Parent-Child Interaction Therapy (PCIT) for Selective Mutism

Research suggests that variants of Parent-Child Interaction Therapy (PCIT) may be efficacious in treating early childhood anxiety disorders, including selective mutism (SM). PCIT for SM (PCIT-SM) is a family-based intervention created by Dr. Steven Kurtz that includes two phases of treatment. The first phase is Child-Directed Interaction (CDI), which is intended to build a strong foundation for later bravery practice. CDI involves the use of play therapy skills in the absence of speech demands to help the child build a rapport with the clinician as well as to enhance the relationship between the child and the caregiver(s). CDI continues to be incorporated throughout treatment.

Once rapport is established, the second phase of treatment, Verbal-Directed Interaction (VDI), is introduced. VDI offers a framework for facilitating speech in youth with SM. VDI utilizes specific types of questions and prompts as well as strategies for responding to and redirecting nonverbal communication. VDI is often paired with behavioral interventions including shaping, positive reinforcement, and systematic desensitization to increase the child’s brave behavior. Caregivers are coached on their implementation of CDI and VDI skills in order to act as their child’s own bravery coach. Using the skills outside of the therapy setting helps to generalize treatment gains across environments. For multilingual families, clinicians can provide caregiver support in using PCIT-SM strategies in various languages and settings in an effort to increase verbalizations in all languages spoken by the child.

PCIT-SM can be adapted for the school environment and within the community. For instance, once speech is established in the therapy setting, therapy sessions may move from the clinic into the community (e.g., school, a park, the library, local stores) in order to provide opportunities for “brave talking” practice in naturalistic settings. SM clinicians often work closely with a child’s educational team and can provide training on PCIT-SM strategies to use in the school environment as well.