I’m on the phone with Dr. S and I thank you for participating in this interview. I think the content that you’re going to share is going to be very helpful to the listeners. To start, just to frame your own professional expertise because I think that in itself is going to be helpful to the audience. Can you just say describe what kind of a doctor you are and what kind of work you do? I’m a specialist assistant and I’m working in a major university in Canada. It involves not only patient care about the education of medical students and the residents and we are very big in research. So I work in a major university in Canada and I’m in big cities and I’m a specialist Okay, now can you describe what was going on with your daughter when you originally contacted me?
I contacted you and my daughter was five years old. I’m afraid that at that time she was pretty shy. Her talk was very limited. In school she may talk but not nearly as much that an average child would be. She would avoid most of the situations. Of course, like you were very limited. She needed a lot of help in even doing conversations with the kids in the park or even relations or friends. Every social event was kind of a concern for us because of her. And we were really concerned because she was not enjoying what she was doing.
You had a feeling that you want to do what she cannot do. How did you originally come across the term selected mutism? Well, I think it takes a long way back. We even had this suspicion when she was almost like two years old. She was not talking very well. Initially, we thought it was kind of a disability in learning or things like that. We went to the expert when she was two years and I must say that we are in a big city in Canada and they’ve diagnosed, one of the expert diagnosed autism, one of them Aspergers, the other person said it was normal and another person said it was kind of a personality disorder. So, we went in some of those routes and got some training.
But as you can see, our gut feeling said, this is not the thing. But the specialists reinforcing their decision and the treatment force that I’d be accordingly. We had a little bit of substance in there, but it was very fluctuating. And many people in our relations said it would be fine with time. So we had nearly three years with kind of a treating substance and defeat. But I must say that nobody was sure of the diagnosis. So when you started your work with me, you know I like to measure everything on a scale of one to ten. So measuring the severity of the problem at that point in time. And there are different layers to the problem. Obviously the thing that, or the dynamic that had your attention the most was her difficulty with using words and speaking.
But there was an underlying lack of happiness. There was anxiety. There was a self-esteem thing. There was the talking problem. There was the detachment thing. So the severity of the problem, one to ten, if ten was the most initially, what number would you have given it? If ten out of ten is the best in two or ten. In this case, if ten is the most severe. I would say she was probably at an eight out of ten in the beginning. Okay, now we’re going to just flash forward for a minute. So you guys graduated from treatment recently. So if it was an eight-ish when you started and now we’re going down the scale, and one is basically perfect, what number would you give it at this point? I would say two out of ten, so that we have some room.
Okay, so describe the progress. Describe what you see now that you feel good about. Well, I think she’s now, she’s finished her kindergarten then. She’s considered to be one of the smartest kids in the class now. She’s always happy, the teachers and her friends describe her as a very friendly and happy kid, she’s into almost all the social activities and average people do. And be so happy that we can see that she’s enjoying what she’s doing. And everybody who even met her for a while tells us that, oh, your daughter’s very smart, is doing very well. So it’s a very, very pleasant situation at this time. Talk specifically about where she is, about how her verbal performance has improved.
Well, I think, I’m not sure, one of my friends said that, oh, she’s only six years, you’re almost both like eight or nine. That’s what she is. And many people would say that, oh, she’s a kind of a chatterbox. Oh. A chatter box, right. And you showed me the video, she was on stage and she was actively singing. And the thing that I love, you know, when we do our session by Skype and I can see you guys, she’s very free flowing with her words. I mean, it’s a wonderful thing. Given not a specific example of where she’s free with her words now where originally she was not. Well, I think, for example, there was a graduation ceremony and it’s like, on the case, and they’re all the parents and the camera flashing and everything.
And at the end of it, you know, we have a photo session, you know, and kids are, you know, pausing for the photo. And we could even hear her talking so loudly. She’s almost like, she’s leading the show there. Lot of the enjoyment and happiness there. I think that when we go to a program and she’s on the stage, she’s so thrilled about doing that. There is no, there is no anxiety, she excited through it. And she’s, she pose us in front of everyone for the picture. It’s like a, like almost like a miracle. All right. Now, now we’re going to do the difficult part of this discussion because it is my intention when people listen to an interview like this that they can, not only do they think of this as a testimonial, and I do thank you for that, but I want to give the listeners insight regarding how we achieve success.
