Good Intentions, Wrong Room
The space between wellbeing support and clinical work (and why it matters which side you’re on)
I put a disclaimer in every continuing education course I run for voice teachers and performing arts educators. I’ve refined that thing over the years, but the gist of it never really changed:
Nothing in this course qualifies you to treat clinical performance anxiety, depression, or trauma. It qualifies you to recognise, to refer, and to create a safer environment. Those are meaningful things, but they’re not the same as clinical intervention.
And I’ve watched that disclaimer get absorbed by many and, in several cases, ignored. The latter was actually the reason I stopped offering classes (I know it’s not my fault if people decide to behave unethically, but seeing my name mentioned in combination with misappropriation is just something that I couldn’t consolidate with my sense of ethics anymore).
So I want to clarify this straightaway: This isn’t about those people specifically but rather about a pattern I’ve been watching build for several years, that genuinely accelerated after the pandemic, and that I want to address again (I’ve done it before, and I usually get pushback, but so be it). Yes, it does irritate me professionally (I’d be lying if I said it didn’t), but that’s not what this is about, because I’ve seen, more than once, what happens when things go wrong. And “wrong” in this context doesn’t mean ineffective.
It means actively harmful to the person on the receiving end.
Change has been happening for quite a while, but the mental health picture in the performing arts changed significantly during and after the pandemic, and the data is quite conclusive. As an example, the British Association for Performing Arts Medicine (BAPAM) reported a 396% rise in the number of performers seeking mental health consultations compared to pre-COVID numbers1. And once we got back into the studio (or even beforehand if we were still operating online), teachers could obviously see that their clients (and often themselves) were greatly destabilised by the experience.
Studio relationships are often extremely close. They are long-term and can last for years. And I think I’m not giving away any secrets when I say that work which involves the body and emotional access often also requires a certain amount of allowing ourselves to be vulnerable. Students will sometimes disclose things they haven’t said anywhere else because they trust us. And in the absence of proper clinical support, which has historically been difficult to access and has remained underfunded relative to need, the voice teacher can sometimes become an “available person”.
The voice teacher in me totally understands that, and I also want to say that the impulse to help when you can see someone struggling and you’re the person they trust is not the problem. But what people do with it sometimes is, and that’s where the psychotherapist in me always takes over…
Trauma-informed practice vs trauma intervention
“Trauma-informed” is now used as a credential in performing arts spaces in ways that sometimes (NB: I’m not saying always) doesn’t match what it actually means, and I’ve written about this many times before so won’t regurgitate it all (I’ll put links in the footnotes). 23
In short: Trauma-informed practice is an adjustment to how you deliver your existing role. You assume that some people you work with have a history of trauma, so you create conditions of choice and safety. You don’t inadvertently replicate dynamics that are known to retraumatise; you learn to spot certain signals and know when to refer. The SAMHSA framework, which is a commonly cited reference (I’ve mentioned/linked it in footnote 2), describes it explicitly as appropriate for settings where trauma-focused clinical approaches are beyond the scope of practice of most staff.
And that’s it, right there. “Beyond the scope of practice” is not some kind of judgment on the capability of the practitioner in question. A teacher can be deeply trauma-informed, but that doesn’t make them a trauma therapist. A physiotherapist can adjust their practice to account for a patient’s trauma history, but that still doesn’t mean they’ve suddenly become a trauma specialist.
Trauma-informed means you’ve adjusted your awareness. Trauma treatment means you’ve taken clinical responsibility for intervention (or “healing”, as some people would call it). When you cross that line without the training to do so safely, you’re not just outside your scope. You’re in territory where you often don’t even know what you don’t know, and that’s unfortunately where people get hurt. And I want to stress this again: I don’t think this happens out of malice, and the intentions are usually good. But that doesn’t make it less harmful.
And I want to take this one step further, because when people hear the word “trauma”, they are often a bit more careful by default. What about anxiety though? Especially voice teachers are constantly confronted with performance anxiety…
The thing about somatic anxiety (and trauma) intervention…
Without getting too specific, but I see more and more posts and articles where voice teachers introduce somatic anxiety and trauma “release” work into their studios, and it’s frequently marketed (yes, I’m gonna use that word) as some breakthrough tool for performance anxiety. I’ve also seen the fallout when it doesn’t go the way the practitioner expected...
Don’t get me wrong, many of these approaches are legitimate modalities with a good evidence base, and I use some of them myself in my work as a psychotherapist. Because quite frankly, if you apply some of these techniques, you need to understand safety and containment strategies; you need to be able to recognise dissociation, know when to stop, manage what happens when the process moves too fast or too slow, and you also need to deeply understand the difference between productive stress/tension release and a response that has started to turn into destabilisation. Psychotherapists learn these things with real clients in a clinical setting for a very good reason. And during training, that learning is SUPERVISED.
