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In the Consulting Room. E[psode 1. Silence Speaks · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:01
  SPEAKER_00: Hello, this is Kim Lee.
• 0:03
  SPEAKER_00: Welcome to the first episode in the series From Inside the Consulting Room.
• 0:12
  SPEAKER_00: These are ten accounts of child psychotherapy from inside the room in which I see children.
• 0:22
  SPEAKER_00: This episode is entitled The Boy Who Couldn't Speak.
• 0:28
  SPEAKER_00: He sits on the floor.
• 0:31
  SPEAKER_00: He's been in the room for nearly 15 minutes.
• 0:36
  SPEAKER_00: There's a sheet of paper on a table next to him.
• 0:41
  SPEAKER_00: He begins to draw.
• 0:42
  SPEAKER_00: And he's drawing very carefully, but he's pressing the pencil hard against the page.
• 0:50
  SPEAKER_00: He hasn't spoken, not once.
• 0:54
  SPEAKER_00: And the rest of the session remains just the same.
• 1:00
  SPEAKER_00: Every week children walk into consulting rooms carrying stories that they don't yet know how to tell.
• 1:09
  SPEAKER_00: And sometimes those stories appear as anger, anxiety.
• 1:15
  SPEAKER_00: Sometimes they appear as something else entirely.
• 1:19
  SPEAKER_00: And sometimes that something else is silence.
• 1:24
  SPEAKER_00: Harry was a nine-year-old boy, and he was referred to me for therapy because he just seemed to stop talking.
• 1:34
  SPEAKER_00: He rarely spoke to teachers or classmates.
• 1:38
  SPEAKER_00: And if questions were directed towards him or attention was paid to him, he just lowered his head and remained silent or would turn his back.
• 1:51
  SPEAKER_00: People initially assumed he was shy, and indeed his parents regarded him as that, just saying he's a bit shy.
• 2:02
  SPEAKER_00: But this shyness and silence had persisted for about 18 months.
• 2:09
  SPEAKER_00: Now, from a clinical point of view, Harry's behavior was consistent with something called selective mutism.
• 2:17
  SPEAKER_00: And selective mutism is a condition in which slowly we begin to see a child having less and less verbal communication with others.
• 2:30
  SPEAKER_00: We see that that starts to find expression in social situations and sometimes even within the home.
• 2:39
  SPEAKER_00: And it's often associated with social anxiety and emotional inhibition.
• 2:47
  SPEAKER_00: And children experiencing this difficulty may fear drawing attention to themselves or saying something that could provoke criticism.
• 2:57
  SPEAKER_00: Often that's not a thought sense, it's more of a felt sense.
• 3:03
  SPEAKER_00: In Harry's case, the ongoing parental conflict that he had been experiencing for a considerable time created what could be regarded as an emotionally unpredictable environment.
• 3:19
  SPEAKER_00: He was the only child within the family.
• 3:22
  SPEAKER_00: So silence appeared to function as a kind of protective adaptation, sort of reducing the risk of emotional exposure in situations that already felt unsafe.
• 3:35
  SPEAKER_00: And I suppose in his own way, he was being invisible.
• 3:41
  SPEAKER_00: Invisible in the sense that he wasn't placing demands upon others.
• 3:48
  SPEAKER_00: He was adapting.
• 3:50
  SPEAKER_00: Almost a chameleon-like position.
• 3:54
  SPEAKER_00: Now Harry had been seen by other mental health services, and what I found concerning was that the focus of clinical intervention had been to get Harry to speak.
• 4:05
  SPEAKER_00: Nothing at work.
• 4:06
  SPEAKER_00: And frankly, I wasn't surprised.
• 4:08
  SPEAKER_00: Because it seemed to me that everybody had made a fundamental mistake.
• 4:12
  SPEAKER_00: They were failing to recognise that in his own way Harry was communicating.
• 4:18
  SPEAKER_00: But people simply viewed his selective mutism symptoms as the problem.
• 4:25
  SPEAKER_00: And then thought, well, that's what we have to fix.
• 4:29
  SPEAKER_00: Some clinicians viewed his symptoms sort of as representative of a possible autistic spectrum disorder, which I could sort of see the clinical logic for, but it wasn't a view that I shared.
• 4:43
  SPEAKER_00: And when I examined the case history in more depth, I could see that what was a better explanation was protective adaptation.
• 4:51
  SPEAKER_00: And that was the most likely explanation for his difficulties.
• 4:55
  SPEAKER_00: And it should be remembered that symptomatic expressions of this can be very powerful and misleading.
• 5:04
  SPEAKER_00: They require a delicate kind of handling, yet simultaneously not one where the child is treated as fragile or ill.
• 5:13
  SPEAKER_00: That really doesn't help.
• 5:15
  SPEAKER_00: But it's an interesting paradox because, as is so often the case, the when a child becomes silent in this way, what they're signaling is a kind of distress that's unspeakable.
• 5:30
  SPEAKER_00: And that I think touches our own our own sense of distress.
