, as you think about working with clients, families, or colleagues whose cultural or linguistic backgrounds differ from yours?
Hofstede’s research focused on employees as work groups, not on groups of people we might refer to as cultures. Anthropologists, sociologists, and other social science professionals often struggle to define precisely when a group becomes a culture, but some of the definitions of a culture from Module 1 can help: a group of people who share several fundamental values, and who all engage in similar actions because of those values, and who teach new members of the group about the values and about the necessary actions, is closer to being a culture than is, say, the group of people who happen to be walking on a single city block at one time (even though those walkers might also be said to share values, actions, and a tendency to teach newcomers about both). Are speech-language pathologists a group that can be described using Hofstede’s six dimensions, or members of a culture, or both? (We will address speech-language pathology as a culture in Module Four. Feel free to skip up and read out of order, if something interests you!)
Individuals: Identities as Intersecting Continua
A second important element, as we consider the influence of cultures and identities in speech-language pathology, must include recognizing that people have specific individual characteristics, only some of which reflect their membership in groups. Even more importantly, those multiple individual characteristics intersect, interact, and amplify each other in critical ways, especially in terms of how they are interpreted by other people (Crenshaw, 1989). A person might have the individual characteristic of being tall, as one example, but this person will not be merely tall. They might be a tall woman, which society interprets one way; or a tall thin man, which society interprets another way; or tall and nonbinary with purple hair, which society will interpret in yet another way.
In addition, as we recognize that individual characteristics fall along continua and are combined in different ways, we also need to address our human tendency to assign ratings or rankings to differences. People assign terms such as “better” or “bad” when the concept in question is little more than a benign difference of opinion. How many conversations have you had about the “fact” that cats are “better” pets than dogs, or about someone’s strongly held belief that bluegrass music is “good” but jazz music is “bad”? We all, as human beings, tend to rank our own and other people’s individual characteristics, even when those characteristics could be described as simple differences. We also rank combinations of characteristics; think about your immediate judgments about, and almost instantaneous ranking of, a neatly dressed 40-year-old person who has received several promotions in the last 10 years whom you observe helping his grandmother.
As we think about how individuals and their characteristics are perceived by other people, we also need to acknowledge that people are also known to be comfortable with the familiar (Monahan et al., 2000) and known to shift toward positive evaluations as things become more familiar (the mere exposure effect; Bornstein & Craver-Lemley, 2022). We can overcome these general tendencies, but on the whole people seek familiar food while traveling (Björk & Kauppinen-Räisänen, 2016), feel greater comfort with more familiar people (Reis et al., 2007), prefer paper or computer-based exams depending on their familiarity with the two formats (Russell et al., 2010), and, famously, show an increased preference for nonsense syllables as those syllables become more familiar after repeated presentations (Zajonc, 2001). Combinations are again relevant, as well; we find certain combinations of characteristics to be more familiar and therefore preferable, and we often react negatively to a person whose combination of characteristics we find unusual. As applied to people, for example, you might be aware that women and members of many racial, ethnic, and national groups in high-paid positions of executive leadership still struggle with U.S. society’s overall familiarity with, and therefore comfort with and acceptance of, some specific combinations of gender, race, salary, and authority.
How do these constructs play out for us, in our attempts to focus on client-centered, culturally and individually appropriate speech-language pathology?
One comprehensive and useful model for thinking about the influence of individual identities in speech-language pathology was first presented by Morgan (1996) in her analysis of power-based inequalities in education. Drawing on the work of many other scholars (especially the French philosopher Thomas Foucault and the American scholar of law Catharine MacKinnon), Morgan presented a visual web of 14 continua, each of which represents one trait or characteristic of an individual. Morgan’s model emphasizes the range and the combination of possibilities for individuals, and it also emphasizes that society often treats one section or end of any continuum as preferred.
We can start building toward Morgan’s model by thinking about something like the figure below. Each of the three characteristics (age, paleness, and financial stability) is a continuum that represents an individual characteristic. People fall somewhere between younger and older, fall somewhere between paler skinned and darker skinned, and live in circumstances that can be described as somewhere between financially unstable and financially stable. Where do you fall on each continuum? Go ahead and mark yourself somewhere on each line in this figure!
Notice also, as you begin to position yourself on these continua, that you probably have a sense already about which ends or portions might be perceived by some people as preferable. Have you ever felt less respected than you might have wished because you were perceived as too young, too old, or too poor? Similarly, many of you might have felt less respected or less powerful, in some situations, on the basis of nothing more than your darker skin, regardless of your professional skills or other characteristics. Morgan’s model provides a useful, visual way to begin to analyze these and other interactions between individuals.
