149 | Silence in the Playroom: Navigating Child-Centered Play Therapy with a Selectively Mute Child

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks.

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Your source for centered and focused play therapy coaching.

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Hi, I'm Dr. Brenna Hicks, The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class in child-centered play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode. I am answering a question from Nell in Maryland

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and Nell is asking about

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a child who is not speaking in sessions

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and not that he is selectively mute.

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He

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presents as selectively mute but has not

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been provided that diagnosis per her email.

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So I think I might be making an assumption there, but

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I'll read little parts of her email so that you get a sense of what's going on.

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And she has some questions surrounding

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what to help the parents understand and how best to support him in the playroom. So,

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thanks now for writing in, I appreciate your question.

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So the client is 11 years old

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and his parents report that he's talkative and sociable at home

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and with family members that he's comfortable with,

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but he struggles to connect with peers and adults that he does not know.

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Well,

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he's been tested and is not autistic.

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And then this is where it gets a little sticky.

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So his mother's quote, goals for the sessions. End quote

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have been that he verbalizes in hopes that he

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will feel more comfortable talking outside of therapy.

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And she suggested

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that Nell tells him we could talk for five minutes and then be quiet for five minutes.

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Oh Lord, have mercy. Ok.

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So that was my ad lib not part of the

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need to be clear since you're not reading it. Ok.

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So then

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Nell told his mother that it's important that the

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therapy room remains a safe place for her son.

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Good for you, Nell.

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And that he does not feel pressured to talk there

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like he does in other settings in his life.

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And then she goes on to say that he mainly plays with stuffed animals

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and has them talking to each other for several sessions,

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including the telephone in the playroom.

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He seems to be acting out different animals being forced to talk on the phone.

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And then Nell says I've been following the CCPT model

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since we started meeting.

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And I was hoping that as we continue to

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work together and he felt safe during our sessions,

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he would eventually start to talk.

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We're 12 sessions in and he has still not said a word to me

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when I tell him we have five minutes left and then two minutes left,

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he looks at me and nods,

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but that is the most direct interaction that I've had with him

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and also noteworthy.

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I am the third therapist his parents have taken him to and

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their pattern is that they end therapy because he is not talking.

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I

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would love your suggestions on where to go from here with the client and his parents.

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OK. Nell Let's dive in. Thank you for this.

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This is actually a really helpful question.

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All right. So let's begin with

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mom

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slash parents. OK.

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So in this scenario,

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and I feel like I'm a broken record on these topics, but it's worth repeating because

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I think this is probably one of the greatest elements of struggle.

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We have to be really intentional and purposeful as

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child-centered play therapists about setting expectations with parents.

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So

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we have to make it clear that

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there are stages, there are phases, there's a timeline,

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we have to help them understand what the process looks like in the playroom.

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We have to understand,

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we have to help them understand what the child-centered model looks like.

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So now I think first and foremost,

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obviously,

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I suspect at this point you've probably met with them three times if you had

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an initial parent consult and then a five week and then a 10 week,

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I suspect you've probably met with them three times or at least, I hope you have,

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but it may warrant in the next meeting with them.

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Kind of starting from scratch and maybe going back to ground zero. A little bit

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and really helping them understand the big picture of what this model is,

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what the approach is, why,

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what the outcomes are going to be, what the timeline looks like.

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And I think that will

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get you further down this road with this family than you are now.

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So I would absolutely say that's probably the most important priority

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as far as mom and dad are concerned.

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But here's something else that you need to consider and work into the conversation.

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In my opinion.

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It sounds as though and it obviously, you know,

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I'm not there meeting with these parents and it's hard to deduce just from one email.

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You know,

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all of the exchanges that you've had and

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what those conversations have actually looked like.

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So

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I'm just going on what I've been given and I might be misreading this. But

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if I'm reading it correctly, which I kind of think I am.

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It sounds as though mom specifically, maybe both parents

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are thinking that

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this whole issue is about him talking

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and this is where not only are the parents wrong,

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but this is where your advocacy comes in.

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This is where your psychoeducation comes in.

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This is where your clinical training comes in.

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And this is where you help paint a very different picture

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because what is actually going on in a child that is not talking?

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Is this a talking verbalization communication issue? Absolutely not.

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What's the undercurrent root cause of this?

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I'm sure all of you just said anxiety good for you. OK.

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So here's what parents need to understand.

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This is

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super heightened

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unmanageable levels of anxiety.

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When a child chooses not to talk,

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whether it's diagnosable of selective mutism or not,

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it is a willful choice,

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but it is not a conscious choice.

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It is my anxiety is so overwhelming

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and I my emotions are so big and I feel so overwhelmed.

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I clam up and can't say a word.

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So parents need to understand that this is not

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a talking issue and therefore talking is not the focus

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and not that you have a focus. Let me make that clear child-centered approach.

