The following is a case study taken from Anthroposophical Therapeutic Speech by Barbara Denjean-von Stryk and Dietrich von Bonin

Case History E: Vocal Nodules. Male patient, aged 37, architect

1.1 Period of Treatment

January to October 1997, thirteen sessions of thirty minutes each.

2.1 First Impression

The patient is about two metres tall, slim, his haircut is in the ‘Che Guevara’ style, he is well-groomed. He says that he does not know anything about this kind of therapy, but since his doctor recommended it, he has decided to give it a try.

2.2 Biographical and Medical Aspects

The patient is thirty-seven, happily married, no children. He is an architect in a joint office with other architects. At present he is without commissions, which means that he is de facto out of work.

Medical Diagnosis: Vocal nodules, that is to say a hardening on the vocal chords which bother him when speaking. Having been removed by surgery, they reappeared very quickly. Prognosis: Irreparable. Accompanying symptoms were hoarseness and a certain inhibition during conversations.

2.1 Speech Diagnosis

Stance: There seems to be a disfluency in the area of larynx and collarbone; his head is slightly bent back, as a consequence the chin in slightly protruding; his shoulders are slightly pulled forward. In contrast to this, his arms and legs appear to be loose and relaxed.

Breathing: When the patient speaks it sounds as if he is holding his breath.

Voice: Sonorous, ‘stuck’ way back in his throat.

Articulation:His articulation is not formed, not at any of the placements. This gives the impression of purely vocalic, sonorous sound.

Thinking: The patient expresses himself in a simple but clear way.

3.1 Therapeutic Aim

Short-term: Lure his voice forward. Activate his exhalation in speaking. Make him seize his limbs harmoniously. Find support in articulating.

Medium-term: Relieve the strain on the vocal chords by practising regularly.

Long-term: Stabilize this ‘relieved’ way of speaking and transfer it to his everyday language.

3.1 Course of Therapy

a) The Means of Therapy

The patient is willing to practise by himself, which is a necessary prerequisite since he can only come once in a fortnight only, the journey taking him five hours altogether. Due to unexpected professional commitments there were often two to four weeks between individual sessions.

1. A basic constitutional exercise was stepping the hexameter with arms coming

down while speaking (approach with neurasthenic patients). Taking hold of the limbs in speaking; activating the breathing.

2. Pfiffig pfeifen…(Piffling fifer) a) with the tip of the toes on every pf; b) with an arm

gesture. These two ways were to be practised which the patient did very intensively. To balance out he also practised the exercise gently from the eighth session. We started with the first stanza of the exercise, gradually including also the other two. Focusing on the pf also made it possible to activate the labial placement (lips).

3. Wuchtig wogt Wirbelwind…(Warning warblers wallow weightily) B while

bouncing a ball. To further support the labial placement and activate the exhalation.


Sequence from the 8th session:

1. Hexameter

2. Pfiffig pfeifen…(Pifling fifer)

3. Zuwider zwingen…(Tu-whit twinkle ‘twas) (with arm movement)

4. Halt hebe hurtig…(Halt! habit hoarding) (stamping in a standing position)

5. Wuchtig wogt…(Warning warblers!) Pfui, pfeife pfiffige…(Fie, fifer fifing) (bouncing a ball)

In the second part of the therapy session we would do various exercises to fully grasp the different placement; Protzig preist…(Proxy prized); Tritt dort…(Trip dauntless); Marsch schmachtender …(March smarten ten).


b) Therapeutic Process

To begin with the lip placement was seized actively, followed by the tongue/tooth placement and then the palate placement. This went along with activating the exhalation in speaking and directed movements of the arms and legs.

The patient practised regularly, diligently and consistently. At a certain point of the therapy he managed to shape a part of the sequence competently by himself, which proved that he was able to connect with the true quality of the work.

Steps of Development


  • First his hoarseness disappeared in the sessions but was still there in his everyday speech.
  • Next the hoarseness disappeared in his everyday speech, reappearing only occasionally on the telephone.
  • Before the summer holidays the patient finally went for a control check-up which shows that the vocal nodules had nearly completely disappeared.
  • After the summer holidays the patient was informed after another examination that the nodules were gone and he was free of symptoms.

Interestingly enough the patient had more than enough commissions from June and needed to draw up a waiting list after the summer holidays.

4.1 Findings at the End of the Therapy

Due to the fact that he practised regularly and consistently, the patient was able to learn how to relieve his vocal chords, even in his everyday speech. His speaking on the exhalation improved greatly. The more active articulation brought his voice forward to the right place.

5.1 Recommendations

Since the improvement was due to his active practising, it would be good to continue this process adding further sequences from time to time (once in six or twelve months), so that the patient will ultimately be able to make a habit of grasping all the sounds (the vowels in particular which are most closely connected with the voice) in a healthy way.