Gender Biases in Traditional Voice Education

By Liz Jackson Hearns and Brian Kremer

Authors of The Singing Teacher’s Guide to Transgender Voices

Nowhere else in the musical arts are gender roles as staunchly established and upheld as in voice. The binary gender system presides over voice parts, repertoire choices, role casting, competitions, costuming, dressing rooms, and more. Because the established social gender roles of singers have never been deconstructed or recalibrated, the prevalence of the binary system is so ingrained that it often goes unnoticed until someone who does not fit into the system disrupts it. That disruption leaves many voice teachers and music educators at a loss for means to guide their students in ways that support them artistically and help build their careers in such a heavily gendered environment. It also leaves many gender diverse singers, or would-be singers, unable to find or rely on culturally responsive and pedagogically competent teachers, alone in trying to discover their own authentic, true voice. By engaging in discussion and education about gender-inclusive voice care for singers, we can develop new ways of hearing and guiding voices that affirm, welcome, and hold a place for all singers of all genders.

Voice Part Categorizations

One of the more obvious places that gender binaries impact singers and singing education is voice part classification. The traditional Fach system is, in many ways, an antiquated guide for the modern singer, and especially so for a gender diverse singer. Even choral voice parts are delineated and described as they relate to the gender of the singer. Two singers could have identical voice ranges, weight, color, and style; they could sing the same repertoire and audition for the same stage roles, but each might have a different voice part category because of their gender. Does the gender of the singer somehow change the sound of their voice?

Choosing to adopt a particular voice part category requires that the singer choose a gender, essentially. This can be limiting for transgender and gender nonbinary singers because of the traditionally gendered associations that accompany voice classifications. Female low-voiced singers, male high-voiced singers, and gender nonbinary singers are left without any appropriate voice part category. The ensuing confusion on the part of the casting directors may prevent transgender and gender diverse singers from being considered for stage roles, choral contracts, solos, or competitions, because these singers do not fit the mold. Rather than consider the validity and usefulness of the system and make room for growth beyond its outdated modes, educational institutions and casting agencies attempt to box these diverse and boundary-defying singers into established gender norms. Trans singers are then left bewildered with nowhere to belong, and face enormous obstacles to artistic and career development.

Repertoire

Because the singing instrument is the only instrument that creates words, singers are tasked with telling understandable and compelling stories, either as themselves or through character interpretation. The gender identity of the singer may prove to be a factor when deciding if a piece is the right fit, so that the artistic intent of the singer complements the artistic intent of the composer or librettist. Voice teachers may be inclined to suggest repertoire for their students that is either overtly or deceptively gendered, which may be appropriate for the voice quality but grossly inappropriate for the singer. There are very few, if any, pastoral pieces for bass-baritone or songs of sexual and military conquest for soprano. Trans singers may have few options when creating performances or audition books to find repertoire that aligns with both their technical skill and personal identity.

Voice Pedagogy Language

Voice teachers and students form deep personal and artistic bonds inside the voice studio, and it should be a safe place for discovery and exploration for all singers, regardless of gender. Traditional voice pedagogy assumes a level of comfort with one’s body and voice that is likely not present for a transgender or gender nonbinary singer. Trans singers sometimes must overcome the difficulties and limitations that arise from gender dysphoria, especially around voice. Voice is a characteristic through which we categorize people by gender, subconsciously and automatically, and trans people are often acutely aware of the ways that voice can influence how the world sees and hears us. That awareness can lead to extreme discomfort around making vocal sound at all, discomfort with the body as it relates to voice, discomfort or disconnection from sensations in the body, or hypervigilance about parts of the body or the sound of the voice.

Gender-inclusive voice pedagogy can include language that differs from traditional ways of teaching voice by giving agency and autonomy to the singer when learning new skills or taking on new vocal tasks. Gender neutral language also helps alleviate—or at the very least prevents exacerbation of—some symptoms of gender dysphoria for singers, especially when referring to the parts of the body needed for singing or qualities of vocal sound. Rather than describing the sound of a voice as “masculine” or “feminine,” the teacher is challenged to use more specific descriptors, which may actually improve pedagogical efficacy for all students, including trans singers.

First Steps

Transgender voice care is a burgeoning field and serves a population in need of qualified teachers and practitioners. As voice teachers, our responsibilities are to support our students and to help them meet their musical, artistic, personal, and career goals. This often requires us to push ourselves beyond our comfort zones and work together toward changes in the systems that hold our students back. There is still much to learn in this realm of voice, and the first steps involve recognizing and reframing our own subconscious judgments, self-perceptions, perceptions about others, biases with regard to voice, and other factors that we may carry into a lesson with a trans student that could pose serious barriers to that student’s success. The Singing Teacher’s Guide to Transgender Voices aims to aid in the development of a successful vocal pedagogy for the training of transgender singers, help the academic community understand the needs of transgender students as it pertains to vocal training, and engage in a broader discussion about the presence of transgender students in lessons and classes and how this positively impacts teaching, curriculum, and classroom environments.

