Gender Affirming Voicework:
An Introduction for Music Therapy
Informed by personal experiences, my queer autoethnographic research, and literature from the fields of speech–language pathology, vocal pedagogy, and music therapy, I offer an introduction to gender affirming voicework in music therapy, the training that it might involve, and several questions/issues that need further exploration. As a new holistic method grounded in a queer theoretical framework, I envision this work to be a therapeutic space focused on accessing and embodying affirming gender expressions by working with the intersections of the physical voice, the psychological voice, and the body as these each become relevant to an individual. This work involves the use of singing, vocal improvisation, chanting, toning, movement, imagery, and relaxation experiences to address areas of vocal function and emotion/identity. Stigma and trauma can come with living in this incredibly gendered and binary world. As such, gender affirming voicework emphasizes radically and queerly listening to our own vocal, psychological, and bodily expressions and the ways these fluidly shift from moment to moment. This is in effort to speak, sing, move, and live in the most affirming and authentic way we can.
Date received: 4 June 2019
Date accepted: 31 August 2019
Publication date: 1 November 2019
Over the past two-plus years, I have been immersed in a personal journey of accessing and embodying affirming gender expressions, particularly vocal expressions, as a nonbinary trans person. This further evolved into beginning to develop a gender affirming voicework method in music therapy for gender-based work. Various types of experiences have surrounded my early development of this method, including engaging in voice lessons with a former voice teacher, several Alexander Technique1 lessons, and both full and adapted Guided Imagery and Music (GIM)2 sessions. It also has involved engaging in voicework sessions completely on my own, where I explored beginning possibilities of what gender affirming voicework might become. Here, I brought together my knowledge as a music therapist and trained singer as well as my experiences from within those voice lessons, Alexander Technique lessons, and GIM sessions. For the purposes of my Master’s thesis, which I completed as part of my degree requirements at Slippery Rock University (PA, USA), I more deeply considered the development of gender affirming voicework through the research method of queer autoethnography (2019).
Queer autoethnography is the telling of self-stories as informed by queer theory (Tony Adams3 & Stacy Holman Jones, 2008, 2010, 2011, 2016). This research method emphasizes telling stories that dismantle binary, fixed, and normative understandings; contextualize meaning making; and interrogate issues of power and privilege. In the spirit of autoethnography, which often turns to showing an idea instead of strictly telling it to the reader, I encourage you to refer to my full thesis (2019) – firstly, for an example of what queer autoethnography might be, and secondly, to witness a more complex and nuanced exploration of what presides in this current article. Autoethnography is a method that emphasizes creative processes such as writing, art, and music to not only be final products but also ways of engaging in research (Tony Adams & Carolyn Ellis, 2012; Carolyn Ellis, Tony Adams, & Arthur Bochner, 2011; Carolyn Ellis & Arthur Bochner, 2006). Queer autoethnography, in particular, emphasizes that as we write, we continue to become something different, realizing new and ever-evolving meanings within the stories we tell (Tony Adams & Stacy Holman Jones, 2011). Even as I have re-engaged with my own queer autoethnography for the purposes of writing this article, I have come to new and deeper understandings of what gender affirming voicework in music therapy might be.
All things considered, my understanding of gender affirming voicework is deeply informed by my own personal experiences of accessing and embodying more affirming gender expressions for myself. As I have more recently begun to work as a music therapist alongside others who wish to access and embody more affirming gender expressions, my understanding has further expanded to begin more deeply considering the complexities of this work within the context of a therapeutic relationship. This work continues to be informed by a queer theoretical framework as I aim to dismantle my own binary, dichotomous, fixed, and normative thought processes; contextualize my understandings; and interrogate issues of power and privilege within therapeutic relationships and in relationship to the accessibility of this work.
To further contextualize my experiences and the beginning development of gender affirming voicework, it is important to locate myself. I am a classically trained singer and 26-year-old music therapist. I am white, queer, and physically nondisabled and live with dysthymia (persistent depressive disorder) and asthma. I am also an American–English speaker with a graduate-level education who grew up in a rural area of the mid-Atlantic region of the United States and in a lower-middle-class family. Additionally, I am a nonbinary trans person who was assigned female at birth.
Despite developing more intimate understandings of my gender, I don’t think I will ever find perfect language to offer others. Because of this, I am often hesitant to attempt defining my gender as it feels as though it is constantly becoming something else. I worry that my words will grossly concretize something that is so complexly malleable and shifting. Definitions can limit and reduce us to one way of being even as they can be helpful for communicating and understanding. That shared, I am growing to know that a parcel of my gender truth(s) is that nonbinary and agender have become the most comfortable set of words to describe myself, as they feel able to hold my continued tensions with gender.
Succinctly, though perhaps inadequately described, I am drawn to understanding myself as genderless, meaning that I have no gender and solely connect with different and/or multiple points along a spectrum of culturally constructed ideas of masculinity, androgyny, and femininity. Where I connect in relation to this spectrum has shifted over different periods of my life. I have realized that I go through short and sometimes long phases where my style and sense of gender settles into/onto/outside of this spectrum, at multiple points simultaneously. It is difficult to describe this if you have not witnessed or experienced it personally, but my relationship to my gender feels different across these phases. It is always nonbinary, but nonbinary along a spectrum of culturally constructed gendered meanings. As I reflect on my gender, my understanding often continues to expand into more complex territory, which is beautiful yet also challenging to communicate to others.
Although all axes of my identity have importantly shaped my life experiences and my understandings of what gender affirming voicework might be, I have more specifically considered gender given the nature of this work. That is not to suggest that my whiteness, identity as enabled, and other aspects of my identity do not influence this work. Considering this work from within the intersections of multiple axes of identity will be important moving forward.
Attempting to queer Self
As I aim to continuously queer my understanding of gender affirming voicework, I am still struggling to find the language. Within my master’s thesis (2019), I have previously stated that I use Self with a capital S, referring a person’s innermost world – to their truest and most whole understanding of themself as it may change from moment to moment. I’ve expressed that I understand Self to be the notion of being connected with the center of your being – to being fully with yourself. I’ve aligned this with poststructuralist thought (John Paul Jones III, 2013), not understanding the Self to be a stagnant, fixed essence that carries with it a singular truth and which remains unchanging, existing in isolation from others, but instead that the Self is in a constant state of becoming something else, impacted by its interconnectedness to other people, to other Selves. Self has been used and understood as fixed truth within traditional psychoanalysis (Winnicott, 1988), and because of this, my thesis advisor, Susan Hadley, has challenged me to consider whether I should continue to use the word. I continue to grapple with the ways I have compartmentalized aspects of experience and equated Self to only be the inner emotional world. I’m growing into a more complicated way of thinking, understanding the Self as a complex interplay of the body, bodily functions, intersectional identity, experiences, emotions, and so on. My descriptions of the Self have, at times, been antithetical to this understanding. I’m now wondering in what ways my ideas of Self have become intertwined with my ideas of authenticity, which I understand to be a central focus of gender affirming voicework. I will explore this in more depth later in this article. While I continue to wrestle with the history of this word and my own understandings, I am resistant to abandoning Self, instead wanting to intentionally re-author it into a more fluid, complex, and queer understanding.
I offer a creative attempt at describing my Self using imagery and metaphor. I experience myself as one person, one body of ocean with countless possibilities of expression. That body is both physical (i.e., my physical body) and mental (i.e., my inner emotional and cognitive experiences of myself). The ocean is vast and something I will likely never completely understand. I can never witness the full ocean – not the distance it covers vertically (its depth) nor the amount of land it covers horizontally (its breadth). Even if I were to go out into outer space and turn around, I wouldn’t be able to take in the intricacies of the ocean; I wouldn’t be able to witness what lies beneath the surface of the water. And even if I went down to the ocean’s bottom, I wouldn’t be able to recognize the fullness of how large the ocean actually is. All of that expressed, the ocean is still a singular body of water that overlaps with other bodies of water, so it is unclear where my body of water really ends or where another one starts, as there are no clear distinct edges. That is my understanding of my Self. It is complex, never completely figured out, and always in a state of becoming by the movement of water on Earth and by the boats, people, animals, objects, etc. that enter and leave that ocean. It is a fluid and shifting me that bears witness to my personal experiences and the experiences of others. I share this, yet I don’t fully understand how it all relates to ideas of the Self and gender affirming voicework.
