Advice for Speech and Language Therapy Students

I receive many queries from speech and language therapy (SLT) students. It’s great to know there is a lot of interest out there in Voice! From voice disorders to performance and singing voice, voice therapy allows for working with both medical and artistic aspects of voice function and production.

Working in the NHS

The field of Voice is specialized and is a relatively small field within the remit of Speech & Language Therapy. Most NHS Voice job advertisements require the post holder to have at least two years of general speech and language therapy experience. If you don’t have this then see below for ideas to acquire experience.

Voice is very often combined with Head and Neck work as they both fall under SLT ENT (Ear, Nose and Throat) posts. However, it is possible to work solely in either field. In both fields, you and your team will be closely allied to the ENT teams and patients will be referred from the ENT department. Some hospitals have specialist Joint Voice Clinics run by a Specialist / Lead/ SLT and an ENT Consultant.

The advantages of NHS work include close links with ENT and allied teams, regular clinical supervision and specified time and funding for attending study days/courses.

Working privately

Voice work lends itself to working privately more easily than some other fields in Speech & Language Therapy. Most SLT’s who work privately have considerable experience and have established links with their referral sources. Generally, fees for services reflect the experience, client range and level of expertise and training of the clinician. Fees also reflect the location and clinical setting e.g, central London settings tend to be more expensive because of room hire and overhead costs. However, they offer convenience and accessible travel for many clients.

Some clinicians belong to The Association of Speech & Language Therapists in Independent Practice (ASLTIP). ASLTIP run courses in setting up in Independent Practice.

My own work background

My 1st degree was in the Humanities. I worked for a few years in business before doing my MSc in Speech and Language Therapy and Pathology. I still had a small role in the business when I qualified which allowed me some time to choose my first SLT role. I also did a VoiceCraft 6 day voice course in that time (taught by the late Alison Bagnall), which definitely cemented my interest in Voice. Many students wish to start working in Voice immediately after qualifying. Apart from this being difficult to secure, especially within the NHS, my own view is that this isn’t necessarily the best career route. A more general grounding is advisable and allows for more freedom and choice in your career, including being able to secure work abroad if this is something you are interested in. Gathering experience also makes you good at your job. It is difficult to work in private practice without first acquiring good voice skills and experience dealing with clients some of whom will be challenging and complex.

My first SLT role was a part-time community post. It wasn’t the job I applied for. The post I thought I was interviewing for was an adult neurolgy out-patient and ward based job. However, as I had a car and the other applicant didn’t, I was given the community post! Looking back, it was the best grounding and training for me. It familiarized me with the local area and gave me the chance to see a great variety of patients and medical conditions including patients with Parkinson’s disease, Multiple Sclerosis, MND, dementia, various communication difficulties following stroke etc.

When the 6 month community post ended, I took a hospital based job in the same trust (The North Middlesex Hospital) where I had had a long and enjoyable student placement). This second job gave me a plethora of experience working on hospital wards. It’s also where I began treating out-patients including voice and stammering patients and my first transgender client. It was in this post also that I did my advanced level dysphagia training and worked with swallowing disorders.

I continued to attend Voice Special Interest Groups (SIG’S) and to do voice courses, including several advanced level VoiceCraft courses. The devisor of these courses, Alison Bagnall, invited me to become her associate and work in her private practice in Adelaide Australia. I took up this offer and worked long days solidly in voice for 6 months in private practice. The high volume of clients I saw solidified my skills as did regular opportunities to discuss clients and therapy techniques in detail with Alison and the ENT consultant. Also in my time in Australia, I worked at The Julia Farr centre for severely brain injured clients (3 months) and then in a private practice in Brisbane with the widest variety of clients I had ever seen! The clients and settings included stroke patients in hospitals, the elderly in nursing homes, home visits to dysphasia and brain injured clients. Many clients also came to the clinic, including those with dyspraxia and adult and pediatric voice patients.

I knew when I returned to the U.K that I wanted to work in Voice and about 6 months later, I applied for a 4 day Voice job split over two trusts: Ealing and Hammersmith Trust (the latter job based at Charing Cross Hospital). After 1 year at Charing Cross, the one day a week Transgender Voice post, previously filled by an experienced locum, was advertised. I applied, and was successful. It was challenging, not least because of the 10 month waiting list and distant links to the Gender Identity Clinic (GIC).

I worked hard to develop stronger links with the Gender Identity Clinic and other Speech & Language Therapists nationally and Internationally. Over time, the transgender Voice post was expanded (due to demand for the service) and I reduced Voice days at Ealing to accommodate this.

