Voice, and the Problems of Self Protection: PART 2

We continue the conversation we started in Part 1, and go on to talk about how fear, safety, and habit can shut down a healthy-looking voice and how to restore freedom with calm breath, gentle exposure, and compassion. Functional voice loss, hypersensitivity, and clear boundaries between coaching and therapy shape a humane approach to vocal change.

• the guarded larynx and fear avoidance loop 
• resilience as faster return to baseline 
• hypersensitivity, globus and the close-cough cycle 
• desensitising with calm breath and small wins 
• functional neurological voice loss and conflict over speaking out 
• a case of lost high range resolved through joyful sound 
• ethics, scope of practice and supervision 
• teamwork across clinic, coaching and therapy 
• kindness over public shaming to unlock authentic sound

Drop us a line, be in touch, and until we meet again, I hope that your voice finds the space it needs to be really heard

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Transcript

Welcome Back And Context

SPEAKER_00 0:01

A warm welcome to this, the second part of a conversation I'm having with Dr. Ginevra Williams, a voice rehabilitation specialist coach. And if you listen to the first part of the conversation, you'll know that this is a conversation around difficulties that people have with their voices when we can't really see anything wrong. There's nothing to see on the vocal folds, there's no biological pathology there, there's no organic lesion or cyst or polyp or anything like that. But yet that person knows that their voice can't work. In this part two, we really delve a little bit deeper into some of the more complex voice problems around the holding patterns that we might see, ranging from people who are struggling a bit with stamina all the way through to people who have total voice loss. And at this point, I should also mention Ginevra's colleague, Stephen King. Ginevra and Stephen have just published a paper called The Guarded Larynx, and this is work that they have done together around the holding patterns and compensatory mechanisms that we're familiar with, perhaps in the rest of the body, in physiotherapy, for example, and we're looking at how those might play out in the voice and in the larynx. This very, very complex system. And we look at what the fear avoidance model might mean for voice. We look at situations where people may have complete voice loss, even, and what kinds of ways we might help those people, what kinds of conversations we might need to be having. So I hope you'll really enjoy this part two. This is VoiceCast with Nikki Kennedy, exploring voice in every sense, the sound you make, the story you tell, and the presence you bring. I'm Nikki Kennedy, your host, a classical singer, vocal health and rehabilitation specialist, and an executive coach. And my work is about helping people transform, find new directions, get unstuck, and express themselves in ways that feel authentic and true. Together we'll look at how your voice and your presence can shape change in work, in life, and in yourself. Well, nearly exactly, I'm actually going to just rewind a little for listeners so that you can pick up the thread and get back into the flow if you listened to the first episode. Now, if you didn't listen to the first episode, not to worry, you'll soon catch up. There is a reference here to a conversation that we had a little earlier in the first episode, which I'll just fill you in on. So we were talking at this point in the interview about guarding, about the body's protective mechanism where there's injury and the muscles around the injury immediately start to hold on to prevent further injury. It's an important protective mechanism, and we are speaking about that in relation to the larynx. So Gineva was referring back in this next bit to a conversation we had where I described how I had experienced this myself recently after a piece of minor surgery and had been keen to get back to driving, as I'm the only driver in the family. And when I went back to see the nurse, the nurse looked straight at me and said, You can't drive yet because you're still guarding. And I understood that my although I was no longer really in pain, there was just this caution around that part of my body that had been operated on where I wasn't yet moving freely because I had been naturally just protecting it unconsciously against any further damage or injury. So that was a great incentive to me. I went home and really got working on freeing things up and those exercises I'd been set to do, and so that when I went back I was allowed to drive. So this is where we pick up the conversation, and then we'll be moving on into all of these other fascinating areas of voice.

