TPC-Journal-V1-Issue1

48 The Professional Counselor \ Volume 1, Issue 1 article written by Kearney and Vecchio (2007), the researchers point out that “this disorder is not due to a communication disorder such as stuttering and it is not due to a lack of knowledge or comfort with language” because affected children speak well in certain situations (p. 917). A case study conducted by Schwartz et al. (2006) revealed that a very small percentage of children with this disorder have speech and/or language difficulties. Selective mutism is distinctly dissimilar from shyness due to the severity of anxiety and duration of symptoms. Shyness is not paralyzing like selective mutism and the vast majority of children who suffer from selective mutism do not fully overcome their anxiety without formal intervention (Stanley, n.d.). Finally, selective mutism has been described by some as oppositional; however this assumption implies that mutism is a conscious choice. This viewpoint is clearly disputed by recent research on this disorder (e.g., Cunningham et al., 2006; McHolm et al., 2005; Sharkey & McNicholas, 2008). Anxiety appears to be the most likely culprit at the core of this disorder. There is evidence that family history of anxiety often plays a role in the disorder while speech and language problems, along with willful opposition, do not seem to contribute to the development of selective mutism. Approaches to Treatment Because the etiology of selective mutism is unclear, there is much disagreement among researchers regarding effective treatment approaches. Additionally, scarce quality research has been dedicated to examining the effectiveness of individual treatment approaches and interventions. As Sharkey et al. (2007) notes: “Despite the very handicapping nature of this disorder and its negative impact on both short- and long-term functioning in children and adolescents, the evidence for effective treatments is sparse and predominantly in the form of single case reports or small series using a variety of techniques” (p. 539). Although a systematic approach has not yet been developed, there are some common goals among varying treatment programs. An initial goal of treatment is to lower the child’s anxiety and develop healthy coping mechanisms for dealing with anxiety (Shipon-Blum, 2007). Interventions aimed at achieving this goal include relaxation skills, meditation, and breathing techniques. Increasing self-esteem and confidence in social settings is another integral objective of most treatment programs. The last and most evident goal is to increase verbal communication in social settings. As the final stage in the treatment process, increasing verbal communication may take years as well as long-term therapeutic intervention depending on factors such as the duration of the mutism and severity of symptoms. Psychodynamic Approach Early treatment approaches for selective mutism were mainly derived from psychodynamic theories. Interventions and techniques from this realm of therapy seemed to be the best fit as selective mutism was historically viewed as a result of unresolved inner conflicts or traumatic events during early childhood years (Kratochwill, 1981). Psychodynamic theorists describe mutism as a defense mechanism which the child utilizes rather than expressing feelings directly towards a parent, most commonly the mother (Cline & Baldwin, 1994). Through this approach, the primary goal of the counselor is not to directly address the mutism, but rather understand its origin (Cohen et al., 2006). This is accomplished by carefully examining the child’s early psychosexual stages of development as well as the mother-child relationship, then eventually addressing the fears directly with the child (Cline & Baldwin, 1994). There exists a major pitfall in this type of therapeutic approach. Symptoms of this disorder are deeply rooted in anxiety; therefore, pressure to verbalize thoughts and feelings can overwhelm the child. While expression can be accomplished through nonverbal means such as art therapy, substantial conversation and uninhibited free association are extremely difficult to achieve. It is more likely that the child will become tense and freeze up when placed in the structured setting of the counselor’s office and asked to communicate. Shipon-Blum (2007) explains that psychological approaches are effective only when “all pressure for verbalization is removed and emphasis is [placed] on helping the child relax and open up” (p. 6). When pressure to verbalize is reduced, anxiety decreases and therapeutic interventions can subsequently occur. In 1963, Browne, Wilson, and Laybourne (as cited in Garcia, Freeman, Francis, Miller, & Leonard, 2004) examined the effectiveness of psychodynamic therapy for selective mutism and concluded that the treatment was costly and commonly yielded a poor outcome. Freeman, Garcia, Miller, Dow, and Leonard (2004) added that there are no major case studies or research to provide evidence that these approaches are successful. While psychotherapy is rarely utilized as a primary