I had an increasing demand from clients to work privately. Initially, I developed my private practice (evenings and weekends) along side my full-time NHS work. I also ran Voice courses. By my reducing 2 days a week in the NHS, department money became available to train a developing specialist in transgender Voice. Reducing NHS days also allowed me more time and freedom to develop my private work. In addition, it created flexibility to more easily attend conferences, to develop and run courses, and to accept invitations to give presentations. My experience has led to requests from the media to contribute to broadcasts relating to voice disorders, performance and singing voice and transgender voice. It remains important to me to promote the profession of Speech & Language Therapy and the field of Voice to a wide audience.

Gathering experience

Clinical placements and observation:
Gathering experience and knowledge is crucial If you are interested in working in Voice. Many students contact me to say they do not get adequate exposure to voice therapy and voice patients during their training. You may be lucky enough to secure a clinical placement working with an SLT/ENT team. If not, you can approach relevant SLT Departments and clinicians. Observation placements are becoming less prevalent and less possible for many SLT’s due to their heavy clinical demands and reductions in posts.

Also look out for Voice courses and conferences that offer discounts to students. I prefer to structure observation and training days for students and have set days for this as it is difficult for me to accommodate individual requests for observation sessions due to heavy clinical demand. I also feel it’s important to allow time for questions from students and time for me to answer!

Please see the ‘Courses’ page on my website for the next student course. The fees are kept to a minimum.

Volunteering

One way of maximizing your chances of observing Voice work is by becoming a volunteer in an SLT dept./clinic that has a Voice service. In exchange for some observation of therapy with clients, exposure to working with ENT depts., etc., a volunteer is expected to carry out administrative tasks which help the therapists e.g photocopying of materials, filing etc., and perhaps assisting with the running of voice groups. Hospitals require volunteers to go through an official vetting process including a CRB (Criminal Records Bureau) check before being issued an official hospital volunteer I.D card.

Courses

Experiential voice practice can be difficult to acquire at courses. However, attending Voice courses is important in exposing you to the language of voice, therapy techniques and visualizations of the function and structure of the larynx. Most of the Voice courses and conferences I attended were partly, or fully self funded. I was driven by my passion for Voice and a wish to acquire a high level of knowledge and expertise. Prior to securing my first SLT job, I had gained invaluable experiential voice practice by attending the complete 6 day VoiceCraft course. Understanding and developing your own voice will aid your therapy and competence and can potentially increase the range of clients you work with.

U.K Voice courses are advertised in the Royal College of Speech & Language Therapists (RCSLT) fortnightly Bulletin publication, where both courses and Special Interest Group (SIG) meetings are listed. The British Voice Association (BVA) also host regular Voice study days and courses.

Special Interest Groups (SIGS)

The most economical way to gather exposure and knowledge in Voice is by attending Voice SIG’s. There are many Voice SIG ‘s around the country e.g the London Voice SIG and the Oxford Voice SIG, which hold 3 study days a year. SIG’s do not offer direct voice training but are designed to enhance knowledge, facilitate discussion and expose attendees to a variety of Voice issues and practices. A variety of speakers are invited to present including ENT Doctors, Specialist SLT’s and Voice specialists. Allied professionals may also present e.g laryngeal Osteopaths, psychotherapists and counsellors.

SIG’s follow the Royal College of Speech & Language Therapists SIG protocols and each SIG has a committee which organizes the study days. SIG’s have an annual membership scheme which is very reasonably priced. There is a reduced fee for students. It is also possible to attend any SIG without being a member for a slightly increased fee per study day.

Reading

A good Voice text is a must. It is a field which produces an excellent array of books. Plural Publishing has an extensive volume of texts. I highly recommend the following:

• The Voice and it’s Disorders by Greene and Matthieson, (Whurr Publishers)
• Voice work, Art & Science in Changing Voices by Christina Shewell, (Wiley-Blackwell)

For working with Transgender clients, an understanding of the field and the input of various health professionals from psychiatrists to surgeons is crucial. Recommended texts include:

• Transsexual and Other Disorders of Gender Identity, Ed. James Barrett (Radcliffe)
  ( includes a chapter on The Role of The Speech & Language Therapist)
• Voice and Communication Therapy for the Transgender/Transsexual Client, ed’s Richard K. Adler, Sandy Hirsch, Michelle Mordaunt ( Plural Publishing)

GOOD LUCK IN YOUR ENDEAVOURS!