SPEAKER_01 4:35

What's got them in the pickle in the first place is fear. And um we can talk about the fear avoidance model, which is a very useful model to consider in this. And it's when you have an onset of pain, and then you experience the pain, and you either catastrophize or you don't catastrophise. So when you experienced your guarding, which wasn't necessarily pain, it was just a bit of holding and a bit of change in the way that you were using your body. You could have gone away and thought, oh goodness, I'm still doing that. I'm got, I'd better be really careful, I'd better stop moving so much. Or you could have gone away and and did what you did, which was okay, let's see what I can do and get moving, get going, get using it. Um, don't be fearful. And if you do go around down the fear model and the catastrophizing and the holding, then what happens, of course, is the pain increases and things get worse and worse and worse. Why are you doing that? You're not doing that because you're stupid or because you are faulty or because you know, any of those. You're doing it because you need to feel safe. And I think that is crucial for people to realise that they've got themselves in a pickle because they've been aiming to keep themselves safe.

SPEAKER_00 6:11

So it is an a a a perfectly appropriate protective mechanism, but it's being deployed beyond its use, is effectively what you're saying there.

Resilience, Mindfulness And Faster Reset

SPEAKER_01 6:19

Yeah, beautifully put. Thank you.

SPEAKER_00 6:28

No, but we needed to hear all of that. And actually, it really triggered something in me because there's something I talk about when I'm working with people on presentation, people who are afraid of standing up in front of people. So I've come to meditation and mindfulness, I suppose, quite late in life, uh, because I think I have a particularly sort of busy and active brain, so it's always been particularly difficult for me to sit still and do those things. And and and rather I've always thought it doesn't work for me, it's not for me, it's tedious, it's boring. But I've come to recognise the value of it. And one of the lovely pieces of evidence is a piece of pain research which happened, and you probably are very well aware of this. I'm very interested in research on pain. This was a study, I think there have been a few studies, where they've taken some pretty advanced meditators. I'm you may well know the study, uh, and they inflicted two different types of pain. I may get this wrong because I'm doing this off the cuff, but two different types of pain. One was a physical pain, and one was an emotional psychological pain where where they jeered at them when public speaking. And the control group was a normal group of the population, and the um the other group was a group of very, very advanced meditators, people who really, really spend a lot of time on that. And they looked at the responses in the brain, and both sets of people felt the same, they had the same spike of pain as the amygdala, which is our for for listeners, is the threat response part of the brain, fired off that immediate response that that happens very rapidly, and we're going to talk about that more, I think, in a moment. There's a very rapid instinctive response, and then it's the prefrontal cortex that later on sort of starts to rationalise. And you know, when you step into the pavement and something whooshes past and you go, and oh, then then you think, oh phew, it was just it was a bus passing and it didn't hit me. And so the the response is immediate, then the the rationalizing comes a bit later. And the difference between these two two groups was not in the amount of pain they felt, but in the rapidity of the return to normal. In other words, the control group, the normal population, they remained in a catastrophizing catastrophizing state for longer. So, as well as the thing that you described where somebody might go away and catastrophize over time, this happens also in the milliseconds too.

SPEAKER_01 8:47

And it that is that's a brilliant piece of research. And that demonstrates how I describe resilience, which is it's not about being tough, it's about being bouncy. And I love that when Yeah. So when when shit happens and you feel awful, or you feel upset, or you feel terrified, or those things, it's how quickly you bounce back. It's not how bad you feel in the moment.

Hypersensitive Larynx And Globus

SPEAKER_00 9:13

Yeah, how quickly you can turn it round and see the positives and I suppose that's by part of why one of the things that we're so often being advised around at the moment is things like gratitude and journaling. It's the it's that kind of reminder to self. No, to self, you know, things aren't as bad as all that. They could be worse. So we've been talking about many, many things that can play into voice disorders and problems with voices. Uh, I really was taken in the paper by the conversation around the hypersensitive larynx and about about choking as well. And there's some parallels in sport there. Would you like to say a bit more about that?