Okay. So the first part of the treatment was to get some realistic education about what selective mutism was. You had received diagnoses previously, like autism, learning disability, personality disorder, etc. Okay. So we arrived at the conclusion that selective mutism was a variation of OCD. The obsessiveness being the thinking worry and anxiety, the compulsion being the verbal shutdown. Okay. So the first step after that was mother and father getting to be on the same team and learning how not to enable the problem. Could you please comment on that? I think that’s one of the most important steps because here I must say that, you know, the father and mother, they are the therapists actually.
You have to be on the same team in the same wavelength to have the best results. And all of it is, I should say, Jonathan, that it is your ability to diagnose anxiety and also the, you know, that your instruction, feedback and setting it up. And part of the thing before we were not on the same team is because we were not clear. We were confused. There’s no diagnosis. We don’t know where we are going. So how can we understand team? The moment we started talking to you, we got the diagnosis. Both of us are hearing it. This is the thing. Then we got the clear instructions. I must say that, you know, I was probably leading the show and my wife was a little bit, you know, trading along, but you also understood this is the way to go. That was important in getting on the team. And that is more, most important for the daughter because you see a uniform approach if one kind of approach rather than a exact manner from the patterns before.
So when she sees that approach, then she sees before to get on the track as well. Can you give a couple of examples of how you learned not to enable? Now, I just, I want the listeners to just be careful here. I don’t want, I strongly advise somebody who’s listening to this interview not to run out and to copy what you’re saying right now because the process of non-enabling was learned methodically. The word to methodology is very important, but just give a couple of examples of how you learned how not to enable. I think the moment you said about the non-enabling, we understood intellectually that this is the right way to do it. But it was so hard, it was heartbreaking. Just imagine, you were doing that all the time.
And we were thinking we were helping her. But yes, we were helping her not to change at that time. But non-enabling takes lot of courage and lot of cooperation. For example, you go to a, you just go for a walk, able to come along and ask you, ask what all how are you feeling and where are you going and she doesn’t say, but five seconds or even ten seconds look like an hour of, or to us. But we had a hang in there not to help her, let her talk, if she doesn’t talk, we’ll say, oh, she’s not in the mood to talk. It’s so simple but it’s so hard to do immediately but that was very, very important. So when you would, that you were implementing a technique that I referred to as freeze the moment.
So when you were freezing the moment and you were breaking the reflex of her expectation that you were going to do the thinking and the talking for her and you see her struggling and this is a biggie here, what kind of emotions did you have to deal with when she was not speaking to the person who was trying to interact with her? Well, I think as I said, those ten or twenty seconds would be like an hour and you can see my daughter’s pain on the face and my lips would start speaking even when my brain stays like, no, no, no. Oh, it was very, very, very hard but it was very important to be consistent at that point. It was really important at the beginning but looking back, you know, I think when you are seeing the results, that’s the best thing we did.
Okay, now we’re moving on to what I think in addition to the non-enabling is probably the most important part of treatment and the most difficult for the parents to do and that is how you learned how to process with your daughter and the way that I’m using the term processing, it was the process of how you helped her identify thoughts, feelings, reasoning. It was getting her neural, N-E-U-R-A-L for those listeners who don’t understand what I’m talking about, pathways to work in a way that they were previously being under use. So can you talk about how you did that? Of course, I mean, that is a very important step as well, the part of the thing and the most important thing I felt was that, you know, we should never get emotional at that time when we do the processing.
Just easy to be. But the important thing that we got help is that you’re not processing when it is happening. That is a very good advice from you and a very good strategy. Whenever it happens, something happens, please, we’re momentous, you’re not talking at that time and if you talk or process at that time, you’ll be emotional anyways and then you come home in the evening, by the time you got enough preparation and you train yourself, emotionally attached to it or emotionally involved with it and then you go in a neutral way, what happened? This has happened and that person asked this question and you didn’t answer. What was going in your mind? What do you think the other person felt? The deeper question is actually, even though she didn’t answer initially, made her understand the situation and think about in her own way, now what’s going on?
Why did I do like that? What does other person felt? It’s interesting but that really helped her to think in a different way, out of the box and come out of her shell. Initially, it was not forthcoming and we had to be patient and consistent but within a couple of months, you started improving and then she started giving us answers which are very good and we used to email you those kinds of talks and then I look back and I read through them, I can see the improvement with each month actually. You’re saying a lot of important things here. You said that at the beginning, she was not forthcoming and this is what I want parents to understand just because you asked the kid a question and they don’t respond, that’s when the parents have to really deal with their own frustration.
