A Bridge Over Troubled Voices

This October, the BBC welcomingly celebrated the 80th Autumnal birthdays of both Paul Simon and Art Garfunkel. It was nostalgically heartwarming to hear the podcasts, watch the concert in Central Park again and hear the amazing songs. I don’t know if it was because I heard and sang along to Bridge Over Troubled Water several times, that the word ‘bridge’ lodged in my brain. Or perhaps, just by pure coincidence, it became a month where ‘bridge’ became an extremely high frequency word.

The other triggers which most likely brought this word to the fore for me was a theme that’s been repeated in both my own work with clients and with SLTs attending for their remote supervision sessions. The theme was to do with generalisation of voice exercises into habitual voice. It’s an essential component for effective outcomes but one that I think receives too little attention.  

Something clients frequently say after a few, or even one or two sessions of therapy is: “I can get a clear voice during the sessions when I’m practising but not when I’m just speaking normally’”. This can set up a variety of thought cycles in the client including: 
“I don’t think I’m doing the exercises the right way” and/or “the therapy isn’t working”. Clients repeating lack of generalisation experiences can also make the therapist question whether the therapy is working. How to generalise voice skills has to be one of the most frequently asked questions I receive from therapists during their supervision sessions. It’s an aspect I always cover in voice courses.

Explaining the process of voice therapy to clients is a core aspect of my method of working. Even with this approach, many clients will raise generalisation very early in their treatment. One client with long standing dysphonia, spanning many years, described feelings of frustration at the start of his forth session. He reported that he could not sustain the non-dysphonic voice he achieved in his practice in a sustained manner in noisy social settings. The level and length of his dysphonia would not indicate full generalisation after 3 sessions. Whilst a therapist may be in full possession of that knowledge, the client rarely is. 

I can no longer count the amount of analogies I use to increase clients’ understanding but it felt like I needed a new metaphor to help this client along his voice journey. 

I seem to have spent my time on many therapy bridges this month, sometimes encouraging the courage it takes to step on to the bridge, as for some psychogenic cases and often describing the challenging nature of the medial stage of therapy. Whilst voice therapy can follow a smooth path, In many cases there are bumps to overcome. Encouraging clients to hold on as the bridge sways provides a very good chance of successful outcomes. Reassuring each individual that you are walking the steps with them maintains confidence in the therapeutic relationship brings until they reach their solid ground.