Vocal Health

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Why should music therapists be mindful of vocal health, and what can we do to protect our speaking and singing voices? If we need partial or complete vocal rest, what are some suggestions for adapting music therapy sessions?


I have lost my voice while teaching long classes, leading huge groups in a loud psych hospital, cheering on our local football team with friends in our favorite – but smoky – bar, and drinking a lot of coffee. Teachers are 32 times more likely to have voice disorders than colleagues in other professions (Voice Academy, 2003a). Music Therapists – Board Certified (MT-BCs) put tremendous strain on our vocal folds with many hours of teaching, counseling, advocating, performing, singing, masking loud medical equipment, and possibly compromising posture, breath support, and good singing technique.


Drink a lot of plain water on a regular basis. Drinking a ton of water once you feel dry is showing up late for a very important date. Better late than never, but you missed the downbeat. You should drink water much sooner, and enjoy sips all throughout the day. Water slides down your esophagus and into your stomach – the very act of swallowing closes a flap above the vocal folds to prevent anything from entering your lungs. Your larynx only receives that necessary moisture from water after it has been absorbed through digestion.

Overall health is important. You should aim for plenty of rest and an appropriate amount of exercise, while tempering use of alcohol and exposure to smoke. I hate to admit it, but you should even limit your caffeine intake. These substances may dry and irritate your throat. Instead, enjoy a healthy balance of fruits, vegetables, and… a compensatory amount of coffee on the weekends! Wait, no, that part’s not mentioned in the research…

I love to stretch and take a few deep breaths when warming-up. While driving in the car, especially driving to the morning’s first session, I might sing a few long tones, hum several scales, and gently rehearse musical material I will soon be using, in a comfortable range.

Be mindful of the clinical environment’s temperature, humidity, acoustics, and noise level. Belting or otherwise straining your voice is unnecessary, and should be especially avoided in dry climates. Even just rapidly moving between various climates can hurt your voice. Be mindful of your own internal environment, too. Regulate your intake and activities in order to be kind to yourself. Love your instrument.

Need motivation? Boyle and Engen (2008) described research which found that 80% of voice disorders may be avoidable yet may cause long-term consequences (Brodnitz, 1971), that up to 55% of professionals relying on their voices experience gastric reflux as opposed to only 0.5% in the general public (Koufman, 1999), and that two-thirds of people with voice disorders also report symptoms of depression (Voice Academy, 2003b). So… drink some water. Read some research. Make a few small changes.

If you should ever feel hoarse, overuse, inflammation, reflux, illness, etc., then I encourage you to consider partial or complete vocal rest, while reflecting on your intake, activity, and environment. Serious cases should seek medical guidance.


MT-BCs depend on our voice, but as creative professionals with research and clinical expertise, we are always ready to adapt. In my experience, our ability to therapeutically apply empathy and compassion exceeds any need to speak or sing.

Transpose songs to best fit your vocal range. Avoid songs which put undue strain on your voice. Shift your focus towards more instrumental selections or musical improvisation. Lead a drum circle exclusively using facial affect and body movements. Conduct a color-coded boomwhacker choir. Prepare posters (or use a projector if available) with simplified music diagrams and demonstrate the egg shakers, the bongo, the open-tuned ukulele, etc. Use recorded music or music videos for lyric analysis, guided relaxation, movement to music, improvisation structure, choral accompaniment, music listening, and more. Can you lead music lessons, iPad apps, rhythm competitions, name that tune, music bingo, and other fun activities without speaking? Bring a notepad or a communication board. Print your session plans, adapted to provide clear directions for clients to read aloud. Find new ways to co-treat with another music, speech, physical, or occupational therapist. Turn it into a new challenge, and have fun!

Voice Academy. (2003a). Voice Academy website helps teachers address vocal problems. Retrieved by original authors September 28, 2005, from http://www.uiowa.edu/~shcvoiceJpressrelease.html

Woodhull, M. (n.d.). Vocal Health Tips. Retrieved October 8th, 2015, from http://www.singingforaliving.com/articles/vocal-health-tips/

Boyle, S.H. & Engen, R.L. (2008). Are music therapists at risk for voice problems? Raising awareness of vocal health issues in music therapy. Music Therapy Perspectives, 26(1), 46-50.

Brodnitz, F. S. (I 971, Feb.). Hormones and the human voice. Bulletin of the New York Academy of Medicine, 47(2), 183-191.

Koufman, J. (1999). What are voice disorders and who gets them?? Retrieved by original authors May 26, 2006 but may no longer be available, from http://wwwl.wfubmc.edu/voice/ahout/About+Voice+Disorders.htm

Voice Academy. (2003b). Voice Academy text. Retrieved by original authors May 26, 2006, from http://www.uiowa.edu/~shcvoice/textonly.html