Most therapists, particularly those working with younger clients referred by their families, schools or colleges, will know what it’s like to encounter a client with a central issue or problem that others in their life are eagerly waiting to be resolved. The awareness for the therapist that ‘results’ are expected of them can be intense—even when it comes from the most well-meaning onlookers. However, this sense of pressure to deliver often sits alongside recognition within the therapist that the client’s issue, whatever it is, usually serves some fundamental purpose for them—perhaps providing a feeling of safety, or a sense of identity—and that aiming to eradicate it too soon may thwart the therapeutic relationship and therapeutic process as a whole. This creates tension: as therapists we are taught to keep our clients’ needs and wishes at the heart of our work. However, it’s hard not to take into consideration the perspectives of an exasperated or concerned parent, or a teacher who believes a student would do so much better if only this ‘one thing’ about them could be changed.
When Jonathan was referred to me by his college for text-based online counselling last year, this kind of tension was one of several notable things I had to contend with. Jonathan, who was 18, was said to be struggling with selective mutism—ie. he could speak, and had spoken earlier in his life, but for several years had not been doing so. Understandably, staff at the college Jonathan attended and others around him were puzzled and concerned, noting how significantly not speaking seemed to hold Jonathan back—socially, developmentally, and academically. Conventional ‘talking’ therapy clearly wasn’t an option for someone who wasn’t speaking, so a lot of hope was placed in the ‘chat’/instant-messaging type of text-based support I provided—especially since Jonathan had agreed to give it a go. It would enable him to communicate with me in a way in which he felt comfortable since texting and the written word were his principal means of interacting with others.
Text-based online counselling, which I’ve been practicing for the past six years, can often feel a little like working in the dark—and this has its benefits and disadvantages. Unable to see or hear each other, both therapist and client are free from the distractions and assumptions that often come with interacting face-to-face. Instead, much becomes invested in the power of the written word as one drills down into the client’s reality and opens up their inner world. However, it can also be a painstakingly slow process and important things can remain hidden, especially things that relate to the client’s physicality or social presence. Working via text with Jonathan meant that his not speaking was not immediately apparent, which it would have been had I sat in a room with him attempting to communicate verbally.
In our first couple of sessions I sought to build a relationship with Jonathan gradually and placed emphasis on finding out what he wanted to change in his life as opposed to spelling out what other people had told me about him and what they wanted to be different. Jonathan told me that building confidence, and learning to worry less about what other people thought of him were his key concerns. To me it seemed important to go gently and stick with these themes at the beginning. However, after a few weeks I came to feel that Jonathan and I could carry on indefinitely without the issue of him not speaking arising. It began to seem avoidant of Jonathan and, on my part, rather collusive. I knew this substantial ‘fact’ about him (his mutism) and I wasn’t bringing it into our conversation. However, it was the issue I was being tasked to address, and in a very short amount of time as, initially, I was allocated only eight sessions with Jonathan. During an early supervision session with my supervisor, we came to the conclusion that I could only sit for so long with this ‘elephant in the room’—or rather, ‘elephant across the screen’! It was important, we determined, that I made use of the golden opportunity I had to work with Jonathan non-verbally (ie. using text-based chat) to open up a discussion about his not speaking.
When embarking on online counselling with new clients I always ask why a client has opted for this particular way of engaging in therapy. Often this can be very telling and launch us straight into the work—particularly when a client acknowledges choosing online over face-to-face counselling because, for example, they feel shy or socially awkward, or because they’re too ashamed to discuss their issues in front of another person, making doing so through a screen a safer option. At the outset Jonathan hadn’t given me much to go with, stating only that he had little confidence, didn’t think he’d be able to manage counselling face-to-face, and that other people in his life felt online counselling would be a good idea. Indeed, he’d given me little in any of our sessions up to that point—politely responding to my questions and answering them in a way that felt lean, spare and tentative. It was time to ramp things up a little. “I know you’ve mentioned you struggle with confidence”, I wrote to Jonathan next time he and I engaged online. “I’ve been told you actually struggle with speaking to others and wonder if you want to tell me a bit more about that.”
