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

Abstract

A discussion of the first part of a two-year treatment of a selectively mute adolescent, J, during the writer's predoctoral internship attempts to add to the limited literature on treating adolescents with selective mutism (SM) and, specifically, the use of mother-child dyadic work. Hayden's (1981) description of symbiotic mutism and Mahler's theory of separation and individuation (Mahler, Pine, & Bergman, 1975) are used as a relational lens through which to conceptualize J's symptom picture, understand evolving transference and countertransference dynamics and guide therapeutic interventions. The use of photography and drawing as nonverbal mediums to facilitate J's emerging “voice” and differentiation from mother are discussed. Despite J's continued silence with the therapist, the considerable intra-psychic and behavioral shifts exhibited by J (including increased speech with strangers) and her family over the course of the treatment, and built upon in the second year of the treatment with Lauren DeMille, described elsewhere in this issue of Journal of Infant, Child, and Adolescent Psychotherapy, attest to the possibility of therapeutic progress in the absence of speech.