Working with Telehealth

Have you found yourself shouting at your screen during video calls ?

Many of us have now got used to working or socialising using video conferencing tools such as Zoom. Like when using the phone, you may find yourself raising your habitual vocal loudness, or pushing your voice and body more to try to reach out to the person you are conversing with. I’ve done this myself, and I have to remind myself to lower the vocal effort and loudness.

You should also be aware of the way your back and neck are aligned when talking. Make sure your screen is eye height and you are sitting comfortably and not sticking your neck out (like a turtle). Think ‘up’ and let go of any tension you may notice creep into your neck, throat or upper body. Keep you feet on the ground or supported well by a kneeling chair. Try to take regular talking breaks online to rest your voice. You may also find that doing some head and neck stretches and rolling your shoulders around regularly throughout the day will help.

Remember that the voice reflects the equilibrium of your mind and body. If you are noticing vocal strain, discomfort or fatigue, work out what you are doing that is pushing your voice too much and what you can do to rebalance.

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Compassion and Shame

“Ooh, what will others think of my body in this bikini??!”

Unlike other mammals, humans have ‘tricky’ minds.  Our newer ‘thinking mind’ (pre-frontal cortex), has the ability to ruminate, plan, self-monitor and imagine. It has the tendency to beat us up about not feeling good enough, fluent enough, sounding male or female enough, speaking clearly enough, hitting the top notes easily enough… The ‘not enough’ problem…

These sorts of critical thoughts come round again and again and can lead to anger, anxiety, worry or shame, resulting in avoiding talking, talking less, avoiding situations and not going for what is important in life.

Chilli, my cat on holiday in the picture (kindly drawn by my 11 year-old son), shares the older reptilian part of his brain with us: the amygdala and limbic system. This part of our mind ensures that we keep ourselves safe and procreating: avoiding harm, seeking food, care, status and sex.  It is the seat of our emotions: sadness, anger, anxiety and happiness.  It catalyses us into fleeing from danger, to fight or seek comfort.   It has evolved to keep our species alive very successfully.

Humans have evolved to possess a very high functioning, but extremely ‘tricky’ mind.  Our brain makes us feel, do and think in ways that are sometimes costly to our emotional and physical wellbeing.  We can’t help how our mind has evolved. We cannot change our inherited genetics, and we cannot change where and when we were born, nor who we were brought up by and surrounded with in our childhood.  Try this thought experiment: imagine how you would be today as a person if you were brought up by your next-door neighbours, or the mafia.

The science of the human mind means that there is a lot that is not our fault about the way we think, feel and behave. However, there are ways to alleviate suffering and move towards a preferred, richer life.  To talk, speak and communicate more easily wherever and whenever you want.

One way is through Compassion.  Compassion as defined by the researcher and Clinical Psychologist Paul Gilbert, at the Compassionate Mind Foundation, is “a sensitivity to the suffering of self and others (and its causes) with a commitment to try to relieve it and prevent it”. This requires courage, strength and wisdom. Compassion Focused Therapy is an evolutionary, attachment based therapy approach developed by the team at the Compassionate Mind Foundation. Its aim is to help develop less shameful and critical thinking, feelings or behaviours.

Therapy includes:

• Psychoeducation – Why do we have such ‘tricky minds’ and how does my ‘tricky mind’ make me feel and behave the way I do
• Soothing breathing rhythm – to physiologically bring your parasympathetic calming nervous system on line.
• Imagery work and compassionate letter writing – to develop a compassionate self
• Reasoning skills training – to explore the critical and shameful thoughts we have
• Behaviour change – Experimenting with your behaviour and trying out new things
• Developing attention and exploring feelings and sensations.

I have trained with the Compassionate Mind Foundation and I can explore the therapy techniques with you to develop a strong, wise and compassionate self to feel more confidence communicating. 

 

Authenticity

Art by Karina Kaye.  She says “My work explores how visual art can act as a visual distraction from pain”

 

We want to be who we are. We want to be our authentic selves.  Who owns the definition of ‘authenticity’ can get tangled up in the pressures that bear down on us consciously or unconsciously. We want to sound like ‘ourselves’.  For some people, particularly those I work with at the London Gender Identity Clinic, are on a journey from a very known and familiar place to an unknown and unfamiliar place (Michael White).  Many of the trans women want to expand their voices out to sound more feminine and to express in their voices what they have always felt like on the inside.  They may struggle with the stereotypes of what a woman should sound like and judge themselves harshly on this, or feel fear or shame. Others are very accepting of their voice and are not afraid to communicate with whatever their voice sounds like.  The dysphoria regarding the voice can be intense and painful.

I endeavour to support my clients to move towards a more comfortable place in themselves about how they sound, both through vocal exploration and emotional support.  The key to this is to not fall into the heterocisnormative judgement of what the voice must be like.

The aim is to guide my clients to feel compassion towards their voices, to go on a journey of discovery and find their authentic voice. This is what true freedom to express oneself from the inside out is all about.