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You don't go in with an agenda and you're not focusing on an issue, right? But

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either way

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the issue and what the child needs to address is not the talking.

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It is the uncontrollable levels of anxiety.

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So here's what mom and dad need to walk away with

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as

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he reduces his anxiety

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and as he is better able to manage his big feelings,

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he will naturally feel more comfortable speaking

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and he will naturally not feel so fearful of

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talking to people that he doesn't feel comfortable with.

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So

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if we only address the talking,

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that is a band aid on a gaping wound,

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what we need to address is the

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massive levels of anxiety.

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So if mom and dad can grasp that,

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then hopefully they will have a better sense of what you're

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waiting for in the playroom and what you're expecting will unfold.

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All right. So now that we've talked about parents,

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let's talk about your little guy.

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All right.

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So first and foremost,

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you mentioned that

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he plays with the stuffed animals and has them talking to each other.

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OK. So I'm going to assume that you mean that literally? And that in session,

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he is actually

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having a dialogue between stuffed animals.

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So if he is voicing

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one animal talking to another,

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he is in fact talking in sessions.

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So let's make that very clear.

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I anticipate mom is wanting him to talk to you,

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but he is in fact talking in sessions and he's talking in front of you,

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which means

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that's already better than it sounds like what he does in other situations

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where he doesn't connect with peers or adults that he doesn't know.

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And I've worked with quite a few

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children that have been diagnosed with selective mutism

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and there is a staged process of their overcoming their fear of speaking.

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So it's, I don't say a word. I don't make any noises.

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There are no sounds, I am completely mute.

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It usually starts with giggles or noises first

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and then it moves into sounds and then it moves

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into whispers and then it moves into like one word

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at a time and then it moves into several words

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strung together and then it moves into full sentences.

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There is a very stairs stepped process that kids go

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through when they are developing a comfort with speaking.

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So the fact that he is dialoguing play

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with animals is huge,

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that is something to celebrate. So if mom and dad can't see

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the significance of that,

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then that's definitely something that needs to be shared.

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And here's why he's doing this in the capacity that he is,

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the animals are talking right now. So it's third person,

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he's not first person talking yet. I mean, he is actively doing the talking, but

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in a narrative dialogue of two animals talking back and forth,

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there's a distance

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where he can feel a little bit safer and

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a little bit more removed from actually talking.

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So if the two stuffed animals are talking, it's not him, right?

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So he's practicing his comfort,

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he's practicing his ability to talk in front of people even though he's using

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the animals to do it as third person because it gives some space.

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So

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we will often see third person play and

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then it eventually transitions to first person play

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as they feel more safe and comfortable and they can have

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the ownership and the responsibility of whatever that play is.

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So I think that's a

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really significant thing that should be celebrated 1st, 2nd

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and this sort of goes back to parents.

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But specifically your question, I would love suggestions on where to go with him.

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Let's just

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lay this out on the table.

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We do not change our approach

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to accommodate parents requests or demands.

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I'm gonna say that again.

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We don't change our approach to accommodate parents requests or demands

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ever.

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For any reason.

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I don't care how hard they push. I don't care how much they beg.

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I don't care if you're scared, they're gonna pull their kid out.

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I don't care if they're threatening you.

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I don't care if they're not bought in and

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you can tell that they're hanging on by a thread

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And if you'll just do this one thing, it might pacify them

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under no circumstance.

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Do we change what we do

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to accommodate requests and demands from parents? Why?

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Because they don't know what is best

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and we do.

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It's just that simple. It's not to be defiant. It's not to refuse.

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It's not a power trip. It's none of those things. It's I know what your child needs

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and you've trusted me enough to trust me with your child.

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You need to trust the process and you need to trust my clinical judgment.

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My clinical judgment says this child needs child-centered play therapy

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and if you just let it unfold,

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your child will do the work that your child needs to do.

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And that has to be communicated in that simple of terms.

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I know that you'd really like me to ask him to

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talk for five minutes and to not talk for five minutes.

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But here's why I won't do that.

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Here's why that's not child-centered.

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Here's why the child-centered method is more appropriate.

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All of those things have to be worked into conversations with parents

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and it's respectfully and it's gently and it's

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lovingly and it's all of those things,

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but it is very firm and it's direct.

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So

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we will never ever change what we're doing because a parent is forcing us

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to do it or insisting upon it or any of those other things.

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All right. And then finally

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you mentioned he's 12 sessions in

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that is only 25 to 30% of the way through the national average,

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30 to 40 sessions is the average with

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the meta analysis study saying that 38 sessions was the magic number.

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So across 60 some odd studies,

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if children reached 38 sessions,

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their presenting issues were resolved.

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Well, 12 in

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you're 30

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or so percent of the way.

