Trans and Gender-Diverse Voice & Communication Therapy:Competency Framework (original) (raw)
Related papers
International Journal of Transgenderism
Background: Speech and language therapists (SLTs) deliver voice and communication therapy for trans and gender diverse people to facilitate authentic vocal and communicative expression. Davies, Papp and Antoni (2015) have provided a comprehensive review of the literature, with recommendations for good clinical care. Several areas highlighted as gaps in the research were identified by the current authors as ones where evidence is expanding. Aims: To demonstrate 1) an expansion of the evidence base in particular innovations in voice group therapy for trans women and trans men; 2) the importance of delivering voice and communication therapy as part of a complete approach to trans and gender diverse health care; and 3) Developments in training and competency in the UK. Method: Data was drawn from three small-scale projects, two surveys and one audit. Measurements: Data from survey and audits and pre-and post-group acoustic measures of and client self-perceptual measures, including the Transsexual Voice Questionnaire (TVQ MtF); a client-generated set of questions for trans men; and the migration of vocal identity map, adapted from Narrative Therapy practices. Results: Positive outcomes for both pitch measures and client perception were recorded. Audit and survey data provided evidence of developments in training and competency in the UK. Conclusion: Evidence supports group therapy as a successful approach for trans individuals across a number of parameters of voice and self-perception. Voice group protocols for both trans men and trans women should take account of the social context within which to explore relational presence and authentic voice. SLTs within Gender Identity Clinics provide voice and communication as part of a broader pathway of care, alongside sharing professional knowledge and skills. Current UK developments are documented as indicators of positive responses to the growth in the number of SLTs seeking to develop specialist skills within this field. KEYWORDS. voice-communication-group-therapy-authenticity-identity-competency Voice and communication interventions delivered by speech and language therapists (SLTs) are increasingly being shown as helpful for transgender and gender diverse people in achieving congruence with the individual's internal sense of gender identity (
Transgender Health, 2019
A service evaluation was undertaken with 10 participants identifying as trans men who received voice and communication group therapy and 12-month follow-up at the London Gender Identity Clinic between February 2017 and March 2018, to investigate levels of satisfaction, how helpful they found the program in facilitating vocal change and skill development, and whether they would recommend it to others. Methods: Participant evaluations of overall and ideal rating of masculinity of voice, and level of feeling comfortable with voice, evaluations of voice skills and changes in speaking and reading fundamental frequency were retrospectively reviewed and analyzed. Results: Six participants reported being very satisfied with the service; four were satisfied. Eight participants found the program very helpful in achieving voice and communication change; two found it helpful. Eight strongly agreed and two agreed with recommending the service. Participants' overall and comfort ratings of voice significantly increased (p < 0.01), while there was no significant change in ideal ratings (p = 0.063), and a significant decrease in the difference between overall and ideal ratings (p < 0.01). Participants achieved a significant decrease in fundamental frequency for reading and speaking (p < 0.01), a significant decrease in voice fatigue (p = 0.039) and restriction in voice adaptability (p < 0.01), a significant increase in confidence in public speaking (p < 0.01), but no significant change in vocal projection (p = 0.07). Conclusion: Ten trans men reported high levels of satisfaction with the voice group program and long-term follow-up, making significant positive shifts in voice skills and vocal self-perception. These findings apply locally but suggest appropriate interventions toward a transmasculine voice modification protocol.
This study highlights the experiences of trans * individuals in regard to the use of gendered language by their medical providers. A total of 20 individual interviews were conducted with trans * -identified individuals. Thematic analysis was used to analyze participants' responses. Participants discussed both positive and negative experiences with gendered language in a health care setting. Four primary themes emerged through their experiences that were then used to develop recommendations for providers interested in improving the health care of trans * individuals: (a) medical forms; (b) insurance sex versus gender identity; (c) binary language; and (d) whole person, well-being care.