SPEAKER_01 9:58

Yeah, hypersensitivity is it's again linked to this pain-fear loop. And when we have an odd sensation in the larynx or in the throat, our instinct is to cough, to get rid of it, or to clear our throat, or maybe to swallow. We want to get rid of it somehow. So we close to get rid of it. And if that odd sensation continues and becomes amplified by the brain, then it can become problematic. And this is often the case with a sensation in the throat. For example, there's a thing called globus, which is the sensation of a lump in the throat. You feel like every time you swallow there's something there, or you can feel something in your throat all the time. And you go and have it looked at, and there isn't anything there. And it's very confusing because your senses are saying, but there is a lump, I can feel a lump. And it is just a hypersensitivity where the there's a sensation in the throat which has become amplified by those pain sensors in the brain. It goes round and round and gets bigger and bigger and bigger in the brain, subconsciously, and we start to believe what our brain is telling us that there is something there. And that's a very difficult one to wrap your head around the whole idea that your brain is making it up because you know your brain should be a bit more clever than that. But it does sometimes it just gets itself in a tangle and gets into a loop. So that sensation, that's the globus sensation, it could be a tickle, it could be a tightness, it could be a discomfort at certain times, certain pitches or certain loudnesses or things like that, which which will trigger a discomfort in the throat. And that instinct to close or to swallow or to cough uh will uh uh of course spasm, tighten. We might cough, we might just go into some kind of tightness or spasm. Um and that again the only route through that is to calm the nervous system, to restore that calm, that trust, that safety. Which you can do with breathing techniques, you can do with meditation techniques, you can do with breathing and counting, you can do with desensitizing, so making sounds in a safe way, just increasing that that positive loop in the So really what you're describing is is this memory, the body remembering things long after the thing has gone, and just habit to creating a new habit to uh to to to sort of be efficient about getting rid of the problem long after the problem's no longer there. It's remembering and it and also making it bigger.

SPEAKER_00 13:21

So it's amplifying it and remembering it so it becomes uh a a really difficult loop. So how as well as calming the nervous system, how how else might you talk about that with a client?

Calming The System And Desensitising

SPEAKER_01 13:37

I would explain about the the pain response in the brain as being uh it is literally just just wiring in the brain that fires off and says, uh-uh, there's pain somewhere. And wiring can get exaggerated, it can get tangled, it can get oversensitized. So it it's why that happens, we don't know, but we do know that anxiety will make it worse. Yeah. So the more you worry about it, the worse that sensation will be. But it's interesting that our response to discomfort or pain is to tighten and close, and that is the very thing that is going to cause the problem and make it worse. So this is where the body's response is paradoxical because it it's not helping.

SPEAKER_00 14:41

It's not helping, it's trying to help and it's not helping. And so we have to effectively try to override that, not by not by pushing those thoughts away, perhaps, but by bringing, as you say, calm around the nervous system by uh bringing positive experience into play and rehearsing those positive experiences.

SPEAKER_01 15:05

Yeah. And saying thank you to our body for looking after us. Um, you did the right thing at the time. Now I don't need that. Thank you very much. You can let go of that, and we're gonna replace you with something that's more useful right here and now.

Functional Voice Loss And Speaking Out

SPEAKER_00 15:20

That's lovely. Time for a short break. And when we come back, we're going to be delving into some of the really complex voice loss scenarios, so functional neurological voice disorders, and one that really I find uh a very important topic, and we've talked about a little bit in this podcast in other episodes, perhaps not so much from a specifically voice point of view, but from an advocacy point of view, and that is conflict over speaking out. So this is where people kind of lose their voice because there is something there that has meant that they haven't been heard in the past, that they haven't been listened to, or that they feel that it's dangerous to be heard. We also delve a little bit into the boundaries around this work because, of course, as I've mentioned, we are treading into psychological water, but we're not psychotherapists, and so we talk a little bit about the boundaries around that. I want to come back to your fear avoidance model and to the guarded larynx paper. I think we've talked a lot about the kinds of people that you and I may see quite frequently as uh non-clinical practitioners working with people just to help them to recover to full efficiency as athletes, really, vocal athletes or speakers. But I think it's really interesting. In your paper, you do talk about some of the more extreme areas of voice loss, like the functional neurological voice disorders and psychogenic voice loss. And I feel like just talking a little bit about that, that can inform, as I said earlier, you know, it can inform how we work with healthy voices too. Would you like to speak a little bit about that?

