Skip to main content

Verified by Psychology Today


The Use of Voice in Therapy

The key to becoming a skillful therapist is to find your true voice.

As a former violinist, I understood the precarious balance involved in creating the ideal sonorous richness from the instrument. Too much pressure in your bowing, and you would create harsh metal dissonance. Too little, and you would lose any sense of musical life or passion. Reaching that happy medium allowed you to connect fully to your audience.

Now as a psychiatrist and therapist, listening to the stream of people’s thoughts and deepest worries, I have wondered about what it means to be skillful in my practice, to succeed in helping my patients. And over time, I have found that the tune of my own “instrument”, the key of my voice, has buffeted the language I use, highlighted the nonverbal cues of connection.

As an infant my mother said I loved to cry with gusto, and as a four-year-old, I declared that I would become an opera singer. I would whirl around in a gypsy-colored shawl and belt improvised arias to the backyard trees. Yet as time progressed, my voice settled into a soft, nasal tone, often causing those around me to ask, “Come again?” At other moments of stress, my voice would swing the other way: high-pitched, strained, insecure.

As a medical student starting psychiatry, I was shy, hesitant, uncomfortable with the sudden intimacy of talk therapy. Sitting in a small hospital room with a perfect stranger, I was scared to speak.

Here, I now faced those who had often just cried, shouted, pleaded--all extremes. And I had to jump in the abyss with them, asking them about who had broken their heart, who was poisoning or stalking them, who had they betrayed in anger.

They would stare at me in various stages of sorrow, fear, fury, but always intense, lost, desperate to cling to anything. Trust was a moot point at this stage of the game. I had to talk to them. I had to be there for them.

Over time, I found my voice a crucial tool in this process, something I wasn’t even consciously molding. But it began to unfold itself out of compassion and need, the tones that adapted to a patient’s state of mind.

I could not afford to be meek and uncertain, or to screech in exasperation. Here was somebody who had emerged from the black curtain of shame, was forced to spill their soul in front of you. I had to repay his/her faith. My voice had to be firm, steady like ballast that kept them upright.

I found my voice changing, harmonizing the despair I heard. Confident and reassuring for the depressive, who was often brittle and disconnected, fresh off a suicide attempt. Flat, monotonous, gentle to approach the terrified paranoiac, where even a glancing half-laugh would set them off. Tough and unflappable for the charming manic, who loved to draw more glee (and less discipline) out of those around them. I even had to display strategic, tart authority for the wavering manipulations of someone with a personality disorder.

My voice settled into a rhythm, my signature sound. I used its inherent softness to approach someone without threat, without insistence. But I backed it up with a hint of gravitas, to give credence to the seriousness of my patients’ crises, to empathize with tragedy. I kept my intonations smooth, calm, controlled, to offer security. I would explain how together we could sail forward across currents of pain. And I could see their frightened affects soften with relief, that my speech offered solid ground.

Nowadays, when I meet a new patient, I go into the zone easily. My timbre is polished, fluent. My voice is still prone to softness, to quaver on occasion, but I use these qualities to my advantage now. I am not there to preach, to dominate, or to cower or implore. I am there to support, to guide, to help seek balance. My voice leads the way.

Photo: Wikimedia Commons

More from Jean Kim M.D.
More from Psychology Today
More from Jean Kim M.D.
More from Psychology Today