• 5:35
  SPEAKER_00: And we then start to approach the child as if we have to be careful.
• 5:40
  SPEAKER_00: When in fact that's not true.
• 5:41
  SPEAKER_00: We don't have to be careful.
• 5:43
  SPEAKER_00: We have to be thoughtful and understanding and open, but not in a way that gives the child the message that they are in some way fragile.
• 5:54
  SPEAKER_00: It's a curious, paradoxical situation, and we therapists face them all the time.
• 6:02
  SPEAKER_00: So what I felt was really important was to recognise that the perfectly healthy parts of this child were being overshadowed by his silence, and those weren't being seen.
• 6:16
  SPEAKER_00: So they needed to be brought to consciousness.
• 6:19
  SPEAKER_00: So in simple language, I just accepted that he was communicating in his own way, and I endeavoured to communicate with him in mine.
• 6:31
  SPEAKER_00: Inside the consulting room, Harry spent many of his early sessions just drawing, not necessarily looking at me.
• 6:39
  SPEAKER_00: Occasionally he'd glance.
• 6:42
  SPEAKER_00: And at first the drawings appeared quite ordinarily age appropriate, but there were things like houses and trees and cars and you know occasionally something slightly different.
• 6:55
  SPEAKER_00: But gradually something began to emerge.
• 6:59
  SPEAKER_00: One of the things that kept repeating itself were was two houses.
• 7:05
  SPEAKER_00: Two separate houses, and there was always a line between them.
• 7:12
  SPEAKER_00: On one occasion on one occasion a small figure emerged standing between them.
• 7:20
  SPEAKER_00: And I said nothing.
• 7:23
  SPEAKER_00: But then it happened again in the next session, and I said, It looks like the boy, I think if he was intended to be one, I think it looks as if the boy in the drawing is standing between two places.
• 7:40
  SPEAKER_00: And he nodded.
• 7:42
  SPEAKER_00: And it was the first time he had responded to something that was direct.
• 7:48
  SPEAKER_00: And I say direct, it was direct to the picture.
• 7:54
  SPEAKER_00: So I took a bit of a risk and I commented that the boy in the picture looked to me as if he might be alone, and I wondered where everyone else was.
• 8:04
  SPEAKER_00: And he paused and just then pointed with his pencil at the two houses.
• 8:13
  SPEAKER_00: Over the weeks, Harry began to whisper, occasionally and never spontaneously, and always in response to something which was a kind of practical, non-intrusive observation or suggestion.
• 8:27
  SPEAKER_00: And it was the beginning of something unfolding.
• 8:30
  SPEAKER_00: And as much as I wanted to learn much more about his experiences and what had led him to the stage of silent emotional containment, it was crucial that I was just patient and that my approach to him was not direct, that it was through his drawings.
• 8:51
  SPEAKER_00: Now, one day I noticed that the images in a particular drawing had started to include animals, and they'd become kind of larger than usual, and it seemed to me as if he was occupying the space on the page, as if he was being more expansive, and perhaps maybe showing a little bit more of himself.
• 9:14
  SPEAKER_00: One of the images was an alligator with long protruding teeth, and I said with a slightly mock, scared tone, My goodness, look at his teeth.
• 9:23
  SPEAKER_00: Is he hungry or angry?
• 9:25
  SPEAKER_00: And I was greeted with a broad grin from him, and he then growled and laughed.
• 9:31
  SPEAKER_00: There are moments in my work with children which give me a very great deal of joy, and this was one of them because it signaled here is the small person being brave enough and trusting enough to show me something.
• 9:48
  SPEAKER_00: Children exposed to parental conflict often experience powerful loyalty dilemmas.
• 9:55
  SPEAKER_00: They can feel caught between two emotional worlds, and speaking openly can feel dangerous.
• 10:03
  SPEAKER_00: Silence therefore becomes a psychological solution, but it also signals internal conflict and one which very often doesn't have words.
• 10:15
  SPEAKER_00: It finds expression in so many different ways which are often hard to understand.
• 10:20
  SPEAKER_00: But Harry showed me something of himself, and it was a communication directly from his internal world.
• 10:28
  SPEAKER_00: And it marked the beginning of slow change, and this never ever occurs in a straight line.
• 10:34
  SPEAKER_00: It happens little by little, and sometimes there are backward steps.
• 10:39
  SPEAKER_00: But in working with Harry's parents, helping them to understand where this boy was stuck, progress began to be made.
• 10:49
  SPEAKER_00: He didn't just suddenly become talkative, it took time.
• 10:52
  SPEAKER_00: But gradually he began to speak a few words here, whispered perhaps, every now and again a short sentence.
• 11:01
  SPEAKER_00: And with each small moment of communication the burden of silence began to loosen.
• 11:08
  SPEAKER_00: Inside the consulting room, silence is never empty.
• 11:13
  SPEAKER_00: More often it's carrying a story that the child has not yet felt safe enough to tell.
• 11:21
  SPEAKER_00: Thank you for listening.
• 11:22
  SPEAKER_00: Episode two will come soon.