Doing the Inner and Outer Work: Culturally Responsive Practices in Gender-Affirming Voice Care

Abstract

Purpose: This article aims to raise clinical awareness of (a) the barriers and forms of oppression that transgender and gender-expansive (TGE) people face, (b) the ways in which discrimination can subconsciously be enacted by practitioners and institutions, and (c) to provide actionable steps for providing gender-affirming voice care (GAVC) services. Method: This article draws on empirical evidence of inequitable access/barriers to resources and the heightened risk to well-being for TGE people, as well as the theoretical foundations from the field of psychology that lead to culturally responsive care of the voice. It clarifies and expands the tenets of gender-affirming practice and trauma-informed care and identifies action steps for practical application in this specialized area of voice. It highlights the need for greater self-reflection and ongoing education when providing GAVC services, particularly as it relates to the practitioner's understanding of the intersections of racism, transphobia, neurodivergence, and disability justice. Conclusions: In addition to having strong voice skills, practitioners who are lifelong learners, remain pliable to learning new ideas, and have a strong and sincere desire to provide GAVC are needed to work with this population. Those providing GAVC are recommended to first deepen their self-reflection skills and understanding of their own identities, as well as acquire a humble understanding of the 2SLGBTQIA+ community, especially in terms of the intersections of race and gender expression. The authors recommend personal and professional work through a justice, equity, diversity, and inclusion (JEDI) journey. This includes increasing one's counseling skills in order to provide tailored support that is specific to the client's needs. This article aims to provide a concrete entryway for the practice of gender-affirming care as it applies to the voice, while acknowledging that maintaining ethical gender-affirming practices requires a lifelong commitment to continuing education.