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ACQ Volume 11, Number 3 2009 143
failures, to make their lost dreams come true. The
complaints of parents about their offspring thus refer us
first of all to their own problems. (Mannoni, 1987, p. 3)
Chloe’s parents each speak of their own backgrounds in
terms of something that they experience as missing or failing
in some way. By unknowingly placing their child in the
position of fulfilling their ideals, the child is spoken for. In
allowing the parents to recount their own stories, we begin
to hear where the child is placed in relation to their histories,
and the way the child is caught up in these. When, finally, the
demand of others to speak is removed, and there is
someone to listen, Chloe begins to speak. Chloe speaks on
her own terms, rather than in response to a demand.
If a child is mute, there are others who insist that the child
speaks. This silence can be heard as a refusal of the other’s
demand for the child to speak in such a way that their
speech is reduced to a mere echo. By refusing to speak on
demand, the child attempts to take up a position different to
that which is placed upon her unwittingly by these others,
including the parents.
In dealing with a child who is presented by his or her
parents as not speaking, the diagnosis of selective mutism
is only one part of the story. The child’s mutism may be a
response to the selective deafness of those around her. It is
through the process of speaking and being heard that we
allow the parents to let go of their own childhoods in order
to provide an opportunity for the child to speak for herself,
without being spoken for. This creates the possibility for the
child to emerge and to speak in her own name.
References
American Psychiatric Association. (2000). Diagnostic &
statistical manual of mental disorders (4th ed.). Washington,
DC: American Psychiatric Press.
Gidden, J. J., Ross, G. J., Sechler, L. L., & Becker,
B. R. (1997). Selective mutism in elementary school:
Multidisciplinary interventions. Language, Speech, and
Hearing Services in Schools, 28, 127-133.
Johnson, M., & Wintgens, A. (2001). The selective mutism
resource manual. Bicester, UK: Speechmark Publishing Ltd.
Mannoni, M. (1987). The child, his “illness”, and the
others. London: H. Karnac.
Paul, R. (2007). Disorders of communication. In Martin,
A., & Volkmar, F. R. (Eds.), Lewis’s child and adolescent
psychiatry: A comprehensive textbook (4th ed.), pp. 418–
430. Philadelphia, PA: Lippincott Williams & Wilkins.
Stone, B. P., Kratochwill, T. R., Sladezcek, I., & Serlin, R.
C. (2002). Treatment of selective mutism: A best-evidence
synthesis. School Psychology Quarterly, 17(2), 168–190.
Verhaeghe, P. (2007). Chronicle of a death foretold:
The end of psychotherapy. Retrieved June 2009 from
Verhaeghe.shtml
Nino admitted having had no part in planning the
PowerPoint presentation for Chloe. He said, “I should have
been deaf”. He said it was hard to hear about Chloe as it
made him worry. He said it “kills” him to see or to hear about
his daughter’s difficulties as she reminded him of himself and
his own troubles. He stated that as a child he had nobody
to comfort him or pay attention to him. Following some
reflection on this point, he added that he had no one to listen
to him. This was how Nino had proposed himself in the past,
but also how he spoke of himself in the present.
Nino took himself off to see his general practitioner
where he was referred to a psychologist and prescribed
antidepressants. He explained that coming to the parent
sessions prompted him to seek help for himself. Dominique
reported that he had not been “shutting down” since our
discussion about this in the session some months ago.
According to the parents, Nino was also “shutting up” in the
sessions, which allowed him the possibility of listening.
I attended a school meeting with my teaching colleague.
The class teacher, principal and Chloe’s mother were present.
The principal reported that Chloe began to talk after the school
removed the demand on her to speak. Chloe’s teacher was
thrilled to announce that Chloe, who had always appeared
“frozen” and unhappy at school, was now animated and
smiling and keen to participate. She put up her hand in class
to volunteer for tasks and spoke audibly with her teacher or
in a small group of children. Chloe was reliant on her best
friend Christine, but had recently used this to her advantage,
performing in a class play in front of the whole school,
reciting her two lines with Christine by her side.
I presented an account of Chloe and her family in a team
meeting. I spoke of the parents’ demand for “strategies”,
and of Chloe, who cannot be heard. I then focused on the
parent sessions and some of the changes reported to have
taken place with Chloe. At the end of the presentation, one
colleague suggested that the parents’ demands should be
met. They should be given information. Another colleague
asked, “What are the outcome measures and individual
service plan?” My colleagues cannot hear what I am saying,
just as the parents cannot hear Chloe’s attempts to speak.
My colleagues insisted on providing more strategies, more
behavioural measures, as if they had not heard her wanting
to speak. Their response was akin to the parents’ demand
for strategies, despite the fact that when these were given
previously, the treatment failed. The team identified with the
parents. What I am proposing is not able to be heard by the
team, reiterating some of the deafness surrounding Chloe,
who cannot be heard beyond the level of the demands of
the parents.
Conclusion
In our work with a child with selective mutism, we are
constantly dealing with the demands of others: demands for
information, for strategies, for anything that will make the
child speak. The challenge for the therapist, however, is not
to align him or herself with the parents and others’ demand
for the child to talk, but to consider what lies behind the
child’s silence. It is only by thinking beyond the diagnosis of
selective mutism that we can consider what is particular
about the child, including his or her family situation.
Mannoni (1987) proposed that the child’s symptom is
central to the problems experienced by the parents in their
own past histories. She wrote:
Society confers a special status on the child by
expecting him, all unknowing, to fulfil the future of the
adult. It is the child’s task to make good the parents’
Debbie Plastow works as a speech pathologist in child and
adolescent mental health and in private practice. She is a member
of The Freudian School of Melbourne.
Correspondence to:
Debbie Plastow
Speech Pathologist
Eastern Health Child & Adolescent Mental Health Service
Melbourne
phone: 03 9843 1200
email: