PCIT for Selective Mutism

Parent-Child Interaction Therapy (PCIT) is a research-backed treatment for children, teens and young adults with Selective Mutism.

Selective Mutism (SM) is an anxiety disorder in which children speak readily in one setting (usually home/with caregivers) but they fail to speak as expected in other settings and with lesser known people (e.g., at school, with grandparents, at soccer, with family friends). The lack of speaking rises to the level of a disorder when the child misses out on social and academic opportunities and is not able to meet their needs through speaking.  Early intervention is imperative. Every interaction where speaking does not occur reinforces the cycle of negative reinforcement that these children are stuck in, leading to less and less likelihood of speaking.

Parent Child Interaction Therapy for SM (PCIT-SM) is a type of CBT treatment. PCIT was originally developed for children with behavior problems and has been adapted to meet the needs of children with SM.

The way that PCIT works is really unique: For younger children, the therapist does not directly interact with the child at first (which is good, since the child would likely not speak to the therapist).. During therapy, parents play toys with their child while they are coached in the ear in what to do and say, using a specific skill set they have learned to promote speaking. Even though, yes, the child is already speaking to the parent, the caregiver learns skills to promote speaking to other adults. In this way, the caregiver, rather than the therapist, is the agent of change. It is then much easier for the child to speak to someone new, because the new person will be using the same skills that the child learned first through their parent. School personnel (teachers or counselors) are also trained to serve as speaking coaches. The therapist eventually interacts with the child to become another new person that can speak with the child and then facilitate more speaking challenges.

In therapy, youth practice speaking in a variety of settings and with a number of people until they learn to tolerate their speaking-related anxiety and to be able to consistently use speech to meet their needs (e.g., asking to go to the bathroom). They continue to attend therapy until their parents and teachers feel confident as speaking coaches and they have had success speaking in a variety of settings and correcting issues such as too low vocal volume or answering questions with one word.

Although some kids with SM seem to 'grow out of it,' the disorder can continue into the teenage and adult years. PCIT-SM is still the standard treatment, but it is adapted to the needs of someone older. Treatment may begin to look more like CBT/exposure therapy for social anxiety disorder.

P.S. SM and its treatment is relatively unknown by mental health professionals, school staff, and lay people. In addition to therapy, I facilitate free parent support groups to help caregivers find community while coping with the challenges of SM.