Mind the gap – Vocal health care in singing education
In Part 11 of her AOTOS Keynote speech, Dr Gillyanne Kayes tackles the vocal health care gap, starting with five questions for the live audience:
- Raise your hand if either you or one of the singers you work with has experienced a voice problem
- Raise your hand if you’ve ever had a singer come to you post diagnosis looking at you with hope and expectation in their eyes
- Raise your hand if ever a new client has approached you saying: “I think I’m having a voice problem. Can you help me?”
- Raise your hand if a client has been signed off but is still none the wiser about how to apply it in their singing voice. Quite common isn’t it?
- Raise your hand if you’d like to see better communication and mutual respect between the medical and singing voice communities.
Good. Congratulations. You have identified the vocal health care gap, and the thing is, I’ve had lots of conversations with clinicians about this. The thing is, both sides acknowledge that there is a gap.
We all want our singers to be healthy. Nothing challenges singer agency more than not being able to use their voice. So supporting singers when they hit a vocal problem is – in my opinion – part of our duty of care.
The question then becomes – how, when and what. And with WHOM. Who is qualified to diagnose, to treat and intervene, and where are the boundaries?
Baseline information about vocal health problems allows us to understand the difference between a skills and development issue and a potential voice problem. If your student has difficulties with breath management, it doesn’t mean necessarily they have a voice problem.
For us, once we’re armed with this baseline information we can encourage the singer to seek further help, and offer support and if necessary help with the referral process.
Ideally what should happen next is diagnosis and hopefully, relevant treatment from a clinical team. There is a caveat there and I’ll mention it later.
This is a good point for US to step back and allow the singer to go through that process without interference unless our client expresses concerns and we feel we might be able to advocate.
Notice I say advocate, not interfere. Avoid contradicting a diagnosis – even if you have a lot of knowledge and you think it might be insufficient – where does THAT leave the singer? And remember the singer might well trust you more than the clinical team.
There are ways of contacting the team, asking for clarification and setting up 2-way conversations. I’ve found that – so long as there’s mutual respect – this goes well. And I have more than once requested clarification of a diagnosis, and suggested singers seek a 2nd opinion.
Post treatment, you are can now liaise with the practitioners who have done this work. THIS is where we need to step back into the gap. Remember Speech and Language Therapists in the NHS are only allowed to work on speaking voice. They need your help to get the singing voice back on track.
And during this time it’s a great idea for you to stay in touch with the clinical team, assuming your client wishes it. I think it’s important that singing teachers receive ongoing clinical supervision. Because this is one thing that’s been identified in conversations with Speech and Language Therapists, is that even when the singing teacher is moving the singer onto the next stage, they need that contact. And if a teacher thinks they can be a voice rehabilitator and has nowhere to go for supervision, that could be problematic. Personally, when I’m working with someone, I seek supervision if I need it.
I do want to say something here just from my personal observations and experience. If as a singing teacher you’re going to do this kind of work – taking a singer who’s either post-operative or who’s had a muscle tension dysphonia or some other kind of issue and has received treatment – taking them into the post-rehab phase and back on stage – I think you’d better be a very experienced teacher with many years of teaching hours under your belt.
Assisting with voice problems other than support and referral is not a bandwagon for a new teacher.
So we’ve got work to do – let’s use this time as an opportunity to pilot new models of singer health support. We know there are people out there doing it and let’s see where we can go with this.”
Gillyanne’s Further Reflections
“I probably spent more time researching the nuances of this issue than any other topic. And I am grateful to various colleagues for their time in sharing their own insights. As a matter of fact the issue of how we create a conduit between singer, singing teacher and clinical team is something that I have been mulling over for years.
Jeremy and I have done several ‘voice skills’ training sessions over the years for SLT Voice SIGS or CENS and one big take-home for us is the difference between our professions. SLTs in the UK do not receive training to work with singing voice and this means there is sometimes a misunderstanding about the value of the work that they do do with singers when in trouble. This includes work to address compensatory muscle patterns that the singer may be using in their everyday voice use that may have contributed to the problem arising e.g. muscle tension dysphonia; or because there has a pathology issue e.g. nodules, polyp or cyst as well as working with singers both pre and post-operatively when surgery is required.
In a voice clinic ideally the SLT will have access to scoping facilities as well as supervision during this time, so that they can check on progress. Singing teachers do not have this important checkpoint. Hence the need for good lines of communication between all concerned. I opened a Panel discussion on this back in 2023 at the Congress for the Union of European Phoniatricians explaining that there is often a strong bond of trust between a singing teacher and their client: we need this to be a help and not a hindrance in the recovery process.
It is fair to say that in the UK at least, singers’ vocal health has been somewhat of a battle ground and – due to the legacy of the master-apprentice model in our profession – an arena for competition.
Perhaps one reason in the UK, is the difference between our medical community (based for the most part on the NHS), where teamwork is essential, and the singing teaching community, where collaborative working is relatively rare.
This needs to be resolved and at Vocal Process we are interested in talking with other education providers as well as clinicians so that singers in trouble can get the help they need from a variety of disciplines. Helping singers with voice problems is not a solo act – it needs a coordinated multi-disciplinary approach. Watch this space!”
Do you think that rehabilitation of a singer with an undiagnosed voice problem is part of the singing teacher’s remit?
How might you advocate for a student in this situation?
What would you like to see created to fill the vocal health care gap?
Click here for part 10 of Gillyanne’s AOTOS Keynote – Singing Teaching is an Unregulated Profession: Is that a good thing?
Click here for part 12 of Gillyanne’s AOTOS Keynote – Are We Trauma-Informed? A Guide for Singing Teachers
Join the Vocal Process Learning Lounge with over 600 voice training resources, including My Singer Has a Voice Problem – a CPD-Accredited set of 21 short videos filmed with Specialist SLT and singer Carrie Garrett on clinical diagnosis protocols, laryngeal pathology, voice disorders and support for singing teachers.
If you’d like to see the diversity of teacher backgrounds and specialities in our own Registered Teacher community, head to our Meet The Team page
And feel free to contact Gillyanne for a Discovery call to find out more about our next Accreditation cohort here
