Holistic Voice Therapy for the Whole Person University of Minnesota faculty and students learn about—and provide—transgender voice treatment. Academic Edge
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Academic Edge  |   August 01, 2018
Holistic Voice Therapy for the Whole Person
Author Notes
  • Marilyn Fairchild, MA, CCC-SLP, is a speech-language pathology clinical supervisor at the University of Minnesota–Twin Cities. She is an affiliate of ASHA Special Interest Group 11, Administration and Supervision. fairc003@umn.edu
    Marilyn Fairchild, MA, CCC-SLP, is a speech-language pathology clinical supervisor at the University of Minnesota–Twin Cities. She is an affiliate of ASHA Special Interest Group 11, Administration and Supervision. fairc003@umn.edu×
  • Sheri Stronach, PhD, CCC-SLP, is an assistant professor at University of Minnesota–Twin Cities. She is an affiliate of ASHA Special Interest Group 14, Cultural and Linguistic Diversity. sstronac@umn.edu
    Sheri Stronach, PhD, CCC-SLP, is an assistant professor at University of Minnesota–Twin Cities. She is an affiliate of ASHA Special Interest Group 14, Cultural and Linguistic Diversity. sstronac@umn.edu×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Special Populations / Transgender / Professional Issues & Training / Academic Edge
Academic Edge   |   August 01, 2018
Holistic Voice Therapy for the Whole Person
The ASHA Leader, August 2018, Vol. 23, 38-39. doi:10.1044/leader.AE.23082018.38
The ASHA Leader, August 2018, Vol. 23, 38-39. doi:10.1044/leader.AE.23082018.38
It can be scary to learn something new. We see this through the looks of trepidation on the faces of our students each semester as they head into their first-in-their-life sessions with their clients. As veterans in the field, we thought we were done with those apprehensive days.
But then a new opportunity came our way, and we felt compelled to answer.
Our university clinic received a call looking for transgender voice therapy—a previously unexplored yet intriguing clinical service area—and we agreed to try to help. We started by reaching out to a nationally recognized expert in the area of transgender voice. Through her mentorship, we found a training workshop led by speech-language pathologists. This training demonstrated how complex and holistic this service area is.
As we continued to attend trainings, read books and connect with experts in this area, our department began discussing how to best build students’ cultural competence for working with transgender voice clients and other members of the lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) communities.
Interdisciplinary training
Meanwhile, a physical therapy graduate student approached us with an idea: engaging with our department to further LGBTQIA competency development in allied health fields. To this end, we secured a small internal grant to form a collaborative among the departments of speech-language pathology, audiology, physical therapy and occupational therapy.
Our first initiative was a cross-departmental training event to increase students’ competency for work with LGBTQIA clients. This training addressed best clinical practices, such as using appropriate pronouns, taking relevant case histories, and creating inclusive spaces. Participants engagement during this training was high, and reviews after the event were strongly favorable.
We are now exploring initiatives to continue this work and bolster cross-disciplinary relationships through, for example, a series of workshops focused on cultural competency.

Students show a growing ability to ask the clients questions that lead to meaningful answers, to answer clients’ questions effectively, and to implement a variety of treatment techniques, such as pitch-matching, exploring resonance, and integrating multiple parts of voice and communication.

Launching the program
After two years of departmental preparation and education, speech-language pathology graduate-student clinicians started seeing their first three transgender voice clients earlier this year. As we began working with these clients, our goal was to engage and empower the clients and the graduate student clinicians.
In our holistic approach, we engage the clients to participate actively in the therapy process, with an emphasis on collaborative voice work rather than an expert model. The treatment broadly addresses how an individual is seen and heard by the world beyond just voice.
Clients often arrive with a history of having their physical and metaphorical voices questioned, and our sessions include client-led discussions of issues they feel are important and relevant to their process. These conversations address topics such as what having a feminine or masculine voice means, finding vocal role models, and what it feels like to be misgendered and how that affects their progress.
In just one semester, our clients are expressing increased confidence in their voices and demonstrating increases in outcome measures (independence with pitch-matching exercises during sessions, for example, and improved compliance with home practice programs).
We believe a key to the program’s success is its emphasis on community engagement—working with rather than for our communities, which include our clients as well as LGBTQIA advocacy groups, providers and student groups. We customize treatment so that clients are the experts on their own experience and help to set the plan of care. Our clients report a better understanding of vocal health and patterns of vocal use. The stories that they share are now less about being misgendered and more about being affirmed in their gender identities.
We engage speech-language pathology graduate students through weekly group meetings to review materials (including podcasts, books, videos, apps and webinars), get answers to questions from a professor of voice, and research goal-writing through a variety of sources, including a social media group on transgender voice therapy.
The intersection of voice, identity, speech-language treatment and counseling provides unique challenges for our graduate student clinicians. Our use of a holistic treatment approach may have overwhelmed the students at first, but they experienced significant clinical development during the semester. They show a growing ability to ask the clients questions that lead to meaningful answers, to answer clients’ questions effectively, and to implement a variety of treatment techniques, such as pitch-matching, exploring resonance, and integrating multiple parts of voice and communication.

In our holistic approach, we engage the clients to participate actively in the therapy process, with an emphasis on collaborative voice work rather than an expert model.

What to know
What started in our department as the exploration of a new clinical intervention area has broadened to become an opportunity for rich collaborative learning, community engagement and interprofessional education. Here are some of the lessons we have learned.
  • Embrace the unknown. Don’t be afraid to explore new knowledge and skill areas.

  • Partner near and far. Potential collaborators may be in your building, across campus or in your local community.

  • Be flexible in your thinking and learning. Issues related to sexual orientation and gender identity are dynamic and complex, with no all-inclusive glossaries of terms or standard protocols. Reaching out and engaging in conversations with members of LGBTQIA communities is the most effective way to learn more.

  • Think broadly. LGBTQIA issues are not restricted to voice. All audiologists and speech-language pathologists need this competence. After all, clients with any diagnosis may also be members of LGBTQIA communities.

  • Be patient with yourself, with your students and with your clients. It takes time to grow a program like this, and you may make mistakes along the way.

  • Celebrate your successes. When someone finds their voice, they are empowered to live their life on their own terms. How lucky are we to be a part of their journey!

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August 2018
Volume 23, Issue 8