Areas of concern

Clearly there are many aspects of an atypical voice that could be addressed in any course aimed at ameliorating the effects of functional dysphonia. The current course focuses predominantly on the following broad areas.

• Understanding the mechanism of voice production.
• Improving auditory awareness/self-monitoring skills.
• Developing vocal hygiene strategies.
• Identifying and eliminating potentially abusive vocal behaviors.
• Relaxation.
• Breathing technique/breath support.
• Easy onset of voice.
• Establishing a resonant voice quality.
• Voice projection and volume control.
• Helping clients develop their own personal action plan.

These areas are discussed in more detail in the later sections that describe each of the Voice Packs.

Teaching technique

Therapists will be well-acquainted with teaching techniques and will have their own favored methods. However, a repetitious, structured pattern to intervention (particularly in a group situation where it is often necessary to have up to six clients carrying out synchronized tasks) can be beneficial. The following well-known delivery design has proved useful.

1. Therapist explains the task.
2. Therapist demonstrates the task.
3. Therapist and client carry out the task together.
4. Client describes his/her vocal behaviors and any insights into their voice production.
5. Therapist provides feedback.
6. Client carries out the task on their own.

Perhaps the most important step in this approach is Step 4, in which the client is encouraged to develop their self-monitoring (auditory and proprioceptive). Encouraging the client to develop awareness of their voice production and the mechanisms and techniques that improve this is an essential part of voice therapy. Clients will ultimately know their own bodies better than anyone else. The voice therapist is a facilitator, assisting the client to develop greater awareness of effective voice production. Clients should be encouraged to experiment with safe ways of producing voice and encouraged to discuss their insights with the therapist (and other group members where relevant).

Delivery mode

Strengthening the Speaking Voice can either be delivered to groups or used as a structured intervention for individuals. For group work it is recommended that no more than six clients attend each group session, in order that the voice therapist can provide sufficient individual attention to group members.

The course consists of three Voice Packs that are typically delivered one per week over a period of three weeks. Each session will last about one hour. However, there is no hard and fast rule dictating this delivery mode and the course has been used successfully when delivered according to other regimes, such as fortnightly and with sessions of longer duration, according to clients’ needs. The gender and age profile of groups also does not appear to have influenced the success of its implementation. In fact, several clients have commented on how the diversity of the group members proved helpful to them in setting their own perceived difficulties in a wider context.

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