Vocal therapy for transgender people
Logopedija, 2021
Transgender people can engage in a number of procedures to deal with the incongruence between their physical gender and the one with which they identify. One of the experts involved in the process of gender transition is a speech-language pathologist (SLP), whose role is to collaborate with the client on the goal to develop vocal, language and communication behaviors that match the desired gender identity. This case report presents one such collaboration, which included voice and communication therapy for a male-to-female transgender person aimed at the voice feminization.
Experience Report on Setting Up a Transdisciplinary Outpatient Unit for Transgender Health
The Journal of Sexual Medicine, 2017
Introduction & objectives: Voice is an important gender marker in the transition process as a transgender individual accepts a new gender identity. Perceptive-auditory and acoustic analyses of the voices of these individuals have determined that vocal pitch is one of the most important markers of gender. The aim of this study was to describe and relate aspects of a perceptual-auditory analysis and the fundamental frequency of male-to-female (MPF) transsexual individuals. Population sample: A case-control study was carried out with individuals aged 19 to 52 years who attended the Gender Identity Program of the Hospital de Clínicas of Porto Alegre. Methods: Vocal recordings from the MPF transgender individuals (vowel / a: / and six phrases of Consensus Auditory Perceptual Evaluation Voice (CAPE-V)) were edited and randomly coded before storage in a Dropbox folder. The voices (vowel /a:/) were analyzed by consensus on the same day by two speech-language audiologists who had more than ten years of experience in the voice area using the GRBASI perceptualauditory vocal evaluation scale. Acoustic analysis of the glottic source was performed using the advanced Multi-Dimensional Voice Program software. The resonance focus and the degrees of masculinity and femininity for each voice recording were determined by listening to the CAPE-V phrases. Results: There were significant differences between the groups regarding a greater roughness (discrete degree) (p ¼ 0.031), greater frequency of subjects with F0 between 80e150 Hz (p ¼ 0.003), and a greater frequency of hypernasal resonant focus (p <0.001) in the MPF cases compared with the controls. Conclusion & recommendations: The MPF group of individuals showed greater roughness (discrete degree), altered vertical resonant focus, more masculine voices, and more severe fundamental frequencies than the controls. This information may contribute to better therapy planning and vocal feminization surgery for transgender women.
Counseling Transgendered, Transsexual, and Gender-Variant Clients
Journal of Counseling & Development, 2002
espite the recent focus on multiculturalism and diversity within the counseling field, the transgender population has been given insufficient attention in research and in counselor training. Although gay, lesbian, and bisexual issues are beginning to receive much needed attention in multicultural texts and professional journals (e.g., the 1998 special issue in The Counseling Psychologist, the recent publication by the American Psychological Association titled Handbook of Counseling and Psychotherapy With Lesbian, Gay, and Bisexual Clients, by Perez, DeBord, & Bieschke, 2000), discussion of transgender issues is rare in such publications. For the most part, mental health practitioners' views about transsexuals, transvestites or cross-dressers, and others with transgender status have "not been informed by objective empirical research" (Fox, 1996, p. 31). Consequently, counselors are ill-prepared to meet the needs of such clients. The purpose of this article is to inform counselor educators, counselors, and supervisors about the salient clinical issues that arise when working with transgendered clients. Specifically, the following areas are addressed: (a) the emerging and evolving definition of the transgender community, (b) the politicization of the transgender movement, (c) clinical issues and interventions for use with transgendered clients, and (d) the presentation of an actual case that details the progression of personal therapy with a transgendered client. EVOLVING DEFINITIONS The term transgender was coined in the late 1980s by men who did not find the label transvestite adequate enough to describe their desire to live as women (Prosser, 1997). Alternately, the term transsexual was deemed inappropriate because many nontraditionally gender-identified persons did not necessarily want to reconfigure their bodies surgically and hormonally and did not share the desire to "pass," or to fit into normative gender categories of male and female. Included in the full spectrum of people with nontraditional gender identities are pre-and postoperative transsexuals, cross-dressers or transvestites, intersex persons, and those who are disinterested in passing. Among the many terms used interchangeably to describe this community are transgendered persons, gender-variant persons, and trans persons. For consistency in this article, we use transgendered persons and its variations. Today, the continued proliferation of identifying terms within the transgender community, including gender-bender, gender outlaws, gender trash, gender queer, transsexual lesbian, and so forth, reflects the diversity within this community as well as the ongoing struggle for self-definition. Novelist Leslie Feinberg (1998), who is transgendered and an activist for this community, observed that "our lives are proof that sex and gender are much more complex than a delivery room doctor's glance at genitals can determine, more variegated than pink or blue birth caps" (p. 5).
