How Does Play Therapy Help Children with Selective Mutism?

A few months after graduating from university, I began working at a community health centre in the northern part of Melbourne. In this first month, I was assigned to a child who was described as being unable to speak around certain people or in specific settings. At home, they were known as a "motor mouth," but at kindergarten and with extended family and friends, they were silent. This behaviour started when they were four years old. By the age of six, they were diagnosed with selective mutism.

During the initial parent interview, the parents appeared anxious and extremely keen for their child to talk. I could see the stress in their eyes and how desperately they wanted to help their child speak. They asked, "Can you help us?" Being new in the field, I was unsure, but I believed strongly in play as an intervention and said, "I haven’t had such experience before, but I am happy to start the process."

Since then, I have seen many more children who were described as chatty at home but silent at school, all diagnosed with selective mutism. You may wonder if I have helped them. Did they talk to me in the end? Well, yes, some did, and that was huge, but some didn’t. However, significant changes in their confidence in social interactions were observed.

The more I worked with these children, the more I identified that increased pressure made them more anxious. Any treatment for children with selective mutism should be very gentle and pressure-less. This is where play therapy excels—it is gentle, permissive, and pressure-less. These children came to my office, chose to play with whatever toy they wanted, and decided whether or not to speak with me. They played in a specific way that they felt comfortable with. I was there to track them, be 100% present with them, label their non-verbal cues, and accept their choices. As time went by, utilising an approach that involves indirect and defocused communication created a safe space. It was then that their anxiety decreased significantly. They started to interact with me non-verbally, through gestures, and sometimes by writing. As this went on, my role evolved to helping them become aware of the psychological and emotional content that arose through their play. This process helped them make sense of their presentation, and some of them integrated the issues into their psyche, which eventually led to them beginning to talk. Those who did not talk presented as significantly less anxious in social settings.

In play therapy, the relationship between the therapist and the child is vital. The quality of this relationship, and the fact that the therapist allows them to take the lead and encourages them to experience a sense of autonomy and control during the sessions, make a difference.

If you have any questions about selective mutism, play therapy, or how I can help, please don't hesitate to contact me. I'm here to support you and your child on their journey.