The first quarter of 2019 was characterised by busy clinic practice and delivering varied teaching and presentations. During an unusually sunny February, I taught two courses at my treatment rooms and gave a presentation at University College London (UCL) :
- 2 day Vital Voice Course
- 2 day Working With Transgender Voice Course (one free place given to a very newly qualified SLT just before she began her first job).
- UCL: The invitation to give the lecture at UCL regarding transgender voice was particularly welcome. I had made suggestions in earlier years but the very full syllabuses did not allow for extra topics. I believe that students themselves were keen to have this additional lecture and I hope they enjoyed and felt more informed by the content. It was certainly a poignant moment for me to return to the building where I studied for my own MSc in Speech & Language Therapy and Pathology. Although Chandler House has gone through some major renovations since my time there between 1993- 1995, the room I gave the lecture in was the main lecture room I once sat in as a student which took me back….
- ASLTIP: March took me off to Milton Keynes one weekend for the Association of Speech & Language Therapists (ASLTIP) conference. ASLTIP had invited me to give a two hour presentation on voice and I settled on the title: Physics, Myths and Direct Therapy: A Journey Through Voice. A two hour talk takes a long time to prepare but the feedback was very good with some SLTs saying they felt inspired and as I’ve said before, successful teaching and presentations involve inspiring at least some of the audience!
- EPATH: In April the European Association for Transgender Health (EPATH) beckoned. Their conference was held in Rome this year which added special interest and heavy costs for attendees! I’ve been going to the EPATH conference since it’s inception, the first two years, as chairman of the Voice & Communication committee. It was nice to attend with less duties this time but giving even one presentation at a conference requires significant input and the type of material I would be presenting was important. It had been a collaboration between myself, my associate SLT colleague Rhiannon Grebert and Professor Carol Fairfax from Reading University.
Sharing research findings:
My research associates and I began gathering data from trans women all over England who had had speech therapy either within the NHS or via a private SLT service. We only included data from participants who had received speech therapy from one service and excluded data from participants who had received therapy from a mix of providers. In total, we received responses from 84 self-selected participants. For busy working clinicians, any research is difficult to carry out without assistance. The presence of my associate SLT colleague Rhiannon Grebert was invaluable in this project, not least for the planning and data collection . We were also fortunate to gain our link with Reading University who gave ethics approval for the research.
Research involving clients themselves is an issue close to my heart. The editorial of the latest edition of the International Journal of Transgenderism (IJT) specifically discusses the need to include trans and gender diverse individuals in research to do with their care:
“Whenever possible, [this] research should be grounded from inception to dissemination, in a meaningful collaboration with transgender community stakeholders”.Adams et al, 2017
Our own research project was a pilot study entitled: Service users’ satisfaction & self -rated outcomes with Voice feminisation therapy. The following is a summary of our findings:
- The majority of participants had socially transitioned and undergone between 3-15 individual voice therapy sessions, up to an hour long each, with 1-4 weeks between them. This also matched with what participants wanted.
- Just over half were satisfied with therapy, their modified voice and felt they had achieved a feminine sounding voice- the primary goal for 94% of respondents.
- However, only 25 % felt their therapy ended because they had achieved all (or most of) their voice change targets.
- Social transition status effects voice satisfaction (voice satisfaction was lower for those who had made a full social transition).
- The format of the session effects voice satisfaction (74% preferred individual sessions. 7% were unsure and 12% preferred a mix of individual and group sessions).
There were limitations to the study not least that only 15% of respondents had experience of group voice work. In my 22 years of practice I’ve seen that the majority of trans women, still by far the largest group presenting for speech and language therapy, have high vocal hopes and expectations . As reflected in our study, which included responses from clients from all regions of England, the majority are seeking a ‘somewhat to very female voice’ outcome by the end of therapy. (Goals for non-binary or gender non- confirming individuals are often different. A gender neutral voice may be the goal in these cases and generally easier to achieve).
In my 22 years of practice I’ve seen that the majority of trans women, still by far the largest group presenting for speech and language therapy, have high vocal hopes and expectations . As reflected in our study, which included responses from clients from all regions of England, the majority are seeking a ‘somewhat to very female voice’ outcome by the end of therapy.
Part of what drives me to achieve outcomes that clients are happy with is the value I place on what clients say would enhance their social functioning. We hope a lot more work will be done involving trans individuals themselves and that therapists and services continue to listen.
Part of what drives me to achieve outcomes that clients are happy with is the value I place on what clients say would enhance their social functioning.
The findings of our research indicate the value clients place on having individual voice sessions. In The Antoni Method of Voice feminisation, individual sessions and some degree of self practice are the crucial starting point to gaining voice skills and confidence. However, group sessions which follow individual sessions can offer invaluable benefits to many clients.
One of the points I was able to make to the EPATH audience was the level of social support included in my programme of voice feminisation. In many cases, it forms around 50 % of my work with each client. The long term goals of helping individuals become more empowered and sufficiently confident and self-supporting is an ever present feature of much of my work because it’s linked very closely to successful voice outcomes. Interactions with others are key to social functioning and in groups focusing on Voice and communication, individuals can often make great strides forward with long standing social anxiety issues.
Interactions with others are key to social functioning and in groups focusing on Voice and communication, individuals can often make great strides forward with long standing social anxiety issues.