The Selective Mutism Clinic provides assessment and treatment of selective mutism and extreme shyness in preschoolers, school-aged children, teenagers, and adults with selective mutism throughout Australia. Families in remote and rural areas can access our service through our ‘Outreach’ program. Services are also available at the clinic for other childhood emotional and behavioural problems. Adults with selective mutism or social phobia can receive treatment from the clinical psychologists at our clinic who provide treatment for adults.
SYDNEY-BASED TREATMENT PROGRAM
Assessment and program planning
Your family will be seen by one of our Clinical Psychologists who are all registered psychologists with endorsement as Clinical Psychologists and have at least Masters or Doctorate level training in Clinical Psychology as well as specialised training and experience in treating selective mutism. Families who attend the clinic first undergo a comprehensive assessment.
The program involves the child and parent and uses specific evidence-based strategies to teach the child how to manage their anxiety in preschool/school and in public, thus enabling them to enjoy communicating and lead a less-anxious childhood. Many children who we work with also have other issues, such as behavioural issues at home, self-esteem issues, emotion regulation, toileting and eating issues, Autism Spectrum Disorder (ASD), learning difficulties, speech and language difficulties (separate from the selective mutism), and social skills difficulties. Each of these issues can be assessed and targeted as part of the overall treatment program.
The treatment strategies are mostly Cognitive Behavioural Therapy (CBT) because research and our experience has shown that these are the most effective treatment strategies for selective mutism. There are many strategies that are specific to selective mutism treatment such as a ‘Sliding In’ technique, and differ somewhat from standard strategies used for social anxiety. CBT addresses children’s avoidance of talking by helping them to gradually confront and practise increasingly more difficult forms of non-verbal and verbal communication. This is done at a pace that the child can cope with. Children with selective mutism also have particular anxious beliefs about how other people might respond or think about them if they heard them speak (e.g., ‘they might tell everyone that I talked’, ‘they might think my voice sounds funny’). CBT helps them to start to think in a more helpful and rational way about talking. The program requires parents and teachers to be committed to implementing strategies both within and outside of school, both of which are extremely important. Parents will be given skills to help their child gradually increase their communication with extended family, friends, in public places (such as the shops and extracurricular activities), and in other settings. A successful program requires both parents and classroom teacher to be motivated and committed to working on strategies to help the child. Selective mutism is one of the more severe anxiety disorders in children. It therefore takes some time for a child to learn to talk freely and spontaneously to everyone in all situations. Our experience shows that it takes approximately 12-24 months for selective mutism to resolve with an intensive treatment program. We often have children at the end of the treatment talk in front of the school assembly! So it is a condition, like other anxiety disorders, that can resolve completely. However, there are various factors that will impact on the rate of progress. These factors include the age of the child when they first present to treatment, the severity of the condition, the commitment and motivation of parents, classroom teachers, and schools to implement the treatment program, and the existence of co-occurring conditions (e.g., other anxieties, behavioural problems, or ASD). A child in preschool will often take less time than the above estimate (e.g., 6-12 months), and a child in high school will generally require longer treatment. Because the commitment and motivation of the classroom teacher plays a large role in these children’s response to treatment, we usually spend considerable time helping the school to select the most appropriate classroom teacher. For this reason, we encourage parents to start the program before the new school year, rather than “waiting to see how the child goes”.
School treatment program
The Clinic implements an intensive school or preschool program and provides the classroom teacher and other relevant school personnel (e.g., learning support, aide, vice principal, principal, counsellor/psychologist, speech pathologist) with regular phone consultations to support them to implement this program (i.e., a 45-minute phone consultation and follow-up email every 4 weeks). The classroom teacher must be present for these consultations as the main strategies discussed are intended for the classroom teacher to implement in the classroom during their daily teaching as well as in individual sessions with the child and parent.
Following the initial assessment with the family, a phone assessment with the classroom teacher is organised, which involves gathering information about how the child is going at school, in terms of their communication, anxiety, social skills, academic skills, and emotion regulation. We also start to provide education about selective mutism and the treatment program that we are recommending for the child in the school. Following this consultation, the classroom teacher and supporting staff receive ongoing phone consultations (usually once every 4 weeks for 45 minutes) in which the classroom teacher is trained to implement the program in the school that will help to reduce the child’s anxiety and gradually move them towards confident communicating. Each phone consultation is followed by a summary of the child’s progress with the program and our recommended strategies to implement before the next phone consultation. Generally the family pays for these school consultations unless other arrangements are made. We realise that the school program is intensive, however with the right support from the school, most teachers find the consultations to be invaluable professional development for learning about anxiety and other psychological issues in children. Most schools provide support for the teacher to allow them to carry out our program, and we are happy to speak with principals and support staff if they are any specific enquiries about the program.
