Words are the primary tools of most therapies and selective mutism in children is about an inability to speak in some contexts while able to do so freely in others. While a relatively rare symptom, Monzo et al (2015) suggests it is an increasingly common presentation in children 4 to 14 years. In their review of the literature they note that it occurs where speaking has become fraught with conflict and aggression and hence dangerous. ‘It is a multi-determined symptom which covers a complex family and wider situation’.
From the perspective of the Bower Place Model, it is essentially a relational symptom, more connected to the outside than the inside and hence best addressed through a relational therapy. As it is also about speaking the use of more than one modality of communication as the protocols require, would be indicated. The practitioner would look to use of diagrams, drawings and physical representations like family sculpting and sculpting with toys to represent the world of the child and family. As with all clients the Bowernote protocol for recording notes in the clients view and for them to own would be ideal.
Monzo, M., Micotti,S. & Rashid, S. (2015) The Mutism of the Mind: child and family therapists at work with children and families suffering with selective mutism Journal of Child Psychotherapy, 41:1 p22-40