CSD Gender Affirming Program Helps Clients Find Their Voice

As a Communication Sciences and Disorders graduate student in 2014, Kevin Pasternak, MS ’16 knew that a gender affirming voice training program would be a great resource for Boston.

Back then there were about 10 clinicians in the Boston area teaching gender affirming voice training (GAVT). Beth Israel Deaconess Medical Center was the lone hospital offering GAVT.

Emerson jumped at the idea and created a program within a semester. Pasternak now works at the University of Wisconsin Voice and Swallow Clinic where he works with people who have voice disorders and with GAVT clients. He also teaches classes for the Speech@Emerson online program.

At the time, Barb Worth was working on GAVT at Beth Israel Deaconess, and Pasternak interned there so he could learn from the program and come back to train others. As Emerson’s program grew, they tapped Worth to join them in 2019. Worth was already familiar with the College from teaching at the school and working with Emerson interns and clients at the hospital.

How It Works

“If you are someone coming to us looking for a more masculine or feminine presentation, clinicians create a treatment plan. For example, we may practice vocal warm-ups, work with a pitch app, or do resonance drills,” said Worth.

Success is judged by the client. It could be a perceptual measurement of vocal quality on things such as breathiness or resonance.

“Resonance is what gives the color to our voice, so you can have a voice that has a bass-ier quality, and a voice that has more bird-like quality, but could be speaking at the same pitch,” said Worth.

Success can also be measured by endurance — how long a client can control their desired resonance, and implement it for a sentence, a paragraph, and ultimately, a conversation.

“Clients say, ‘Now I can go to work and communicate. I’m gendered correctly and my voice matches what I want from a gender standpoint,’” said Worth. “There is a satisfaction in what they’re looking for.

“There’s no cookbook recipe. Ultimately, it’s about tailoring each session to their individual needs so that they can create a voice that they want.”

The program doesn’t bill insurance, per a longstanding CSD policy, but no one is denied. It costs about $30 per session, and group sessions are $25. Some insurance companies do pay for GAVT, and more are starting to cover it, said Worth.

Group sessions can be very helpful, as they are conversation based. They also are less predictable and so communication is unpredictable. The participants play games, and even incorporate drama techniques. Last summer, they partnered with an Emerson student getting their masters in Theatre Education.

“Once you start to increase your cognitive load to use strategies where you need to think on your feet, and communicate about complex info, it becomes more challenging. Some clients say, ‘I’m good at dinner, but I when have to give a presentation, or have a challenging conversation at work, my strategies fall apart,’” Worth said.

“Clients formed a group to work on group presentations. It was really successful because they had to up their game. It’s also really helpful to get peer feedback and support so you have other people supporting you in your journey.”

The vast majority of clients are referred by worth of mouth. Fenway Health and Boston Children’s Hospital (BCH) refer a lot of people. BCH has a large transgender health department, and their speech pathologists do GAVT work, but it can’t accommodate all its clients.

‘You’re Working Collaboratively’

GAVT was a major part of why Kaila Harris, MS ’21 decided to attend grad school at Emerson. Her thesis is on client perceptions of GAVT. She likes that it’s a fairly new field, and there’s not a lot of existing research.

“It falls under the Voice sub-speciality. Next year in my clinical fellowship,  I will be working with gender affirming voice clients,” said Harris. “There are a lot of reasons I love voice work – the connection to expression and identity, and really working with somebody to help them figure out what they like best for their voice and what feels authentic to them.”

Harris greatly appreciates that GAVT helps clients feel safer and helps bolster confidence for different environments, such as a work presentation. She added as a cisgender person, she doesn’t want to make assumptions or do too many clinician-led goals. She wants sessions to be focused on client-led goals.

“There are a lot of different layers to impact someone’s life. At the same time, you get to play around with different vocal characteristics. ‘What do you like about this?’ and ‘What do you like about that?’ ‘Want to try this? Want to try that?’ You’re working collaboratively, and that’s an enjoyable process,” said Harris.

The majority of the clients come to feminize their voices. A lot of that has to do with the fact that trans women won’t see significant changes to their voice from feminizing hormones alone. Those taking masculine hormones will hear their pitch drop, but some don’t feel that’s satisfactory and seek further help.

“Some clients are not on hormones or don’t want to take hormones,” said Worth. “Some clients want a more gender-neutral voice, and others want to understand what in their voice is gendering them so they can enhance, dampen, or modify that in some way.”

Ralph Drake ’23, a Visual and Media Arts major, has been a client since the start of 2021.

“I wanted to join the program as it was recommended to me by my endocrinologist as a way to support my transition,” said Drake. “The program has taught me several techniques for softening my voice and raising pitch, both aspects of traditionally feminine voices I was hoping to acquire.”