Understanding and Treating Psychogenic Voice Disorder: A CBT Framework

This book provides a step-by-step guide to understanding and treating psychogenic voice disorder by combining speech and language therapy with skills drawn from the field of cognitive behaviour therapy (CBT).

Beginning with a new classification of psychogenic voice disorder, the authors then provide a description of the CBT model and give helpful and systematic guidelines on using this approach in combination with speech and language therapy skills. They provide invaluable guidance on how to extend the standard voice case history to include a psychosocial assessment, and how to apply symptomatic voice therapy principles and techniques for this patient population.

Later chapters show how to assess and work with patients suffering from symptoms of anxiety and lowered mood, and how to understand and respond to various forms of psychopathology that may present in association with voice disorder. Finally, detailed case studies illustrate how an experienced therapist might respond to individual assessment and treatment challenges.

This book provides a step-by-step guide to understanding and treating psychogenic voice disorder by combining speech and language therapy with skills drawn from the field of cognitive behaviour therapy (CBT).

Beginning with a new classification of psychogenic voice disorder, the authors then provide a description of the CBT model and give helpful and systematic guidelines on using this approach in combination with speech and language therapy skills. They provide invaluable guidance on how to extend the standard voice case history to include a psychosocial assessment, and how to apply symptomatic voice therapy principles and techniques for this patient population.

Later chapters show how to assess and work with patients suffering from symptoms of anxiety and lowered mood, and how to understand and respond to various forms of psychopathology that may present in association with voice disorder. Finally, detailed case studies illustrate how an experienced therapist might respond to individual assessment and treatment challenges.

Doody Review Services

Reviewer:Mary Elizabeth Moody, MA, CCC-SLP(George Washington University)
Description:This book addresses issues of psychogenic voice disorders from a perspective that provides renewed insight. This is a worthy contribution to the field, underscoring the validity of, and symptoms of, psychogenic-based dysphonias, presenting specific and original templates for assessment, and providing healthy facilitators for cognitive and physical intervention.
Purpose:The purpose appears to be fourfold: to understand beyond a Freudian perspective what is happening psychologically to patients experiencing conversion hysteria; to create profiles which would describe the different contributing factors; to discuss the use of cognitive behavior techniques in treatment for these patients; to encourage the communication between speech pathology and psychology in the treatment of such patients. The authors meet these worthy objectives.
Audience:The authors encourage practitioners in the fields of both psychology and speech pathology to work with each other to better understand psychogenic voice disorders, so the book is directed to both groups. The book is also appropriate for students of both disciplines.
Features:This book defines and provides models for voice disorders with underlying psychogenic origins. In addition to well presented criteria differentiating the types of psychogenic disorders, the authors provide a cognitive and behavioral orientation both etiologically and with regard to treatment. I especially like the treatment approaches that stress reconstruction of cognitive direction. Whether we view our priorities in treating as emotionally biased or behaviorally related, the long-appreciated reality is that psyche and voice are intertwined. I appreciate that in this day of deeper medical, surgical, and physical intervention for dysphonias and aphonias, the authors have yanked back the layers shrouding the problem and reminded us of this very basic fact. Indeed, I find that very often, voice disorders are better served by dealing with the whole person - a person embodying multiple characteristics and facets -- rather than addressing the problem as an isolated entity. For these reasons, I am grateful that the authors have restored a humanistic approach to voice problems.
Assessment:This book fleshes out areas which have been ignored and malnourished in the understanding and treatment of voice. There is decidedly useful information beyond the specific psychogenic models presented. Even when our patient profiles do not correspond in all criteria to the model types presented, we can find practical and relevant information on a less stringent basis that bears application.

Peter Butcher BA (Hons), MPsychol, CPsychol, Associate Fellow of the British Psychological Society(AFBsPS); and an accredited member of the British Association of Behavioural and Cognitive Psychotherapies (the BABCP).
Peter has experience working as a cognitive behaviour therapist since the 1970s, a special interest in sharing psychological skills with others, and 20 years association with speech and language therapists working with psychogenic voice disorders. Peter has published widely in international journals on CBTand related subjects, including psychogenic voice, and he has presented papers on these subjects at national and international conferences.
In thefieldof trainingnon-psychologists inthe useofpsychologicalmethods, Peter has co-edited Sharing Psychological Skills, a special issue of the British Journal of Medical Psychology in 1985. In the area of psychogenic voice disorders, Peter has authored or co-authored a number of research and theoretical pages, as well as cowritten (with Annie Elias and Ruth Raven) Psychogenic Voice Disorder and Cognitive Behaviour Therapy (Whurr, 1993) and co-authored (with Lesley Cavalli) a case study of combined speech and language/psychological treatment in Wanting to Talk (Whurr, 1998).

Lesley Cavalli MSc BSc(Hons) CertMRCSLT, Specialist Speech and Language Therapist and Lecturer in Voice, Speech and Language Therapy Department, Great Ormond Street Hospital NHS Trust & Department of Human Communication Science, University College, London.
Lesley Cavalli currently combines her clinical work at Great Ormond Street Hospital with a lectureship in Voice at University College, London.She started her career as a Speech and Language Therapist in 1988 and has specialised in voice disorders in her clinical work, teaching and research for the past 16 years. Her current clinical post involves the tertiary assessment and treatment of children and young adults with a wide range of ENT-related conditions, including psychogenic voice disorders. She is the lead Speech and Language Therapist for the Joint PaediatricVoice Clinic at Great Ormond Street Hospital and Deputy Head of the Speech and Language Therapy Service.

Annie Elias, Specialist Speech and Language Therapist in Voice, The Kent and Canterbury Hospital.
Annie Elias has worked with children and adults with voice disorders since qualifying as a speech and language therapist in 1980. In her first post at The Royal London Hospital both Annie and her colleague Ruth Raven began working in a model of cotherapy sessions with Peter Butcher. Together they explored combining voice therapy with CBT and this led to several journal articles and an earlier text. Annie moved to Kent in 1986 to become Head of Speech and Language Therapy Services for part of East Kent. She has maintained a specialist clinical caseload in voice and is a visiting lecturer in Voice at University College, London.