Advertisement
Research Article| Volume 37, ISSUE 2, P292.e15-292.e33, March 2023

Download started.

Ok

The Experiences of Trans and Gender Diverse Clients in an Intensive Voice Training Program: A Mixed-Methodological Study

Published:February 02, 2021DOI:https://doi.org/10.1016/j.jvoice.2020.12.033

      Summary

      Intensive schedules in behavioral voice therapy and training have been proposed to have a range of positive benefits including enhanced outcomes, high client and clinician satisfaction, and reduced client attrition. In the sub-field of behavioral voice training for trans and gender diverse clients, intensive schedules may also present a means of increasing service access opportunities for a vulnerable population. Despite the proposed benefits there has been limited research investigating client experiences in intensive voice training programs. The current study utilized a mixed-methodological approach to compare participant experiences in an intensively scheduled (three 45-minute sessions per week, over 4 weeks) versus a traditionally scheduled (one 45-minute session per week, over 12 weeks) voice training program for trans and gender diverse participants aiming to develop a perceptually feminine-sounding voice. Participant experiences were compared using a satisfaction questionnaire delivered to both training groups as well as thematic analysis of semi-structured interviews conducted with participants in the intensive group. Results suggested that individuals in the intensive training program had both positive and negative experiences related to the intensive schedule, but all viewed the program favorably and expressed a preference for intensive training based on their experiences. However, it was also found that overall satisfaction and attrition did not differ significantly between the intensive and traditional training groups and that many factors contributing to participant satisfaction in the intensive program were unrelated to the intensive schedule. Results from the current study also suggest that experiences in intensive programs may be highly variable and mediated by factors such as clients’ individual personalities and preferences. The current study concludes that intensive schedules present a viable alternative to traditional schedules in practice, with additional considerations and directions for future research also discussed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Coleman E
        • Bockting W
        • Botzer M
        • et al.
        Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7.
        Int J Transgenderism. 2011; 13: 165-232https://doi.org/10.1080/15532739.2011.700873
        • Vincent B.
        Introducing trans terminology.
        Transgender Health : A Practitioner's Guide to Binary and Non-Binary Trans Patient Care. Jessica Kingsley Publishers, 2018: 17-38 (Available at:) (Accessed October 6, 2020)
        • Oates J.
        Evidence-based practice in voice training for trans women.
        in: Adler R Hirsch S Pickering J Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide. 3rd ed. Plural Publishing, 2019: 87-103
        • Mills M
        • Stoneham G
        • Georgiadou I.
        Expanding the evidence: developments and innovations in clinical practice, training and competency within voice and communication therapy for trans and gender diverse people.
        Int J Transgenderism. 2017; 18: 328-342https://doi.org/10.1080/15532739.2017.1329049
        • Davies S
        • Papp VG
        • Antoni C
        Voice and communication change for gender nonconforming individuals: giving voice to the person inside.
        Int J Transgenderism. 2015; 16: 117-159https://doi.org/10.1080/15532739.2015.1075931
        • Newman RY
        Gender Euphoria: A New Collection.
        2018
        • Kalra M.
        Voice therapy with a transsexual.
        in: Gemme R Wheeler CC Progress in Sexology: Selected Papers from the Proceedings of the 1976 International Congress of Sexology. Plenum Press, 1977: 77-84
        • Oates J
        • Dacakis G.
        Submission to the Senate Inquiry: Prevalence of Different Types of Speech, Language, and Communication Disorders and Speech Pathology Services in Australia.
        2014 (Available at:) (Accessed October 6, 2020)
        • Antoni C.
        Service delivery and the challenges of providing service to people who are transgender.
        Perspect Voice Voice Disord. 2015; 25: 59-65https://doi.org/10.1044/vvd25.2.59
        • Davies S
        • Goldberg JM.
        Clinical aspects of transgender speech feminization and masculinization.
        Int J Transgenderism. 2006; 9: 167-196https://doi.org/10.1300/J485v09n03_08
        • Baker E.
        Optimal intervention intensity in speech-language pathology: discoveries, challenges, and unchartered territories.
        Int J Speech Lang Pathol. 2012; 14: 478-485https://doi.org/10.3109/17549507.2012.717967
