How a change in voice can changes lives
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Story

How a change in voice can changes lives

20th Aug 2021
How a change in voice can changes lives
Speech pathologist Vanessa Murray helps her clients to develop characteristics of voice that align with their gender identity.

Vanessa Murray is a speech pathologist based in inner Melbourne who supports trans, gender diverse, and non-binary (TGDNB) people using an individualised program of voice and communication training. In honour of Speech Pathology week, we interviewed her about how she helps her clients develop a communication style congruent with their gender identity and why more speech pathologists need to offer respectful and accessible healthcare to the LGBTIQA+ community.

As a speech pathologist, how do you approach this specific kind of voice and communication training?

It’s a tailored program that is delivered by Speech Pathologists to TGDNB people who are looking to alter their vocal presentation and communication style so that it’s congruent with their gender identity. Its foundation is in traditional voice therapy and it is guided by standards of care as outlined by the World Professional Association of Transgender Health (WPATH). The overarching goal is to assist clients in obtaining their goals safely, passionately, and with authenticity.

Is it dangerous for TGDNB people to try to alter their voices without professional intervention?

Some people might feel that downloading apps or jumping online to look at YouTube videos is a good way to start. While there is certainly some merit to these methods, there is no online feedback on the strategies they try. Clients can develop vocal strain because they haven’t got the foundations of voice therapy to help support their voice.

What techniques do you use?

While each person is different, there are some fundamentals that we should consider for each person as they embark on this journey. I like to start with mindful breathing because it helps to foster a healthy relationship with breath. My clients often find it very calming and breath is strongly connected with voice production. From there, we ensure vocal strength and flexibility and rule out any underlying vocal pathologies, disorders, or even misuse. Clients may have tried to increase their pitch without doing vocal warm-ups or without knowing how to do that safely. We can assist people to develop characteristics of voice like pitch, resonance, or intonation, and we can also address non-verbal communication such as posture and facial expression. We can even look at gait and how people move through space.

Why is it important for TGDNB people to have the option to start their voice work earlier in the transition process?

I firstly think about gender dysphoria, which is quite a difficult term to define given that it is different for each person who experiences it. The main underlying feature is extreme distress or discomfort when consistently not being recognized for the gender you truly are. For some people, voice and communication are the greatest sources of dysphoria so it’s really important to focus on those goals early on in the transition process, sometimes even before commencing gender-affirming hormone therapy or changing gender markers on official documents.

What positive impact do your clients report from participating in voice and communication training?

They report an increase in confidence, social integration, and the freedom to live their lives authentically and safely. Sarah, who is a trans woman I have been working with over the past few months, has overcome a number of barriers not least of all navigating her social and employment-based transition during a global pandemic. This has meant a decrease in face-to-face interactions and an increase in group calls and teleconferencing both with and without video. Without the video, we lose a lot of those visual cues including presentation and facial expression. When I spoke with Sarah the other day, she mentioned that therapy has meant that she has been able to make significant changes to her voice, that she is misgendered much less often, and has much more confidence in work and social settings.

How can we encourage more speech pathologists to offer these services to the TGDNB community?

As trans visibility is increasing in the community, we are seeing more and more people offering these services. However, we still have huge waiting lists all around Melbourne and we actively want to encourage other speech pathologists to embark on this journey. My colleagues from La Trobe University and the Royal Children’s Hospital have put together a series of modules to encourage speech pathologists to embark on training so that they can offer these services. There is also a working group that was established in 2015 called Gender Identity and Voice where we collaboratively look at ways to support speech pathologists who are working in this area.

Is the program government-subsidized and widely accessible?

It is only indirectly subsidized by the government. There is a really popular and successful TGDNB clinic at a student-led clinic overseen by La Trobe University that is able to offer the program at a low cost. For clinics preferred by the Monash Gender Clinic, sessions are offered at no cost. While the majority of speech pathology services are private, rebates are available through team care arrangements in consultation with a client’s General Practitioner.

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