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“Why are we here?”
“To see a lady who will make you speak.” “But you know I will not speak to her.”
[Conversation in the waiting room between Alicia (not her real name) and her mother on the first day of therapy]
The above interchange is what the therapist heard the first time she saw 7-year-old Alicia in the waiting room of an outpatient clinic. Alicia peered at the therapist from between her parents, while the therapist invited the family into her office. As could be expected, Alicia did not say “hello,” despite the urgings of her parents. They explained in hushed tones that this was one of the reasons they were seeking treatment for her.
The other reason had been strikingly apparent from the first moment we met Alicia. She was completely without hair, including eyelashes and eyebrows. During the initial interview, her parents described the history of her selective mutism and all of its particularities. These included the fact that Alicia would not talk to teachers or doctors in the United States even in Spanish, but would do so in the country where her parents came from and where Alicia visited once a year.
The parents were gracious and helpful in providing all the observations they had made of her mutism over the years. However, when the therapist tried to broach the problem of the alopecia, the parents seemed uncomfortable talking about it in her presence and behaved almost as if they believed she was not aware of it. Respecting their wishes, the therapist put aside the discussion of this topic for a later date. The parents were then invited to step out for about fifteen minutes to allow Alicia a chance to meet alone