353 | Selective Mutism and CCPT: Trusting the Process

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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,

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I'm Dr. Brenna Hicks,

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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,

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I'm answering a question

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from Erin in New Jersey.

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And this is about

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a child who is selectively mute.

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That has

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become so much more prominent

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in the last year or two.

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I would say in the first,

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gosh,

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15, 16 years of my career,

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I had only worked with one child who was selectively mute.

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And in the last 2-3 years,

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actually,

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probably since COVID,

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to be honest.

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It has just increased exponentially

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and it's coming up all the time with therapists everywhere.

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So we know this is a pretty pervasive issue,

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and I'm really excited to dive into this question.

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So,

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Erin in Jersey,

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thank you.

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I'm actually coming to New Jersey soon.

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So,

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just a

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public service announcement.

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I'm gonna be doing a weekend workshop in New Jersey in April.

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So,

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if you all live in that area and or you can

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fly,

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swim,

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drive,

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row,

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whatever to Jersey,

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we're gonna be doing a conference for live CEUs.

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So keep that in mind.

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All right,

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let me read parts of the email and then we'll

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process this together.

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I've been working with a six year old who presents with selective mutism.

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She has not spoken in our sessions,

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but she has made sounds

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and does speak at home and minimally at school.

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She makes sounds and nonverbal gestures in our sessions and has laughed.

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She is unable to detach from Mom in sessions,

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and in her most recent one,

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she cried.

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Mom joins her in the playroom.

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I usually present the playroom to her,

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but she does not readily engage with anything

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unless I give her a directed play item.

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I'm stuck because I want to give her confidence and trust to play and explore,

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but it seems to be the biggest hurdle in her independently navigating the playroom.

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Any ideas or guidance would be helpful.

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All righty.

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So,

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there's a lot of layers here,

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and I'm going to kind of systematically unpack them.

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First and foremost,

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we need to recognize selective mutism for what it is.

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It is not its own existing

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thing.

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It is anxiety.

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So,

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once we get rid of the selective mutism component,

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not that we get rid of it,

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but

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once we understand that that is in light of

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unmanageable levels of anxiety,

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paralyzing levels of anxiety.

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Then we recognize,

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OK,

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so I know how to handle an anxious kid in the playroom.

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We can't have an expectation and,

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and this needs to be made clear to parents too.

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I,

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I've been talking about this a lot with therapists lately.

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We have to set expectations with parents because if their goal is,

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quote,

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my kid needs to talk.

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That is not what

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CCPT is going to focus on,

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and that is not the goal.

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That's a band-aid on a gaping wound.

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I say that all the time,

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but this is what we're up against all day every day.

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The rest of the world wants to put a band-aid over something.

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And if we quote,

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get the child to talk,

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which obviously we're never going to do that,

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but I mean,

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even if I'm indulging the request,

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just get my child to talk.

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Well,

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even if I quote,

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get your child to talk.

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That is a band-aid over a wound that probably needs

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massive surgery.

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Because

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at its core,

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we're looking at unmanageable,

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paralyzing levels of anxiety.

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Even if your child starts talking again,

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have we addressed the anxiety?

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Likely not,

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uh,

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if it was a directive approach.

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So,

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child-centered play therapy

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is extremely well suited for anxiety.

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We know this.

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Therefore,

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we're going to trust the process.

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We're going to trust kids,

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and we're going to know that anxious kids

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go through the process a little more slowly.

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So,

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Erin,

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back to some of what you said,

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she has made sounds and made makes nonverbal gestures and has laughed.

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Those are huge.

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Components

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we wait

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when you have a child that is selectively mute

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we wait

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for any vocalization whatsoever.

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Often they come in and they are completely silent.

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So the first time that they grunt or moan or giggle or laugh

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or gasp or do anything that makes a sound from their vocal cords,

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that is a huge moment.

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It's a step.

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Toward eventually being more free,

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eventually having a reduction of anxiety where you can communicate freely again.

