Article Review - Navigating the “Passagio” Between Voice Therapy & a Singing Lesson

Article Review: Navigating the “Passagio” Between Voice Therapy and a Singing Lesson: Ethical Considerations for the Speech-Language Pathologist by Katherine McConvile. (Perspectives of the ASHA Special Interest Groups: Volume 5; 658-661, 2020)

This informative and thought provoking article discusses the factors that guide speech pathologists’ ethical decision making when working with the singing voice. The article also seeks to provide answers to the following question: What is the line between medically necessary voice therapy that targets singing vs. habilitative voice training which would be more appropriately serviced via singing lessons?

McConville begins by affirming the role of the speech pathologist in the care of the singing voice: Where a singer presents for treatment with a voice that is considered ‘disordered’, it is appropriate for the SLP to target the patient’s singing technique if it is contributing to or impacted by the disorder, provided the clinician has the appropriate skills and background to intervene in the singing modality. McConville acknowledges that the line distinguishing between voice therapy and a singing lesson has not always been well defined due in part to the overlap in vocal tasks/exercises that span from the clinical setting to habilitative voice training. These factors present an ethical grey area for SLPs, hence the need to consider the important differences between voice therapy and singing lessons.

Some key take home messages from this article:

*Voice therapy aims to correct biomechanical inefficiencies that impede upon the singer’s vocal quality and function, whereas singing lessons presume the voice is functioning at a “normal” level, and can thus be shaped technically and artistically to maximize the singer’s healthy baseline function.

*Voice therapy and singing lessons may utilise similar vocal tasks and vocalises, however the rationale for their use across the settings is different.

*When setting treatment goals, use language that is clear and specific about the vocal subsystems and perceptual voice features that are being targeted. Avoid vague statements such as “the patient will achieve target voice in singing”.

*Voice therapy is not appropriate in scenarios where there is no longer intent to treat a diagnosed voice disorder, and prescribed vocal exercises involve modifications to the voice that are purely technical or artistic without hindrance from a traceable element of a voice disorder.

*Clinicians need to be decisive in determining when treatment objectives are met in order to avoid providing unnecessary treatment.

At the end of the article McConville concludes that line between voice therapy and a singing lesson is likely more of a gradient. We highly recommend a more detailed read of this article – it highlights many important ethical considerations when working with the singing voice, and from the topics discussed one can also glean clinically useful information such as when voice therapy is indicated vs. when a referral for singing lessons is appropriate, and recommendations for use of language in goal setting and documentation. This fantastic article it will no doubt prompt you to reflect on your previous clinical management of singers as well as your current practices.