It doesn’t mean that the child is not processing your facilitating attachment, your bringing issues to a conscious level and I’ve got to say that you did a heck of a good job and you are a role model for the fathers out there because you took the lead in the parenting therapy here and most fathers, I hate to be sexist but in most cases it’s the mother, I would say 95% of the cases it’s the mother who in essence pilots or quarterbacks, the process so it’s all to your credit and I have to tell you that when I was interacting with your daughter, either by phone or by Skype, I felt it was so gratifying to see her put the sentences together, the thoughts together, the reasoning together and that did take a lot of work. Okay now let’s touch on the issue of medicine and I want to be really careful here because most people, most parents who have a child, a young child like this, want a quick fix, is not possible in most cases, it takes some hard work but anyway we did use medicine at a specific time for a specific reason, for specific objectives can you please and I appreciate the fact that you’re a physician commenting on this, could you comment on how we used the medicine?
Of course I think there are two things with the medicine, one, many people have a feeling that no, medicine is a chemical, we shouldn’t use that in kids, that as wrong and second thing is that okay, medicine is an easy fix, you know, you just give the medicine and she’s performing, that’s fine. I think both these concepts are wrong and I personally don’t like to use medicine at all but then you convinced us and showed us was so impressive and they used the medicine in a very low dose, used it only when you was ready for it, say for example, she, what are the thoughts of that okay well I have to improve upon the talk, I had to perform this way, that was devoted in her mind but she was not getting the courage and that’s the right timing which we added the medicine as per your instructions and that did really wonders and once she stabilized in the performance we gradually weaned off, it was only very low dose, only for nine months, we weaned it off, it’s almost like, you know, just planting the tree like you make the fall, you put the water on the right moment, you had a little bit of fertilizer on that but I think I’m so impressed with the way we use the medicine and it’s off now and she’s, she’s consistent now, you know, even without the medicine.
That was a very good analogy you just used and just to elaborate when you said that when she was ready you first did the work of getting the parents to be on the same team, you did a lot of non enabling work, you got her attention that expectations were different and then when she was stuck because of the OCD dynamic at work the medicine really helped create a sense of internal ease to help her negotiate the process and then what we did was we took her after a certain level of success, confidence and happiness had been attained then we gradually took her off and now she’s been off completely, okay, now the last couple of questions here. The number one is how is your life different now that this problem has been resolved?
Well I think when our kids have a problem your mind is stuck or move like it’s a continuous thought and also to see that she’s suffering it is a heartbreaking act. Within this year, I mean we have moved out of that, now we are very happy, what she’s doing, we will be enjoying every day wherever we go we are happy, it says that we have to go to a party she’s excited when I, she’s her excited and I’m excited, it’s like a, it’s a very very pleasant situation now. Initially like when we are going through the processing and your technique was hard to do and many times we had like you know we were struggling to keep up and we had a little bit of emotional problems at that time but you know everything, everything is worth it because all of that ends well and we are very happy with how she’s doing.
Last question, what advice do you have for parents who are in the same situation that you experienced? Well I think the message is very clear, I would say if you have any concern about your kid you will probably right and don’t just leap on it, just get the right help early enough and earlier the better, that’s number one and I think I must say that you are probably the best in this field and I can see the response within a year. Second thing is that you know, so get the right help early, second thing, don’t give up, I mean you may find it hard to do but you know no pain no gain and if you’re not taking the pain you’re not getting the gain.
The third thing I would say is that if you realistic in the goals don’t expect that you know every kid has their own temperament and their own levels and their own personality or don’t expect the girl to be the you know or so how realistic, when we can always push the limit but have realistic expectations. These are the three things I would say and I have one specific comment about the parents, I mean there may be many others like that thinking you know I’m alone or the other parents who don’t get enough help from the partner. My comment is that it still doable, in my case actually you know after some time I realized that my wife does even though she wants to help a lot she’s not have the same capacity so instead of slowing down I just went ahead she supported me as an asset and I run the show, it’s doable so that’s my specific comment but otherwise the three things get help early, don’t give up, have realistic goals. Dr. S thank you very very much for. Very welcome and thank you very much for everything that you did.
