Expanding the evidence: Developments and innovations in clinical practice, training and competency within voice and communication therapy for trans and gender diverse people

Abstract

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 in which evidence is expanding.\ud \ud 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.\ud \ud Method: Data were drawn from three small-scale projects, two surveys, and one audit.\ud \ud Measurements: Data from survey and audits and pre- and post-group acoustic measures of and client self-perceptual measures, including the Transsexual Voice Questionnaire (TVQMtF); a client-generated set of questions for trans men; and the migration of vocal identity map, adapted from Narrative Therapy practices.\ud \ud 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.\ud \ud 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

Toward a Protocol for Transmasculine Voice: A Service Evaluation of the Voice and Communication Therapy Group Program, Including Long-Term Follow-Up for Trans Men at the London Gender Identity Clinic

“…Transmasculine people's vocal identities are beginning to be understood within and beyond a desire to achieve an unequivocal masculine end-result in binary cisnormative terms. 20,21 Tackling the social invisibility of this population and creating opportunities for transmasculine people to discover personal vocal and communicative authenticity are paramount. 15,16,22…”

“…Voice and communication interventions applied to transmasculine people are beginning to be tested. 16,21,22 Azul et al 18 state that more research is needed exploring the parameters of functional voice production and communication skills relevant to transmasculine people, placing participants' self-evaluation at the forefront of the enquiry. Mills et al 21 report early stages of developing a voice and communication protocol for transmasculine people through a pilot and follow-up voice group program.…”

“…Azul's factors 1 above formed a useful framework for program content that addressed vocal dynamics 21–23 as part of presence and personal impact, 24 and took account of the perception of others (Table 1). Client input on what was considered most useful in voice therapy was central to producing a practical guide for trans and nonbinary people, including transmasculine voice.…”

“…Client input on what was considered most useful in voice therapy was central to producing a practical guide for trans and nonbinary people, including transmasculine voice. 17 In addition, studies using approaches that are solution focused, 25 mindful, 26 systematic, 27 narrative, 28 and compassion focused 29 further informed interventions in vocal dynamics (pitch, resonance, loudness, intonation, voice quality) 17,23,30,31 and social communication (public speaking, projection, assertiveness, nonverbal signals, presence) 17,21,22,24 offered in group contexts. 16,17,21,32 Group therapy programs have been reported as effective for transfeminine and transmasculine people because group cohesion, commonality of experience, shared learning, feedback, and witnessing, all act as a catalyst for voice and communication change.…”

“…16,17,21,32 Group therapy programs have been reported as effective for transfeminine and transmasculine people because group cohesion, commonality of experience, shared learning, feedback, and witnessing, all act as a catalyst for voice and communication change. 17,21,22,32…”