I remember my very first case with a child who presented with selective mutism. I was under supervision and direction. I was working at an early childhood development center provisionally licensed as an Associate Professional Counselor. When first approached by the mother seeking treatment for her child, I had to disclose to her that I would need to obtain training and supervision on this topic before I could see her child for play therapy services. I immediately went to my supervisor who had experience treating selective mutism with play therapy. At that time, there was very little written about selective mutism and there was no formal training on the topic that I could find. I created a team of specialists and supervisors. I sought out consultation with several seasoned play therapists familiar with selective mutism, a speech pathologist and a pediatric psychiatrist.
With that first selective mutism case, I met with my team of supervisors every step of the way. That case became my “field training” and the foundation for what eventually developed as an area of expertise.
It’s been 16 years since that first case and since that time I have treated 18 cases of selective mutism in young children and I have provided supervision and consultation for approximately 25 cases with therapists all around the world in the past 9 years. I’ve recently written a chapter on this topic in a book about prescriptive play therapy and I published a 4 hour recorded training called Treatment of Selective Mutism in Young Children Using Play Therapy
I’d like to give you a sneak peek into what treating selective mutism with play therapy is all about and why it’s important and worthwhile to obtain specialized training and consultation.
Reasons for Treating Selective Mutism With Play Therapy
There are really just 3 major reasons for treating selective mutism with play therapy as I explain here.
- Play therapy works to help children heal and grow. A meta-analytic study conducted and published in 2015 showed that when children are treated with child centered play therapy there are significant treatment outcomes (Lin & Bratton, 2015). Cognitive behavioral play therapy (CBPT) is also a directive play therapy approach that adapts the long-established efficacy of CBT used to treat anxiety in adults (Hoffman et al., 2012). I believe deeply that we need to meet children and families where they are. We need to develop a goal-directed treatment plan that considers the current symptom severity, systemic considerations and developmental needs of the client. (For further training based on the research and play therapy treatment planning please review this 2 hour recorded webinar).
- Play is the language of children. When children are unable to speak in certain social situations it only makes sense that we would join in their world through and with the language of play. Play therapists are trained in knowing how to be present with a child while observing and acknowledging what we see and hear the child showing us through the play. Play therapists understand that the relationship between child and therapist is the most essential aspect of the therapeutic process. It is through play we are able to form that therapeutic bond and allow for the process of healing and growing.
- Selective mutism is a complex and difficult disorder to treat. While most of the established treatment approaches are rooted in pure behaviorism, play therapy allows a much broader scope of treatment options. The treatment plan can be based on each individual child client’s developmental status, environmental and systemic issues and severity of symptoms. Within the framework of play therapy, we can use those tried and true behavioral interventions when it is the right time. The broader scope of play therapy allows for us to first establish that all-important therapeutic trusting relationship. Since selective mutism is a complex disorder, it requires a broad and deep collection of tools and treatment options which the field of play therapy provides.
Symptom Severity and Understanding Underlying Anxiety
Treating selective mutism with play therapy is particularly tricky, because there is the anxiety itself to be addressed AND there is the resulting symptomatic behavior that often digs the client deeper into the anxiety. It can be a vicious cycle for the client. Add to this mix parents, teachers and peers who badger or pressure the child to speak and you’ll find yourself looking at a case that resembles a big tangled cluster. It can be hard to know where to start or what to address first.
While the research is relatively limited, what we do know is that identifying where a child with selective mutism is on a continuum of symptom severity helps us to determine what kind of play therapy we use at various stages.
In my work training and supervising therapists I teach that a prescriptive approach is ideal. With this approach, we can know when pure child centered play therapy is appropriate (for example when a child is completely non-communicative with the therapist in session). We can identify when a lightly structured cognitive behavioral play therapy approach is most appropriate. And, we can decide when a very directive behavioral play therapy approach will be effective, all depending on where the child’s symptom severity level is.
Two Opportunities to Learn More about Treating Selective Mutism with Play Therapy
- I have a 4 hour recorded version called EffectiveTreatment of Selective Mutism in Young Children with Play Therapy that includes a 3.5 hour video and audio presentation along with additional reading material. This training counts for 4 hours of non-contact APT approved play therapy training. Go HERE to learn more and sign up for this training.
- You can schedule private HIPAA-compliant supervision and/or consultation sessions with me 1:1 via my conferencing platform to discuss your case and obtain support, private training and supervision. Contact me HERE to get started.
In Summary . . .
Selective mutism is a complex disorder and can be very challenging for a therapist to know how to treat. Play therapy is an effective way of treating this disorder but specialized training is important to have. The research is limited but fortunately I have brought together all of the research supported tools and resources and share that with therapists who choose to train with me or obtain supervision and consultation.
Hirschfeld-Becker, D.R., Masek, B., Henin, A., Blakely, L.R., Rettew, D.C., Dufton, L., et al. (2008). Cognitive-behavioral intervention with young anxious children. Harvard Review of Psychiatry, 16, 113-125.
Lin, Y., & Bratton, S. C. (2015). A meta-analytic review of child-centered play therapy approaches. Journal of Counseling and Development, 93(1), 45-58.
Shipon-Blum, E. (2015). A brief guide to understanding and treating selective mutism via social communication anxiety treatment (S-CAT)®. Retrieved from http://www.selectivemutismcenter.org/aboutus/SelectiveMutism.