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Understanding and Treating Psychogenic Voice DisorderUnderstanding and Treating Psychogenic Voice Disorder: a CBT framework

Peter Butcher, Annie Elias & Lesley Cavalli
(Wiley Series in Human Communication Science)


Review by: Pamela Parry

I remember the very first BVA day I attended as a brand new paid up member, November 21st 1997, at the Commonwealth Institute in Kensington. The day was titiled "Voice: psychology and stress" and I had been experiencing some non-pathological voice problems for a while and went along not knowing what to expect.

One of the speakers was Peter Butcher and his talk entitled, "Speak Your Mind to Find Your Voice" was a revelation to me. He had clients, mainly women who were going through similar experiences with their voices and here was this man full of empathy for them and in a position to help them. That day was a real turning point for me and I was determined to work out what was going on with me and help other people in a similar situation. Fast forward nearly 10 years to the Nottingham Voice Days in March this year and browsing through the new books on display I saw the name Peter Butcher on the front of this book and grabbed the nearest copy. It was through Peters interest in the psychological causes of voice disorders and a request from specialist SLT Annie Elias one day in the early 1980's while both were working on different floors and in different departments in the out patient building of the London Hospital, Whitechapel, that a collaboration was about to form to be joined later by co-author specialist SLT Lesley Cavalli and would end up eventually as this informative book. Annie asked Peter if he would be willing to see some of her patients that were not responding to standard voice therapy, or if they did respond they quickly relapsed. They did an initial study of 19 individuals to look at the origin, nature and treatment of psychogenic voice disorder. What emerged was that cognitive behaviour therapy techniques were very valuable in treating the majority of patients and that SLT's should be familiar with these when working with voice patients.

I think the book is great and has come at the right time when more and more of us are becoming anxious and depressed and it is starting at a younger age. It is laid out well with 10 chapters covering the definitions of psychogenic voice disorder, the signs and symptoms of psychogenic dysphonia and aphonia, the essence of CBT which is understanding what is going on in a persons mind right now, how that person makes sense of experiences as well as thoughts and images and how to change those dysfunctional thoughts, the assessment of voice and personal history, symptomatic voice therapy approaches, assessing and treating anxiety and depression in voice patients and deciding when not to treat patients who have post-traumatic stress disorder (PTSD) or obsessive compulsive disorder(OCD).The final chapter is a fascinating read of case studies of psychogenic voice disorder providing examples of the diagnostic features that distinguish each case and the management techniques applied that include voice therapy and CBT.

I would love to see more collaboration as detailed in this book with psychotherapists, SLT's and specialist singing teachers. We can all learn so much from each other. I loved the book, it covers a huge amount even though it's not a particularly big book and I have to keep going back and re-reading several chapters but it is one that I will keep at my side to dip in and out of constantly.



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