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Rebecca was referred to her local CAMHS service at the age of seven presenting with selective mutism. Her parents had split up with some acrimony when she was just three years old. She stopped talking to her father, who moved out and, almost at once, started a new relationship and a new family. She now sees her father only irregularly and has remained mute in his care, though she will speak to her new baby half-sister. Rebecca had never spoken at nursery or school, managing by smiling, nodding and following what the other children did. Her teachers report now that she is bright but immensely shy in class, showing greater social engagement in the playground as long as she does not perceive herself to be observed. However, she had continued to speak at home with her mother and two older siblings until, between the referral to ourselves and Rebecca attending the clinic, she stopped talking with mother altogether after a trip to the dentist for a check-up. In parallel parent sessions, it has become clear that Rebecca’s mother finds it difficult to either reflect on the dynamics between them or to stick to boundaries when parenting Rebecca. She expresses quiet distress that her daughter has stopped talking with her but this takes the form of a feeling of deep personal hurt and rejection. She now tends to ‘walk on eggshells’ around Rebecca, going to great lengths to organise alternative ways for Rebecca to communicate at home such as gestural signing or writing in a special notebook – all of which Rebecca robustly ignores.
Prior to each session, I wonder if Rebecca will be able to stay in the room without her mother and how her mother may facilitate or hinder their separation. If mother does not bring Rebecca in, she will cling aggressively to her leg and refuse to come in at all. Although we have been working on mother being able to leave the room over several weeks – and have settled on aiming for a ‘simple goodbye’ – their parting still always feels tou