Family Counseling Applied to Family with a Selectively Mute Child

Marriage and family counseling became popular in the late 70's and 80's. This type of counseling focuses on the couple or family as a unit and the success is based on the unit's ability to adjust. The goal is to reduce problems through intervention (Parrot, 2003). This type of counseling was used in a school-based setting for a case study. Juan and Julia (both 35-years old) and their children Enrico (14), Mary (9), Anna (5), and George (4) started family therapy due to Anna being a selectively mute child (Sloan, 2007).

Selective mutism occurs when an individual consistently fails to speak in certain social settings. Children with SM know how to speak and understand language but fail to do so due to what is perceived as a social anxiety (Sloan, 2007). Anna, the youngest daughter of Juan and Julia, was in kindergarten for roughly 7 months before her teacher referred her to the School-Based Services Program of the Child Guidance Clinic because she had never spoken to other students or her teacher. She did, however, behave properly and would sit, write and obey the rules (Sloan, 2007). Julia claimed that Anna spoke fluent English at home and did not appear to have any psychological problems. They noticed that around the age of four, Anna slowly stopped talking to anyone outside of the family, and only then inside the home (Sloan, 2007).

Selective mutism has been treated with some level of success at the Child Guidance Clinic of Manchester, where the colleagues suggest developing a strong bond and relationship with whichever parent Anna is closest to, which was Julia in this case (Sloan, 2007). The period of time where the Hispanic family, Caucasian counselor and school worked through the cultural gaps was a critical process that took time. A Spanish translator was used to aid in Juan's understanding of the session, the therapist visited the family in their home, and therapy was paced in a way that the family did not feel pressured or rushed (Sloan, 2007).

Before the actual treatment sessions began, Anna was observed while she partook in everyday activities such as classroom time, playing on the playground, and at lunchtime. It was noted that she displayed little to no emotion while the other children played and talked around her, and when someone tried to talk to her, she would blankly stare at them. At home, she played like a typical child would at that age (Sloan, 2007).

After the process of acclimating the family to the therapist, family sessions and private sessions for Anna began. Part of the treatment goal was to use strategic therapeutic interventions in order to reduce conflict in the home. The therapist put Juan and Julia in charge of conducting the family sessions while listening in another room. They were instructed to develop ways to make Anna feel at ease while speaking in the therapy office, which was located in the school (Sloan, 2007). At first, the parents played a board game with Anna, trying to just put her at ease in the school setting. The door to the therapy office was left close and the therapist observed from another room. They next two sessions were conducted with the door open, with the idea that it would help desensitize Anna to her surroundings (Sloan, 2007). The following two sessions were held with the door open and the therapist sitting right outside the door in clear view of Anna. Because of Anna's competitive nature, she had a desire to win whatever games were being played and she enjoyed herself. By the time they had completed the first six sessions, Anna felt comfortable enough to speak to her parents with the therapist in sight, but would close up if the therapist actually came into the room (Sloan, 2007).

The therapist wanted Anna to try to start speaking in other social settings, and gave Juan and Julia a set of walkie-talkies that he wanted Anna to use with her sister while in a grocery store. After a while, Anna started whispering into the walkie-talkie and after a few weeks, she was comfortable enough to talk openly in stores if she was in the presence of her parents (Sloan, 2007).

It appeared that some of the family game sessions were failed attempts due to George, the 4-year-old son, who was thought to be developmentally delayed. Because Julia was only getting a few hours of sleep per night, and George needed care in the mornings, she was severely sleep deprived. The therapist got George into a therapeutic daycare, which gave Julia time to sleep in the mornings. The daycare addressed George's issues and this enabled a positive environment at home. Therefore, Julia felt less stressed and this spread through the overall happiness of the family (Sloan, 2007).

The individual sessions with Anna proved to be a challenge. She was always eager to get out of class to meet the therapist, but then she would sit in complete silence once they were face to face. The therapist would challenge her to do different things, such as showing her ability to move her arms around or kick her legs, and this would often provoke a smile from Anna, which she quickly covered with her hands (Sloan, 2007). The therapist then came up with a game called "sit on your hands day", knowing that Anna was competitive and loved to win. The object was to sit on her hands for as long as possible, and every five minutes she would earn a point. While Anna sat on her hands, the therapist told funny stories and jokes, which made Anna laugh. Because she didn't want to remove her hands from beneath her, she would smile, laugh, and giggle without covering her mouth (Sloan, 2007).

While in the classroom, different interventions were used to communicate with the teacher. They developed different hand signals and required Anna to use full head nods or shakes when trying to communicate "yes" or "no". It was brought to the therapist's attention that Anna was afraid of the bathrooms in the school and she had never used one. Due to this fear, she wet herself in class one day. After getting cleaned up and changed, the therapist took Anna on a tour of the school, showing her all of the bathrooms and getting her accustomed to them so that she wouldn't be afraid to use them. They then developed a hand signal Anna could use in class to say that she needed to use the bathroom (Sloan, 2007).

As time went on, Anna began drawing her feelings and expressing herself through art, which was encouraged by the therapist, her family, and teachers. The therapist continued to make home visits, watching the family interact and encouraging them to keep gently prodding for communication from Anna in social settings (Sloan, 2007). By the end of first grade, Anna was laughing, smiling, drawing, and whisper reading during her therapy sessions. She would also whisper to her teacher. She began openly talking to the therapist within the office on the last day of school, telling him how she felt about the different games and approaches that had been used in the past. After two years of not speaking, she talked for two hours (Sloan, 2007). Because Anna's treatment was school-based, it was suspended over the summer, but her parents were able to continue their role as cotherapists in the home. When school resumed, she was still comfortable with talking to her therapist, but still would not speak with the teachers or students (Sloan, 2007).

In second grade, Anna expressed an interest in speaking with her classmates. Her best friend was brought into three peer sessions, with no success. On the fourth session, Anna was able to speak openly, although quietly, with her friend. After two months of this, Anna was able to speak openly in the therapy office to her peers and teacher, and began whispering to people in the hallways (Sloan, 2007). Family game sessions continued, although Anna seemed apprehensive about talking to the therapist with her family present (Sloan, 2007). Because Anna still wasn't talking to her teacher or peers outside of the therapy office, they started having sessions in the classroom. After months of small steps, she was able to talk to her teacher on the playground and even began whispering to other adults throughout the school (Sloan, 2007).

By the end of her second grade year, Anna no longer felt the need to have the therapist walk her through the process of reaching her goals. She was doing it on her own now, and after two full years of being in treatment, Anna had spoken to all of her classmates and became active and vocal in her class. Because of the family therapy sessions, Juan and Julia felt more comfortable interacting with teachers, staff, and the therapist. This pushed them to want to be more active in the community and they started attending school and community events (Sloan, 2007).

The family therapy was very helpful and positive in the case of Anna and her family. Utilizing the family system as a means for support, they all worked together to achieve the goals set forth by the therapist and Anna herself.

References

Sloan, T (2007).Family Therapy with Selectively Mute Children: A Case Study. Journal of

Marital and Family Therapy. 33, 94-105.

Parrott, L (2003). Counseling and Psychotherapy. Pacific Grove, CA: Thomson Learning.