This direct introduction of Jonathan’s mutism into our dialogue certainly moved things along in our relationship. I swiftly learned from him that his non-speaking became an issue shortly after he moved to a new secondary school, leaving his old friends behind.It then became further entrenched a few years later when he recognised he was gay and began to feel alone on account of his sexuality. Jonathan also offered further key facts about his family make-up and personal history. For example, his father left when he was young and they no longer had any contact. These significant details were exciting, as it seemed that things were finally moving and Jonathan was beginning to open up. However, I now recognise that all this new information pushed me further into a ‘fixing’ mode as I tried to use the ‘jigsaw pieces’ I had gathered to neatly form a complete picture that would explain, and ideally resolve, Jonathan’s mutism.
To this effect, I asked questions that probably felt too probing for Jonathan, for example: “How did you feel when your Dad left?” I also slipped into asking what I can now see were obviously ‘closed’ questions, for example: “Do you want to start speaking again?” As most therapists will have learned in the early stages of their training and are probably reminded of time and again through experience, closed questions can be a sure-fire way to shut down a client, or prompt them to give an answer you aren’t prepared for. Jonathan’s answer to my question of whether he wanted to speak again was a dead-end ‘no’. Over half-way through our eight sessions, and after what felt like a brief period of promise, our work together had hit another impasse.
This is where online group supervision (which immerses me in the same medium I use to communicate with my clients) came in. In my small but diverse group of fellow supervisees, one suggested I switch from focusing on Jonathan’s past and the possible causes of his mutism and instead ask about his future—his hopes and aspirations. From there, I could then ask where his mutism might fit in. Her non-threateningly inquisitive and solution-focused outlook seemed to be exactly what was needed. In the next couple of sessions I asked what Jonathan wanted out of life and discovered he wanted to become a teacher in order to support and encourage other young people to make the best of themselves. He also wanted to find a partner and possibly start a family. This gave me what felt like a ‘foothold’ with him, and a safer place from which to question and get him thinking about his mutism. “What skills might you need”, I asked, “in order to be a good teacher?” Then, “how would you go about finding and building a relationship with a partner?” For a while Jonathan avoided using the “S” word (speaking) but acknowledged that a degree of confidence and good communication skills would be key to achieving both those goals.
The final stretch of our work together followed a three-week break over the Easter holiday and then another break when Jonathan went on a college trip. Although breaks can sometimes disrupt the flow of therapeutic work, they can also allow clients the opportunity to test out the new skills they want to develop and the therapist, while not withdrawing completely, can step back into the role of observer or supporter. With Jonathan, I was pleased to learn that he’d managed the college trip well and that he was also starting to speak more in class. “Speak?” I asked tentatively, “as in verbally?” “Yes”, he replied, “a little”. Prior to our break we’d been working on challenging negative thinking, which for Jonathan primarily meant worrying what others would think when he spoke, and assuming they’d see him as stupid or awkward. It seemed as if what we’d covered in these sessions was gradually settling within him and prompting him to take risks and make changes. With text-based online work, of course, clients can’t immediately see the beam on your face when you take delight in their progress. However, Jonathan’s updates in his last few sessions generated plenty of emoji smiles from me as I conveyed how glad I was to hear how he was doing, and urged him to recognize, and give himself credit for, the significant steps forward he had made.
When Jonathan and I completed our final session he reported regularly talking with his peers, asking questions and contributing to group discussions in class at college. I was initially quite stunned at his progress—asking myself how absolute his mutism had actually been, and precisely how much he really was speaking now. However, I then realised these questions were technical and, in working with Jonathan online via text, I’d never discover the answers. Trusting Jonathan’s positive self-reporting (echoed by affirmative feedback from his college referrer) was all I could do. Working with Jonathan in an online, text-based format taught me to simplify my approach as a therapist and to allow the client to ‘fix’ themselves on their own terms, not on mine, or anyone else’s.
Written by FELICITY RUNCHMAN
Originally published MARCH 2019
Artwork by KATE HOLFORD