Efficacy of intensive voice feminisation therapy in a transgender young offender
Journal of Communication Disorders, 2018
Research suggests that transgender young offenders are a uniquely vulnerable caseload that may benefit from speech pathology intervention to help bring their voice into alignment with their gender identity. However, no previous studies have investigated treatment efficacy in this population. This study investigated the impact of intensive voice feminisation therapy targeting fundamental frequency and oral resonance in a 17 year old transgender individual within a youth justice institution. Acoustic analysis, listener and self-ratings of vocal femininity, self-ratings of vocal satisfaction, a post-treatment structured interview, and pre-and post-treatment completion of the Transsexual Voice Questionnaire (TVQ MtF) were utilised to determine treatment impact. Outcome measures indicated therapy was effective at increasing the client's vocal pitch and perceptually femininity without compromising vocal quality. However, the client was still not consistently perceived as female post-intervention and had difficulty implementing feminine speech strategies in discourse. This case study provides preliminary evidence for the effectiveness of intensive voice feminisation therapy in a youth offending population. This research also highlights the potential utility of speech pathologists working in youth justice settings, even when the timeframe for intervention is limited. Furthermore, this research paper validates the use of perceptual outcome measures in transgender voice work, by replicating previous findings in which significant correlations were found between perceptual ratings of vocal gender and client satisfaction. The term 'transgender' refers broadly to a population of individuals whose gender identity differs from their assigned sex at birth (Antoni, 2015; Coleman et al., 2011; Gelfer & Van Dong, 2013). Within this population, a broad distinction can be made between 'transfeminine' (assigned male at birth, transitioning towards the feminine end of the gender spectrum) and 'transmasculine' individuals (assigned female at birth, transitioning towards the masculine end of the gender spectrum) (Davies, Papp, & Antoni, 2015). Some transgender individuals may feel that their external appearance or presentation does not align with their internal gender identity, spurring a process of transition whereby the individual attempts to bring them into alignment (Coleman et al., 2011; Oates & Dacakis, 2015; Wylie et al., 2014). For some, the goal of this process is to be consistently perceived and accepted by others as their desired gender, often referred to as 'passing' (King, Lindstedt, Jensen, & Law, 1999; Oates & Dacakis, 2015). Vocal patterns are one aspect of personal presentation that a transgender individual may seek to modify as they transition (Byrne, 2007; Oates & Dacakis, 2015). If an individual's gender identity and external presentation do not align, this can be a source of ongoing psychological distress (commonly referred to as gender dysphoria) (
Considerations for Voice and Communication Training Software for Transgender and Nonbinary People
Journal of Voice
Transgender and gender diverse people often experience voice-gender incongruence, which is inversely correlated with health and quality of life. Such incongruence could be reduced with voice and communication training, but expert-administered training is often inaccessible while self-guided training is difficult and potentially risky. Training could alternatively be provided through software (eg, smartphone apps), but such software is at an early stage. This qualitatively driven mixed-methods study thus includes surveys and interviews with 21 transfeminine, transmasculine and nonbinary people to identify general views of voice and communication training software as well as most desirable features of such software. Participants were positive about the general idea and described ways to effectively implement four critical features: feedback, accountability, automated goal setting, and training characteristics other than pitch. They also discussed optional or undesirable features. These findings may inform development of voice and communication training software, thus improving health and quality of life for gender minorities.