A resource for speech pathologists
 Limitations
There are a range of issues that a speech pathologist may confront when working with transsexual clients that may affect the manner in which therapy is delivered and whether or not therapy is successful. These issues are outlined below with strategies for dealing with them.
The client has external stressors that are impacting on therapy. These may include psychosocial or financial issues, such as employment, divorce/separation, acceptance by important people in their lives and the wider community.
- Allow the client to express issues and provide affective counselling.1, 14
- Refer the client to a professional counsellor that has experience working with individuals with transsexualism.
- Consider postponing therapy until the client feels they are able to focus on therapy.19
The client has reduced support and therapy transfer opportunities.
- Refer the client to group counselling and/or therapy sessions.
- Arrange for the client to become an active member of a ‘phone buddy’ system to practice voice techniques through a safe and friendly medium.
- Provide the client with information regarding appropriate support groups.
The male-to-female client is not presenting to therapy in the female role.
- Provide informational counselling to the client regarding the therapy process, emphasising the importance of vocal hygiene procedures.14 Explain the necessity of practising techniques outside of clinic sessions and reach an agreement with the client as to whether there will be sufficient transfer opportunities to ensure therapy effectiveness.13
- Set goals that do not immediately and noticeably modify everyday communication. For example, focus on extending pitch range, ensuring optimum respiration support, intonation variability and understanding differences in communicative characteristics between genders.13
- Encourage the client to choose communicative setting/situation where the client can consistently present in the female role (i.e. clinic sessions, home environment with supportive family or friends).
The client presents with a very low pitch (often related to tall physical stature).
- Provide informational and affective counselling to explain that pitch should complement stature and that the voices of taller females are often lower. Provide the client with examples of females with lower pitched voices and establish other aspects that assist in the perception of ‘femaleness.’14
- Focus on other verbal and non-verbal aspects of communication such as intonation, articulation, speech rate, body posture and physical appearance, which will impact on the client’s ability to ‘pass’ as a female.14, 38
- In respect to therapy on pitch, establish goals with the client that are realistic to prevent future disappointment if goals are not achieved.14
- Surgery may be an option. However, it may be unsuccessful in changing the client’s pitch level and should be considered as an adjunct to speech pathology 17
The client presents with an additional voice problem.
- Address the additional voice problem before commencing voice therapy on feminising verbal and non-verbal communicative characteristics.1
- Refer the client to an ENT.14
The client presents with hearing problems.
- Refer the client to an audiologist and ensure that they are maximising their hearing abilities.
- Use Real-Time Pitch software to provide the client with visual feedback regarding pitch and other resources that do not rely on the client to auditorily monitor their communication.
The client has reduced access to therapy. This may include financial and geographic restrictions.
- Investigate alternative voice clinics that the client can access:
- Geographic restraints: identify speech pathologists closer to the client’s area that are willing to provide therapy.
- Financial restraints: suggest voice clinics that are conducted by university students or clinics that conduct group therapy sessions.28
- Modify the structure of sessions and targets for therapy. For example, conduct longer sessions for clients who are unable to attend regularly.14
Poor motivation and willingness to change
- Discuss with the client possible factors that may be contributing to their lack of motivation.
- Inform the client that continual non-attendance or lack of home practice and dedication needs to be resolved, otherwise they will be placed back on the waiting list to allow for other clients to access therapy.
- Inform the client that weekly therapy sessions alone will not develop or increase their female speech characteristics. The client is required to practice outside of the clinic setting in order to successfully achieve their goals.
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