Chapter 1
The voice work continuum

Background music

Someone is walking down the street. You recognise them as a famous fashion model and are impressed with their grace and beauty. As they pass, they take out their glamorous mobile phone, and you hear them speak. Their voice is tight, rough, nasal and monotonous, and suddenly they seem far less appealing.

A person stands up to speak at a conference. They are unprepossessing in appearance; their face is round and shining, their hair obscures their eyes, their dull grey clothes are rumpled and ill-fitting, and they look nervous. But when they start to speak, you are captivated by the warmth and energy of their voice; their resonant sound somehow draws you in. 'What an interesting person', you think. 'I'd like to know them better'.

Although consumer society is obsessed by the visual image, and we are bombarded every day by pictures of people who appear 'beautiful' in some way, there is still an unconscious sense that what we hear in a voice reflects the true personality of the person and has a deeper truth than what we see.

Most people take their voices for granted. They seem to flow naturally from our intellect and emotions, but because they are the background music to our words, they have a powerful, and often unconscious, effect on listeners.

There is a parallel with the typography that shouts out at us every day. Advertisers have long known that the font they use to describe their goods will have an effect on those seeing it. You may be drawn to buy antiques sold to you like this

but would expect a different 'mood lettering' if you were to be attracted to a new computer shop:

• ALL NEW PCS AT HALF PRICE

Reverse the two, and although you might not be aware of it, you would pick up a different sort of feeling:

• FINE ANTIQUE AND SECOND-HAND FURNITURE BARGAINS!

So it is with voices. Voice is a two-way psychosomatic phenomenon; it is shaped by the speaker's psyche (our personality and current emotions) and soma (the health, structure and usage of our bodies). As the bridge between our inner and our outer worlds, it also affects the psyche and soma of the listener. Cultural perceptions of voice certainly influence this relationship, but there is a relationship between the inner and outer worlds of voice nevertheless.

No matter how interesting a speaker is, if their voice is tense, monotonous and rough with a 'whining' nasal tone, it may affect the tension in your own body. You do not feel good listening to them and may want to get away from that sound as soon as possible. If a conference lecturer has little voice variety as they speak for half an hour, the lack of energetic change in the voice is likely to make the audience feel heavy and listless - particularly in that challenging after-lunch slot or towards the end of a long day.

Conversely, there are qualities that we hear in sung or spoken voices that can make us feel good. The open, powerful voice of a gospel singer, with its rich resonance and huge pitch range, gives you a sense of strength and energy. On a crowded bus, you may turn to look at someone whose deep, husky voice is attractive with its tone of intimate evenings. The high, ethereal notes of a chorister singing the Allegri Miserere may make you feel as if your heart is lifting. We deliberately use images because sometimes the effect that a special voice has on our feelings and physical sensations can be expressed only in such words.

Through vocal sound, we express our physical, psychological, social, cultural and spiritual lives, and our voices grow and change with us in the dance of our individual life.

Who wants to change their voices?

We breathe, and we voice - the first two activities of our life. Spoken voices feel like an extension of personality, flowing effortlessly out of our heads and hearts, our thoughts and feelings. For some, working on the voice would seem like cosmetic indulgence at best and false betrayal at worst. Yet every year, thousands of people do work to extend, change or mend something about how they sound.

Many of those people are professional voice users for whom the voice is a vital part of their work. Actors work with a voice teacher to develop the power and subtlety of their voices, and even an experienced singer may go for regular lessons to continue to develop skills and repertoire. Business people may work with a voice coach to develop animated and appealing sales presentations. Many non-professional voice users enjoy extending and developing their voices in lessons or choirs. In the latter, they can feel the power and exhilaration of their voice streaming out in the company of others.

Some people have a sense that their voice 'lets them down'. It does not work in the way they want, and a busy call centre operator or over-stretched teacher may seek help because they are regularly losing their voice towards the end of a day. For some, the spoken voice does not seem right for what they feel is their 'true self'. A senior manager in a company may recognise that their voice does not reflect their real authority and work with a voice trainer to find that 'true' power. Voice teacher Patsy Rodenburg (2015) makes an important distinction between the natural and the habitual voice. The latter may have become laden with tensions, defences and strain; if 'liberated' by voice work, the speaker is likely to feel that their voice is healthier and that it better reflects their personality.

Sometimes there is an actual voice disorder. The voice may be affected from birth, as is the case for many children born with deafness, cerebral palsy or a cleft palate, whereas other people develop an abnormal voice as a result of use or illness. This often leads them to an ENT specialist who may prescribe medical treatment or a course of voice therapy.

Voice problems and voice disorders

'Voice problem' is a term used by the general public, whereas the diagnosis of a 'voice disorder' is made in the clinical world if a speaker or singer is referred for a medical opinion. There is often, however, a blurring of these distinctions.

Daniel Boone (2015) described a voice problem as occurring when 'things that we do or fail to do prevent our natural voices being heard'. He estimated that around 25% of the population may be 'displeased with the way that they sound, and with the way that their voices affect their careers and social lives'.

Boone's definition of a voice disorder was 'something that needs to be treated by a specialist'. If a speaker has unexplained (not related to a cold, cough or other illness) hoarseness that has lasted for more than 2?weeks, they should go to see their local doctor; if the doctor is concerned, they will refer the client to a hospital ENT department for a thorough laryngeal examination.

Some people live with their hoarseness for months or even years without seeing a doctor, but there is always a risk - however small - that the husky voice may be caused by something serious that needs urgent treatment.

Voice story: Librarian

Some years ago, Laura, the librarian in a university department, asked me if I could give her some exercises to help her voice. 'I'm ashamed to say that I strained my voice singing at a rugby match last month and it's still croaky'. It would have been easy to offer practical advice and exercises. But Laura was in her mid-50s and an ex-smoker, and I knew that there was a risk that this was not a simple voice strain. I suggested that she should first get a check with a specialist, sooner rather than later, to see that the yelling had not done any damage. Her family doctor referred her to the local hospital ENT department, and 6?weeks later she told me that a small cancerous growth had been found on one vocal fold, which would be treated by radiotherapy.

This is unusual, but it is a warning to voice practitioners to recognise the difference between voice problems and voice disorders and that if they have any concerns, an appropriate medical appointment should be made. A lifetime's dissatisfaction with a voice that goes squeaky when nervous, short-term huskiness after flu or karaoke singing, or a sound that is not interesting in lectures rarely needs a visit to a medical specialist. But long-lasting hoarseness or a new vocal limitation may be a warning sign that something is wrong with the vocal folds or with voice muscle function. Such changes need a medical examination at whatever age the speaker may be. Chapter 21 describes the voice disorders that can occur.

The voice practitioner groups

Although there are increasing opportunities for practitioners in parallel fields to get together, some know little about the other practitioners. We look at the training of each profession, the typical client range with whom they may work and how you might find a local practitioner.

Speech and language therapists/pathologists (SLT/Ps)

This profession assesses and works with people of all ages who have difficulty with communication or swallowing. Most students follow an undergraduate or postgraduate course with both academic and practical strands and generally graduate with a science-based degree or...