Welcome to Voice and Communication Therapy at Indigo Gender Service (Indigo)

We are a team of speech and language therapists working with trans and non-binary people to explore your authentic voice. We are looking forward to working with you

Our specialist speech and language therapy team will guide you as you make changes in a way that does not put your voice at risk.  They  can offer advice, voice assessment and specialist intervention to achieve and maintain a voice that matches your authentic self.      

The speech and language therapists (SLTs) are members of the Royal College of Speech and Language Therapists (RCSLT) and registered with the Health and Care Professions Council (HCPC). Our specialist SLTs are also members of the RCSLT Trans and Gender-Diverse Clinical Excellence Network.    

What is Voice and Communication Therapy?

Voice and Communication Therapy is a form of specialist speech and language therapy. Our therapists support you to achieve your authentic voice – a voice that aligns with you!

Voice and communication therapy is  a range of breathing and vocal techniques. The therapy doesn’t involve surgery or any invasive procedures. Exercises are designed to enhance how you use your voice.     

The team will help you find a voice and communication style that is uniquely your own.

Is Voice and Communication Therapy for me?

Accessing Voice and Communication Therapy is your choice, it’s not something that you must do.

• If you don’t want to change your voice, then you don’t need to access Voice and Communication Therapy. It’s important to recognise that you don’t need to change your voice to suit other people or to fit in with ideas of how people should sound.
• If your voice causes you to feel uncomfortable or dysphoric, or you would just like to explore aspects of your voice, then Voice and Communication Therapy might be for you.
• If you would like Voice and Communication Therapy in the future but need other support, you might like to ask for a referral at a later date. We understand that you might have lots of appointments with Indigo. To get the most from Voice and Communication Therapy you should attend when you can commit to all the appointments and home practice.

How is our therapy delivered?

Voice and Communication Therapy starts with an initial one-to-one appointment that lasts around an hour.

Following this, we will invite you to attend group sessions, which consist of six two-hour sessions. It is important you attend all six sessions.

After group sessions, we will have a one-to-one outcome appointment that lasts about 45 minutes.

During appointments and therapy, we will work with you on one or more of the following areas:

•  Pitch - how high or low your voice is
• Intonation – the tune of a spoken sentence
• Resonance – vibrations mainly in the head or chest that add authenticity
• Volume or loudness when speaking or projecting the voice
• Articulation – how speech sounds are made
• Language use, such as using direct or inclusive sentence styles
• Body language and facial expressions, such as smile talk, seating, gait and gesture.

The aspects of voice and communication you choose to change are up to you. The team will provide you with home practice to firmly establish these techniques.  

How do I access Voice and Communication Therapy?

I am already a service user being seen by Indigo Gender Service:
You can request to be referred to Voice and Communication Therapy after you have received a diagnosis of Gender Incongruence by the team. Please note that there is currently a waiting list to access Voice and Communication Therapy.

I am not an Indigo Service User:
It is important to ensure you are following safe techniques when undergoing voice therapy. There is a lot of information on the internet from non-certified YouTube videos or forums which detail unsafe techniques and can lead to permanent damage to the voice. 

The VCT team would always recommend being seen by a specialist speech and language therapist to ensure correct voice evaluation prior to therapy has been undertaken and the correct advice and techniques are followed. Most people will achieve better outcomes with the support of a speech and language therapist. 

Access to Speech and Language Therapy through a Gender Identity Clinic (GIC) can be requested alone. Therefore, if you are a trans or non-binary person you could ask for a referral to a GIC for just VCT and nothing else. This would ensure free access to specialist voice and communication therapy. Thus, we would strongly recommend this route.  

However, we recognise there are long wait lists and not everybody feels they can wait to be seen by a Voice and Communication Therapy Team. This information has been provided as signposting only. We cannot recommend any clinical advice if you have not been seen for an evaluation of your voice.

Please note that vocal misuse, and exploring voice exercises on a voice that is damaged, can lead to permanent long-term damage to your voice.