Plural books honored as Doody’s Core Titles for 2015

We are thrilled to announce that Doody’s has released its Core Titles in the Health Sciences for 2015 which includes 21 Plural books! Doody’s Core Titles in the Health Sciences 2015 is primarily for medical, nursing, and allied health librarians around the world who are charged with making the book buying decisions for their libraries within budget guidelines. A core title is a book or software title that represents essential knowledge needed by professionals or students in a given discipline and is highly recommended for the collection of a library that serves health sciences specialists.

Core Titles for 2015:

Effective Communication: A New Health Care Obligation

Beukelman Effective Communication Image

By: Sarah W. Blackstone, David R. Beukelman, and Kathryn M. Yorkston
Editors of the new Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

Prior to his accident, Frank was a 26-year-old energetic, physically active young adult with a wide range of interests and a full social life. A C3–C4 cervical spine injury left him unable to move his limbs. When medically stabilized, he was transferred to the surgical intensive care unit, where he was ventilator dependent and in halo traction. He was unable to speak and his only intentional gesture was a gaze shift. The hospital communication team helped Frank establish a reliable yes/no response (looking up to indicate “yes” and down for “no”). They encouraged his nurses and family to offer other choices as well (“maybe” or “later” or “I don’t know”). A speech-language pathologist showed him a speech-generating device (SGD), but when initially asked if he wanted to use it to “talk,” he responded by looking down, “No.” Later that same day, the team demonstrated the SGD again, showing him how he could use it to control the TV and a fan. When asked if he would be willing to give it a try, he replied, “Yes!” by looking up. Within 24 hours, Frank was using a template on the SGD to call a nurse, ask for medication, control a fan, and turn the TV off and on, all with a simple serial scan method and a switch. Over time, he became an active participant in his recovery process, asking doctors questions and participating in decisions about his treatment plan.

Effective communication between patients and providers is a core component of patient-centered and value-based health care. According to the Joint Commission (2010, p.1), effective patient provider communication is the successful joint establishment of meaning in which patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood. To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.

The medical encounters that occur across the continuum of health care are usually time constrained and many are stressful, high-stake interactions. When communication breakdowns occur, the impacts can be devastating for patients, family members, providers, and the health care system. Research shows that communication difficulties are among the major causes of sentinel events and can negatively affect patient outcomes, safety, and satisfaction, as well as result in increased readmission rates, length of stay, and additional health care costs. Because of the diversity of patients and families served in our health care systems, successful communication can be very difficult to achieve. In fact, many patients present with multiple communication vulnerabilities.

At age 4 years, 6 months, Guillermo was in the ICU, intubated and awake following a series of surgeries for tracheoesophageal reconstruction. Guillermo and his family were from Honduras and spoke Spanish only. Guillermo was most relaxed when his mother or eldest brother were sitting next to his bed and rubbing his arm. Although hospital policy supported his family remaining at bedside throughout the day and night, there were moments when they needed to step away for personal care, to attend team meetings along with a translator, or for other reasons. The speech-language pathologist provided Guillermo with a simple voice output aid (Ablenet Little Mack) with messages that included, “Where is my family,” recorded in both Spanish and English, so hospital staff could understand him. The speech-language pathologists also made a 20-target Go Talk+ device (Attainment Company) available to him. It featured 15 target photos of family members with messages such as, “I want mom,” “You’re my best friend, Frederico,” “I love you,” and “Hold my hand,” as well as some medical messages. All messages were recorded in both languages.

We define “communication vulnerability” as the diminished capacity of an individual to speak, hear, understand, read, remember, or write due to factors that are inherent to the individual (e.g., disabilities related to receptive and expressive language skills, hearing, vision, speech, cognition, and memory, as well as language spoken, lifestyle, belief system, and limited health literacy), or related to the context or situation (e.g., a noisy environment, being intubated in an intensive care unit after surgery, suffering injury while traveling in a foreign country, having cultural practices, lifestyles, or religious beliefs that are not understood or accepted by providers).