Frequency of sessions, costs, and rebates
The frequency of sessions in the clinic after the initial two sessions will vary from family to family and will be arranged with the psychologist throughout the course of treatment. We are aware that treatment for selective mutism is generally long-term (i.e., 12-24 months) so we attempt to space the sessions out to keep treatment affordable for most families. We would normally see children and their families more frequently at the start of treatment (e.g., every 2-3 weeks). This is to provide more intensive support initially while developing and getting the treatment program under way. We then gradually lengthen the time between sessions (e.g., every 3-6 weeks depending upon the child’s progress, and how confident you feel in being able to continue the strategies between sessions). Because we are not seeing families on a weekly basis (like treatments for other childhood psychological conditions), it is crucial that parents and teachers continue to work on the strategies every day with the child in order to help improve their anxiety and communication. Each session lasts approximately 50 minutes and costs $230. Medicare rebates are available for children who have a Mental Health Care Plan (MHCP) via their GP, Paediatrician, or Psychiatrist and allow you to claim between $85 and $124.50 for each session (up to 10 sessions every year). School phone consultations are generally paid for by the parents, unless other arrangements are made, and cost $230 for a 45-minute consultation, which is followed by an email to the school and parent(s) which summarises the child’s progress and recommended strategies. Medicare does not cover the cost of any phone consultations, although private health funds may do depending upon your health fund and level of cover.
OUTREACH TREATMENT PROGRAM
The Selective Mutism Clinic’s ‘Outreach service’ is available for families throughout Australia, including Melbourne, Brisbane, Adelaide, Perth, as well as rural and remote areas and where there are no specialised services for selective mutism. This program is delivered via regular telephone consultations to parents and also to the classroom teacher and relevant school personnel.
Outreach program – assessment options
- One option for assessment for families in the Outreach program is an initial face-to-face, combined assessment and session at the clinic in Sydney. This is a 3-hour session, where the parent(s) attend the first half alone, and the child attends the second half with their parents. For younger children it is recommended that someone is available to mind the child for the first half (which can be one of the parents). The cost of the 3-hour appointment is $690.
A face-to-face assessment can be beneficial because it allows the psychologist to meet you and observe your child’s level of anxiety. The psychologist can also demonstrate how to conduct one of the main treatment strategies to you in that session and observe your child’s level of responsiveness. However, we recognise that the cost of airfares and accommodation for a family can be expensive, and our program is just as successful for those families who opt for a phone assessment rather than a face-to-face assessment.
- When attending the clinic in person is not an option for families in areas outside Sydney, an assessment can be held with the parent(s) over the phone. This assessment lasts for approximately 1 hour and costs $260. Following the assessment above, the child’s parent(s) receive ongoing phone consultations to learn strategies to teach their child about anxiety and other emotions and various strategies to help their child work on building their communication in the school program and in other social situations outside school. The cost of these 50-minute consultations are $230.
School Treatment Program for Outreach Families
The school treatment program in the Outreach program runs in the same manner as our local program that Sydney-based families receive – this involves 45-minute phone consultations with the classroom teacher and other supporting staff at regular intervals (usually every 4 weeks) throughout the course of treatment. Please note that Medicare do not provide rebates for any phone consultations, although private health funds may do so depending upon your fund and level of cover. The frequency of the phone consultations depends upon many factors including the child’s progress, and the ability of the parents to work independently on homework exercises in between the consultations. We understand that due to finances, parents may want to space out the sessions further than we would generally recommend, in which case we will let you know if we believe the sessions are not frequent enough to be effective. The Selective Mutism Clinic’s ‘Outreach service’ has been successfully provided to children and their families throughout Australia for over 10 years, including Melbourne, Canberra, Brisbane, Adelaide, Perth, Darwin, Hobart, as well as rural and remote areas.
The clinic provides professional supervision in relation to the assessment and treatment of selective mutism to other health professionals around Australia, including psychologists, speech therapists, school counsellors, guidance officers, teachers, and social workers. The clinic director is Dr Elizabeth Woodcock, a registered Clinical Psychologist and member of the Australian Clinical Psychology Association (ACPA). Elizabeth previously worked at a psychiatric service for children and their families at Westmead Hospital and was Head of Psychological Research for SANE, a leading mental health organisation in London. She has provided assessment and treatment for preschool and school-aged children with selective mutism, extreme shyness, and other childhood psychological and behavioural problems in both the public and private sectors for over 15 years. Elizabeth oversees all of the clients at the clinic via regular supervision with the clinical staff. All of the clinicians who provide treatment for children with Selective Mutism are registered Psychologists with AHPRA. They have Masters or Doctorate Training in Clinical Psychology as well as specific training in the treatment of children with Selective Mutism. The clinical staff have extensive experience working with children with selective mutism, given that approximately 30-50% of their caseload at any one time is children with Selective Mutism. Read information about the clinical staff of the Selective Mutism Clinic. See the frequently asked questions for more information about selective mutism and our treatment programs and other common enquiries that we get about Selective Mutism.