• ‘The Voice Book for Trans and Non-Binary People: A Practical Guide to Creating and Sustaining Authentic Voice and Communication’ by Matthew Mills and Gill Stoneham (2017). This is a practical guide designed for people wanting to use their authentic voice. With the purchase of this book, you will also gain access to videos led by clinicians.  We use some of these examples in our own therapy groups.
  
  Reference: Mills, M., & Stoneham, G. (2017). The voice book for trans and non-binary people: a practical guide to creating and sustaining authentic voice and communication. Jessica Kingsley Publishers.

• Videos about Voice and Communication Therapy from Indigo’s Consultant Speech and Language Therapist, Dr Sean Pert (He/Him) can be found here: 

• You can also access an independent speech and language therapist. We do understand that this is dependent on personal funds to access independent therapy, which is not always possible for everybody. I would strongly recommend a referral to speech and language therapists through a GIC, which would be free at the point of access for service users. Indigo Voice and Communication Therapy team has no affiliation with independent speech and language therapists and cannot provide any recommendations or take responsibility for a person accessing independent Speech and Language Therapy. This link provides details for independent Speech and Language Therapists.  https://asltip.com/find-a-speech-therapist/ 

• You can request your GP to refer you  to your local NHS adult speech and language therapy voice service. It’s worth noting that referrals are not always successful through this route. 
   

How does Indigo VCT deliver voice and communication therapy sessions?

All our therapy sessions are delivered with groups of trans and non-binary people. This is so you can explore your voice in real-life conversations and explore your voice with the support of other trans and non-binary people.

You can choose online therapy sessions OR in-person therapy sessions. You will have SIX, two-hour, weekly therapy sessions.  We are currently offering evening therapy sessions 5pm-7pm and afternoon therapy sessions 1pm-3pm.

I think I have a voice disorder, can I still access Voice and Communication Therapy?
If you experience problems with your voice, which could include, but is not limited to hoarseness, roughness, Strain, and pain using your voice. You must speak to your GP. Your GP may recommend a referral to Ear, Nose and Throat (ENT) services. Speech and Language Therapists cannot start voice therapy until the ENT specialist has checked that your voice is ready.

If I have problems with my voice, why must I be seen by ENT before starting VCT?

In VCT you will use your voice more. You will also be using your voice in different ways. This is very demanding for your voice. It is important that your voice is ready to start voice therapy. Speech and Language Therapists cannot start voice therapy until the ENT specialist has checked that your voice is ready.

Reasons for an ENT referral may include:

• Frequent throat clearing, acid reflux (heartburn), smoking, and/or pain when using your voice.
• Hearing roughness, breathiness, strain, or weakness in your voice.
• Hearing a different voice quality.
• Computerised voice evaluation showing a possible problem with your voice (voice disorder).

Speech and Language Therapists are bound by professional clinical guidelines issued by The Royal College of Speech and Language Therapists (RCSLT), and The Health and Care Professions Council (HCPC).

RCSLT state: Dysphonia or aphonia can arise as a symptom of a number of conditions, including voice disorders, head and neck cancer, and neurological conditions. It is therefore important that the individual is thoroughly assessed by a physician (such as a GP or ENT Doctor) and screened for other symptoms prior to undergoing voice therapy.

Appropriate investigations should be undertaken in accordance with the relevant pathway, for example, referral to ENT on the suspected cancer two-week wait pathway (see NICE guidelines on referrals) or referral to a Neurologist.

In keeping with the Ear, Nose and Throat Clinical Guidelines: Hoarseness (Dysphonia) (Stachter et al., 2018), individuals with hoarseness lasting for greater than three weeks should be referred to a specialist (e.g., ENT Doctor) for investigation of the cause.” (RCSLT, 2023).

Reference

Royal College of Speech and Language Therapists (2023). Clinical Guidelines: Voice – Guidance. London: RCSLT. https://www.rcslt.org/members/clinical-guidance/voice/voice-guidance/ Accessed 10/10/2023.