A Case Of Lost High Range

SPEAKER_01 17:12

Yes. And and this is on a continuum. Alright, and the continuum is at one end, it's when things are appear to probably be absolutely fine, but you might just have stamina issues. You know, you might get tired a bit quicker. On the other end of the continuum, we might have complete voice loss, total inability to create sound with your voice. And everything in between, and they will all look healthy. All of those larynxes will look healthy. So going to the complete voice loss end, what might cause that? And it would be some kind of trauma. Cases might be, for example, sexual assault. And if somebody's been raped and has tried screaming out and it's not been heard, or they've not been able to attract attention, or they haven't been listened to when they've gone to ask for help afterwards, any of those uh situations, their subconscious will say, Look, the worst thing happened and your voice didn't save you. Nobody heard you. It's not not worth it. And the subconscious will shut down the voice because speaking out is is either pointless or painful. And um this is I have to stress, this is totally, totally subconscious these responses. As soon as somebody realises that this might be the case, then they can get on the path to to to sorting it through. But the subconscious response will be silence. And that can be on various levels, and we call it conflict over speaking out. It can be if somebody's been made redundant and they feel they've been made redundant unfairly, that they haven't been listened to, they haven't been heard, their opinion has not been valued, and they come away from that situation feeling that you know there's unfinished business and their subconscious will shut down healthy voice use. And sometimes that will be just going quieter, sometimes it'll be a tightening, a sort of overall general tightening, sometimes it'll be something that looks a little bit like spasming, and we'll see the voice tightening over time. It starts off clearly and then tightens as it goes through. And any of those can be from what might look to somebody else like a fairly normal situation. I mean Made redundant is not an unusual thing. It's unpleasant, but it's not unusual. But it all depends on the circumstances and your relationship with your work and how you it went about and all of all of those, and you as a person, and we all cope with things in different ways. You can't judge the way somebody copes with a situation because you would have done it differently. And I've seen several people actually lose their job or their role in a particular environment and lose their voice alongside it. And I've seen people lose their ability to sing high because they weren't heard when they screamed. And that can be um, I mean it can be in in assault, it can be other situations. Um I'm gonna tell you a a story about a woman I saw um a while back earlier last year, and she was a a doctor in the army, and she had been a very keen singer at school, hadn't sung much during her medical training because it's just difficult to be a member of a choir when you're doing that. Um, but then she wanted to come back to singing in her 30s, and her top range had gone completely, and she couldn't work out why her top range had gone. And she went to a singing teacher and she tried working on it, and it wasn't there, it wasn't coming back. And so she came to me and she said, you know, I'm thinking there was a time when I was um away with the army, and I was the the doctor in charge, but she said she was only in her late twenties, and she was in a Jeep driving through the night, and they went over a landmine, and the explosion threw the vehicle up in the air, everyone was was thrown about. She was wearing um body armour that smashed into her neck as she was thrown, and she said she didn't think anything of it at the time because she had to deal with everybody else. Yeah, she was the doctor, and there were people with with much greater injuries than her. Then, I mean, she survived it, she was okay. And I said, Supposing when that happened, what you wanted to do was shout out, and you couldn't shout out because you had to be the grown-up, you had to be the sensible professional person to deal with other people's problems. You couldn't deal with your own problem then, and so we then explored some emotional games, and I said, I don't want you to to scream in pain because that's that's not going to help. Let's do something similar that comes from joy and crazy uh expressions. So we we were in the the my teaching studio in Soho, which has got amazing views out of the window, and we were shouting to the rooftops, all sorts of noises and sentences, and we went through all these different emotions just whooping for joy, and then we sort of step by step took the whooping into singing, and suddenly you know, just in the moment, she got her voice back just there and then. Doesn't happen very often like that, Nikki. This was a one-off session, she came for one hour, and in that hour sorted completely because the story seemed to fit.

SPEAKER_00 23:51

Yeah.

Ethics, Boundaries And Supervision

SPEAKER_01 23:52

Now, what's really important in this is that may or may not be the cause of the voice problem. And I say that every time I say, look, you know, we've got a story here. It may not be true, but it seems to fit.

SPEAKER_00 24:08

And it seems to help.