Stigmas of gender expression
Gender is an integral part of our identity, and we are socialized to interact with the world within the context of normative binary understandings of gender and gender expression that intersect with other (also limiting) axes of identity (e.g., race/ethnicity, sexuality, and so on). Considering the impacts of attempting to exist within these often-limiting notions of gender, I turn to the work of sociologist Erving Goffman (1963) who discussed stigma.
While the stranger is present before us, evidence can arise of [their] possessing an attribute that makes [them] different from others in the category of the persons available for [them] to be, and of a less desirable kind – in the extreme, a person who is quite thoroughly bad, or dangerous, or weak. [They are] reduced in our minds from a whole and usual person to a tainted, discounted one. Such an attribute is a stigma […] (p. 11).
There is stigma that comes from both intentionally and unintentionally breaking outside of normative gender narratives. Consider the cis woman who speaks loudly and with confidence about their beliefs and opinions. Or the cis man who speaks gently and with lots of expression in their voice. Or any trans person who identifies with a gender other than what they were assigned at birth. Consider further the trans woman who doesn’t wear makeup. Or the trans man who doesn’t pursue hormone therapy or surgical transitions. Or the female-assigned nonbinary person who chooses to express their gender in more feminine ways. Or the intersex person who is born outside of the imposed sex binary. And all these people have multiple interlocking identities which will further impact the way they experience any stigma. As I consider the aforementioned people, I witness Erving’s understanding of “stigma symbols,” which mark a person as not normal or even ‘human’ when considered alongside normative constructions of gender. I write all of this not to pathologize gender non-conforming persons but instead to recognize the stigma that can come from existing within this gendered world. The act of stigmatizing is the problem, not the stigmatized person.
Of great importance to what might surround a person coming to gender affirming voicework, Erving wrote that “a discrepancy may exist between an individual’s virtual and actual identity” (1963, p. 30). This relates to ‘gender dysphoria,’ an experience that many, although certainly not all, trans and nonbinary individuals might have (American Psychiatric Association, 2019). According to the American Psychiatric Association (2019), gender dysphoria “involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify” (para. 1). Erving (1963) went on to express that “[t]his discrepancy, when known about or apparent, spoils [the stigmatized person’s] identity; it has the effect of cutting [them] off from society and from [themself] so that [they stand] as a discredited person facing an unaccepting world” (p. 30). Within this world, we learn how we must exist in order to be accepted, whether partially or fully. We are taught to behave, to be compliant and unspoiled, to move, to think, to voice in ‘normal’ ways.
Although my personal work expanded into something much bigger than my voice, I entered the waters of this work first due to experiencing a disconnect between my voice and gender as I came into my own gender as a nonbinary, agender person. I often experience tension when a listener hears my voice and automatically assigns it as belonging to a woman. This led to a desire for a speaking voice that would be perceived in a more androgynous-something-outside-of-man-and-woman kind of way – something that would not as easily lead to female perceptions of gender and that would hold my gender in all the ways it shifts. My voice was one of many other stigmas, including my sometimes feminine, sometimes masculine clothing choices, shaved head hair style, body type, and so on.
Considering stigma, Erving (1963) emphasized how a stigmatized person must learn how to navigate their stigma by developing various strategies. These strategies can include removing or compensating for the stigma in their lives, understanding the stigma as a learning experience, or even hiding their stigma. This last response to stigma, in particular, can lead to a kind of emotional turmoil (e.g., depression, isolation, and anxiety). My own journey within this work has led to the realization that I’ve hidden a lot of myself not only from my Self but from the broader world.
As mentioned earlier, I’ve come to understand that authenticity is integral to gender affirming voicework, specifically a focus on returning to the authenticity of the inner child within us who existed prior to the learning of gender took hold. That is, it involves accessing the child that existed prior to being stigmatized into removing, compensating, or hiding gender and/or gender expression. Consider the child who flops their body in any which way they please. Or the child who cries and screams and yells and belts loudly because they haven’t learned not to. Very young children often move and voice without care regarding how they’re perceived. They often emote without filtering themselves. I personally believe that accessing this childlike authenticity is one of the most important aspects of what gender affirming voicework might be. My understanding of this work is that it involves accessing and embodying expressions of gender which come directly from this inner childlike authenticity – less from outside societal forces that impose filters on who we must be in order to be accepted as ‘real’ and ‘valid.’ This feels connected to ideas of the Self that I described earlier; however, again, I am grappling with the inadequacies of language and my own evolving understandings.
Erving Goffman’s work and conversations with colleagues have led me to further queer my understanding of gender affirming voicework into something more complex, specifically with sitting at the intersections of how this work can encourage, in some ways, the removal, compensation, or hiding of gender stigmas while also encouraging a returning to authentic ways of being. For example, I wanted to access a voice that didn’t as easily mark me as female. This can perhaps be understood as wanting to remove my stigma to be more ‘normal.’ I need to stress that I don’t believe there is anything wrong with this if it is an authentic representation of gender. That expressed, removing stigma to fit into gendered norms may very well be a tool for survival when considering the violence that many trans and nonbinary persons experience, particularly trans women and nonbinary, male-assigned people of color (Human Rights Campaign, 2018). For me, I’ve grown to understand that a fluid, queer voice is an important articulation of my gender, both for myself and in navigating this world. These physical changes to my voice have been situated alongside returning to my own authenticity while also accepting that, as a nonbinary person, I will likely always be read within a binary by those who do not personally know me. I believe that it is important as professionals that we support those who seek therapy in realizing their own ever-evolving understandings of themselves. So often, trans and nonbinary people are policed and told what is real and valid about their bodies and genders, even told what they can and cannot do with their bodies due to barriers that are in place for different kinds of gender affirming medical treatments. This is incredibly damaging and invalidating. We, as therapists, have an important role in this.
Relatedly, I’ve further come to understand stigma and the navigation of stigma to be a kind of trauma; albeit not the kind of trauma we typically consider in therapeutic work. It is the trauma from years and years of microaggressions which can implicitly or explicitly position our gender and gender expressions as unacceptable or abnormal. Kevin L. Nadal (2018) has situated microaggressions as part of a systemic traumatizing of people. In a personal memoir by genderqueer author Jacob Tobia (2019), gender socialization is positioned as a trauma and emotional abuse that must be coped with. Jacob further described how growing up involved navigating the trauma of needing to let go of certain aspects of their gender and gender expression or face rejection. Both the letting go and the rejection is traumatizing. Jacob painfully conveyed this, saying:
… I want the world to understand that depriving a child of the ability to express their gender authentically is life threatening. I’m sharing this with you because I want you to understand that gender policing is not some abstract, intellectual concept; it is a pattern of emotional abuse that came from every direction and singularly robbed me of my childhood. I’m sharing this with you because I want you to understand that telling a boy not to wear a dress is an act of spiritual murder (n.p.).
Jacob importantly marked gender socialization to be trauma, and this idea resonates with me when I’ve considered my own childhood and even adult experiences surrounding my gender. This trauma doesn’t necessarily go away – we just find different ways of navigating it.
In my understanding, gender affirming voicework comes down to two parts that perhaps occur concurrently as they become relevant to an individual’s needs – accessing and embodying affirming and authentic expressions and healing from gender-based trauma. More specifically, I understand the work to involve accessing the inner childlike Self within a person. This Self authentically bares itself to the world without care to the way stigma might slap them squarely in the face – it’s the part that moves, thinks, and voices in ways that are affirming. Simultaneously, I understand this work to emphasize creating a healing space to navigate the impacts of traumatic gender socialization, especially as we understand how deeply the voice is connected to our body, gender, identity, and emotional world. While this work is likely more pertinent to trans and nonbinary individuals whose gender and expressions are often deeply stigmatized, I suggest that most if not all people – whether trans, nonbinary, or cis – are in some capacity impacted by gender-based stigma. This suggests that gender affirming voicework is a space not only for trans and nonbinary individuals but all wishing to more authentically exist within their gender.
