Culturally Competent Care for Transgender Voice and Communication Intervention

Abstract

Purpose Despite constituting 4.5% of the population, the lesbian, gay, bisexual, transgender, queer+ community is poorly understood by the health care community. Seventy percent of transgender individuals report discrimination in health care, and 51% of speech-language pathologists do not know clinical techniques for transgender clients. This community is particularly obscured by its high degree of diversity, which can be confusing for clinicians who are unfamiliar with the nuances of the culture or unprepared to adapt to a gender-affirming therapy model. Method Methods focus on gender affirmation and community trust building. Specific targets included exploring self-expression through reflection, metatherapy, and observation of self and others in regard to various communication strategies. Clients were provided opportunities to practice and experience a gradient of degrees of gendered communication to make the experience affirming to their gender identity. Results Results were reflected in two case studies, Kasi, a transfeminine client, and RJ, a transmasculine client. Kasi began therapy as directionless, abrasive, and conflicted about their voice and transition goals. They concluded therapy focused, motivated to communicate more clearly, and achieving technical targets that were unexpected given starting points. Kasi made this progress in collaboration with the resilient focus of the clinical team on their validity and affirmation. RJ began therapy highly distrustful of therapy but unable to pursue hormone replacement therapy for pitch lowering. Their goal was to achieve voice modification through therapy. RJ finished their treatment consistently gendered as male on the phone and in public, with 130 Hz without testosterone. Conclusions Voice therapy is a vital health safety service for transgender clients, and increasing access to culturally competent care should be a concern for all speech pathologists. Building trust and empathy with this community will be a significant step in breaking down gatekeeping practices in the field and in the larger medical practice.