Voice Modification for People in the Transgender Community

The Department of Communication Sciences and Disorders of The College of Saint Rose in Albany, N.Y., offers a voice modification program for individuals in the transgender community, focusing on enhancing communication for male-to-female (MTF) transsexuals. Those who are female-to-male are also welcome to take part in individual therapy sessions in our clinical facility. The program was initiated in October 2007 in response to a local mental health counselor who requested voice therapy for two of her clients. At that time there were no formal voice services for this clinical population in this region. Jack Pickering, Ph.D., CCC-SLP and Daniel Kayajian, M.S., CCC-SLP direct the program and provide clinical supervision.

Program Structure

The program’s structure includes weekly two-hour sessions that involve both group and individual intervention. Student clinicians team up with clients to complete several activities during each session. Sessions begin with discussion of participants’ positive and negative communication interactions and their future vocal needs. Clients have the opportunity to share their experiences in a safe environment, with student clinicians acting as reflective listeners and supportive communication partners.

The initial discussion is followed by vocal warm-up and exercise, including the application of vocal function exercises to increase vocal strength and flexibility (Stemple, Glaze, & Klaben, 2000). Exercise is a prerequisite to voice modification, as building strength and flexibility will increase the likelihood of success and reduce the chance of vocal stress and strain. Next, clients complete vocal skills activities that address each client’s individual needs. These activities focus on modifying voice quality, pitch, inflection, loudness, resonance, and/or other characteristics that facilitate the perception of female voice. The small but growing list of resources on transgender voice is used to guide the development and implementation of these activities (e.g., Adler, R. K., Hirsch, S., & Mordaunt, M., 2006; Carew, L., Dacakis, G., & Oates, J., 2007, Gallena, S.K., 2007; Gorham-Rowan, M & Morris, R., 2006; and Stemple, J.C., 2000).

Typically, broader aspects of language and communication are emphasized next, with attention to linguistic differences between men and women, the use of nonverbal communication, and the influence of physical appearance on gender perception. Our clients have also suggested that we attend to behaviors such as coughing, sneezing, and throat-clearing, because these often affect listener perception of gender (Adler, Hirsch, & Mordaunt, 2006). In order to focus on connected speech, clients recite movie monologues that serve as a connected speech context; these videotaped monologues are used to evaluate each client’s application of communication skills. The monologues provide an opportunity for student clinicians to serve as coaches; clinicians and clients are encouraged to provide supportive, critical feedback on the monologues. During the last 10 minutes of each session, we discuss the strengths and weaknesses of the session and make a plan for the next meeting.

Among the activities incorporated into the program is an ongoing project in which clients and student clinicians collaborate to develop and implement classroom presentations to raise awareness of the transgender experience (e.g., societal perceptions of transsexuals, the challenges inherent in transitioning from male to female, and the important distinction between gender identity and sexual orientation). The presentations are discussed and planned as part of each session, providing a context for generalizing skills learned during the intervention process. The choice of project was a collaborative decision among clients and student clinicians, who suggested that presentations to clinical and mental health college classes would provide a context for practicing voice and increase awareness about the important issues of people in the transgender community.

Planning classroom presentations is a structured part of each session. Presentation scheduling is completed first. Matching client schedules with classroom presentations is a functional challenge negotiated between student clinicians and clients. Clients who are unable to present during a class period can still take part in the preparation and rehearsal. Once clients are scheduled, classroom presentations (including introductions) are scripted. The women in the voice modification program rehearse their introductions, questions, and responses over several sessions; the result is a series of connected speech samples, some of which are videotaped. Student clinicians evaluate voice during the session and in the videotaped samples, and they provide supportive feedback relative to individual client needs. When the clients go into a classroom, they introduce themselves, respond to scripted questions, and then respond to spontaneous questions from the audience. We collect audience feedback at the end of each presentation.