Reviewing the current literature
My understanding of gender affirming voicework has expanded into holistic work, despite my entry point into this emerging method beginning with the physical voice and literature from the field of speech–language pathology. This literature explored possible avenues for vocal change for trans men, trans woman, and (subsumed within their experiences) nonbinary male- and female-assigned persons.4 These avenues include the use of hormone therapy, vocal surgeries, and/or speech therapy (Eli Coleman, Walter Bockting, Marsha Botzer, Peggy Cohen-Kettenis, Griet DeCuypere, Jamie Feldman, Lin Fraser, Jamison Green, Gail Knudson, Walter J. Meyer, Stan Monstrey, Richard K. Adler, George R. Brown, Aaron H. Devor, Randall Ehrbar, Randi Ettner, Evan Eyler, Rob Garofalo, Dan H. Karasic, Arlene Istar Lev, Gal Mayer, Heino Meyer-Bahlburg, Blaine Paxton Hall, Friedmann Pfäfflin, Katherine Rachlin, Bean Robinson, Loren S. Schechter, Vin Tangpricha, Mick van Trotensburg, Anne Vitale, Sam Winter, Stephen Whittle, Kevan R. Wylie, & Ken Zucker, 2012)5, which can be utilized for vocal feminization and masculinization of trans and nonbinary voices (David Azul, 2015; Richard Adler, Alexandros Constansis, & John van Borsel, 2012; Shelagh Davies & Joshua Goldberg, 2006; Shelagh Davies, Viktória G. Papp, & Christella Antoni, 2015).
Although beyond the focus of this current article, it is imperative to explore the impacts of different types of hormone therapies and vocal surgeries on vocal function and health. It is also imperative to understand literature regarding speech therapy, recognizing how a clinician can work to create clinical changes around gendered parameters of the voice (e.g., pitch, intonation, resonance, articulation, speech rate, strength, language use, and nonverbal communication) which influence perceptions of gender based on gendered patterns of speech (David Azul, 2015; Richard Adler, Alexandros Constansis, & John van Borsel, 2012; Shelagh Davies & Joshua Goldberg, 2006; Shelagh Davies, Viktória G. Papp, & Christella Antoni, 2015). These perceptions of the voice are steeped in the social norms that surround us regarding gender (David Azul, 2013), with the voice also containing multiple cues to other aspects of identity (e.g., geographical location, heritage, language, age, race/ethnicity, sexuality, and so on).
Even as this literature has been vital within the beginning development of gender affirming voicework, it has also presented fixed understandings which are antithetical to a queer theoretical framework. Most notably, most of the literature found focused on the experiences of trans women (and subsumed within this, male-assigned nonbinary persons). Although present, literature on vocal masculinization is sorely lacking in comparison to literature regarding vocal feminization through the use of speech therapy (Richard Adler, Alexandros Constansis, & John van Borsel, 2012; David Azul, 2015; David Azul, Ulrika Nygren, Maria Södersten, & Christiane Neuschaefer-Rube, 2017; Shelagh Davies & Joshua Goldberg, 2006; Shelagh Davies, Viktória G. Papp, & Christella Antoni, 2015). More specifically within this focus, literature that considered the speaking voice focused on vocal feminization and the experiences of trans women (and nonbinary, male-assigned persons). Literature that considered the singing voice focused on vocal masculinization and the experiences of trans men (and nonbinary, female-assigned persons). David Azul (2016,, 2013,, 2015) along with Ulrika Nygren, Maria Södersten, and Christiane Neuschaefer-Rube (2017) have emphasized the need to understand this diversity of vocal experiences and the need for client-centered perspectives in speech therapy, especially when considering vocal masculinization and the experiences of trans men and nonbinary, female-assigned people given their overwhelming lack of discussion regarding their experiences. Clinical guidelines in speech therapy suggest a very fixed understanding of the voice (e.g., the emphasis on a singular, consistent vocal pattern). Although these guidelines offer encouragement to “not routinely exclude clients who have two speech/voice patterns as their treatment goal” (Shelagh Davies, Viktória G. Papp, & Christella Antoni, 2015, p. 121), bimodal (and thereby multimodal) speech patterns were positioned as something potentially incongruent with the therapeutic goal of a consistent single speech pattern. Personally, I find it frustrating and dismissive to explain away queer vocal fluidity as unhealthy or therapeutically unachievable, and I hope that the field of speech-language pathology begins to shift its language and understandings to wholeheartedly embrace queer voicings.6
Also present within the majority of the literature was an emphasis on either the speaking voice or the singing voice with little to no discussion of the overlap that exists between them. While this dichotomy of singing/speaking might make logical sense when considering the impacts of testosterone on the voice (Coleman et al., 2012), it doesn’t address the complexity of vocal experiences. Perhaps speech–language pathologists attend to the overlap in other capacities, but in reading the literature, I didn’t recognize it within a conversation on trans and nonbinary persons. Although I have shifted into a queerer and more complex understanding, at one point this pattern mirrored the kind of dichotomous thinking I had about my own vocal transition in that I was focused on either my singing voice or my speaking voice. This centered around my tensions with potentially taking testosterone (i.e, a type of hormone therapy), which would likely give me access to a more androgynous speaking voice but would also significantly impact the way I use my singing voice (Richard Adler, Alexandros Constansis, John van Borsel, 2012; Alexandros Constansis, 2008,, 2009).
With the support and encouragement of Susan Hadley, I have been unsettling the dichotomy of singing/speaking to embrace the idea of “accessing a speaking voice through my singing voice” (personal communication). I now understand that although I might use my singing voice in a slightly different way than I might use my speaking voice, these voices and others come from the same place, the same instrument. My thoughts have shifted to: If when I am singing I am able to access certain timbres and qualities of sound that feel so connected to who I am as a person, can’t I also access these sounds when I am speaking? This has more broadly shifted into considering how music therapy could be a space where this kind of voicework might exist – where a person may be able to move fluidly along a continuum when singing and speaking in search of something truly affirming for who they understand themself as in any given moment. This moment of queering, of embracing the both/and of singing/speaking, has provided a clinical space informed by queer theory. The voice is not understood as either/or but both/and simultaneously. This offered such clarity, even as it uncomfortably unsettled fixed understandings. It might seem simple and obvious now, but this was a deeply important moment in considering what gender affirming voicework might be because it was so drastically different from what I experienced in the speech-language pathology literature and was certainly new to the field of music therapy.
Bringing in the music
Knowledge regarding vocal pedagogy and vocal function can be integrated with knowledge from the field of speech–language pathology. Reflecting on the literature and my experiences as a practiced singer, it became clear that many of the areas that speech–language pathologists focus on overlap with that of singers and voice teachers. Of the greatest significance to my own vocal situation, we as singers work with pitch, creating different vocal qualities by working with our resonance. Further, we also work with other areas that are explored within speech therapy, including articulation, vocal strength, nonverbal communication or body language, and what might be more broadly understood as vocal expression. Resonance and pitch are two of the most important parameters of gendered vocal expression (Shelagh Davies & Joshua Goldberg, 2006; Shelagh Davies, Viktória G. Papp, & Christella Antoni, 2015; James Hillenbrand & Michael Clark, 2009; Marylou Pausewang Gelfer & Quinn Bennett, 2013; Verena Skuk & Stefan Schweinberger, 2014).