Eleven-year-old Joshua had a bone marrow transplant. He was acutely aware of his suppressed immune system and created and used several communication tools during the time he required the use of a Bi-PAP noninvasive ventilator. Using a simple voice output communication tool, Joshua insisted on having the following message available at all times: “If anything falls on the floor, use the Sani-wipe to clean it before you let it touch me. Also, if your gloves touch the floor when you pick it up, change your gloves before coming near me.”

In the book, Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professions, we describe how health care facilities and the providers who work within them can begin to assume a more active role in supporting patients who are communication vulnerable. Speech-language pathologists, nurses, administrators, and physicians are key to improving the “culture of communication” within their facilities, spearheading interprofessional practices that benefit all patients and ultimately providers and the facility’s bottom line. Currently, the role of communication intermediary is assumed by a few providers or family members with a personal commitment; although a rising number of health care organizations are beginning to specify policies and role assignments regarding the coordination of communication support services, communication facilitation for all patients with communication difficulties (not just those who are deaf or have second language issues), or a legal or medical intermediary designated to ensure that communication vulnerable patients accurately participate in legal and medical decisions.

Examples of promising practices and strategies across health care settings are highlighted in individual chapters that focus on doctor visits, emergency services, Intensive and acute care settings for children and adults, inpatient and outpatient rehabilitation, long-term residential care, and end-of-life care. In this book, we have invited authors who have considerable expertise in patient provider communication services across the range of health care settings to share information about the policies, intervention strategies, communication materials, and technologies that are being implemented within their medical settings to support the needs of communication vulnerable patients.

The wife of a person with ALS described his end-of-life experience: He was having a great deal of difficulty breathing and simply could not get comfortable in his hospital bed or wheelchair. We decided to go with in-hospital hospice since his pain management was not well controlled. In hospice, he regularly used his (eye gaze-accessible) SGD to tell us what he did and did not want. I am so grateful that he was able to use it extensively during the last few days of his life. I do not know what we would have done without it.

The authors recognize that there continues to be a considerable gap between clinical research evidence, what is mandated by health care policy, and what is experienced every day by patients, their families, and providers during medical encounters because of the ways in which many health care organizations currently deliver care. In other words, we recognize that implementation, or the process of putting effective patient-provider communication policies into practice, continues to be a challenge within many health care organizations; however, in the final chapter of Patient-Provider Communication we discuss a number of implementation strategies.

References
The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author.

About the Authors
Sarah W. Blackstone, PhD, CCC-SLP, is president of Augmentative Communication, Inc. She has authored multiple texts in the augmentative and alternative communication field as well as articles in Augmentative Communication News and other publications. David R. Beukelman, PhD, CCC-SLP, is the Barkley Professor of Communication Disorders at the University of Nebraska-Lincoln. He has served as director of research and education for the Communication Disorders Division, Munroe-Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center. Kathryn M. Yorkston, PhD, BC-ANCDS, is a professor of rehabilitation medicine and head of the speech pathology division within the Department of Rehabilitation Medicine at the University of Washington Medical Center.

2015 Plural Publishing Research Award Winners

We are thrilled to announce the winners of the 2015 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and the honorees and their faculty sponsors were acknowledged at the annual CAPCSD meeting, which took place this year in Newport Beach, California, April 15-18.

“We received 82 complete applications for the Research Awards this year. The quality was very high in all of these applications, making for a lively review process. In the end, there was one each at the MS/AuD level and the PhD level that were truly outstanding,” according to Richard C. Folsom, who chaired the award committee this year.

Eric Bostwick, 2015 Research Award Winner

Eric Bostwick, 2015 Plural Research Award Winner

At the MS/AuD level, the award went to Eric Bostwick at the University of Wisconsin-Madison. Eric is an AuD student working with Dr. Bob Lutfi and his research is entitled, “Decision Weights and Stimulus-Frequency Otoacoustic Emissions.”

Bridget Perry, 2015 Research Award Winner

Bridget Perry, 2015 Plural Research Award Winner

At the PhD level, the award went to Bridget Perry at the MGH Institute in Boston. Bridget is a PhD student working with Dr. Jordan Green and her research is entitled “Early Detection of Dysphagia in ALS.”

