Author: Jesse Nerenberg, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, June 04, 2025

Have you ever found yourself struggling to speak in a way that feels easy or natural? Maybe your voice tires quickly, or you notice it doesn’t sound like it used to. You might feel hoarse, strained, or like your voice isn’t keeping up with what your mind wants to say. This can be frustrating, especially if your voice is a big part of your daily life—whether you’re giving presentations, teaching, talking on the phone, or simply chatting with family and friends.

As a speech-language pathologist (SLP) at Well Said, I often work with adults who come in with voice concerns that affect their work, their confidence, and their quality of life. One therapy approach that many people find helpful is called Conversation Training Therapy, or CTT. It’s a newer method that’s gaining attention for being practical, efficient, and very much focused on real life. In this blog post, I would like to walk you through what CTT is, who it is for, how it works. My hope is that by the end, you’ll have a better understanding of how this type of therapy might help you find ease and confidence in your voice again.

What Is Conversation Training Therapy?

name suggests: conversation. It was developed by SLPs Jackie Gartner-Schmidt and Amanda Gillespie (in collaboration with five others). Instead of isolated drills, repetitive exercises, or reading word lists, CTT works on your voice through natural conversation. It’s designed to be as functional as possible, helping you build healthy voice habits by doing the kind of speaking you do every day.

Many traditional voice therapies involve practicing single sounds or reading scripted phrases. While that kind of focused practice can be important, it doesn’t always help people apply what they’ve learned to real-world speaking. CTT skips that step and goes straight to the source. The idea is to support your voice in the exact context where it matters most: spontaneous, flowing, natural speech. What I often tell my clients is that while it may not feel as “therapy-like” as doing exercises, practicing skills in the context of spontaneous conversation can actually be viewed as more beneficial, since the end goal is to be applying those skills to spontaneous speech.

Who Is CTT For?

CTT was originally developed for adults experiencing voice disorders, especially those related to muscle tension or inefficient voice use. For example, people with muscle tension dysphonia often speak with tightness in the throat or strain in the voice that gets worse with use. Others may have voices that sound hoarse, breathy, rough, or simply don’t carry well in a room. Some people feel their voices tire easily or don’t match how they feel inside.

Even if you don’t have a formal diagnosis, you might benefit from CTT if you’re often told to speak up, if you find it hard to be heard on video calls, or if your voice feels like it’s working too hard by the end of the day. Actors, teachers, leaders, retirees, caregivers, and anyone else who uses their voice frequently can all be good candidates. I often use elements of CTT with clients who are looking to become more engaging speakers, or be heard more easily in a noisy environment or simply want to learn more about how to use their voice effectively. I was lucky enough to use CTT on an almost daily basis in my final student placement during my training as a speech therapist, so I have become quite comfortable using it to teach voice-related skills. Anytime I am doing a session I can still sometimes hear my former clinical educators voice in my head asking me “Is this functional? Make it functional.” And that is one of the greatest benefits of CTT: it is functional.

Why Focus on Conversation?

The heart of CTT is its focus on natural communication. While there’s nothing wrong with structured practice or drills, many adults come to therapy wanting to improve how they sound and feel when they’re actually talking to other people. Most of us don’t speak in isolated syllables or scripted sentences in real life; we talk in flowing, unscripted, often emotional or complex exchanges. That’s where we need our voices to work well.

Conversation is dynamic. It’s spontaneous. It changes with our emotions, with the people we’re speaking to, and with the context we’re in. Working on your voice in conversation helps train your brain and body to use better patterns automatically, even when you’re not thinking about it. It also helps build confidence more quickly, since you’re practicing in the same kinds of situations that may have felt difficult in the first place. Therefore, it is very applicable, and feels that way more immediately than other therapy approaches.

What Happens in a CTT Session?

When you first begin CTT, your therapist will likely start by helping you build awareness. You might record a few samples of your speech and listen back together, not to judge or criticize, but to become curious about what your voice is doing. You might notice things like tightness in the throat, shallow breathing, or a tendency to rush through words. Sometimes, simply hearing yourself speak can offer insights into why certain habits have formed and how we might begin to shift them.

From there, you’ll set goals together based on what matters most to you. Maybe you want to speak without strain, be heard more clearly in meetings (in-person or via video), or simply feel less fatigued at the end of the day. These goals guide your sessions, and they remain flexible.

In each session, the focus is on real-time conversation. You and your therapist might talk about your day, a hobby, current events, or a story from your life. During these conversations, the therapist listens closely and offers cues that help you adjust your voice in the moment. These might be suggestions to slow down slightly, change your breath support, or try a different pitch or rhythm. The cues are usually small and simple, but they help you feel the difference between speaking with effort and speaking with ease. The first cue is always a focus on “crisp and clear consonants” which encourages vocal clarity and a more forward vocal “posture” (closely-related to resonance) to allow excess muscle tension to relax.

This in-the-moment feedback is part of what makes CTT so effective. Instead of thinking about your voice in theory, you’re practicing strategies while actually speaking. Over time, these adjustments become more automatic. You might begin to notice that your voice feels stronger or lasts longer before getting tired. You may receive more positive feedback from others, or feel more confident in situations that used to feel difficult.

How Is CTT Different from Other Therapies?

One of the biggest differences is that CTT is entirely based in conversation. This makes it feel more natural, especially for adults who are already juggling busy schedules or who may feel self-conscious about traditional voice exercises. It also means that therapy feels more relevant from day one. You’re practicing what you actually do in real life.

CTT is also flexible and personalized. Because no two voices, or clients, are the same, the therapy adapts to you. I always give my clients the opportunity to pick the topic of conversation. I often explain that, at the end of the day, the content is not what is important, it is the skills we are practicing; but it is so much fun to talk about something that actually interests you. This personal touch helps make therapy feel collaborative and meaningful, rather than formulaic. As well you and your therapist can develop a strong rapport because you get a chance to get to know a little more about each other as people.

Another important difference is the emphasis on efficiency. Since you’re working directly on the skill you want to improve (your voice in conversation) you may see benefits more quickly. You don’t have to translate skills from isolated practice into real-world speaking. You’re already doing that from the start.

What Does the Research Say?

Though CTT is still a relatively new approach, early studies have shown promising results. People who go through CTT often report improvements in vocal quality, endurance, and satisfaction. Some studies suggest that it can be just as effective as more traditional voice therapies, and in some cases, even more efficient. This is especially true for functional voice disorders where the structure of the vocal folds is normal, but the way they’re used needs adjusting (like muscle tension dysphonia).

Research also shows that clients tend to enjoy the conversational format, finding it engaging and applicable to daily life. That’s no small thing. Motivation and comfort in therapy are huge predictors of success. If therapy feels useful and connected to your goals, you’re more likely to stick with it.

Conclusion

Your voice is one of your most personal tools. It connects you to others. It helps you share your thoughts, your work, your humor, your emotions. When something feels off with your voice or how you are using it, it can affect how you express yourself and how you show up in the world.

Conversation Training Therapy offers a practical, engaging way to reconnect with your voice and learn how to use it more comfortably and confidently. By focusing on natural speech and building healthy habits through real conversation, CTT helps you make lasting changes that carry over into your daily life.

If you have questions or think this kind of therapy might be right for you, look into booking an initial consultation with one of the therapists at Well Said. Your voice and communication are worth the attention.

To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.

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