I’ve grown to appreciate the voice as the unique, queer instrument that it is, with its shape malleable and shifting. For example, the body of a cello overall stays the same shape over time, whereas the vocal tract (i.e., resonating chamber, oral cavity/mouth, pharynx/throat, and nasal passages) is constantly shifting to create differently sized spaces for different vowels through the movement of the articulators (i.e., lips, tongue, teeth, jaw, and soft palate). These differently sized spaces create opportunities to either amplify or dampen certain bands of frequencies (i.e., the overtones of any given pitch). Formant frequencies are frequently discussed within speech–language pathology literature and refer to the various frequencies that are amplified within the vocal tract for various vowels (Johan Sundberg, 2006). Vowels have specific formant frequency patterns that make each vowel identifiable from the next (National Center for Voice and Speech, 2018). Although not a completely correct metaphor, but one that is perhaps helpful for understanding this, the vowels that we speak/sing are almost like individual instruments in that we are often able to identify an instrument (e.g., flute, clarinet, cello, etc.) based upon the timbre/resonance that we hear. Understanding this vocally, the format frequency patterns of an “ee” and “oo” makes those two vowels distinguishable between each other. This is also related to how we’re able to recognize singers/speakers based on just their voices.
Alongside the ways the articulators form specific vowels, the size of the vocal tract itself (outside of what the articulators are doing) influences which frequencies resonate better than others (John Sundberg, 2006). The longer the vocal tract, the lower the formant frequencies as there is more space for those frequencies to resonate (Jo-Anne Bachorowski & Michael J. Owren, 1999). We can physically raise or lower our larynx through the way we voice, thereby shortening or lengthening the vocal tract, creating smaller and larger spaces, impacting the quality of the voice. Relating all of this back to speech therapy, singers will (un)knowingly engage in formant tuning (i.e., shifting the articulators of the voice to create small changes to the space within the vocal tract without compromising the clarity or integrity of the vowel itself) (Adam Kirkpatrick, 2009; John Nix, 2004; Johan Sundberg, 2006). This is also called vowel modification, and the aim of this is to get the pitch being sung or one of its harmonics to clearly resonate within the vocal tract. Changing which harmonics are amplified affects the quality of the sound and how that sound is perceived. It is noted that when higher frequencies are enhanced, and lower frequencies are dampened, the tone is brighter (Adam Kirkpatrick, 2009). Further, with warmer, richer tones, the vocal tract is strengthening the lower frequencies and dampening the higher ones.
All this expressed, it is clear that singers can have a complex understanding of the voice, particularly of working with pitch and resonance, and both of which are significant when considering gender-based vocal work. It is important to note that many singers do not experience their voices within the more technical acoustic-based language mentioned above, but rather in terms of felt experience. Engaging with a deep understanding of the way the voice functions is important for gender affirming voicework. This knowledge has been very helpful to not only providing me with a more in-depth understanding of the voice but also a richer and deeper relationship with my own voice. Further, it has assisted me in considering how a person might work with pitch and resonance when singing to access a more affirming voice at any given moment.
Bringing it back to music therapy
Prior to more specifically identifying overlaps between the aforementioned literature and music therapy literature, it is important to note that the majority of my engagement with the following occurred concurrently to my engagement in my own voicework. The fluidity of moving back and forth between my own real-life experiences and literature was important as it assisted me in more deeply exploring what gender affirming voicework might be.
With that, considering the more technical aspects of the suggestions offered in speech–language pathology literature for speech therapy with trans and nonbinary individuals (Richard Adler, 2012), I explored the use of clinical music therapy techniques such as progressive muscle relaxation, diaphragmatic breathing exercises, clinical improvisations, and most obviously, the use of the singing voice through familiar songs and vocal exercises. I grounded these in healthy vocal technique informed by my training as a singer and further centered these on the gendered vocal parameters mentioned within speech–language pathology literature, particularly those of resonance, pitch, and vocal quality. Similar to suggestions by Richard Adler (2012), poetry and song lyrics were used as practice opportunities for voicing in new ways. Because I am a music therapist and not a speech–language pathologist, speech therapy protocols and speech therapy techniques themselves were not used. The work I’ve done has come from within the space that I am most familiar – my training as a practiced singer and music therapist. Speech–language pathology knowledge has been used to inform the basis that I already have.
My understanding of gender affirming voicework is that it could mirror what you might experience within a voice lesson while also integrating aspects that are more improvisational, allowing the work to be less focused on the goals of a singer and more focused on speech goals. More specifically, my own personal work included the exploration of vocal sound, playing with pitch and pitch range, playing with vocal harmonics and vowel formal frequencies, and exploring vowel modification to play with resonance. I found improvisation, in particular, to be particularly helpful for speech-based work given that it involves spontaneous sound making, which mimics the spontaneity of everyday conversation. Improvisation encourages sound to sit within this natural in-the-moment space, while still providing opportunities for intentional shifting of vocal sound.
An in-the-moment queer improvisational space is something that I’ve come to understand as important to gender affirming voicework. It is queer because of the ways improvisation sits in this fluid, liminal, ‘becoming’ space. I’ve personally been deeply influenced by a CoreTone exercise found in Sanne Storm’s dissertation research (2013) which was aimed at developing a voice assessment specific to music therapy. The assessment itself includes the measurement and analysis of vocal harmonics (i.e., formant frequencies), and it focused on communicating qualitative information about the voice within an interdisciplinary mental health setting. It is too complex to discuss at length here, but I intend to explore in another article how Sanne’s voice VOIAS assessment might play an important role in gender affirming voicework assessment.
Sanne Storm (2013) described the CoreTone exercise as a kind of tuning into the central pitch that a person returns to when talking, toning on that with the intention to let it become relaxed and easy to sound. In talking with Sanne, she expressed to me that the CoreTone was about letting this note spring forth from the speaking voice and move into singing, sticking to the sound, repeating it over and over again while recognizing that it might change but that this is where the voice is now (personal communication). This exercise concretely articulates the overlap between singing and speech, and it uses vocal harmonics and qualities of sound as parts of the voice assessment. I understand the CoreTone to be a kind of “home base” of the voice. It shows where a person’s voice gravitates and provides the opportunity to consider whether that gravitation feels like an authentic and true representation of the person and who they know themself to be. That is, at least in this moment as it will, of course, likely change over time, from day to day. While Sanne’s exercise was developed for the purposes of a voice assessment and not developed for gender-based work, it has been an important springboard for my understanding of gender affirming voicework.
As mentioned before, I entered the waters of what this work might be first by focusing on the physical aspects of the voice (i.e., work similar to what speech–language pathologists might do). This eventually shifted into a more complex understanding of gender affirming voicework, with the recognition that this work might also include psychotherapeutic work. For example, the voice and voicework can be a metaphor for identity and reflection of the internal world. These understandings support the ways trans and nonbinary individuals often have complex relationships with their voices, especially as the voice is an important cue of gender (i.e., identity).
The work of Randi Rolvsjord and Jill Halstead (2013) articulated the voice as an important cue of gender They explored gender politics and the voice, focused on work with an (assumedly cis) woman who experienced anxiety and depression in relation to having a very low singing and speaking voice. Therapy with this client focused on active music making and verbal conversations that were centered on her relationship to the music, the experience of singing with the therapist, and her own voice and singing abilities. The therapeutic work done there was focused on exploring feelings and emotions pertaining to the voice and music – it wasn’t on creating physical vocal changes. Importantly, Randi and Jill’s work suggests that the voice, and music therapy in particular, can be a place to disrupt understandings of gender. This is significant when considering the possibilities of gender affirming voicework.
Also important in considering the role of music therapists in this work, Julie Lipson interviewed trans individuals about how they experienced their voice after a music therapy session (2013). The work here was again not on creating physical changes to the voice, but supporting the emotional relationships that people have with their voices. Specifically, Julie discussed how those who participated in their research experienced having reactions and associations to the vocal experience provided, “noticing physiological changes, memories, emotions, and personal characteristics” (p. 78). Participants also described putting a lot of effort into the way they used their voices as well as a need to relearn how to use their voices during various states of vocal transition. Through their research, Julie discussed how music therapists have the training to work with the psychological voice, whereas speech–language pathologists are primarily trained to work with the physical voice. Julie further suggested that music therapy could fill an important and distinctive space different from what is offered by speech–language pathologists.
