This week’s guest is Maribel Serrano Holder. She is a Floortime Speech and Language Pathologist in San Francisco who founded Logopedia Speech and Language Therapy, Inc. which is a studio offering gender affirming voice training, pediatric speech & language therapy, early intervention, feeding, and parent programs. She offers services in both English and Spanish and does a lot of pro-bono work with the Spanish-speaking transgender community. She is currently finishing up her certificate with the International Council on Development and Learning (ICDL) to be a DIR Expert trainer (Developmental, Individual differences, Relationship-based (DIR) Model or DIR/Floortime).

Identity Exploration and Finding Your Voice

by Affect Autism

A DIR Studio

Of all the DIR services websites I look at, Maribel’s is one of the most progressive with the times that I’ve seen in the language she uses and the services she offers. With November’s ICDL conference having the DIR community reflect on our practices, with the opening address from Julia Bascom from the Autistic Self Advocacy Network (ASAN) to Alfie Kohn‘s keynote on why praise and rewards are harmful, to Jarilyn Connor‘s discussion of promoting accessibility for marginalized communities, along with Virginia Spielmann’s look at professional reflection, highlighting Maribel’s studio seems fitting this week.

Maribel calls her brick and mortar space a ‘studio‘, rather than a ‘clinic‘. Her field of Speech and Language Pathology is very ableist and pathologizing, Maribel explains, and didn’t want to pair that with her space. ‘Studio‘ is a very creative space that brings that energy that is comforting and welcoming. She has ‘clients‘, not ‘patients‘, who come to a safe space where they can be themselves and work on whatever they feel they need to work on without any feeling nor judgment.

Gender Affirming Voice Training

It all started with Maribel’s neurodiversity training in her self-reflection and process of self identification. For the transgender community, there’s a three-to-six times probability of being either diagnosed with autism or to suspect undiagnosed autism. Her work started with the LGBTQIA community and organizations. What she was finding was that most of the Spanish speaking trans community were having a difficult time accessing services. Being a Speech and Language Pathologist, she has training in voice, so she started to learn more and get more in-depth training of how to work the voice–not because she felt transgender individuals need to change their voice.

What she was hearing within the community, and especially the Latino community, who are already marginalized, and then marginalized again for being transgender, was that oftentimes it was a safety concern more than wanting to sound like a woman, for example. Maribel started going to talks that local Spanish speaking transgender organizations were offering, and really becoming a part of the community, even though Maribel is not transgender, herself. She was just being there as a support and started offering podcasts, webinars, and information on gender affirming voice training, and making it accessible as a “I’m here if you are interested” service.

It’s all ‘DIR’

She teamed up with an organization in San Francisco and another in Orange County. She offers a rolling scholarship where she’ll support two transgender individuals at a time from each organization and provide pro bono voice training if they so desire. It’s all DIR, Maribel says. It’s all client-led. She follows their lead because they are the masters of their voice. It’s their instrument and they are the ones learning how to play this instrument, she explains, and they get to decide when to begin to use their authentic voice. The purpose for Maribel of this training is to help, support, and provide the tools for finding that voice, whatever it will be.

Sometimes it’s not changing the parameters of the voice, Maribel continues. Sometimes, it’s just about being there and being present in the moment, without the expectation of actually ‘doing‘ something. This work for her is about support and providing equitable access to a community that is sometimes twice or three-times marginalized. She also works with adolescents where you need parent consent and she likes parent participation as well, though. With teenagers who are exploring their gender identity, she says, it’s about holding that supportive space within the family–whether parents or another supportive adult–in this very difficult transition period. It’s about exploring the voice, which also changes during adolescence, and is the same as with adults in that it’s client-led, but has that additional parent support component.

The Importance of Pronouns

Maribel and her staff always identify their pronouns. They aren’t ‘preferred’ pronouns because it’s not a preference. It’s a feeling that comes from the inside, she explains. It is the identity. Maribel identifies as a woman, so her pronouns are she/her/ella (in Spanish). Her neighbour who is trans might identify as a woman and also use she/her/ella which are her pronouns, but not preferred. They just are. It’s about respecting people’s pronouns that might be different than our own, or from what we expect or perceive. I thanked Maribel for pointing this out to me and how important it is for us to educate ourselves. Maribel feels it’s important to highlight that it isn’t a preference.