Morgan’s (1996) original figure, reproduced as our Box 2.4, included 14 continua, well beyond the three used in our simple example. The original figure’s age is starting to show; you might find some of the terminology dated or even problematic. Current popular thinking would probably deemphasize some of her axes or add others, and you might disagree with her about who is privileged or about what society values. Nevertheless, we consider Morgan’s original for many reasons, including that many people find much of it to describe their experiences accurately and including that she deserves credit for conceptualizing displays of this type (especially if you are familiar with updated versions of the idea but not familiar with Morgan’s name).
Box 2.4. Morgan’s (1996) Model of Intersecting Axes of Privilege, Domination, and Oppression.
From Morgan, K.P. (1996), in Diller et al. (1996), The Gender Question in Education. Copyright 1996 by Westview Press. Reproduced by permission of the current copyright holder, Taylor & Francis Group, through PLSclear.
Notice as you examine Morgan’s (1996) figure that, whatever corrections or updates you might think it needs, the continua she identified include those that we often use socially and professionally to introduce ourselves or to describe other people: age, race, language, religion, children, education, attractiveness, or the presence of what we might describe as a physical or neurocognitive “disability” (a word we will deal with in later modules). Notice also that her continua are arranged and labeled to show that, on the whole, one end of each continuum tends to be interpreted as the “better” end, in some way, in the traditional U.S. power structure. (Morgan focused primarily on power in education, but educational systems reflect their societies.) She used the words “privilege” and “society normatives” at the top of the figure to label the generally preferred or more powerful end of the axes. She referred to the less powerful ends using the words domination, oppression, and resistance (the lower half of the figure).
These are strong words! Are you reacting to the terminology in some way? You might not feel comfortable with the strong version of Morgan’s ideas, or you might disagree with her about some of the axes, but she used strong words intentionally, because of her desire to improve what she and many other scholars perceived as problems in educational models in the United States. Similar concerns have been raised about many of the models used in our own profession of speech-language pathology, as we will continue to address throughout this website (see especially Section Four).
In summary, Morgan’s (1996) model of individual identities gives us a useful visual representation of several important ideas, as we begin to think about culturally and individually appropriate speech-language pathology, as summarized in Box 2.5.
Box 2.5. Key Points About Individual People
Every person has multiple individual characteristics.
Most of those characteristics fall along continua, meaning that there is a wide range of possibilities for each characteristic.
Societies and groups tend to value, reward, and/or privilege certain places on each continuum, and certain combinations of characteristics, in part because people tend to rank differences.
Any one person will have some characteristics that fall toward the privileged ends of some continua and some characteristics that fall toward the less privileged ends of other continua, and some people will have more characteristics perceived as privileged than other people have.
Your Turn
Spend some time with Morgan’s (1996) original figure (our Box 2.4.). Start by approaching each axis of identity as a purely descriptive line (e.g., from young to old, or from a completely European heritage through a mixed European and non-European heritage to a completely non-European heritage), without considering the associated ideas of privilege or power. Mark where you would place yourself on every continuum, purely as a description of yourself. If you connect the marks, the result will be a wonderfully messy blob or a set of dancing squiggly lines. Enjoy that dancing messiness! That’s you!
Try thinking about some clients or colleagues you felt good with and some clients or colleagues with whom you maybe honestly never quite meshed. Can you relate any of your positive or negative experiences to anything from Morgan’s axes of identity figure? (If your answer about a negative experience is that you differed on several continua, try another layer: Did the mere differences create the difficulty, or was something else in play?)
Which of Morgan’s original axes might you remove, as you look at her 1990s work from the position of the 2020s? Which axes would you add?
Do you agree or disagree with Morgan’s notion that one end or one section of each continuum tends to be preferred, rewarded, or privileged in American society? What changes might you make to the figure’s assertions about privilege, norms, domination, oppression, or resistance? Do you find such terms relevant or irrelevant for thinking about speech-language pathology? (If you are discussing this question with people you do not know well, be actively ready to respect each other’s different views and experiences. You do not have to agree with each other.)
You might be familiar with the term “intersectionality,” which we will address in more detail later. The term is credited in this sense to a 1989 article by Kimberle Crenshaw, a legal scholar. Crenshaw used the term to refer specifically to the fact that being a Black woman is a special case, much more nuanced and more complex than either race-based legal theory or feminist legal theory was recognizing at the time. She also recognized the relevance and importance of what she called the “complexities of compoundedness.” Which intersections or interactions among which of Morgan’s axes of identity do you think might be most complex in speech-language pathology generally, or in your practice specifically? How can you, given who you are and what you know, use those complexities in ways that will be to your clients’ benefit?
The 16 Questions Matrix, or Who-what-when-where are we from-with-in-for?
The third model we will use throughout these modules is a framework for analyzing how and why we make clinical (and other) decisions. Its title, “16 Questions,” refers to the fact that the matrix combining who, what, when, and where with from, with, in, and for results in 16 distinctly different questions.