Moving further beyond this, I suggest that gender affirming voicework might be a place to offer an integrated focus on both vocal function (i.e., accessing physical changes to the way a person uses and relates to their voice and/or body) and emotions/identity (i.e., addressing the emotional, psychological relationship that a person has with their voice and/or body). Here, a person could work with many different facets of themself as those facets become relevant to their experiences. That is, a person would not have to go to separate spaces for emotional support or physical support but could work with the same person who might then be able to understand them in a complex way. This could further be expanded to consider even more holistic ways of working that might begin to open space for body-based work to physically embody gender, address experiences of dysphoria, and work on releasing tension with the body, and also broader work to contain the way that working with each of the aforementioned facets (physical voice, psychological voice, body) might bring about deeply emotional experiences. With intention, the therapeutic space could be understood as non-fixed – as evolving in-the-moment to address the ways in which experience and identity are never a point of arrival. Gender affirming voicework might instead offer the opportunity for queer voicings, where we can fluidly move in and out of ways of being, recognizing that our gender and expressions are in constant stages of becoming.
I understand gender affirming voicework as a potentially holistic, systemic way of working, relating it to the work of Joanne Loewy (2004), who tied together neurological, emotional, historical, and cultural uses of the voice, specific to music therapy. Joanne suggested that the voice is a kind of gestalt of human experience. Their work, alongside Julie Lipson’s (2013), Randi Rolvjord’s, and Jill Halstead’s (2013), importantly connects the behavioral, emotional, and cultural aspects of gender affirming voicework and encourages me to consider gender affirming voicework as holistic, with the capacity to open up many aspects of a person.
As mentioned above, my engagement with music therapy literature occurred concurrently to engaging in my own voicework experiences. It wasn’t until I came to a temporary ending point of voicework that I eventually found that most, if not all, of my own experiences so intimately wrapped within Lisa Sokolov’s Embodied VoiceWork method. This has been incredibly validating. My own understanding of gender affirming voicework has become weaved into the ways Lisa describes her own method. I use her exact words because they so deeply connect with my own understandings.
Embodied VoiceWork is a method exploring the resources and the power within the process of finding and freeing one’s voice. […]
The work is about listening. It is about connecting into and sensing our bodies. It is about giving voice to what is heard and felt. […]
The goal of the work is to embody the voice, to come more fully into one’s body, one’s sound, one’s music and one’s expressiveness. Participants can expect to be more grounded in their bodies and to improvise and sing more freely and expressively. They will be fluent in the language of music. Listening skills will be awakened both internally and externally. This work can open individuals to a powerful experience of emotional, energetic and expressive aliveness (Sokolov, 2019, para. 1–3).
[It is a] method of free, expansive, non-verbal, improvisational singing which aims at the development of fuller human potential through the practice of attentiveness, an attitude of radical receptivity and listening. […]
[…] We listen by sensing what is happening in our body. We open to kinesthetic experience, breath, tone, and to the imagistic language of our inner life. We listen deeply into what we are hearing. Immersion into the language of non-verbal singing brings us into conversation, into a play with the body, with ourself, with others and with the essentials of music (Sokolov, in press, para. 1–2).
Simply put, this method asks people to listen to themselves in-the-moment in a holistic way. This idea of listening has also become a significant part of my understanding of gender affirming voicework.
The emphasis on radical listening feels intertwined with queerness. In a chapter I’ve co-authored with Susan Hadley (2019), we have considered queering our listening practices as informed by Yvon Bonenfant’s work (2010). Specifically considering classical music, Yvon articulated the need to cultivate the aesthetic sensitivity of queer listening by becoming more aware of the ways that we lean in or pull away from voices (and bodies) that unsettle normative voicing, particularly in regards to queer voices (i.e., voices that don’t conform to cis- and heteronormative expectations). Yvon (2010) has discussed this in terms of finding appreciation for queer voices, thereby leaning into them instead of pulling away. Susan and I (2019) have considered this in music therapy spaces. I now consider the ways this kind of awareness could support listening to our own authentic expressions to access a voice that we lean in towards, finding sounds that are affirming and validating. That expressed, I believe beginning to find appreciation for parts of our voice that we also pull away from could simultaneously be important work. Queer radical listening certainly feels relevant to gender affirming voicework.
Returning to Lisa’s method, her work seems to consider the person on a holistic level, with the tools of the method being those of breath, tone, touch, imagery, and improvisation (Lisa Sokolov, in press, 2009). As expressed before, a holistic kind of perspective was not one that I began with, but it is one that I continue to move into as this work progresses. Lisa’s method doesn’t specifically consider gender, but in finding my own experiences validated within it, there are important overlaps.
Gender affirming voicework
I will now share my ideas of what a gender affirming voicework session might be pulling from my queer autoethnographic research (2019) and my own experiences of solo voicework sessions, working with a former voice teacher, experiencing Alexander Technique lessons (refer to footnote 1), and engaging in full and adapted GIM music therapy sessions. I will further integrate understandings I’ve gained since beginning to work in the capacity of a music therapist alongside others who wish to access and embody affirming gender expressions. While I’ve found that a typical session pattern is helpful to providing structure and with getting more engaged with the work, my understanding of that pattern has shifted from what is represented in my queer autoethnography. There, I separated out the body, the voice, and the emotional Self; I framed this pattern to be beginning with the breath and body then moving into the voice and then sometimes ending with more emotionally saturated experiences. This framework occurred partly because my brain likes organization, logic, and reason. However, the reality is that these categories were not experienced in isolation from each other, but instead in messy overlaps. Further, my distinctions between them have, at times, been incorrect. There’s been a need to queer and unsettle the fixed categories that I’ve created, recognizing that the breath, body, voice, and emotions are a gestalt of whole experience. While attempting to move beyond and between these categories, I’m finding that they are, at times, still helpful for articulating my ideas of gender affirming voicework. As such, I still work with some of them in describing what this work might be. I’m now understanding that the pattern of a session might just be that we always begin with getting into an in-the-moment mindset that promotes authenticity. From there, the work might go in many different directions that overlap and intersect as they become relevant to experience.
I believe that an important beginning to this work is to spend time getting physically, emotionally, and mentally connected with our authentic expressions. I’ve found that listening to a steady, relaxing piece of music while in a seated or lying position has been helpful. Here, the focus has been first on getting in tune with the breath, paying attention to how we’re breathing and the space we’re physically taking up while encouraging deep, full, relaxed breathing. The focus is on how breathing feels within our entire body, and it then sometimes shifts to a progressive muscle relaxation in attempts to connect deeper to our physical bodies, allowing unnecessary tension to be released. After this, I’ve sometimes shifted into free movement and stretching to further connect with my own body and release tension; however, this might be different for others depending on their comfort and physical capabilities. I understand this tuning in to be an important part of this work. Tuning in perhaps allows for more possibilities of engaging with our inner authenticity and to stay in the here-and-now.
From here, I think the work can go into a variety of different experiences, including but certainly not limited to movement-based work, imagery work, vocal exercises, song-based work, vocal improvisations, working with the CoreTone, and other chanting/toning experiences. Each of these experiences might have different purposes; that is, they might be focused on vocal function, emotions/identity, or a combination of the two (and others) as they are relevant to the needs of a person. In no particular order, below are examples of what some of these experiences might be.
More movement- and body-based work might be focused on the way we relate to our bodies, move about a room, and take up physical space, with the aim being to shift into authentic and affirming ways of being with and moving our bodies. This kind of work might also include working with what I’m coming to understand as gender imagery – images, sounds, experiences, and ideas that are reflective of inner child-like authenticity as it relates to gender. As an example, I understand some of my own gender imagery to be that of the ocean because of the way it represents the fluidity, expansiveness, and becomingness of my gender. Gender imagery could be integrated into acting exercises such as Michael Chekhov’s Imaginary Body exercise (2002). This exercise involves an actor imagining every aspect of a character (in this case, the gender imagery), stepping into the body of that person – from how they walk to how they wear their coat to how they wear their boots to how they talk. It’s about taking the actor’s body and filling it into the body of the character. Outside of movement- and body-based experiences, I think imagery might also play an important role in supporting other kinds of emotion-/identity-based work (e.g., using the imagery as a focus for improvisation with the aim to connect with gender identity) and with vocal function work (e.g., using the imagery to access what that imagery might sound like within the voice).