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So part of this is also setting expectations of timeline

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and the pace with which a child is going to make changes.

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I actually feel like 12 sessions in

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a child having stuffed animals, talk back and forth and talk on the phone

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when a child is struggling to speak.

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If that doesn't show and demonstrate the work that that child is doing.

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I don't know what could.

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So I would hope that mom and dad would see how much he's working

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and that he knows what he needs to address and he's doing that.

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But I think mom and dad might also need some perspective on.

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We're 12 in and we need to hit 30 to 40.

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So

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I think that will also help because

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if you're the third therapist and the pattern

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is they end therapy because he's not talking,

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you may also want to. And gosh, I feel like all I'm doing is railing on these parents.

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And I, I don't mean for it to come across that way.

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Parents are our partners, right?

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So we have to honor and value and respect

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and understand and validate and all those things.

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So

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I, I don't want this to come across as just I'm

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negative against the whole thing. But

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here's what I might also throw into your next meeting.

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You know, I'm wondering since I'm the third therapist,

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if maybe he's not talking to me and he's not moving forward

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at the pace with which you would like him to

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because

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he's never really had an experience where he can complete his work.

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So I just wonder if maybe he doesn't think that this is going to last either.

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And so he, he's hesitant to really dive in because

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if

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he's not gonna be able to continue with me,

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there's really no point in him putting in the work.

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I think that's

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a worthwhile conversation too

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because

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a child can't trust you and can't build the

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relationship and can't feel safe doing the work,

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especially an anxious child.

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I mean, anxiety already makes you uncomfortable when you're in a relationship,

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building process

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and talking already makes him uncomfortable in a relationship building process.

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So,

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if he also can't trust that you're gonna stick around and

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that he's gonna be able to continue to see you.

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That could be a huge hindrance that's going on internally for him.

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So that might be another

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conversation I work in.

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All right. So, I hope that you'll find that helpful.

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I hope that for those of you that might have pressuring parents

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and, or children that are not talking,

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I think it's important to keep those things in mind.

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Oh And by the way, I don't know if I've shared this story.

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I know I've talked about it before,

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but I don't know if it's been on a podcast episode or not.

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I had a child that did not speak to me one word for an entire course of treatment

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early in my career,

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he would talk to me before the session started

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as we were walking back to the playroom,

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he would chitchat about school and church and his day and what he did that weekend.

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But as soon as we walked into the playroom and shut the door,

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he was completely silent for the entire 50 minutes.

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And I went to a play therapy conference,

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walked up to a child-centered play therapist presenter

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and I expressed my confusion and frustration

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that this child was not speaking to me in session.

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And I said, and I just, I don't know, I mean,

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I reflect and I track and I use the reflective responses.

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But

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I mean, he doesn't give me anything to work with. I have no idea what's going on.

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And she just kind of cocked her head with this sweet little smile and said,

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yes, you do.

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And that's all she said. I just remember being like, wait, what?

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And it hit me like a gut punch, right?

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Like, oh my gosh, I've been expecting this kid to talk to me

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and all along.

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He's been communicating everything he needed to without saying a word.

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And I just had these expectations

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and therefore because they weren't being met, I was just distracted

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by my need for him to talk

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and I have never forgotten that and I have never done that again.

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A child does not need to talk to you

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for child center play therapy to work.

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So don't get caught up in the pressure now of a parent expecting that.

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And for all of us,

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we can't have the desire for a child to verbally communicate with us in the playroom.

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That's not part of the deal. The child-centered way is you choose what you want to do.

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And if you choose to be silent,

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the work still gets done

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and we still unconditionally accept you and we still trust the process

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because they've proven that CCPT works

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with children that have apraxia and aphasia and

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speech delays and speech difficulties and the inability to speak.

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They've proven it's effective with traumatic brain injury where

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people have lost their ability to communicate verbally.

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So we don't need to expect a child to speak.

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And that is a very powerful burden lifter for us. Right?

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All right, y'all, I appreciate you super grateful for every one of you.

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If you want to have a weekly Q and A with me,

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I'd love to have you on the collective go to ccptcollective.com

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and you can sign up for that. It's been so fun. We almost have 100 people on there now.

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Oh my gosh.

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And if you want to ask me a question,

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call or email me brenna@thekidcounselor.com.

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Call 813-812-5525.

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Love y'all. I'm grateful for you. Hope that you're enjoying the,

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well,

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in Florida, it doesn't really feel like spring.

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It's almost kind of starting to feel like summer.

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But for the rest of you,

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I'm hoping that you're enjoying your spring and for my international people.

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I have no idea what season you're in. So

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happy April. All right. Love you all. Talk to you later. Bye.

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Thank you for listening to the Play Therapy Podcast with Dr

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Brenna Hicks. For more episodes and resources.

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Please go to www.playtherapypodcast.com.