ACQ_Vol_11_no_3_2009

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’

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 http://www.dcu.ie/health4life/conferences/2007/Paul%20 Verhaeghe.shtml 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: Debbie.Plastow@easternhealth.org.au

143

ACQ Volume 11, Number 3 2009

www.speechpathologyaustralia.org.au