Somewhat relatedly, in discussing gender affirming voicework, I’ve recently shifted to statements about both accessing and embodying affirming gender expressions. This language is intentional and articulates a difference between recognizing affirming expressions within ourselves and actually embodying them within our day-to-day life. For example, the ocean is intertwined with my own identity. There is an important difference between the experience of recognizing (i.e., accessing) myself as the ocean and embodying myself physically, emotionally, and cognitively as the ocean. For me, the idea of stepping into my own ocean imagery is a powerful and even terrifying experience. Being able to identify the ocean as an expression of myself – to look out at that body of ocean, so to speak – is not the same as entering the water and experiencing myself viscerally. This distinction feels important for what gender affirming voicework might be.
Returning to the different kinds of experiences within this work, voicing experiences supported by the piano might arise in different kinds of ways. For example, in my own experiences I’ve come to understand a difference between voice-lesson-like exercise-based work and more improvisational in-the-moment kind of work. I’ve teased these out for the purposes of explanation, but these are loose categories that are actually quite messy in reality. Further, both are important for what gender affirming voicework might be; however, I’ve personally been shifting more toward in-the-moment ways of working.
Voice-lesson-like work might include warming up the voice in the kinds of ways you might in a practice or choral setting, using a variety of melodic patterns, modulating up and down while working with technique to support sound within the voice as it moves about and creating physical changes as they relate to the gendered vocal parameters. These exercises might then shift into speaking at the end of the pattern in attempts to integrate speech and song. For example, singing a five-note pattern of 5–4–3–2–1 on “ee” and shifting into speaking the phrase “easy is this sound” at the end. While I did find this helpful, I personally had difficulties with connecting my speech and singing in this way, which I partly attribute to the fact that my voice was attempting to navigate an exercise that was outside the context of my everyday speaking experiences. Working with more ‘performed speech’ (such as the speech at the end of vocal exercises) might shift us out of our natural voice and into something with exaggerated or unnatural expression. This does not get at our day-to-day typical organic speech; however, it does involve engaging with technique which is important. More voice-lesson-like work might also involve working with technique or expanding range while singing a song, changing the key of that song. For me, this kind of work involved attempting to consistently access across my voice a certain kind of timbre and vocal sound that I connected with. Voice-lesson-like work is important in considering gender affirming voicework, and because of this, I’m trying to find ways of integrating it into more in-the-moment ways of working.
More in-the-moment work might involve making music around different ‘givens’ of improvisation (Tony Wigram, 2004). This might include warming up by exploring different parts of the voice, working with a specific technique/idea throughout an improvisation (e.g., diaphragmatic breathing, tracking resonance on the palate while shifting notes, feeling a wide open space within the mouth, accessing a sound that feels like ‘me,’ expressing an intense emotion that is currently being experienced within the work, etc.), and so on. This work might also include working with the CoreTone exercise as described by Sanne Storm (2013) and variations of it. I went beyond the specific exercise to instead allow the CoreTone to become the ‘given’ of a toning experience or improvisation, with the understanding that that note could move and change into something else as it needs to. Working with the CoreTone might also shift into working more directly with speech melodies – not just one singular note but a phrase of notes coming directly out of natural speech or poetry readings. These speech melodies could then become the givens of further toning or improvisational experiences. I connect this more in-the-moment way of working with the kind of radical listening described earlier – where the focus is on attending to where a person is and where they want to be, to where they want to grow within the music and their voice.
Noting the differences between voice-lesson-like and more in-the-moment work, I experience the latter as drastically different from the former in that it is focused on being in-the-moment with personal experience and doesn’t invoke a ‘perfection/performance’ mindset for me. It also allows for more directly and intentionally working with the liminal space between speech/song, where there’s little distinction between one and the other. As mentioned above, I’ve gradually shifted toward placing more emphasis on in-the-moment ways of working.
This relates to an approach called Conversation Training Therapy (CTT) (Jackie Gartner-Schmidt, Shirley Gherson, Edie R. Hapner, Jennifer Muckala, Douglas Roth, Sarah Schneider, & Amanda Gillespie, 2016) within speech–language pathology that I’ve very recently been introduced to. This is a novel approach which aims to address how many individuals receiving speech therapy services often experience challenges in transferring techniques (which are worked on within exercises) into their natural conversation. The co-developers of this approach (Jackie and Amanda of the previously cited article) attribute this to the traditional hierarchical speech therapy programs that only engage in conversations after first working with vowels/consonants, then nonsense words, then small words, and so on until in full dialogue. They propose an approach which begins with conversationally-based work from the very beginning, and although this approach has not been directly integrated into speech-language pathology literature regarding trans and nonbinary voices, there are important overlaps to be recognized with gender affirming voicework (e.g., traditional hierarchical speech therapy as voice-lesson-like exercise-based work and conversationally-driven work as more in-the-moment improvisational). In fact, a person I’ve been working with has identified the in-the-moment aspects of gender affirming voicework as a “bridge” between vocal technique and everyday speech.
All of this expressed, gender affirming voicework is in its infancy with many possibilities of the work still to be realized. I cannot speak for others who might experience this kind of work, but profound personal growth has come out of my engagement with accessing and embodying authentic gender expressions alongside deep personal work and an exploration of what gender affirming voicework might be. I strongly believe that it has been the culmination of the various types of experiences I have engaged in over the past two-plus years that have provided the space for me to grow holistically and to become more in tune with my own experiences on multiple levels. I am a work in progress with definite room for ongoing improvement, but I’ve found a groundedness within myself that has been missing for a long while.
Prior to attempting gender affirming voicework, I strongly believe that training is essential. I have been immersed in these ideas and this process for over two years and have primarily worked only with myself. Only recently have I begun to work alongside others, offering discounted sessions to those who seek to access and embody affirming gender expressions. These sessions are discounted first and foremost because this is an emerging method, and it is very much in a process of becoming as I learn alongside those I work with. Secondly, these sessions will likely continue to be discounted as much as possible in efforts to make them accessible to trans and nonbinary people, in particular.7 My personal explorations of accessing and embodying affirming gender expressions have been deeply informative to my understanding of gender affirming voicework.
I do not feel that this work is something you can just read about and do. I believe that it requires an in-depth exploration of speech-language pathology literature surrounding trans and nonbinary voices; an engagement with related voicework music therapy methods (such as Lisa’s Embodied VoiceWork method); an intimate knowledge of healthy vocal use and vocal pedagogy; training around working with imagery in informed and deep ways (such as GIM); an in-depth understanding of trauma-informed work and the ways it could inform understandings of trans and nonbinary experiences; continued learning surrounding trans and nonbinary healthcare and culture; and a deep interrogation and addressing of personal values and biases surrounding gender and other cultural axes of identity.
I am not an expert by any means, and personally think that words like ‘expert’ too easily impose hierarchies and reduce the possibilities for the ‘expert’ to continue to expand. I have so much growing yet to do and intend to pursue training and/or personal work with Lisa Sokolov for Embodied VoiceWork, potentially some GIM training, and other trainings/education around vocal health and function, while continuing to immerse myself in trans and nonbinary culture, spend time with my own voice and body, and continuously work to live with more cultural humility. Despite feeling intimately informed with regards to this work, there is so much more I want to learn.
As I have begun to work alongside others, I have been very thoughtful about what kinds of work I can safely support as I draw upon the current knowledge and training that I do have. For example, I am not working with imagery in the deep ways that I’ve personally experienced as a client because I have not been trained in GIM. That’s not to suggest that all imagery is off-limits, I have just been hesitant given the intensity of my own imagery experiences. While I imagine integrating adaptations of GIM into gender affirming voicework, this is not something that I currently feel able to safely support.