Protecting your voice

Your voice is physical.  If you work it too hard or use it in an inefficient way, it can go wrong.  Singers like Adele often lose their voice and the Guardian reported some time ago on the reasons  Why singers keep losing their voice and ways to manage it.

The larynx is made up of 27 muscles, cartilages, nerves and mucosa.  Speech-breathing, or singing-breathing patterns need to be efficient. The resonating chambers and filter system of the throat, mouth and nose need to be free to move efficiently to allow for the beauty of the spoken and singing voice to occur

Professional voice users are often asked to do too much with their voice.   If a system has too much to deal with it breaks down.

Here are some simple tips:

1. Listen to your voice – if it is tired rest it
2. If you have laryngitis avoid singing until you have recovered
3. Make sure you are well hydrated as the larynx needs to be well lubricated to work well
4. Try not to shout or scream excessively or with too much tension
5. Keep fit and well rested
6. Avoid singing loudly at a very high pitch
7. If there is stress or conflict in your life, find ways to resolve this as it may be contributing to your voice problem.
8. Avoid talking for any length of time against background noise
9. Find ways to reduce excessive throat clearing or coughing as this may cause injury to the vocal folds (cords)
10. Finally, work with a speech and language therapist and/or singing teacher to find efficient ways of using your voice for speaking and/or singing.

Learning a new skill

Changing the way you talk or use your voice doesn’t have to take that long

It has been said that it takes 10,000 hours to learn a new skill. This is not true.  It may take that long to be the top of your field in highly competitive areas, such as sport, music, computing, writing and so on.  But how long does it really take to change the way you physically do something, or learn a completely new skill?

This TED talk  by Josh Kaufman explains that Learning a new skill doesn’t take that long

According to his research it takes about 20 hours and not 10,000 (the equivalent of working full time for five years)

The essentials are:

1. Break down the task into the component parts

2 Learn to  self-correct

3. Remove barriers to the practice

4. Practice

What stops you learning is more emotional than intellectual or practical.  If you believe you can do something new,  you can do it. If you break it down into small component parts and build them up, you can do it.   If you start to notice what you are doing and make slight alterations, you can do it.  If you make opportunities and take away distractors, you can do it. If you practice it repetitively, you can do it.

Josh Kaufman’s ideas are not that different from the way I work with my clients to  help them make changes to the way they use their voice or their speech.   A very useful model that I use to help make changes to behaviour was developed by the team at  UCL Centre for Behaviour Change

Motor learning Theory, is also a very helpful model to help me teach my clients how to acquire a new physical skill.   This involves:  modelling and copying, self-monitoring, focusing on the outcome and not the process, feeding back on the positive outcomes, lots of practice!

 

 

Voice Disorders

Many do not realise what the voice is or what can go wrong with it.   The medical term for a voice disorder is dysphonia

Voice disorders are usually caused by something wrong in the  voice box (larynx) and/or   a problem in the respiratory system (lungs and windpipe), or the spaces above the voice box, such as the tongue, mouth, soft palate, nose or pharynx.

The Larynx (voice box)

Voice disorders may be due to an organic or structural problem in the voice box,  or may be caused by the the way the muscles are used to produce the voice. Some are born with abnormalities to the voice box, or they may be acquired at any stage in life.  There may be discomfort in the vocal tract accompanying the voice disorder.  Sometimes voice problems are caused by underlying stresses or emotional imbalances which are expressed through the voice.

The best way to realise what is wrong with the voice is to have it examined.  This can be done when awake (fibre-optic nasoendoscopy) or when asleep (microlayrngobroncoscopy). This is usually done by an ENT specialist.

Some people require surgery to improve the voice, others need medication and many usually need voice therapy from a qualified Speech and Language Therapist specialising in voice disorders.   Surgery is not normally recommended for young children unless they  have a life-threatening disorder or is required to manage the airway.  This is because the vocal folds in young children are still developing and surgery may result in long-term scarring affecting vocal function.

 

Speech Management for People who Stammer (PWS)

Greater fluency is one of the goals for PWS.  Being able to communicate effectively and comfortably is something we all want.  Whilst it may be difficult to be 100% fluent  all of the time(no one is), it helps if the speech is less of a struggle.

The first thing to understand in the journey of discovery, is what stammering actually is and what you do when you stammer.  It is also important to understand the thoughts, feelings and reactions to stammering, as this has a physical imprint on our speech and may prevent you from living a full and meaningful life.

Physical approaches to manage speech are varied, packaged up in various ways and ‘sold’ on different courses.  What is important to understand is that the brain of a PWS is wired in a different way, so no matter what ‘technique’ is used, it takes a lot of conscious control to change the speaking pattern all of the time.  Changing the way a PWS speaks also interferes with the way language and speech flow in conversation.  Whatever, approach you choose to take, it is important to try it for short periods of time, to build up using it in different situations and with different people. You will need to ‘toughen yourself up’ in the process, so that if it doesn’t always ‘work’ you are kind and compassionate to yourself.

