The mutism of the mind: child and family therapists at work with children and families suffering with selective mutism

Abstract

The study of selective mutism in children who are well-functioning in all other areas of their lives, has featured very little in the psychoanalytic literature. Yet, more and more children from as young as four up to adolescence are being referred with this symptomatic presentation to our public and private clinics. This paper attempts to bridge this gap by presenting a comprehensive literature review and two case histories of children who chose not to speak outside of their family home. The complex family and intergenerational dysfunctional dynamics around issues of trauma, loss, immigration and dislocation, which contributed to the formation of the symptoms of selective mutism are explored. In the first of these two cases, the individual psychotherapy carried on painstakingly by the child psychotherapist began with parent–child psychotherapy; the second one began with family therapy and was followed by individual child psychotherapy with parallel family therapy. Both children, their ‘silent’ parents and families were helped to give thoughts and words to unthinkable events and emotions, thus achieving a better level of communication.

Keywords:

• single symptom
• cumulative trauma
• dislocation
• disappearance
• separation
• mourning
• countertransference