Beginning thoughts on complexities of power and trust
In my queer autoethnographic research, I reflected on issues of positionality (and thereby power and privilege) regarding my experiences of Alexander Technique. Although I found the tenets of Alexander Technique to be helpful, I experienced a lot of discomfort in attempting to give the weight of my body to the teacher who was touching me. I barely knew this person, and I didn’t know their perspective on trans and nonbinary individuals. Further, the gender of this person also influenced the way I experienced these lessons. I recognized from these experiences that my positionality was important in engaging in gender affirming voicework with others. As a music therapist, my embodiment, values, and sociocultural location will impact the ways I relate to others and how they relate to me. Trust and safety feel integral to sharing intimate parts of oneself with another person. Power and privilege seem connected with trust, especially when considering work with a teacher, helper, or therapist. That person sits within a privileged position, and a relationship with them is uniquely experienced dependent upon the interactions of other aspects of identities (e.g., gender, sexuality, race, and so on) between both the helper and the helped. I personally did not experience maliciousness or a misuse of power with this Alexander Technique teacher; however, giving them the weight of my leg/arm/etc. required a certain level of trust and safety that just wasn’t there. These ideas are important when considering gender affirming voicework within the context of therapeutic relationship.
As I have more recently begun to work in the capacity of a music therapist, I have attempted to further examine issues of power and privilege. In particular, I have recognized the importance of leaving room for a holistic and eclectic space where the work can ‘become’ what it needs to be for that particular individual—that is, it can address vocal function, emotions/identity, and/or any intersection of those areas as they become relevant to a person. I believe that it is so important that I do not push the work into one direction but instead allow the person I’m working with to articulate/realize the kind of work they want to pursue. That expressed, in introducing gender affirming voicework to those I work alongside, I’ve described the method as a holistic one which can fluidly intersect and overlap with different needs as those needs becomes salient. I further emphasize that even if we find that our work tends to be focused more on vocal function, this doesn’t mean that we can’t bring in emotion-/identity-based at any point. This is in efforts to keep the therapeutic process queer—to keep it un-fixed, flexible, and adaptable to the needs of a person.
In beginning to work with others, I have been energized by how gender affirming voicework, when approached with a queer thought process, can more individually address a person’s concerns leading to many different kinds of work even as it’s the same method. For example, I work with one person who does not wish to change their physical voice but instead the way they relate to it in efforts to experience their voice in affirming ways (i.e., emotion/identity-based work). I work with another person who is working on creating physical changes to their voice to access something affirming (i.e., vocal function). I also work with a person who wishes to more directly work with both these areas. This kind of flexibility excites me because while there is this grounded tenet of accessing and embodying something affirming, what the work looks like and is experienced as can be as fluid as the person.
Within this work, I have further attempted to queer my own role as a music therapist by interrogating the balance between working with vocal function and emotions/identity within gender affirming voicework. In other words, what’s my role in both a) assisting people with fitting into these normative expectations of gender and expression (e.g., helping a trans woman to access a more feminine sounding voice) and b) challenging normative expectations of gender and expression (e.g., encouraging a person to authentically voice however they want to voice even if it means they are not perceived as how they identify). My role in that is complex because those two areas could perhaps be experienced as at odds with each other. I don’t think either area is good or bad-they just are. That expressed, I do think it’s important to somehow interrogate in this work whether someone is seeking work focused on vocal function because they feel the pressure to perform gender in a certain way or whether they are seeking that work because it is an actual articulation of their gender in this moment. As I’ve written above, I personally believe that accessing a child-like authenticity is perhaps the most important aspect of gender affirming voicework. This has led me to attempting to take up a role where I aim to emphasize voicing in authentic ways and to sit in a curious space to continuously ask: Does that feel authentic for you in this moment? Does that feel like you? Further, within our voicework, I encourage the person to consider similar questions as they attempt to access something that is affirming for them. From here, authenticity is emphasized.
Further attempting to queer my role as a music therapist, I’ve also considered questions such as: What is my role in supporting a person to voice in healthy ways while also encouraging them to access something that is affirming? This calls into question understandings of health and who is defining health. These are important because definitions of health could perhaps be another form of stigmatizing or limiting (e.g., if I were to tell a person that what is affirming for them is not healthy). Because of this, I’ve instead been asking myself and the person I’m working with questions like: Is this affirming sound sustainable—i.e., will this sound cause potential vocal damage in the long-term? Do you feel able to sustain this sound without it hurting or causing fatigue? And, if the sound might cause long-term damage or doesn’t appear sustainable, how can we access this sound in a more sustainable way? This both interrogates the purpose of voicing in healthy ways and further brings the person I’m working with into defining health.
Although these are certainly not the only issues that might arise when considering power and privilege in therapeutic relationship, they are issues that have specifically emerged as I’ve begun to work alongside others who aim to access and embody more affirming gender expressions. I continue to be humbled by how much I still have to learn about gender affirming voicework.
In attempts to invite you into a dialogue with what I’ve expressed in this article, I wish to voice a set of questions that arose throughout my queer autoethnographic research and current clinical work. This is in hopes that we might query these together through further exploration.
How might gender affirming voicework impact a person on a holistic level?
What might be the roles of the music therapist in working with the physical voice, the psychological voice, the body, gender imagery, and the overarching emotional aspects of this work?
What are the complexities of this work within the context of therapeutic relationship?
What kinds of experiences might we offer in gender affirming voicework?
What kinds of knowledge/training do we need to engage in this work safely and effectively?
How might we assess and evaluate gender affirming voicework?
How might we collaborate with other fields/professions?
What considerations are needed to expand this work into different kinds of gendered experiences?
How might we navigate issues of power and privilege within this work?
How might queer theory continue to complicate gender affirming voicework?
These questions hold so many possibilities of breathing new life into the air.
In this article, I have attempted to condense the complexity of my thoughts and experiences into a brief introduction/overview which explores relevant literature, possible ways of working within a session, training that might be needed, and questions/issues to be explored. For a more detailed and nuanced account of what gender affirming voicework could be, I again encourage you to refer to my full thesis (Gumble, 2019). I understand gender affirming voicework to be a work in progress, and there’s no great way of ending a story that’s in the process of becoming something else. However, I will end with a quote that perhaps captures the possibilities of this work in some miniscule way. I hope you are left with the wonder, excitement, and passion with which I am currently filled.
“I am inspired by the ideas that float through this article like pockets of oxygen trapped in a sea meant to breathe life into our bodies long enough for us to escape our realities and offer a bit of hope for what is to come. Much of what is to come is buried in the questions […]” (Amber Johnson in Bryant Keith Alexander, Timothy Huffman, & Amber Johnson, 2018, p. 323).
About the author
Maevon Gumble, MMT, MT-BC is a board-certified music therapist based in Pittsburgh, Pennsylvania (USA) working toward LPC licensure. They currently work as a mobile mental health therapist with both older adults in their homes and adolescents/young people in emergency shelter placement (Familylinks). Maevon also maintains a small private practice (Becoming Through Sound) where they offer gender affirming voicework to those seeking to access and embody affirming gender expressions, particularly vocal expressions. Maevon completed their undergraduate and graduate studies at Slippery Rock University (Pennsylvania, USA) and has served as a guest editor on Voices: A World Forum for Music Therapy for this special issue on queering music therapy. Maevon's professional interest include continued development of gender affirming voicework.8
 The American Society for the Alexander Technique (2019) states that Alexander Technique is a teaching method to “change faulty postural habits […to improve] mobility, posture performance, and alertness along with relief of chronic stiffness, tension and stress” (para. 1). Further, they state that “Most of us have many habitual patterns of tension, learned both consciously and unconsciously. These patterns can be unlearned, enabling the possibility of new choices in posture, movement and reaction” (para. 5). Lessons provide the space to “learn how to undo these patterns and develop the ability to consciously redirect your whole self into an optimal state of being and functioning” (para. 5). In these lessons, a teacher provides verbal and manual guidance, helping a person to recognize and interfere with habitual patterns. It is a hands-on approach, with the teacher having the student lay on a table or sit in a chair. The teacher will go through various body parts, picking them up to support them and asking the student to give them the weight of that body part, letting go of unnecessary tension.
