Hopefully the least scary thing to happen to you this Halloween season is getting a voice client on your caseload. (You think, I had a class on voice disorders once…maybe? You pull out your voice resources. Ew–that’s what the vocal folds look like? Ew–that’s what a vocal fold lesion looks like? Those are TEP’s? Yikes. I’ll stick with my articulation and language clients thank you very much.)
I hear from clinicians all the time, in person and on the web, that they are frightened to even attempt providing therapy to a voice client. Even with all the wonderful new technology and apps available, is it really as bad as walking through a haunted house while clowns lunge towards you?
Taking a step back, I remember that every person with a CCC-SLP trailing his or her signature was not thrust into this profession in the same way I was. I already knew a thing or two (or so I thought) about the voice and was ready to begin my college career as a singer. Alas, this was not in the stars for me as I had a vocal cyst requiring voice therapy and surgical removal. There was no way I was catching up to my same-aged peers with vocal performance degree aspirations to graduate on time. My voice teacher sat me down (I think I may have actually been standing in a voice lesson) and told me the words that would (for the next few years at least) be as frightening as that haunted house clown…”You have to find a new career path.” I was shocked, hurt and lost.
After lifting my chin and changing majors, I decided I wanted to help others in the same situation as me. I would use my vocal upbringing, my musical skills and my unique perspective to become a go-to voice clinician. It wasn’t until graduate school that I actually began to understand how my vocal mechanism worked. I studied video after picture after diagram of the larynx, its muscles, and the vocal folds. Slowly, and after 2 years of singing rehabilitation, I began to learn to love singing again and I now am thankful for that seemingly harsh (but necessary) redirection. My dream had changed, but I became a better performer because of it.
Treating clients suffering from voice disorders requires just as much creativity as treating any language or articulation disorder. It requires out-of-the-box thinking when a particular technique doesn’t work. Which brings me to my first reason voice therapy is not so scary.
REASON NUMBER 1: You are allowed to change your strategy mid-session. I change techniques all the time when I sense the client is frustrated or if the client is unable to achieve a target sound production after a good amount of trying. This is a learned skill and requires humility. I learned this lesson the hard way back in school as I prepared a therapy lesson for one of my first few child clients. I spent hours preparing the “perfect” board game on the computer only to get to therapy the next day and the child was bored to tears playing it. Ego-0, Kid-1. But really, if coordinating respiration, phonation and resonance with Stone & Casteel’s Stretch and Flow or Confidential Voice Therapy (techniques that require increased airflow as the main component in unloading the vocal mechanism) is too difficult for the patient, switch to Resonant Voice Therapy (a technique that uses forward-focused feeling and sound to improve subsystem coordination). If it is not working with the patient seated, have the patient stand and bend over into rag-doll. Use a mirror. Use a tissue. Use a hand. Use your IPHONE to record. Any of this feedback could be the ticket to a successful intervention, so here is the second gem.
REASON NUMBER 2: Odd and strange techniques are encouraged. Sometimes, the weirdest one results in a break-through. If you are confident in your techniques, the patient will be too. As I continue to provide voice therapy to patients, they look at me less and less as though I have 3 heads when I ask them to put a straw in their mouths, bend over and hum Yankee-Doodle. This is because I have seen the outcomes and know that the seemingly silly activities I have patients do in session really provide tangible improvement. This confidence is translated in how I present a task. Some say, “Fake it till you make it.” I say fake it, but make sure you know what you’re faking. You are going to have to feel uncomfortable to make yourself great. Just remember to include the 3 main components of voice therapy in your treatment planning: “Improving Vocal Hygiene, Decreasing Phonotrauma, Coordinating Subsystems.” That’s it. Voice disorders seemed so much more complicated at one time, didn’t it? As a community of SLP’s and AuD’s, we support each other with therapy ideas. I witness daily on my social media perusals where a weary SLP is calling an SOS for a difficult case. We help each other out, so here is the final tidbit.
REASON NUMBER 3: Community means community resources. There is never a dumb question on any list-serv or forum I have ever been a part of. I witness graduate students getting answers from seasoned professionals. I once was scared of the “greats,” but they are people just like me and just like you who just want patients and clients to improve. It is humbling to step back and admit you need to “use a lifeline.” I think this is not a sign of weakness, but of strength as a resourceful clinician. If we can expect honest feedback, we can provide the best care, and isn’t that what it’s all about? See, not so scary!
And in lieu of trick-or-treat candy, here are a few resources that are just as yummy:
Improving Vocal Hygiene
- Water Bottle Wrappers from Activity Tailor
- Vocal Hygiene Handout from The Speech Room News
- Build your own larynx from Anatomy UK
- My Voice Tools from a tempo Voice Center
Eliminating Vocal Abuse/Misuse
- Handout for Vocal Abuse from a tempo Voice Center
- Vocal Nodule and Strain Tips from speech-language-therapy dot com
- 4 Ideas to Stop Vocal Abuse from Carla Butorac’s YouTube channel
Coordinating Vocal Subsystems
- For pediatric voice clients from Smart Speech Therapy
- Using Your Best Voice by Moya Andrews (I have a book of hers I use all the time)
- YouTube video on RVT from Rebecca Goldfarb (This provides an informative demonstration, but I would wish the “patient” was giving more buzz and less vocal fry at times.)
Hopefully now you are armed with some new information on the voice. Don’t be afraid to make mistakes and get messy. (Magic School Bus anyone?) Voice therapy is not nearly as scary as that large pile of paperwork on your desk…(That deserves a Halloween costume…)
Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.