My therapy with selectively mute children is geared to resolve core issues versus focusing on “bridging” technique. This “core” process involves understanding selective mutism as a variation of obsessive compulsive disorder in addition to it being a manifestation of social anxiety and social phobia.  This treatment methodology has been developed over 30 years of clinical experience with literally thousands of patients of all ages with social anxiety and related problems.

With young SM children the treatment is parent-focused. In other words, I teach the parents how to be the therapists. The thinking behind this is that when the child with the typical SM profile is brought to one to one counseling, most of the time the process is quite unproductive. In this scenario the learning curve is usually very slow or totally absent. In addition, when the therapist over-accommodates the mutism with non-verbal strategies it adds to the child’s illusion, and possible delusion, that the world will adapt to him/her.

This over-accommodation, which in most cases turns into enabling the “addiction to avoidance”, is a common dynamic that occurs in school settings

Productive early intervention with SM children can prevent the problem from worsening (which it usually does over time) and evolving into an avoidant personality disorder. My parenting therapy focuses on resolving the avoidance-dependence syndrome that has been a major challenge and source of confusion for the mental health community in general.

The first phase of treatment (in my therapy) includes the following:

1. A basic education of selective mutism which includes understanding it’s architecture. Think of F.A.T.E. :
   F = function (physiology)
   A = action (behavior)
   T = thinking (cognition)
   E = emotions
2. Empowering parents to be on the same team with technique and philosophy.
3. Creating a multi-dimensional list of over-dependent behaviors and thinking.
4. Developing a non-enabling and “empowering” methodology. (Please do not under-estimate the power of the term “methodology”. “Hit or miss” approaches often worsen the problem.)

At this point I teach the parents how to teach the child to identify thoughts and feelings. This is called “processing”. This is usually a daunting challenge, but profoundly important for clinical efficacy. Attaching to thoughts and feelings is the last thing that a selectively mute child wants to do because it causes discomfort. Carrying through with this process requires determination and sustained discipline on the part of the parents. The payoff for this work can be enormous! Very importantly, it requires the parents managing their own emotions, which is a crucial component of therapy.

This recording occurred at session #14 of treatment. I am happy to report that Alec and his parents just visited New York from Texas for Thanksgiving vacation and came to see me in my office. Alec was able to have a discussion with me for a full 30 minutes.

Therapy with Alec and his parents took place via telephone and skype. Therapy also took place via telephone with Kirk and Karla and their 7 year old daughter. Click here to access the seminar “Professional Baseball Player-Selective Mutism Resolved”. If you listen carefully you will again hear the importance of “processing” and challenging the resistance of the “I don’t know disease”, which by the way, is the doorway to avoidant personality.