Breathing should be free and easy. It should be well timed with phonation (voice).  This is what often gets interrupted for PWS; the timing of speech at the level of the vocal folds.  This results in tension anywhere in the vocal tract, which often result in tension elsewhere.  Letting go of tension is an important part of the process. Instead of trying to ‘push through’ you should try to ‘let go’. The Valsalva technique is useful to teach this, which I will talk about in a different post.

Block modification is a widely used ‘stammer more fluently’ speech management technique developed by the American, Van Riper.  The speech management section in his whole programme is about breaking habits of tension.  Cancellation, is stopping after the stammered word and saying it again in a smoother, more relaxed way.  In block modification aims to let go of the stammer whilst in the moment of stammering. Pre-block modification manages the approach to saying a word immediately before saying it. All three stages rely on a) noticing and understanding what is happening in that speech  moment b) letting go of tension c) moving forward and going for what you want to say.   The approach goes hand-in-hand with reducing avoidance of  social and communicative situations. It encourages the speaker to live a full and meaningful life and being who they really are.

Other approaches encourage PWS to change their entire speech pattern all of the time. These techniques are known in the trade as ‘speak more fluently’.  The McGuire programme is well-known for this and focuses heavily on breathing methods.

There is also a place for technology – apps and small devices work on altering the way the PWS hears themselves talking, which effects the way the brain plans movement for speech.

Whatever you chose to do on the journey of greater fluency, be patient and kind to yourself.  If something does not work for you, try something different.  If it works some of the time do more of it. Develop a ‘toolkit’ and stay authentically you…

Voice and Communication Therapy for Trans Women

Voice and communication therapy for trans women is a journey of transformation, moving from a familiar place, to a less familiar or well-known place. Therapy is about exploring and experimenting with a different voice, whilst maintaining your authenticity.  This is vital in order to feel confident and comfortable with your voice and communication.

Voice and communication therapy for trans women involves feminisation of the voice.  This includes raising habitual pitch, making the voice lighter, with a more forward focused resonance and altering intonation patterns.  The Speech and Language Therapist ensures you do this whilst maintaining optimal vocal health. You will learn some simple exercises to practise regularly between sessions.  Therapy will help you find ways to try out using the voice in different contexts.   It provides you with vocal choices and a supporting guide through this part of your journey.

What is voice therapy?

Voice therapy is treatment for a voice disorder.  We will explore what has predisposed you or your child to a voice problem, what precipitated it and what is maintaining it.

Before therapy begins, you should ensure that the voice box (larynx) is examined by an ENT doctor.  Once you have a diagnosis, therapy can begin!

Therapy may involve making changes to your life style, such as what you eat and drink, how much you rest.   Your voice  is often a reflection of stresses or pressures in your life.  Therapy can address anything that is out of balance that may be affecting your voice. You will have the opportunity to tell your ‘story’ and together we will find a way to bring balance to your life and voice.

Direct voice therapy may  involve making adjustments to the way you use your voice: – how you use your breath, the muscles in and around the larynx and other muscles in your jaw, tongue, face and head and neck.  You may also need to adjust your posture.   You will find a way to practise these exercises between sessions in a meaningful and easy-to-do way, so that you quickly start to notice a difference to the way your voice sounds and feels.

By the end of your first session, you will have had the opportunity to tell your ‘voice story’, assessed the voice, filled out some questionnaires, tried out some voice therapy exercises and identified what you want to work towards in simple, manageable steps.

Some people require surgery to manage the voice condition, or need to take medication to help the health of the larynx.  If you require surgery you will learn what to do before and after surgery to help your way to vocal recovery.

 

Please get in touch for more information or advice.

Paediatric Voice Problems

Children are at risk of developing voice difficulties as their vocal folds (cords) are not fully formed until they are 16 year’s old.  The most common voice complaint is muscle tension dysphonia with lesions (vocal fold nodules).  Children may have more complex voice difficulties as a result of other medical conditions.

A child needs to be able to express themselves freely for all vocal tasks.  The voice should be free and feel comfortable.   Children often find it more difficult to self-regulate than adults and may shout and scream more than adults and use their voice forcefully to express their emotions rather than words in calmer conversation.

Children may also have a high vocal load in the primary school years when their vocal folds are still developing, such as singing and acting and sports that use the voice forcefully.  Other children may put themselves under pressure to perform well and the anxiety and stress in their lives may be reflected in their voice.

Voice therapy for children who need to adjust how they use their voice involves understanding what the voice is, how they should use it so that the voice is free and comfortable.  Regular practice  of new vocal patterns, using a gentle, efficient voice across a wide range of contexts and  addressing any psychosocial difficulties affecting the voice usually resolves the voice difficulties.  Therapy needs to be systemic, involving the family and school to support the child.

Therapy is made to be fun and meaningful for the child and takes into account the child and family’s life-style.  Please contact the Voice and Communication Clinic if you would like to find out more.