        • Baker E.
        Optimal intervention intensity.
        Int J Speech Lang Pathol. 2012; 14: 401-409https://doi.org/10.3109/17549507.2012.700323
        • De Bodt M
        • Patteeuw T
        • Versele A.
        Temporal variables in voice therapy.
        J Voice. 2015; 29: 611-617https://doi.org/10.1016/j.jvoice.2014.12.001
        • Warren SF
        • Fey ME
        • Yoder PJ.
        Differential treatment intensity research: a missing link to creating optimally effective communication interventions.
        Ment Retard Dev Disabil Res Rev. 2007; 13: 70-77https://doi.org/10.1002/mrdd.20139
        • Quinn S
        • Swain N.
        Efficacy of intensive voice feminisation therapy in a transgender young offender.
        J Commun Disord. 2018; 72: 1-15https://doi.org/10.1016/J.JCOMDIS.2018.02.001
        • Desjardins M
        • Halstead L
        • Cooke M
        • et al.
        A systematic review of voice therapy: what “Effectiveness” really implies.
        J Voice. 2017; 31 (392.e13-392.e32)https://doi.org/10.1016/j.jvoice.2016.10.002
        • Wenke RJ
        • Stabler P
        • Walton C
        • et al.
        Is more intensive better? Client and service provider outcomes for intensive versus standard therapy schedules for functional voice disorders.
        J Voice. 2014; 28 (652.e31-652.e43)https://doi.org/10.1016/j.jvoice.2014.02.005
        • Fu S
        • Theodoros DG
        • Ward EC.
        Intensive versus traditional voice therapy for vocal nodules: perceptual, physiological, acoustic and aerodynamic changes.
        J Voice. 2015; 29 (260.e31-260.e44)https://doi.org/10.1016/j.jvoice.2014.06.005
        • Fu S
        • Theodoros DG
        • Ward EC.
        Long-term effects of an intensive voice treatment for vocal fold nodules.
        Int J Speech Lang Pathol. 2016; 18: 77-88https://doi.org/10.3109/17549507.2015.1081286
        • Mora R
        • Jankowska B
        • Guastini L
        • et al.
        Computerized voice therapy in hypofunctional dysphonia.
        J Otolaryngol Head Neck Surg. 2010; 39: 615-621https://doi.org/10.2310/7070.2010.090209
        • McCabe DJ
        • Titze IR.
        Chant therapy for treating vocal fatigue among public school teachers: a preliminary study.
        Am J Speech Language Pathol. 2002; 11: 356-369https://doi.org/10.1044/1058-0360(2002/040
        • Fu S
        • Theodoros DG
        • Ward EC.
        Delivery of intensive voice therapy for vocal fold nodules via telepractice: a pilot feasibility and efficacy study.
        J Voice. 2015; 29: 696-706https://doi.org/10.1016/j.jvoice.2014.12.003
        • Verdolini-Marston K
        • Burke MK
        • Lessac A
        • et al.
        Preliminary study of two methods of treatment for laryngeal nodules.
        J Voice. 1995; 9: 74-85https://doi.org/10.1016/S0892-1997(05)80225-5
        • Liang FY
        • Yang JS
        • Mei XS
        • et al.
        The vocal aerodynamic change in female patients with muscular tension dysphonia after voice training.
        J Voice. 2014; 28 (393.e7-393.e10)https://doi.org/10.1016/j.jvoice.2013.11.010
        • Lehto L
        • Alku P
        • Bäckström T
        • et al.
        Voice symptoms of call-centre customer service advisers experienced during a work-day and effects of a short vocal training course.
        Logop Phoniatr Vocology. 2005; 30: 14-27https://doi.org/10.1080/14015430510006659
        • Community Affairs References Committee
        Prevalence of Different Types of Speech, Language and Communication Disorders and Speech Pathology Services in Australia..
        2014 (Available at:) (Accessed October 6, 2020)
        • Gunning D
        • Wenke RJ
        • Ward EC
        • et al.
        Clinicians’ perceptions of delivering new models of high intensity aphasia treatment.
        Aphasiology. 2017; 31: 406-426https://doi.org/10.1080/02687038.2016.1236359
        • Wenke RJ
        • Lawrie M
        • Hobson T
        • et al.
        Feasibility and cost analysis of implementing high intensity aphasia clinics within a sub-acute setting.
        Int J Speech Lang Pathol. 2014; 16: 250-259https://doi.org/10.3109/17549507.2014.887777
        • Patel RR
        • Bless DM
        • Thibeault SL.
        Boot camp: a novel intensive approach to voice therapy.
        J Voice. 2011; 25: 562-569https://doi.org/10.1016/j.jvoice.2010.01.010
        • Dacakis G.
        Assessment and goal setting: revisited.
        in: Adler RK Sandy H Mordaunt M Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide. 2nd ed. Plural Publishing, 2012: 111-138
        • Creswell JW.
        A Concise Introduction to Mixed Methods Research.
        Sage, 2014
        • Pawson R.
        Evidence-Based Policy: A Realist Perspective.
        SAGE Publications, 2008
        • Maxwell JA
        • Mittapalli K.
        Realism as a stance for mixed methods research.