Maribel is a big proponent of identity first. It’s important for us to look for ways to educate ourselves. We can’t expect the transgender community to educate us because it’s so much labour. Acceptance of different neural identities or gender identities is something we have to face our biases about and educate ourselves about to do better. It’s part of learning, she say, to make mistakes, but we must learn from our mistakes and try hard not to make them again. She suggests following A.C. Goldberg from Transplaining about transgender issues.

It reminded me of the podcast with KultureCity where Daniel Platzman saying the onus is on us and Dr. Michele Kong discussing how education was the first step. Whether it’s educating ourselves about race, gender or neurotypes, the onus is on us rather than on those communities who have already gone through so much suffering. I believe we will see continued movements in the coming decade around this.

The ‘DIR’ Framework

I asked Maribel if she finds that the DIR Framework really supports her in providing that safety for her clients around issues that might typically be discussed with a psychologist or counsellor. Most of the transgender voice work that she does is about providing that safe space, she says. The voice work only happens when they feel safe and ready, and at their own pace. For Maribel, in her DIR journey, that has been the biggest piece for her that she can bring to any community that she works with. Maribel doesn’t measure progress. She’s just there as a guide while they decide how far they want to go.

The client has full control, Maribel continues, and this goes for all the areas she works in. It’s about providing the safety and supports as she guides them, but letting them have the power to drive and tell her where they want to go. It’s been a very successful way to do what she does, she says. She doesn’t consider herself an expert. She considers the individual an expert of themselves and parents the experts of their children, while she knows some stuff about communication that she can share. The transgender individual is the expert of their experience. She may know about voice, resonance, and pitch, but they lead and she follows.

She also considers the ‘I’, Individual differences, but the most important piece is that ‘R’: the Relationship. When they come to her studio, they’re like family, she asserts, and she is available for them almost all the time by text if they have questions. That’s her way of being present and letting her clients feel supported. I commented that it might feel very empowering for them to have her support because even though we are the experts of our own journeys, certainly as parents we may not feel like the expert and seek that guidance from our child’s therapists. Similarly, transgender individuals might be looking to Maribel to gain the confidence they need to explore their identity. Maribel agreed that indeed, clients will come to her and not really know what they’re looking for, but know they want to change a few things. Vocal transition can be a big part of the process. She nor they know what the end result will be.

It’s Play-based

It’s really playing with what they can do, Maribel continues. The voice is the most important and powerful instrument because it can shift, unlike with another instrument. It’s really magical to watch the shift in perspective, she says. Other times, they try something and decide they’re happy with their voice as it is. She’s not there to change anything. She just wants to support and guide them. There is no particular way to do it that works for everybody.

They might listen to voices that appeal or call to them and they play with them. It’s very play-based, she says. The types of exercises they do to change parameters of the voice are really quite fun, sometimes silly, and sometimes they work and other times they don’t. It’s a fun exploratory process to discover what ‘my‘ authentic voice sounds like. It’s what she does with whomever she works with from a child to adult. Everybody needs to find their authentic voice, whether from the body, or from an AAC device. It’s very individual and self-determined.

Providing Access to Communication for Non Speakers

When she works with non speaking, pre-verbal children, the goal is always spoken language. Parents want their children to speak. But they don’t know when it’s going to happen or if it’s going to happen, so what she wants to do is give access to communication. She’ll provide robust access to vocabulary like we do with infants. We talk to them. We want to do this with preverbal children as well. Then, she has to figure out what works for that child. What works for one, might not work for another. It’s very individual. She wants to give them the tools to what will be most effective and easy to access and use for them.

Logopedia mostly serves Spanish-speaking population, and they tend to be on the lower socioeconomic status with not a lot of access to devices. Maribel has a few tablets that have internet access and some of the apps that they loan out to families until they figure out another way to provide access. It’s a way to bridge that gap. Families often come in without knowing they can even use these devices. 

Maribel likes LAMP Words for Life. A lot of her families use Cough Drop, which is an app. She can change a lot of things to create her own board for them. There’s direct communication and she can use Spanish. It’s affordable and you can have it anywhere. As opposed to LAMP and Proloquo2go that are dedicated devices, Cough Drop can be used on your phone, computer or tablet. She really likes it and her families have as well. They have great customer service, too, Maribel says.