 According to the Association for Music & Imagery (2019), “the Bonny Method of Guided Imagery and Music is a music-centered, consciousness-expanding therapy developed by Helen Bonny. Therapists trained in the Bonny Method choose classical music sequences that stimulate journeys of the imagination. Experiencing imagery in this way facilitates clients’ integration of mental, emotional, physical, and spiritual aspects of well-being” (para. 1). As a note, I did not understand my reasoning for seeking out GIM to be specifically connected to gender affirming voicework; however, it eventually became apparent that these spaces were intertwined in important ways. My work in GIM importantly led to voicing and exploring inner experiences of childhood trauma, and these sessions needed to be significantly adapted due to the intensity of my experiences and the need to find therapeutic supports that did not retraumatize me.
 In the spirit of my queer autoethnography, I am intentionally including authors’ first names in efforts to unsettle unconscious assumptions that are often made about authors being male and white. First names don’t inherently solve this issue given that assumptions about names could still be incomplete/wrong; however, they do provide some context that is absent with only last names. I am also using first names in efforts to create an engaging and personal text. I recognize that this does not strictly adhere to APA guidelines. This is an intentional queer choice on my part to write new discursive options that humanize people and that at least partially allude to authors’ subjective positioning.
 It is very important to me that I utilize gender affirming language, emphasizing in my descriptions of people’s gender instead of assigned sex. Throughout this article, I do this as much as possible because I intimately understand the painful experience of reading literature which continuously uses invalidating language to describe trans and nonbinary people. However, sometimes when discussing nonbinary people, in particular, it becomes important to include language regarding assigned sex. I do this only when it is imperative to understanding nonbinary vocal situations. I express my deepest apologies if my language causes harm to anyone.
 In line with what I’ve expressed in footnote 3, I am including each person involved in the publication. Despite this not adhering to APA guidelines, I do this throughout the text in efforts to recognize how each author has contributed to the piece. However, after the initial citation, they will thereafter be referenced in APA style (in this case, Coleman et al., 2012).
 For an example of queer understandings of the voice, I encourage you to refer to an ethnomusicology article by Alec MacIntyre (2018), where bodily and vocal performances of drag were explored through ethnographic research, specifically how one drag performer embraced three different personas that consistently voiced very distinctive gendered vocal sounds. The use of three separate and distinct voices suggests that we as people are capable of more than one singular speech pattern; that is, we can speak and sing in multi-modal ways. Although drag cultures are certainly unique and separate from understanding trans and nonbinary communities, the performed gender fluidity of the voice(s) that were explored in this article alludes to the importance of developing literature situating non-binary understandings of speech patterns.
 As mentioned earlier in this article, trans and nonbinary healthcare services (such as affirming surgeries, speech therapy, and so on) are often not covered by health insurances as they are regularly understood as cosmetic and not medically necessary for a person’s health and wellbeing. This means that many trans and nonbinary persons often pay out of pocket, which can be costly.
 It was my hope that I could carry my emphasis on first name citations into my reference list; however, due to the need to have recognizable citations for the electronic systems used for publishing, this was not possible. In efforts to contextualize the last names found in this reference list, I have listed the full names of all authors who I have cited within this paper: Tony E. Adams, Richard K. Adler, Bryant Keith Alexander, Christella Antoni, David Azul, Jo-Anne Bachorowski, Quinn E. Bennett, Arthur P. Bochner, Walter Bockting, Yvon Bonenfant, John van Borsel, Marsha Botzer, George R. Brown, Michael Chekhov, Michael J. Clark, Peggy Cohen-Kettenis, Eli Coleman, Alexandros N. Constansis, Shelagh Davies, Aaron H. Devor, Griet DuCuypere, Randall Ehrbar, Carolyn Ellis, Randi Ettner, Evan Eyler, Jamie Feldman, Lin Fraser, Rob Garofalo, Jackie Gartner-Schmidt, Shirley Gherson, Amanda Gillespie, Erving Goffman, Joshua M. Goldberg, Jamison Green, Susan Hadley, Jill Halstead, Edie R. Hapner, James M. Hillenbrand, Stacy Holman Jones, Timothy Huffman, Amber Johnson, John Paul Jones III, Dan H. Karasic, Adam Kirkpatrick, Gail Knudson, Arlene Istar Lev, Julie Lipson, Joanne Loewy, Alec MacIntyre, Gal Mayer, Walter J. Meyer, Heino Meyer-Bahlburg, Stan Monstrey, Jennifer Muckala, Kevin L. Nadal, Christiane Neuschaefer-Rube, John Nix, Ulrika Nygren, Michael J. Owren, Viktória G. Papp, Marylou Pausewang Gelfer, Blaine Paxton Hall, Friedmann Pfäfflin, Katherine Rachlin, Bean Robinson, Randi Rolvsjord, Douglas Roth, Loren S. Schechter, Sarah Schneider, Stefan R. Schweinberger, Verena G. Skuk, Maria Södersten, Lisa Sokolov, Sanne Storm, Johan Sundberg, Vin Tangpricha, Mick van Trotensburg, Jacob Tobia, Anne Vitale, Stephen Whittle, Tony Wigram, Donald Winnicott, Sam Winter, Kevan R. Wylie, Ken Zucker, The American Psychiatric Association, The American Society of the Alexander Technique, The Association for Music & Imagery, Human Rights Campaign, and the National Center for Voice and Speech.
Adler, R. K., Constansis, A. N., & van Borsel, J. (2012). Female-to-Male Transgender/Transsexual Consideration. In R. K. Adler, S. Hirsch, & M. Mordaunt (Eds.), Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide (2nd ed., pp. 153-185). San Diego, California: Plural Publishing.
The American Psychiatric Association. (2019). What is Gender Dysphoria? Retrieved from https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.
The American Society of the Alexander Technique. (2019). What is Alexander Technique? Retrieved from https://www.amsatonline.org/aws/AMSAT/pt/sp/what_is.
The Association for Music & Imagery. (2019). Frequently Asked Questions. Retrieved from https://ami-bonnymethod.org/about/faq.
Constansis, A. N. (2008). The Changing Female-to-Male (FTM) Voice. Radical Musicology 3, Retrieved from http://www.radical-musicology.org.uk/2008/Constansis.htm.
Ellis, C., Adams, T. E., & Bochner, A. P. (2011). Autoethnography: An Overview. Forum: Qualitative Social Research, 2(1), Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/1589/3095.
Gartner-Schmidt, J., Gherson, S., Hapner, E. R., Muckala, J., Roth, D., Schneider, S., & Gillespie, A. I. (2016). The Development of Conversation Training Therapy: A Concept Paper. Journal of Voice, 30(5), https://doi.org/10.1016/j.jvoice.2015.06.007.
Human Rights Campaign. (2018). A National Epidemic: Fatal Anti-Transgender Violence in America in 2018. Retrieved from https://tinyurl.com/y36v5e73.
Loewy, J. (2004). Integrating Music, Language and the Voice in Music Therapy. Voices: A World Forum for Music Therapy, 4(1), https://doi.org/10.15845/voices.v4i1.140.
MacIntyre, A. (2018). Drag Becomes Them: Voices and Identities Beyond the Stage. Liminalities: A Journal of Performance Studies1, 4(4), 1-24, http://liminalities.net/14-4/drag.html.
National Center for Voice and Speech. (2018). How the Vocal Tract Filters Sound. Tutorials–Voice Production. Retrieved from http://www.ncvs.org/ncvs/tutorials/voiceprod/tutorial/filter.html.
Sokolov, L. (2019). Workshops. Retrieved from https://lisasokolov.com/workshops/.
Storm, S. (2013). Research into the development of voice assessment in music therapy (Doctoral dissertation). Retrieved from https://www.musictherapy.aau.dk/news/show/phd-thesis--sanne-storm--research-into-the-development-of-voice-assessment-in-music-therapy.cid90222.