One of the most significant things that keeps people from coming to therapy is that they feel as though they are going to be judged, seen as weird, or simply not understood by someone else. This has always struck me as something that is very unfortunate. Our sense of what other people think of us can be one of the most damaging things to our self-esteem, and often times can cause significant anxiety or depression. Where does this sense of what is normal come from? Has anyone ever even really met a completely normal person? Why do we feel that we need to define ourselves via what we perceive as someone else's perception? When we look closely at our physical senses, science tells us that they are not entirely reliable. This is true of things that are as seemingly objective as our sight and our hearing. If this is the case, how can we think that we know what other people are thinking with any reasonable degree of certainty?
Since we were small children, we've been told that each one of us fits inside a particular designation, a particular group of people, and that we should behave in accordance with what is expected of us. Deviation from these expectations can cause people to be ostracized, bullied, or possibly even diagnosed with a psychiatric disorder. Many people feel as though their struggles are unique to them, that there is no way that anyone would understand what things are like for them. In some sense, this is true. We are all individuals with all of our own unique desires, needs, and wants. From a broader perspective, however, we are all involved in something known as the "human condition." Within this, we are all very much the same. Some of these similarities transcend race, culture, and even time. The Swiss psychiatrist Carl Jung found in his work with tribal communities that there was a striking similarity with symbols that they used with symbols from the more Western world to identify things in dreams, religion, and expressions of life in general. Jung referred to this as a "collective unconscious" meaning that human beings seem to share many basic things underneath the surface level of our consciousness. In addition, they tended to express many of these things in the same way. The implications of this are profound, indeed. While it may seem difficult to imagine our struggles as human beings as being in some way similar to those of someone from ancient Egypt or tribal Africa, there are underlying properties deep within our unconscious minds that are the same.
One of the most healing properties of group therapy is the similarities that members share with each other. Many people are astonished when they go to a group at just how perfectly other members have described their difficulties. In my work with individuals I have also seen people be surprised that someone could accept them for who they are. No one should have to feel that they are alone. If people are telling you that you don't belong, it is because they fear something within themselves. If you feel as though you need a safe place to be accepted and explore things in your life, contact me and take the first step towards making things better.
Mandala photo courtesy of http://www.milos-art.de
Selective mutism (SM), is defined as a disorder of childhood characterized by an inability to speak in certain settings (e.g., at school, in public
places) despite speaking in other settings (e.g., at home with family). SM is associated with anxiety and may be an extreme form of social phobia.
The prevalence of SM is perhaps much more than one might expect. 1 in every 143 children are being diagnosed with SM. Usually the difference in speaking is noticed when children are attending kindergarten or first
grade as this is typically their first significant social experience outside of the house. There are often co-morbid (or co-existing) disorders that are commonly seen with SM such as social anxiety disorders or sensory integration disorders. Thus, when providing treatment for SM, a multidisciplinary approach is often very effective. Anti-anxiety medication in combination with therapies has also been shown to help achieve the desired results more quickly.
In working with many children who have a diagnosis of SM, one thing that has really stood out to me is the importance of not placing pressure on the child to speak. It can be difficult for parents and caregivers not to place pressure on the child to speak as it is expected in many situations. It also can be difficult to not "jump in" for the child and speak for them. The advice that I usually give around this is to give the child a few moments to try to respond on their own, and then explain that your child sometimes gets nervous. Most people are used to this to some degree, and will ideally shift their attention away.
The other common misconception is that the failure to speak in certain settings is a willful defiance or behavioral problem. While some children who have a diagnosis of SM have strong-willed personality types, the most significant reason for their not speaking is a result of a paralyzing anxiety. Research into some of the neurological reasons for SM has suggested that children who have the disorder have an overly active amygdala. The amygdala is a region of the brain that has a primary role in the processing of memory and emotions. When this limbic area of the brain is put on "alert," it sends out a signal to the rest of the body. This can affect breathing, movement, and emotional responses. The so-called "fight or flight" response is enacted. Thus, situations that are to some people essentially non-threatening (being out side the home, coming into contact with unfamiliar people, etc.) are viewed as a threat to one's well-being.
It is imperative that treatment for SM begin as soon as there is any evidence of its symptoms. Often the recognition happens around the time of the child first school-age experience. As children get older, the symptoms become more ingrained and the disorder is more difficult to treat.
If you have questions around SM, feel free to contact me.
BOOKS Helping Your Child With Selective Mutism: Steps to Overcome a Fear of Speaking By Charles E. Cunningham, Ph. D,
Melanie K. Vanier Why Dylan Doesn't Talk: A Real-Life Look at Selective Mutism Through the Eyes of a Child. By Carrie Bryson
Photo courtsey of sheknows.com
Stephen Quinlan is a Licensed Independent Clinical Social Worker who practices in Dover, NH