Virtual Voices

When I took a counseling course in graduate school, we were taught to let our patients feel their feelings, actively listen, and help them cope. But graduate school never taught me what to do when I had a patient looking directly in my eyes asking me, “What do I do with all of this grief?” I didn’t have an answer yet, so I listened. And what I heard changed everything.

After I left graduate school, I began working at an outpatient clinic where I was treating adults and children. I recall an older patient that came to me with Muscle Tension Dysphonia. This is a voice disorder where excessive tension in the laryngeal and paralaryngeal muscles leads to an abnormal vocal quality. This patient had been unable to speak for months. Her small, quiet voice was strained, hoarse, and no louder than a squeak- if it came out at all.

I had briefly learned about Muscle Tension Dysphonia in graduate school, but I can’t say I felt confident out of the gate. But, I was taught how to research. I read countless journals, pulled out old textbooks, and even resorted to watching singers on Youtube desperately looking for a way to give this woman her voice back.

The difficulty in treating Muscle Tension Dysphonia often starts with the name itself: Muscle tension. Too often, I’ve found that therapists will rush to treat the voice before asking why it went silent in the first place. At first, I was no different. But this patient didn’t have any underlying disorders to treat, so I treaded lightly into unknown territory. We were making progress objectively. I had shown her exercises that reduced muscle tension in the neck for a short period, but as soon as she stopped doing the exercise, her voice was lost. I couldn’t figure out how to make the results stick. But after a couple weeks, I found myself lying in bed at night after one of our sessions, and I thought to myself, “What is truly causing this muscle tension?”

The A-HA moment came during one of our sessions. I had just finished a circumlaryngeal massage, and she was displacing tension with a theraband. As we worked, I asked her gently, “What makes you feel stressed out?”

She paused when I asked what made her feel stressed as if she had never been asked before. Then, slowly, in a soft voice, she told me about her husband. He had Alzheimer’s. He used to be cruel before the diagnosis, and now he was unpredictable and volatile. She was his full-time caregiver. Suddenly, the tension in her voice wasn’t a mystery anymore.

It wasn’t just muscle. It was memory. Trauma. Resentment. Exhaustion. Unspoken grief.

That’s when I learned something grad school never taught me: Sometimes, the voice isn’t lost because the muscles are tight. The voice is lost because the body doesn’t feel safe enough to speak.

We kept working together. Her voice didn’t transform overnight, but something began to shift. As she named her grief, her voice slowly began to return. Not just in sound, but in confidence. We created the space for her nervous system to finally speak its peace, and as a team, we listened.

The funny thing is, this patient didn’t just teach me how to treat Muscle Tension Dysphonia. She taught me how to listen to the history that causes disorders. She taught me to listen with more than my ears- with my heart, my mind, and my soul to discover why these disorders happen in the first place. That patient taught me more than any journal article ever could: emotions aren’t noise and they aren’t barriers — they’re information. Signals. And when we stop trying to “fix” them, we can finally start understanding what they’re trying to say. I can read a thousand textbooks, but what good are they if the patient isn’t writing the final pages?

I still don’t have all of the answers. But now, if a patient turned to me and asked me, “What do I do with all of this grief?”

I’d tell them this. We listen to it. We acknowledge it. We feel it. We let the grief speak. And slowly, we find our way back to our voice.