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So,

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I've worked with many children with selective mutism,

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and the first time they make a sound,

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I'm

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internally doing backflips.

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OK,

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so the fact that that has already taken place,

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that's powerful.

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She is feeling more comfortable.

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She is able to vocalize

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at least sounds at this point.

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And she's using gestures as well.

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So

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she is communicating.

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She's engaged.

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That is

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all

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positive circumstances.

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OK.

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She's unable to detach from Mom and Sessions,

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and in her most recent one,

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she cried.

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Mom joins her in the playroom.

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Here's where we're no longer CCPT adherent.

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Parents do not join kids in the playroom

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for

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dozens of reasons.

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I've talked about it many times in other episodes,

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but the largest being

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that a child

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is not going to be able to work through their stuff

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with a family member present.

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It's a breach of confidentiality.

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It removes the dyad of the child therapist relationship.

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Parents cannot be CCPT adherent.

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children are protective of their loved ones from their junk,

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so they don't want

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their parents to see all the stuff that they have to work through.

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I could go on and on and on.

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So the second that we introduce a parent into the playroom,

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we are no longer adherent to the model.

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The playroom is for you and the child only.

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Yes,

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it can be hard for kids to come back to the playroom,

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but we never force them to.

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Yes,

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it,

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it can be hard for parents to leave

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their child and or it's hard for kids to leave their parents,

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but we

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honor the process and we wait until it's able to unfold that way.

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So,

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Aaron,

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I think the first step for you and for this client is going to be

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setting expectations that the playroom is not for parents.

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And you can just say,

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I know that in the past mom has come back,

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but

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the playroom is just for you and me.

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So moving forward,

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you can choose for mom to sit in the lobby or you can choose for mom to sit in the car

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or however you're going to structure that limit,

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but what you're doing is making it clear,

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I know we've done something different in the past,

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but we're changing it moving forward,

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and I think that will be a huge

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change for her.

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Look,

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she doesn't want to leave mom because mom is a security blanket

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or mom is a crutch

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or mom is the safety zone,

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and we already know she has high levels of anxiety.

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So of course it's going to be

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highly scary for her

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to come into a room without Mom.

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Mom makes her feel safe.

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Mom makes her feel calm,

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but that is furthering the anxiety.

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She has to get to a point where she manages her own fears.

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She manages her own anxieties.

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She has the ability to calm and regulate herself.

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Another person cannot serve that role,

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she has to do it from within,

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internal locus of control.

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So,

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I would absolutely set a limit on mom being back,

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Erin,

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and then

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I present the playroom to her,

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but she does not readily engage in anything unless I give her a directed play item.

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All right,

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here's another deviation from the model.

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We're,

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we're not going to give a child an item.

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We're not going to direct them toward an item.

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And I get it.

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I totally know what it is like

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when you have a child that is sitting in the room,

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they won't talk,

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they won't do anything,

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and they just sit and they're

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uncomfortable and you're uncomfortable and it's quiet

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and that 50 minutes feels like an eternity.

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And we want to rescue ourselves from it.

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So sometimes it's like,

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should I just give them something?

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Should I just suggest something?

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Should I just direct them towards something?

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Should I bring something up?

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All,

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all of those questions,

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we all go through them.

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Because

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it is hard

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to sit in the pocket of discomfort,

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it is hard to sit in the pocket of anxiety.

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It is hard to trust a child and trust the process and trust the model,

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but we do it because we know that it works.

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We do it because we know that it honors the child's pace,

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and we do it because we understand that if we deviate,

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we no longer have a proven model and we cannot guarantee efficacy.

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So

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it's going to take a while before she willingly chooses to do something,

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Erin.

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It's going to take a while.

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She has to overcome a lot.

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And it may be weeks before she chooses to do something,

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but you just continue to say,

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you know,

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you're in charge when you're here and you're

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choosing to just sit there for right now.

