By Jet Sichterman

Selective Mutism is an anxiety disorder that inhibits the ability to speak with some people or in some situations, while people suffering from this disorder are capable of talking in other situations. When your child is struggling with selective mutism, you are probably looking for ways to support your child and help them get over their anxiety. When you finally find something, or someone, that seems helpful you may feel positive, optimistic and hopeful. You want your child to show progress, move forwards and away from the struggles they are facing. But when this is not the case, and your child is experiencing relapse (steps back after a period of improvement), it is easy to start feeling pessimistic, doubting the process, your support team or even yourself. Why does it so often feel like it is two steps forward, one step back with Selective Mutism?

Today I will share with you some of the reasons why relapses happen in the therapy of selective mutism, why they are not necessarily as bad as they might seem and some things you can do to help your child to move forwards again.

Why are relapses so common in therapy of Selective Mutism?
Selective Mutism characterizes itself by fear and anxiety of speaking in specific situations or to specific (types of) people. As with any anxiety disorder, once a child with selective mutism is faced with a situation that provokes anxiety, their body responds. In selective mutism, the body responds in such a way that they are unable to speak and make sounds when their anxiety is triggered.

At the start of the therapy, the threshold for anxiety is usually very high. Even small requests to speak or make sounds can trigger the body to respond. Gradually, when children are in therapy and making steps forward, the threshold is lowered; children learn to resist more of the anxious feelings without their body responding to it as strongly as before.

But in order for children to make steps forward, a few things are VERY important:
1 – Trust in the process and trust in the support of people around them
2 – Being provided with opportunities for success regularly, while at the same time
3 – Making steps forward slowly, at the level that they can handle – taking one step at a time on the anxiety stepladder*

While therapy success of course depends on more than these three, such as the therapeutic techniques used, without all these three characteristics, therapy is unlikely to be successful.

It is easy to understand how, at any point of therapy, one or more of these prerequisites may not be present:
1 – Children may lose trust in the process, themselves or their support team. For example, the process of therapy around selective mutism can take a long time, making it hard to trust things will ever change. Or the child’s parents may have an off day and respond impatiently, a teacher may be busy with the group and forget to respond in the way she knows would be helpful for the child or the therapist may need to cancel an appointment which the child was already prepared for. All of these things can – and often will – happen, after all parents, teachers and therapists are all human beings (and should be forgiven for these minor missteps!). However, for a child with an anxiety disorder any of these or similar events, can crush their trust in the process or in their support team which may be a cause for relapse.

2 – Children may not be provided for opportunities regularly enough. For example, children who are seeing a therapist every other week and do not have others around them who have been trained to provide opportunities for them at the right level of difficulty may feel like they are starting all over again every session. Other times when children are not provided regular opportunities may occur when someone in the support team is absent or when the schools are on holiday and the child is without opportunities for some days or weeks. In some cases, even a weekend can mean a step back.

3 – Children may expect from themselves, or others may expect of them, to take a step which turns out to be too hard for them yet or take two steps or more at once on the anxiety stepladder. They are unable to make sound or speak in a situation which they were expected to and then they have an experience of failure. Any experience of failure can be a reason for a relapse.

It is impossible to prevent all of these things from happening! And so relapse is almost as naturally part of therapy as progress is. Each child, each process and each support team is different and so what causes a relapse for one child may not cause relapse for another child facing the same circumstances.

When relapse happens there are several things the support team can do to try to limit the regression and the duration of the relapse:

– Remain positive about therapy, the process and the belief that change is possible
– Consciously take a few steps down on the stepladder if you suspect something happened which could have caused a relapse and try and help your child have a success experience again
– Identify, if possible, what triggered the relapse and try to make amends and/or improve the situation so that all three prerequisites are met again
– Know that in most cases, the second time the child climbs the anxiety stepladder may be easier than the first time (if and when all three prerequisites are fulfilled)
– Know that in order to overcome a relapse, your child will build resilience and courage in the process – this time is not lost time!

And here are some things to avoid:
– Do not get angry or impatient when a child is unable to do something, he or she was able to do before!
– Do not despair, give up and decide to stop therapy or switch therapists when your child relapses; unless there are other reasons to consider switching or the relapse occured by gross malpractice of the therapist, relapse alone is not a reason to consider switching therapists. By doing so your child misses out on an important learning process to overcome their relapse and you would possibly see a further relapse as your child needs to get used to a new person in their support team.

As you see, the therapy of selective mutism often does include smaller and larger setbacks. Relapse cannot be prevented but at the same time they are not a reason to doubt the process, yourself or the support team. See them as a natural occurrence in therapy, important moments in the process of overcoming anxiety and part of the way forward!

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In light of Selective Mutism Awareness Month, we wrote several posts about Selective Mutism:

– When children won’t speak

If you are in the area of The Hague, The Netherlands, join us for a free coffee morning on Selective Mutism on October 30th!

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