        in: Tashakkori A Teddlie C SAGE Handbook of Mixed Methods in Social and Behavioural Research. SAGE Publications Ltd, 2010: 145-168
        • Shannon-Baker P.
        Making paradigms meaningful in mixed methods research.
        J Mix Methods Res. 2016; 10: 319-334https://doi.org/10.1177/1558689815575861
        • Creswell JW
        • Plano Clark VL
        Designing and Conducting Mixed Methods Research.
        2nd ed. Sage, 2011
        • Porter S
        • O'Halloran P.
        The use and limitation of realistic evaluation as a tool for evidence-based practice: a critical realist perspective.
        Nurs Inq. 2012; 19: 18-28https://doi.org/10.1111/j.1440-1800.2011.00551.x
        • Braun V
        • Clarke V.
        Reflecting on reflexive thematic analysis.
        Qual Res Sport Exerc Heal. 2019; 11: 589-597https://doi.org/10.1080/2159676X.2019.1628806
        • Braun V
        • Clarke V
        (Mis)conceptualising themes, thematic analysis, and other problems with Fugard and Potts’ (2015) sample-size tool for thematic analysis.
        Int J Soc Res Methodol. 2016; 19: 739-743https://doi.org/10.1080/13645579.2016.1195588
        • Braun V
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101https://doi.org/10.1191/1478088706qp063oa
        • Corbin J
        • Strauss AL
        Basics of Qualitative Research.
        3rd ed. Sage, 2008
        • Clarke V
        • Braun V.
        Thematic analysis.
        J Posit Psychol. 2017; 12: 297-298https://doi.org/10.1080/17439760.2016.1262613
        • Creswell JW.
        Research Design: Qualitative, Quantitative, and Mixed Methods Approaches.
        Sage, 2008
        • Fereday J
        • Muir-Cochrane E.
        Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development.
        Int J Qual Methods. 2006; 5: 80-92https://doi.org/10.1177/160940690600500107
        • Leung Y
        • Oates J
        • Chan SP.
        Voice, articulation and prosody contribute to listener perceptions of speaker gender: a systematic review and meta-analysis.
        J Speech Lang Hear Res. 2018; 61: 266-297https://doi.org/10.1044/2017_JSLHR-S-17-0067
        • Fiani CN
        • Han HJ.
        Navigating identity: experiences of binary and non-binary transgender and gender non-conforming (TGNC) adults.
        Int J Transgenderism. 2019; 20: 181-194https://doi.org/10.1080/15532739.2018.1426074
        • Vincent B.
        Breaking down barriers and binaries in trans healthcare: the validation of non-binary people.
        Int J Transgenderism. 2019; 20: 132-137https://doi.org/10.1080/15532739.2018.1534075
        • Azul D
        • Hancock AB.
        Who or what has the capacity to influence voice production? Development of a transdisciplinary theoretical approach to clinical practice addressing voice and the communication of speaker socio-cultural positioning.
        Int J Speech Lang Pathol. 2020; 0: 1-12https://doi.org/10.1080/17549507.2019.1709544
        • International Commission of Jurists
        The Yogyakarta Principles Plus 10 - Additional Principles and State Obligation on the Application of International Human Rights Law in Relation to Sexual Orientation.
        Gender Expression and Sex Characteristics to Complement the Yogyakarta Principles, 2017 (Published online. Available at) (Accessed October 6, 2020)
        • Heng A
        • Heal C
        • Banks J
        • et al.
        Transgender peoples’ experiences and perspectives about general healthcare: a systematic review.
        Int J Transgenderism. 2018; 19: 359-378https://doi.org/10.1080/15532739.2018.1502711
        • Matsuno E
        • Budge SL.
        Non-binary/genderqueer identities: a critical review of the literature.
        Curr Sex Heal Reports. 2017; 9: 116-120https://doi.org/10.1007/s11930-017-0111-8
        • Garrison S.
        On the limits of “Trans Enough”: authenticating trans identity narratives.
        Gend Soc. 2018; 32: 613-637https://doi.org/10.1177/0891243218780299
        • Cheek J.
        The politics and practices of funding qualitative inquiry.
        in: Denzin N Lincoln Y The Sage Handbook of Qualitative Research. 4th ed. Sage, 2011: 251-268
        • Oates J
        • Dacakis G.
        Transgender voice and communication: research evidence underpinning voice intervention for male-to-female transsexual women.
        Perspect Voice Voice Disord. 2015; 25: 48-58
        • Zeeman L
        • Sherriff N
        • Browne K
        • et al.
        A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities.
        Eur J Public Health. 2019; 2: 974-980https://doi.org/10.1093/eurpub/cky226
        • Nieder TO
        • Koehler A
        • Briken P
        • et al.
        Mapping key stakeholders’ position towards interdisciplinary transgender healthcare: a stakeholder analysis.
        Heal Soc Care Community. 2020; 28: 385-395https://doi.org/10.1111/hsc.12870