How to Treat Selective Mutism: Information for Therapists


At the SMC we have developed an innovative approach to the treatment of selective mutism, which is based both on clinical experience of over 15 years and more than 100 cases, and on theoretical knowledge of how selective mutism is generally viewed and treated today.

Raising awareness of the causes and treatment of selective mutism is vital; as with most dysfunctions which are anxiety based and result in "acting in" –introversion, avoidance and timidity, as opposed to "acting out " where the child is literally screaming for help, SM is often left untreated as the child causes little disruption to the kindergarten or school. This is not to say that there is no suffering – the child always suffers profoundly as a result of his SM, as do his concerned parents.

Failure to treat SM is all the more lamentable as SM is usually highly responsive to treatment, and early intervention can avoid a host of residual effects on the child's emotional well-being, and effectively re-channel the child's development onto a more normative, adaptive track.

The two main underlying innovative components of this therapy are as follows: the ecosystems approach, which aims to enable the child to move as seamlessly as possible between the various frameworks in which he lives – home, school and the outside world, in a harmonious way. The treatment is built upon the SM child's optimum functioning – usually at home, where he is not hampered by his anxiety and he can express who he really is –which is at a level of verbal communication and social interaction that is often literally unbelievable to those who see him only in school. The treatment acts as a bridge to facilitate his transferring and generalizing his selectively optimum level of functioning to all his daily environments.

This underlying view is apparent in the location in which the therapy takes place – in the home and in the school – in order to extract the child's home functioning and generalize it to the school or kindergarten.

Which leads us to the second underlying principle: deep respect and belief in the child's nature, and his home environment – the aim is not to change him, rather to build on his and his family's strengths. Thus the school may look at ways to emulate the factors that enable the child to function well at home, while the parents will be incorporating insights and modes of functioning aimed at lowering the child's anxiety levels and acquiring long term coping skills which will enable the child to function well outside the home.

Our treatment is designed to greatly increase the speed and effectiveness of the therapy; the initial home based therapy and ongoing involvement of the parents aims to render redundant large sections of therapy that are called for when treatment takes place in a clinic or only in the school. It is designed to be a satisfying and empowering experience for the child and his family. A complete treatment manual, including manuals for therapist, teacher\nursery teacher and families, can be purchased from our website.