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Um,

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you haven't decided what you'd like to do yet.

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You're not exactly sure what you have in mind.

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You're choosing to just sit.

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And you're going to continue to acknowledge

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what she's doing

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without expectation.

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It's not,

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I'm going to acknowledge that you're sitting there,

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but my tone is I'd really like you to do something else.

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It's factual neutral declaration.

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We trust the child,

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we trust the process,

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we trust the model.

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I had an email this week from a listener and she said,

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I hear you in my head all the time.

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Trust the process,

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trust the child.

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And now I'm saying it.

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So,

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if you hear me in your head,

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it's because I repeat that over and over and over again.

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But it's meaningful.

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We have to

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look,

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we can't trust ourselves.

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We can't trust activities.

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We can't trust our own fears.

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We can't trust anything else.

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We need to fall back on what we know.

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What we know

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is the child will work on their stuff

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in their way,

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in their time,

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how,

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with the time,

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the tools,

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and the opportunity.

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So,

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Erin,

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you're giving her the time,

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the tools,

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and the opportunity

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when you just sit in a playroom with her

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and you trust her,

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and you trust the model and you trust the process,

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and you know that it's going to take a while,

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and you're OK with that because we

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unconditionally accept kids exactly where they are.

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She is paralyzed in fear.

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She is overwhelmed with anxiety.

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It's gonna take her a while to come out of that hole.

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That's a deep pit,

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and it's filled with muck,

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so it's gonna take a while,

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but she'll get there,

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so we're going to just wait.

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And you said,

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I want to give her confidence and trust to play and explore.

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By doing exactly what I'm describing.

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You just trust her and you wait.

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It feels good to just come in and sit sometimes.

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You're choosing to just sit.

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You haven't decided what you're going to do,

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but you know that you,

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you get to be in charge.

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So when you choose to play,

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you choose to play.

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And you just reassure her over and over and over again,

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sometimes for weeks on end.

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That you're just gonna trust her.

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She will eventually trust herself.

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She will eventually start doing work that she needs to do.

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She's just not there yet,

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00:11:39,390 --> 00:11:40,229
but she'll get there.

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00:11:41,440 --> 00:11:41,840
So Erin,

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thank you so much for the question.

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For every single one of you that,

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00:11:45,030 --> 00:11:47,489
and maybe your kid isn't necessarily selectively mute,

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but many of you have kids that will not go into the playroom,

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00:11:50,830 --> 00:11:51,559
they will not play,

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00:11:51,679 --> 00:11:52,500
they will not talk.

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00:11:52,840 --> 00:11:53,080
I mean,

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they talk,

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but they won't talk in the playroom.

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These are difficult scenarios,

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and we have to be confident

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and competent

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and know exactly

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how to handle that.

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00:12:04,900 --> 00:12:05,010
So,

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00:12:05,090 --> 00:12:05,330
Erin,

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thank you so much for the question.

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00:12:06,450 --> 00:12:07,289
That's really helpful.

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00:12:07,609 --> 00:12:08,989
And I suspect that

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a lot of people have takeaways.

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So,

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If you would like to

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say hello,

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00:12:14,080 --> 00:12:15,150
send me a question,

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00:12:15,530 --> 00:12:16,510
argue with me,

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00:12:16,809 --> 00:12:17,390
whatever,

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00:12:17,849 --> 00:12:18,440
please reach out,

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00:12:18,489 --> 00:12:20,570
brenna@thekidcounselor.com.

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00:12:20,890 --> 00:12:22,729
And I always love hearing from y'all,

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00:12:22,840 --> 00:12:25,200
so I appreciate it when you say hello or,

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or whatever.

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I love y'all.

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Have a great week.

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We'll talk again soon.

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Bye.

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00:12:29,929 --> 00:12:33,719
Thank you for listening to the Play Therapy Podcast with Dr. Brenna Hicks.

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For more episodes and resources,

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please go to www.playtherapypodcast.com.