The use of play for assessment and therapy: the case of a child with selective mutism

Abstract

The paper discusses the case of a 5½ year-old girl, living in India, who presented with selective mutism in social settings, mainly outside the home. There were also instances of hyperactivity and disruptive behaviours. The presence of marital discord between parents, problems in communication patterns in the family, and the presence of anxiety symptoms in the mother were other characteristics of the girl's overall clinical picture. The aim of the study was to explore with this child the use of play as a means of assessment and therapy, in order to consider the reasons for her muteness and to facilitate self-expression. A client-centred non-directive orientation was adopted and entailed the therapist reflecting back to the child her verbalisations and actions. The paper discusses the major themes that emerged during play and additional elements of the multimodal therapy that were used – including behavioural modification and parental counselling. The paper also discusses issues that arise when the case is viewed from an Indian cultural lens.

Keywords:

• selective mutism
• play therapy
• play assessment
• India

Notes on contributors

Meghna Singhal is recently completed her PhD Clinical Psychology from the National Institute of Human Behaviour and Allied Sciences (NIMHANS), Bangalore, India. Her areas of interest include developmental psychopathology, critical adolescent issues, child sexual abuse, and treatment of psychiatric conditions in children and adolescents. She has various national and international publications, magazine articles, and newspaper columns to her credit. She is committed to spreading awareness about mental health issues in the general population and fighting discrimination and stigmatisation.

Saurabh Mehrotra is currently working as Consultant Psychiatrist at the Medanta Hospital, Gurgaon, India. He served as the faculty at the Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, for three years. His areas of interest include positive, promotive and preventive health, psychotherapeutic techniques, stress and anger management, crisis intervention, counselling for substance abuse, new age addictions, eating disorders, neurobiology and genetics of psychiatric disorders, and disorders of children and adolescents. He is committed to spreading awareness about positive health, spirituality and health, and the role of positive emotions in wellbeing and happiness.