What Is Selective Mutism And How Can Psychology Help?

By David Hennessy, Clinical Psychologist

David the Psychologist walking along rocky coastline beside calm blue ocean under sweeping clouds, symbolising safety, grounding, and gentle therapeutic support for people living with selective mutism.

Image Caption — David the Psychologist at the coastline. A calm, grounded setting that reflects the gentle, supportive approach used in therapy for selective mutism.

Selective mutism is an anxiety-based condition where a person is unable to speak in specific social situations, even though they can speak comfortably in familiar settings, such as at home. It can affect social interactions, relationships, learning, and occupational functioning in ways that often feel confusing or distressing for the individual and their family.

Understanding Selective Mutism

Selective mutism is more than shyness. It is a complex anxiety response that creates a persistent pattern of silence in situations where speech is expected, such as school, work, or community settings. People with selective mutism may speak freely with close family members or in places where they feel safe and understood. Their silence is not deliberate defiance. It is a protective response to overwhelming internal anxiety signals that restrict their ability to speak.

Symptoms

Consistent difficulty or inability to speak in certain social situations where speech is expected
Ability to communicate in comfortable or familiar settings
High levels of anxiety or distress in specific social contexts
Physical signs such as stiff posture, frozen appearance, or avoidance of eye contact
Frequent reliance on non-verbal communication, such as gestures or nodding

Causes And Risk Factors

Anxiety disorders or elevated social anxiety [1]
Psychological, psychiatric, neurological, or medical comorbidities [2]
Family history of anxiety or selective mutism [3]
Temperament patterns involving behavioural inhibition [1]
Stressful or traumatic experiences that increase fear responses [4]

How Can Psychology Help?

Psychology plays a central role in supporting individuals and families living with selective mutism. Treatment focuses on gradually reducing anxiety, strengthening communication confidence, and supporting meaningful participation in everyday settings.

Cognitive Behavioural Therapy

CBT helps individuals and families understand the relationship between anxiety, thoughts, and behaviour. Therapy involves gradual steps toward speaking, starting with situations that feel safe and achievable and building confidence over time [5].

Behavioural Interventions

These include graded exposure, shaping of verbal responses, stimulus fading, and positive reinforcement. When delivered gently and collaboratively, behavioural interventions can create measurable improvements in communication across settings [6].

Support Network Involvement

Family involvement is essential. Parents and caregivers learn strategies that reduce pressure, increase predictability, and support verbal expression in small, manageable ways. School staff, employers, or other key people can also be guided in how to create environments that feel safe and encouraging [7].

Educational And Occupational Support

Collaborative planning with teachers, learning support staff, or employers helps create environments that reduce anxiety and allow individuals to communicate at their own pace. This may include predictable routines, structured transitions, reduced pressure to speak, and gradual participation goals.

Gentle, Hopeful Realism

Selective mutism can be challenging, particularly when silence is misunderstood as avoidance or unwillingness. Yet outcomes are promising when therapy is consistent, well-structured, and supportive. Progress is often steady and cumulative rather than rapid. The aim is not to push speech, but to gently expand a person’s sense of safety, capacity, and confidence.

Meaningful improvements in communication and quality of life are achievable. With the right support, people living with selective mutism can develop stronger self-belief, reduced anxiety, and greater comfort participating in their world.

Enquiries / Appointments

Click here to contact Hennessy Clinical Psychology

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. text revision). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425787
Viana, A. G., Beidel, D. C., & Rabian, B. (2009). Selective mutism: A review and integration of the last 15 years. Clinical Psychology Review, 29(1), 57–67. https://doi.org/10.1016/j.cpr.2008.09.009
Chavira, D. A., Shipon Blum, E., Hitchcock, C., Cohan, S., & Stein, M. B. (2007). Selective mutism and social anxiety disorder: All in the family? Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1464–1472. https://doi.org/10.1097/chi.0b013e3181493642
Kristensen, H. (2000). Emotional and behavioural problems in children with selective mutism: multiple informants’ report. European Child and Adolescent Psychiatry, 9(2), 109–117. https://doi.org/10.1007/s007870050004
Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 938–946. https://doi.org/10.1097/00004583-200208000-00012
Oerbeck, B., Stein, M. B., Wentzel-Larsen, T., Langsrud, Ø., & Kristensen, H. (2014). A randomised controlled trial of a home and school-based intervention for selective mutism – defocused communication and behavioural techniques. Child and Adolescent Mental Health, 19(3), 192–198. https://doi.org/10.1111/camh.12045
Oerbeck, B., Stein, M. B., Pripp, A. H., & Kristensen, H. (2015). Selective mutism: Follow-up study one year after end of treatment. European Child and Adolescent Psychiatry, 24(7), 757–766. https://doi.org/10.1007/s00787-014-0620-1

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