I asked how it works for bilingual families. Maribel says you can toggle between languages in the apps. But when they model, they use the language that is the dominant language spoken in the home, as you would in verbal speech therapy with any bilingual family. 

Aiming to be Neurodiversity-Affirming 

This is incredible work that Maribel is doing, giving a voice to people who struggle to find their voice and their identity. I was thinking about masking when she was talking about the transgender community. We’ve heard that many autistic self-advocates have masked most of their life to fit in, and I imagine that the transgender community experiences this, too. Maribel had mentioned learning about neurodiversity and exploring her identity earlier, so I wondered if she has discovered her own neurodivergent identity and how that influences her work. 

She is still in the process of exploring her own neurotype, and the more she learned about Individual differences in DIR/Floortime, the more she started to identify with many individual differences mentioned. She also realizes that she has been good at masking her whole life, and that as a person born and labelled female at birth, girls are usually more social and very good at masking. So she started to see that and is still trying to figure it all out. She also has noticed inherited qualities in her child. The whole process of ‘medical’ identification is very expensive. She does believe strongly that she is an ADHD-er and is still exploring self-identifying as autistic. She is being very gentle with herself as she notices and makes sense of herself.

Maribel feels this experience makes her more impassioned about the work she does. Maribel doesn’t disclose with clients unless she sees parents struggling with the disability and not seeing the competence and what they can aim for and achieve. She wonders if it’s crossing the line, but sometimes it’s important to identify, since DIR is about relating and engaging. It’s about meeting people where they’re at, she explains, and if you can find one thing that you can relate with someone on, it shifts the work. As she finished up her expert certificate in DIR/Floortime, she feels that the learning is never going to stop. Learning how to better support community is never going to stop, she states. It’s an ongoing process and journey for her.

Maribel is excited about all that she’s learning and is interested in being more neurodiversity-affirming, trans-affirming, and how to be affirming, in general, of people’s experience, she shares. I shared how I try to be a bridge for parents to understand about neurodiversity because although we now know that autism is genetic, if you didn’t have anyone in your family that you knew was autistic, you still think it came out of nowhere, or think that it’s a big problem to fix. As Dr. Kathy Platzman said, we inherit our nervous systems from our parents. Even if you have neurodivergent family members, nobody ever labelled them as such because it was never talked about before. So I do try to bridge that understanding for parents, myself.

The Light-bulb Process

The identification process is still based on the medical model which is very pathologizing. It is about being that bridge, Maribel agrees, for parents and helping them to be in the moment, rather than focusing on ‘fixing’. All she has is herself, her empathy, and the lived experience of the parent and client. Supporting a family member or caregiver with learning how to be there for the child, and how to be engaged and find that joy is worth more than Maribel can describe, she says. Once caregivers find that, they get it, and then everything else about identifying the traits in themselves that their child has happens naturally as part of the journey. It’s really special to be a part of that, she says.

It’s Strengths-Based

Having this wonderful strengths-based model is a place where we can focus on what’s working, where we can connect and find joy, and find what we are comfortable doing together. Maribel said that when she found DIR/Floortime, she felt like she found her people. She wanted to do the training for quite a long time. She went to the ICDL conference when it was in California a few years ago and wanted to take the training, but had a full-time job. When the pandemic hit, it was a blessing in disguise because she’s done her entire training in this time period and is so eager to continue on this learning journey.

This week’s PRACTICE TIP:

This week, let’s think about how we help our children identify who they are with our guidance, rather than by our direction. Do we validate their feelings? Do we help them develop their sense of self through play? Let’s think about how we can foster them growing into the person they want to be.

For example: Comment on things that your child likes and differentiate how it’s similar or varies from what you like, what their siblings like, or what their friends like. Imagine and wonder about things they want to do without saying yes or no: “Wow, that seems like it would be fun! I wonder what that would feel like.” and maybe, “That seems so scary to me! You are very daring!” or, “I wanted to do that when I was your age!

Thank you to Maribel Serrano Holder for educating us about the important work that she does in connecting with marginalized communities using DIR/Floortime. If you enjoyed and found it useful and helpful, please consider sharing it on Facebook or Twitter. Feel free to share relevant experiences, questions, or comments in the Comments section below.

Until next week, here’s to choosing play, and experiencing joy every day!



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