Augmentative and Alternative Communication: From Novice to Expert Clinician

By John McCarthy, PhD, CCC-SLP and Aimee Dietz, PhD, CCC-SLP

Augmentative and Alternative Communication

Augmentative and Alternative Communication by John McCarthy and Aimee Dietz

Understanding the personal story of an individual who uses augmentative and alternative communication (AAC) can have a positive impact on the attitudes of people without disabilities toward that individual (McCarthy, Donofrio-Horwitz, & Smucker, 2010). Almost any AAC specialist has story after story of moments when they have helped reveal the true abilities of an individual through AAC:

• The eight-year-old boy with cerebral palsy who everyone assumed had below average intellectual ability and presymbolic language skills, was in fact bilingual.
• The forty-year-old woman with bulbar onset amyotrophic lateral sclerosis who cannot dress or feed herself, but still manages her finances, parents her children, and makes end-of-life decisions.
• The eighteen-year-old girl with autism spectrum disorder whose potential to contribute to society was doubted, yet planned for employment after high school and managed a new mobile device-based communication system.
• The fifty-two-year-old man with stroke-induced aphasia who medical staff assumed was “incompetent”; however, still made informed decisions about medical care and enjoyed friendly banter on the golf course with his adult sons.  Continue reading

Plural Sponsors Communication Sciences and Disorders Library in China

Angie Singh, Plural Publishing CEO and President, has donated a collection of voice and communication sciences and disorders books to the Jinan University in China in honor of the late Dr. Sadanand Singh. Dr. Singh, founder of Plural Publishing, Inc. was an an esteemed international leader in the field of communication sciences and disorders.

Donation plaque

Plural’s donation is in recognition of the collaboration between Jinan University and Ohio University in promoting the field of communication sciences and disorders in China.

Plural's collection of communication sciences and disorders books at Jinan University Library in China (2014).

Plural’s collection of communication sciences and disorders books at Jinan University Library in China (2014).

Continue reading

Brand New Practical Resource for Voice Coaches

Body and Voice: Somatic Re-education by Marina Gilman

Body and Voice: Somatic Re-education by Marina Gilman

Body and Voice: Somatic Re-education by Marina Gilman, MM, MA, CCC-SLP, is an excellent resource for teachers of singing, voice coaches, and speech-language pathologists who work with singers and other voice professionals. It provides a new paradigm for working with singers in a way that allows for improved kinesthetic awareness needed to work with their body rather than against it. The text contains a series of lessons designed to train singing teachers, coaches, and voice therapists to recognize in their students the patterns of use and posture that interfere with respiration, phonation, and/or resonance. In addition, it provides tools for the teacher to guide the student to a level of self-awareness of habituated patterns along with strategies to implement change from the inside out. Continue reading

Invaluable Resources for Anyone Who Uses or Trains the Singing Voice

The Vocal Athlete

The Vocal Athlete by Wendy LeBorgne and Marci Rosenberg

The Vocal Athlete and the companion workbook The Vocal Athlete: Application and Technique for the Hybrid Singer are written and designed to bridge the gap between the art of contemporary commercial music (CCM) singing and the science behind voice production in this ever-growing popular vocal style. These books are a must have for the speech pathologist, singing voice specialist, and vocal pedagogue. Continue reading

Bollywood comes to San Diego to raise money for the ASHFoundation

Angie making dinner at ASHFoundation fundraiser

Angie making dinner at ASHFoundation fundraiser

This past Saturday, June 7th, Plural President and CEO Angie Singh hosted a “Bollywood”-themed fundraiser at her home in La Jolla, CA, with proceeds benefiting the ASHFoundation. Created in 1946 by a visionary leader in the field of communication sciences, Wendell Johnson, the ASHFoundation is a charitable organization that supports the advancement of knowledge in this field and seeks to improve the lives of people with speech, language, or hearing disorders. Continue reading

Alphabet Soup: The SLP, CP, and NDT

Fran Redstone, Ph.D., CCC-SLP, C/NDT
Editor of Effective SLP Interventions for Children with Cerebral Palsy: NDT/Traditional/Eclectic

Effective SLP Interventions for Children with Cerebral Palsy

Effective SLP Interventions for Children with Cerebral Palsy by Fran Redstone, PhD, CCC-SLP, C/NDT

Is it reasonable to expect a child with shallow breathing, open-mouth posture, and a tongue thrust, whose body is fixed in extension, to manipulate toys or interact with peers in a stimulating home or school environment? Of course the answer is “no.” It is an exercise in frustration for the child and in futility for the child’s unprepared speech-language pathologist (SLP). I know this because I’ve been there.

When I am asked why I, as a speech pathologist (SLP), should “handle” the child’s body, I am reminded of a second grade class observation I conducted recently of a child with spastic diplegia. This child was ambulatory and cognitively intact but was in a small class for children with language disorders. He was helped to function within the classroom with a one-to-one aide. The youngster began to demonstrate some negative behaviors stemming from the frustration of not being understood. This had resulted from a loss of stability, which led to poor trunk support, leading to poor oral control. I quietly asked the aide if I could intervene and adjusted the foot support and pelvic positioning. The child sat upright and communicated better immediately. Continue reading