“Psychic Twins”: A Psycho-Dynamically Informed Treatment of a Selectively Mute Adolescent and Her Mother – Part II

Abstract

This article describes key aspects of the second year of a two-year treatment of J, a selectively mute adolescent. The therapist was, at the time, a predoctoral intern, and the case was transferred to her after a year of prior dyadic work with patient and her mother. Building upon the conceptualization of the prior student/therapist, the present author included the incorporation of dyadic work into the treatment; both therapists turned to their training in psychodynamic theory and treatment to conceptualize the symptom of selective mutism (SM) as revealing a symbiotic tie between J and her mother. The striking nature of J's symptom as well as its persistence into adolescence created particular challenges around formulating interventions and treatment goals. The reality of yearly transfers of J to new clinicians also complicated the treatment. Despite these difficulties, the writer began to find ways to communicate with J, suggesting the possibility of J's greater separation from her mother. This article also contributes to the relative paucity of treatment literature on selective mutism in adolescence.

Notes

1. I had once heard her voice on a recording that she made at home, per my request. On the recording she repeated, “I want a big dog,” and that she was “bored.” She also made what sounded like a farting noise, which when I asked about in session she confirmed with a bashful smile, and causing me to laugh in appreciation.