Some of the resulting questions and constructs are familiar:
Where are you from?
Who were you with?
Did you feel that you belonged in that group? Were you a part of the “in crowd”?
Which team are you cheering for?
Some of the resulting questions are less familiar, but they are all important.
Consider the question “Who are you from?”.
My personal answer would be that I am from my parents and my maternal grandparents. Those four people shaped me in ways that remain influential in my life. I am from them as people, not solely from the physical place where I grew up. My professional answer, similarly, would recognize the continuing influence on my thinking of a few professors and supervisors from graduate school, as well as the influence on my work of some special later mentors and colleagues. How about you? Who are you from, personally and professionally?
Next, consider the question “When are you for?”.
At first, this question might seem poorly formed or even nonsensical, but it’s very real; we are all acting with some “for time” in mind. (In fact, this is the question that Hofstede’s Stability / Orientation to Time dimension addresses.) In some contexts, we might be for the here and now, focused on being present or on how much we are enjoying our current activity. In much of our clinical practice, however, we tend to be focused, at least in part, either on our own past (being aware that this treatment approach worked for previous clients or was recommended to us in the past) or on our clients’ futures (designing our treatments by considering what their future goals and activities will be).
Consider the entire 16 Questions matrix, shown in Box 2.6.
Box 2.6. The 16 Questions Matrix
Think about all 16 of the questions. As you go about your work as a speech-language pathologist, who, what, when, and where are you from, with, in, and for? Do you occasionally find yourself with some people (who) and some materials (what) at a place (where), without feeling that you genuinely belong in that group? What are you from, as you work, and who are you for, as you work?
As you consider the matrix, some questions will make more or less sense to you or fit any particular situation more or less well. That’s okay. Do your best think through each cell, but in some cases you will not be able to fill in every cell with a meaningful answer. The 16 Questions matrix provides a way to think about ourselves and about our work, but it does not require 16 answers every time.
As you consider the matrix, notice also that it provides not only another way to think about ourselves but, more importantly, a powerful means of evaluating any clinical, professional, or cross-cultural situation, success, or potential disagreement.
Imagine, for example, that you are collaborating with a preschool teacher. One of you has happily planned a macaroni-gluing activity or a dried-beans sensory bin for the children, and the other person finds herself upset by the thought of an activity that she perceives as wasting food. (This example was inspired by a wonderful video that was on a website for California teachers for a while and that I can no longer find! If you happen to know who I should be crediting, please let me know!)
Try using the 16 Questions matrix to help you think through the situation. Which person might be from or in a family that goes hungry at the end of every month? Which person might be from or in a family that has never had to think about food insecurity, or from or in a professional early-intervention background that emphasizes the importance of simple manipulables to encourage children’s creativity? What might both of you be for, and how could you use your recognition of each other’s 16 Questions (and answers) to find a mutually acceptable solution?
The 16 Questions matrix serves as a useful strategy because it summarizes and organizes several key aspects of ourselves in a way that can help us think through our interactions with our clients and colleagues. Being aware of who, what, when, and where we are from, with, in, and for, and trying to be aware of who, what, when, and where our clients and coworkers are from, with, in, and for, serves as an excellent system for thinking through what is really happening or needs to happen when people are trying to work together toward a shared goal.
Your Turn
Use the 16 Questions matrix to analyze a recent clinical or other professional situation that you engaged in and that went well for you. Which features of the situation made it successful?
Try analyzing a recent clinical or other professional situation that did not go as well as you had hoped it would. Does anything about the 16 Questions matrix help you identify something you could try differently next time?
Highlight Questions for Module 2
How does thinking of groups and individuals in terms of characteristics that fall along dimensions or continua differ from thinking of groups and individuals in terms of binary characteristics or in terms of a few categories? Discuss how this change in thinking can prepare us as clinicians and professionals to interact with all clients, families, and colleagues.
Explain Hofstede’s six dimensions along which groups of people vary (Box 2.1). Provide examples from your own experience of each dimension.
Explain the basic format of Morgan’s (1996) model of individual continua of identity (Box 2.4.). Name at least six of the continua from her model.
What does it mean to say that groups’ dimensions or people’s identities might “intersect,” “interact,” or “compound” each other? Provide examples from your own experience.
What is the “16 Questions matrix” (Box 2.6.)? Explain how this framework can be used to evaluate different people’s approaches to clinical or professional situations.
What similarities do you see between or among Hofstede’s model of group dimensions, Morgan’s model of individual identities, and the 16 Questions matrix? How do these three models differ? How are these models related to the definitions of cultures and identities we addressed in Module 1?
Do any of the three models discussed in this module appeal to you more or less than any other? Why? How can you imagine trying to use one or more of them in your work?