SPEAKER_01 24:10

Yeah, it shows it's not your fault. You know, all the way through this, you have done the best thing in the at the time. It's not your fault. And your subconscious has held on to that moment and just said, in that moment, you were not heard, your needs are not met.

SPEAKER_00 24:32

It's absolutely fascinating the way that the the the body, mind, and breath work together, and how the unpacking of all of that can be such a thing. But I I guess that just brings me as we come, you know, we've been talking for a while now, but as we come towards the end of this conversation, I think a lot of what we do in both this vocal health work, but for me and also in my coaching work, there is um a difficult area around boundaries and around ethics because we are treading close to psychotherapy, but we're not in psychotherapy, we're not therapists, um, we're not clinical practitioners, and those boundaries have to be quite clear, I suppose, ethically and uh in every way. Can you just talk to me about those boundaries as we work? We can't avoid working with psychology.

SPEAKER_01 25:38

Oh, boundaries. It's um It's something that I think I've spent a lot of my life fighting. When somebody tells me I can't do something, I go and do it, you know. If somebody says you're not allowed to ask those questions, I think one or I'll show you. I'll show you that I can. Um I do understand how important it is that we we remain safe and that our clients remain safe. And I think if we start asking questions, going down a path that we're not equipped to deal with, then neither of us are going to be safe. Who determines what that is? Uh I would like to think that people who've done a lot of training will be able to work it out for themselves. So if you've done the you talked about the counselling skills course, you've done all your coaching courses, um, I've done coaching courses, I've done a lot of training with psychotherapists and and psychiatrists, psychologists. I have got enough knowledge to know when I what I don't know.

SPEAKER_00 26:59

Yes, knowing what you don't know, I suppose is key. And I think another sorry, you I interrupted you, carry on.

Teamwork, Clinics And Referrals

SPEAKER_01 27:05

Yeah, I've got well, yeah, I I was gonna say that I have to keep relating it back to voice. So if I ask a question, which may be do you remember when this started, or do you remember what you were feeling, or has anything, was anything else in your life happening at the same time that you lost your voice? And those are the sort of questions I'll ask. There might then be a big reveal of something. I mean, it could be yes, that was when I was going through a really difficult divorce. Uh I don't need to ask questions about the divorce. But knowing that it was happening is really useful. And then I can ask, do you think that might have affected your voice? What were you feeling? Were you feeling that you weren't being heard? We I can ask those sort of questions. Because they are directly because they are directly related to voice, and the person in the room with me understands why I'm asking them. Because it is very relevant to the journey we're on. I wouldn't ask questions that are well irrelevant.

SPEAKER_00 28:17

And I think I think that that's as I say, in the in the coaching world, uh and also in in the work that we do, I suppose one of the most important things is is supervision, because that uh you said uh as you said yourself, it's not just about keeping the client safe, it's also about keeping you safe. And so I think having regular supervision is probably key. And uh it it keeps it keeps you aware of when, you know, perhaps somebody a supervisor, if they are, I mean, I'm supervised by a number of different people for different things I do. Um, but certainly having a clinical psychologist as one person who supervises me, if I bring something and the question comes back to me that makes me think, oh, okay, maybe I should maybe I should just beware of that or watch out for that, or or you know, even in coaching I have had an occasion where I did wonder, is this person you know, he he he seems alright, but do I do I need to make a a suggestion that he might want to go and see a um a psychotherapist or a psychologist of some sort? I feel that maybe I do. So having that conversation actively with yourself, I suppose, is i and with a supervisor is important.

SPEAKER_01 29:35

Really important. And to know at every moment in your professional life that you are evaluating yourself and to have the humility to know, shit, I'm out of up there. I'm not sure where to go with this. I don't know whether I'm doing the right thing. And to take that to your supervisor and ask and to have a relationship that is so secure with your supervisor that you can say, look, I really don't know. What do I what what do you think? To sort those things out.

Kindness Over Shaming And Final Takeaways

SPEAKER_00 30:15

And I suppose it's also uh you know one of the benefits of what of working as part of a team, as you say, you know, you're attending voice clinic, and uh I don't go as to the voice clinic as frequently as you do, but I do attend voice clinic, and and there you have got a speech and language therapist in the room, you have the surgeon in the room, you've got a number of other practitioners uh sort of in the in the web that that of referral, and I suppose being part of that team and recognising where somebody else needs to perhaps take over is key.