And at risk of being the “bad girl” again (I’ve got practice 🤣): I challenge everyone who isn’t a therapist and offers a workshop of a couple of hours duration to teach voice teachers to use these often highly activating techniques IN THE STUDIO without any safety, containment or supervision. And to top it off, do that work online where you have NO MEANS to intervene effectively should the proverbial hit the fan.
When someone is activated during a somatic session and something that may have begun as tension release starts to morph into something else, the practitioner needs to be able to bring them back. If you’ve never done window-of-tolerance work, it can get iffy very, very quickly, because you might not be able to read the difference between a body that is releasing and a nervous system that is nosediving. You might think these are “instinctive skills”, but they're really not. They’re trained ones. You can’t develop them in a single workshop or access them by reading about the modality online. They come from supervised clinical practice with enough hours behind you, because that’s the only way to see a range of responses and how to respond to them.
I’ve unfortunately seen what happens when someone is triggered in an online somatic class and the practitioner doesn’t have that skill: The person is left mid-activation in a state their nervous system can’t handle and the practitioner doesn’t know how to help them (their “help” was basically getting the person’s partner to deal with it so they could “come down” while not being alone). And no, that’s not a “teaching moment” or a “growth edge”. That’s harm, and the fact that it was delivered by someone who wanted to help doesn’t change that.
“Oh, you’re such a gatekeeper!”
When clinicians and/or therapists raise these concerns, the response is sometimes that we’re gatekeeping because we’re secretly “territorial”. That these techniques are “harmless” (well yes, some fall into that bracket, but that’s not the ones we’re talking about) or that what’s happening isn’t really trauma or anxiety intervention because it’s been labelled trauma-informed instead. And anyway, we are “shaming teachers who are only meaning well” (and yes, I’ve had all of these launched at me at some point).
I’m not saying the mental health access problem isn’t real. Clinical support for performers can be expensive and is also still largely delivered by practitioners who don’t understand the industry (we’re thankfully improving on the latter, so there’s hope). Performers sometimes prefer working within the studio relationship because it doesn’t require explaining what an audition does to the nervous system, or what it means to have your voice tied to your livelihood and your identity. But inadequate clinical access doesn’t make what I’d call “clinical approximation” safe.
Btw, I’m not saying that voice teachers can’t do genuinely useful work in their studios. I’m thinking of things like normalising performance nerves rather than framing them as evidence of a pathology (but I’m excluding clinical-level performance anxiety here because they’re not the same), or providing psychoeducation, or creating a studio environment where a student doesn’t need to perform being okay. And I honestly think that a voice teacher who does this well is already miles ahead in terms of safeguarding their students’ mental and emotional wellbeing. So the line is rather the application of certain techniques by someone without the clinical training and/or supervision to manage what can happen as a result (as an example, the single-subject ACC for musical performance anxiety study4, led by my wonderful colleague Dave Juncos, ran under close clinical supervision with a specific evidence-based protocol and approximately seven hours of structured training for that protocol alone. So even the research attempting to bridge the teacher/therapist gap understood that more than enthusiasm and a good relationship with a student is required).
If you’re a performer who’s been offered something described as somatic work, anxiety or trauma release within a teaching or coaching setting (as in: not by a trained clinical practitioner or in a therapeutic context), there are things worth knowing before you engage:
What are this person’s qualifications? An online course certificate is not an accreditation, nor are many in-person workshops. In lieu of a clinical degree in psychology or psychotherapy: Practitioners often list accreditation bodies or affiliations on their webpage, and said body might give you an idea what training this particular accreditation usually involves. Was there any clinical/in-person supervision at any point?
What happens if something unexpected comes up during a session? What do safety and containment protocols look like?
Practitioners who understand the scope of what they do can answer those questions, and more importantly don’t mind answering them. The inability to answer them, avoiding answers when asked, or answering with defensiveness or whataboutism, is something that should make your ears perk up.
The need in our community is real and not going away, nor is what I’d call the “supply gap”. It’s not about ringfencing clinical tools, but knowing that certain tools need to be applied safely (“primum non nocere” is still a thing). It’s also about honesty with students about what they’re actually receiving and what falls outside the scope of a voice teacher (or any given practitioner). Even if a voice teacher is also a therapist (there are more of us now than there were, say, 20 years ago), what is the goal? Voice lessons or mental health support? What have you signed up for in the first place?
If people think that’s gatekeeping, so be it, but I personally think it’s rather about informed consent. Which really is the baseline ethical requirement of any professional who works adjacent to a person’s wellbeing.
The desire to help is not in question, but that desire needs to be matched by awareness and training…
If you’re a performer looking for support, or if you’re an educator who’d like to understand what good referral practice looks like in the performing arts, you can find out more about my work here:
Choose a free or paid subscription to stay in the loop.
If you know a voice teacher, music educator or performer who’s navigating this question, please pass this article on.