Monday, October 19, 2009

Elective mutism and the non-talker

Been working with a guy for the past 6 weeks. He is a non-talker. I never know which is worse, the client who has verbal diarrhoea where you can’t get a word in, to the other client who says hardly nothing.

I like this guy. He has virtually no sense of self worth. I mean unusually so and self deprecating to the same degree as well. Presentation is depression and some history of suicidal ideation.

His natural temperament response to stress is flight - as in fight, flight or freeze. He has a GAF response to a degree that I have not seen before. GAF comes from the life positions and stands for “Get away from”. It means that he will have a tendency to get away from others in his life script and thus he is likely to end up alone or with very few social contacts.

In this instance there is actually no problem with this. He enjoys his own company and can spend long periods of time by himself in the country, which he does. That is not the problem. The problem is that he does not tell anyone anything about what he is thinking and feeling. He never has for as long as he can remember. When ever he has a distressing thought or feeling he withdraws and says nothing to anyone. The technical diagnosis for this is elective mutism.

This worked fine at first except that humans cannot keep doing that for too long and eventually they collapse in on self. They will start to either hit the alcohol, drugs, prescription medication, get depressed, develop anxiety and so forth. The Child ego state simply needs the human contact and communication when it is distressed about something. If it does not get it over an extended period of time it has a ‘nervous breakdown’ as they used to call it.

Human communication. Some try to live without

it for long periods but it never works in the long run

The problem for him (and thus me) is that it is completely and absolutely antithetical for him to talk to anyone about his inner thoughts and feelings. But he comes to see me for precisely that goal, to talk about his inner world and hence he ends up as a non-talker (sort of).

The first sessions were difficult because he said so little and there were often prolonged silences. I thought that he would simply decide that it was all too much and I would not see him again. However at the end of each appointment he has initiated the request for another appointment and there has been another change in the last few sessions.

For the first 45 minutes he is his usual muted self. Then as I am thinking of winding things up (a little early) he starts to talk and even initiate conversation. In the last few sessions he has even gone over time (and I have allowed it). I don’t think it is a game about getting more time but he is starting to not want the conversation to stop. And indeed that is what we are doing. We have done very little therapy in the usual sense of the word. We basically just have a conversation. Mostly about him and his life but we are by no means doing the usual therapy things like setting contracts and so forth.

Some seem to feel like they just don’t fit

in with the rest of the human race



  1. I sometimes hesitate to post a comment on a post like this, because I don't want to seem like I am looking for advice (which I'm not). So first I will say that once again I love the pictures with the comments. Your posts make me smile for the visual content.

    As for the subject matter, I can relate to your client (as I am sure other patients can). I am one to embrace others by listening, but not by sharing bits of myself. In large part, I know this is a wall built due to my past trauma. This carries over to therapy. Of course I am there because I WANT and NEED to talk - but it is hard. And I like your comment about him opening up towards the end and you let him. In some sessions, we seem to spend 20 minutes or more with the small talk - but that ofttimes leads to the hard talk. And it's not because I want to extend the hour. I'm glad you can recognize that.

    Not sure what to think about your comment about not doing therapy in the typical sense. I will have to ponder that some. I sometimes feel that way in my own case, but I think it is because I read about what "therapy should be" and recognize that mine is not quite like that.

    Take care,

  2. I love the wind turbine picture and I thought appropriate. When you have nothing to say, to suddenly be pushed out into your other senses. To take you out of your mind into your surroundings. It can be as simple as to suddenly be distracted to watch a squirrel.

    And all I thought I was going to say was I woz 'ere again. But somehow more came out!

    I liked this post as it mesnt something to me.

    It also occured to me that in your sessions, him talking will be like an elastic band which he is gently stretching each time. It will become slowly easier. However if he stops, I am not sure the elastic will stay loose and instead will contract.

    I am tired and I feel I am writing total and utter garbage. Not to me in my head, but that is in my head not on paper!

  3. Hi Kahless,

    Good to see you were here again. I, and I am sure others have missed you in the blogosphere of late.

    Your elastic band is a good point. When he stops I too hope it stays stretched. I might raise that with him the next time we meet.


  4. Hello OLJ,
    Glad you like the visuals in the post. It is something that I just started doing a long time ago when I first came to the blogosphere. It was sort of just a spontaneous thing that I just did.

    Often I don't know why I am picking a particular picture for a particular place in the post. Some times the connection is obvious and sometimes not. In this post they seem to be fairly clear in the connection. Some times I don’t realise the connection until I see it there in the final product.

    I liked your comment about small talk. That immediately sparked my interest and made me think of doing a post on small talk therapy. I grabbed my pad and wrote down a series of notes on the subject. You should see my note pad, it is just a mish mash of writing. Order in the disorder one could say.

    My original reason for writing blogs is precisely what has happened here. It gave me a way to put my note pad ideas out there in cyber space and over time people have tended to comment on what I write. Often these comments allow me to further develop the idea that I have been writing about and this makes the ideas more complete one could say.

    So I might write a post on small talk therapy. As a therapist sometimes I do what the client might see as small talk but there is method lurking deep behind such discussion!!!. Your comment has made me think about what I am doing when I am doing small talk therapy


  5. Uh oh, this guy sounds like me. I didn't realize that these traits are symptoms of a disorder.

    I hardly say anything in therapy. I've been going for over a year. My therapist says, "what are we talking about today" and I don't respond because it's hard to get going, you know? And then he starts talking and we end up spending the time talking about what he wants to talk about. Which is fine because he chooses topics that are important in my therapy. I'm sure whatever I come up with would be trivial in comparison.

    I have a very negative sense of self worth. I still can't get over the fact that my therapist wants to even talk to me, and I keep waiting for him to tell me he is done with me.

    I never tell anyone what I am thinking and feeling. I didn't realize that is a problem. Frankly I don't understand people who need to talk about what they are thinking and feeling. Elective mutism? Hmmmm. How about I'm just a private person?

    So is this why I resort to maladaptive coping strategies? Vodka, klonopin, cutting, etc?

    All I have to do is tell people my thoughts and feelings and I'll be cured?

  6. No this man would not met the criteria for a formal diagnosis of elective mutism. That is much more than being just a private person. The individual refuses to respond verbally in a wide variety of social situations.

    With regards to your question Harriet about all you need to do is tell people your thoughts and feelings and you will be cured?

    No, I am not saying that.
    What I am saying is if someone on a at least a semi regular basis says their inner thoughts and feelings to another and gets a postive sympathetic response then they will feel a sense of belonging, feel a sense of connection and feel a sense of relief and catharsis. People who feel those things are obviously better off psychologically than those who don't.

  7. Ah, I see. Thank you for clarifying. For some reason when I was little I decided people didn't want to be bothered by me. I have never been one to talk about my thoughts or feelings.

    My t wants to me to tell him these things, and that is what I see him for of course. Any suggestions for how to make it easier?

  8. Hi Harriet,

    One way to begin acquiring a new skill in this instance small talk conversation is to be come an anthropologist.
    Go out into the world and observe the human species. Identify who you think does this skill well, take notes on how they do it and then go and be that person and practice being them in this way.


  9. OK, sounds good. BTW, I'm great at small talk. What I'm bad at is talking about my thoughts and feelings.

  10. Opps sorry harriet,
    I had just previously commented on Lee's comment and that was her thing