SPEAKER_01 30:46

And I'm always asking questions in the clinic. I always turn up and I say, Can I ask a question? I've been thinking about, and there's always something that I found intriguing that I know one of the other people in there will have an answer for because their specialization is is different from mine. And that's that's where teamwork is so useful and so brilliant. And I do encourage teamwork with the the people that are training. I do say build your team, build your team around you because it's so important to have those relationships with people who have different skills to yours.

SPEAKER_00 31:27

Yeah, I mean, even as a even as a a voice coach or singing teacher, there are times when you can't get somebody past a block and somebody else could do it in a twinkle of an eye. But it's not because they're a better teacher than you, it's just that a fresh voice dislodged something, and uh but it's sometimes I think people find that quite difficult to feels like an admission of defeat to pass somebody on. Yeah. This has been an amazing conversation, Ginevra. I I'm i is there anything that we have missed that you really would like to mention in particular. Um I know, but it it is true to say that the episode is definitely going to be hard. We'll have to have part two.

SPEAKER_01 32:20

Yeah, um I I think the the important take homes are that voices are complicated. I think we have said that, but just a reminder that it isn't a straightforward noise-making thing, that there is a human with feelings and the emotions that we feel healthy, normal, um, wonderful emotions are crucial for that, and they are so tied in with our voices that we can use those to unlock things, we can use those to explore things, we can understand that emotions are what are probably going to be blocking some of the things with our voice. So I think that that relationship between emotion and voice is really key.

SPEAKER_00 33:19

And and I think that would lead me to my final question, which is if we go back, if we loop back to the the director who's turned around and said to you, not like that, or that was, you know, you're just consistently singing that, how I don't want it, or the thing that has got somebody into that guarding state. If there was one thing that you would change about the way that people work with singers or speakers, what would it be?

SPEAKER_01 33:52

Um kindness and compassion. Understanding that everybody is slightly different. A little bit of understanding what's might be underneath or behind or at the root of something. Uh so the the director saying, No, stop doing that, you keep doing that, I don't want you to do it. Could instead in a private moment say, I'm interested that that that keeps happening. Um is there is th is that something that that you are working on? Is that something that you would like help with? Is that you know just a little bit of understanding rather than public shaming? Which is always horrible.

SPEAKER_00 34:46

Yeah.

SPEAKER_01 34:47

Even even with people that you know and love.

SPEAKER_00 34:50

Oh, it's one of the greatest punishments that society has ever uh uh uh chosen to to to to punish any kind of wrongdoing, isn't it? Public shaming.

SPEAKER_01 35:01

Yeah. Yeah, yeah. So I think just think before you act, think before you speak, and if in doubt, say nothing. Say nothing and just and just look and smile, and the other person will probably come up with something really important that you weren't thinking of.

SPEAKER_00 35:28

So something around it's obviously compassion, kindness, there's something around positivity, we can still aim for really top quality, we're not talking about dumbing down the the product here. We're if anything, talking, I think, about um enhancing it, making it uh uh it more exciting and more um perhaps more even more variable.

SPEAKER_01 35:50

Uh absolutely. If every singer feels that they are able to sing with their own voice to express their own feelings in the way that feels best for them, you're gonna get much better quality singing than if everybody feels they have to sing in a way that fits a template that someone else has defined.

SPEAKER_00 36:12

Thank you. That's a lovely way to end. And uh it's been a lovely conversation. As you say, there is so much more we could talk about, but uh that will have to do for today. Thank you very much, Ginevra.

SPEAKER_01 36:24

Thank you so much for having me, Nikki.

SPEAKER_00 36:29

You've been listening to VoiceCast with Nikki Kennedy. For me, voice has always been more than just sound. It's presence, connection, music, transformation. I hope this episode has offered something to carry with you into your own conversations, into your own story. So drop us a line, be in touch, and until we meet again, I hope that your voice finds the space it needs to be really heard.