Play Therapy For Selective Mutism

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative


Selective mutism is a complex childhood anxiety disorder, which causes a child to not be able to speak despite having the ability to do so under normal circumstances. This can cause an issue in the child’s normal social and academic development.1 Play therapy is a therapeutic intervention that enables children to express themselves in a safe and fun environment. Sounds interesting? Let's dive into what the condition entails and how playing games can potentially help kids heal.

Understanding selective mutism

Selective mutism often affects young children and may persist till adolescence. The symptoms can include avoiding eye contact, social isolation, and displaying physiological symptoms of anxiety when socialising. The exact cause of the disorder is not known, however, there could be several factors such as genetics, temperament and environmental stressors including childhood trauma. Addressing these issues is important to ensure that the child develops into a well-rounded adult socially. A holistic approach is often employed to address all the complex factors involved in the condition.

Role of Play Therapy in Treating Selective Mutism

Play therapy offers a unique approach to addressing the complex emotional and behavioural issues associated with selective mutism. Play is a child’s natural language and is often associated with positive feelings, making play therapy a safe, and non-threatening language for expressing their thoughts, feelings and experiences.2

Through a combination of structured and unstructured play activities, play therapists engage with the children by creating a fun and safe environment to enable them to express themselves and explore their emotions. Through role-playing, storytelling and creative activities, children are empowered to gradually confront their fears and develop coping strategies for their social anxiety. There are different strategies play therapists use to ensure that the play environment remains conducive to the child’s healing process.

Types of Play Therapy Techniques

Non-Directive Play Therapy

Also known as child-centred play therapy, this technique provides children with the freedom to explore and express their feelings by leading the play sessions. The therapist encourages the child to have fun, create their own games and express their feelings at their own pace. Non-directive play therapy lets the child establish their own pace and build trust with the therapist who can then guide them through coping strategies.3

Directive Play Therapy

Directive play therapy is a more structured approach to play. The therapist takes a more active role, using activities like role-playing, storytelling, and puppetry to name a few, to engage children with selective mutism. This empowers them to engage socially and overcome anxiety-provoking situations. These activities are specific to addressing specific therapeutic areas and facilitating positive behavioural changes.4

Expressive Arts Therapy

Expressive arts therapy is a more integrative approach, using art, music, drama and movement to promote self-expression. In this context, this promotes no verbal ways of expressing emotions and anxieties. Some activities include drawing, painting, and improvisational play; facilitating self-awareness and expression and promoting growth and healing.4

The Therapeutic Process in Play Therapy

Initial Assessment and Evaluation

The first thing to expect is an initial consultation assessing the child’s unique needs, strengths and challenges. The therapist first speaks to the child, their parents, caregivers and teachers while observing the child’s behaviour in various settings. This can help gain a holistic view of the child’s condition and the best treatment approach.5

Establishing Trust and Rapport

Building a good rapport with the child is vital for creating a safe space for growth. The child must feel safe and accepted and the therapist establishes this through empathetic listening, validation of feelings and consistency.5

Engagement in Play Activities

Once a rapport is built and a trusting relationship is established, the therapists introduce play-based activities as per the child’s interests and preferences. Pay activities encourage the child to communicate non-verbally, allowing a free flow of thoughts, emotions and feelings through movement. Therapists include props, toys, games, crafts and other things to facilitate engagement and encourage self-expression.5

Facilitating Expression and Communication

Throughout the play therapy process, therapists and children collaboratively explore and address underlying emotions and process anxieties. Therapists aim to help children build social skills, and coping strategies and healthily express feelings through gentle guidance and positive affirmations.5

Benefits of Play Therapy for Children with Selective Mutism

Encourages Self-Expression

Selective mutism affects the child’s ability to express themselves and their feelings through words. Play-based activities can provide a communication method for the child to ensure that their feelings and emotions are processed and communicated in a natural way. Difficult emotions can be safely expressed and the child’s needs can be met safely.3

Enhances Communication Skills

Effective communication with peers is one of the key goals of treatment. By engaging in play activities, children learn to assertively communicate their needs, gain social skills and express their thoughts all in a safe and healthy environment.4,5,6

Builds Confidence and Self-Esteem

As children with selective mutism gain the ability to communicate their needs through alternative ways, they gain the self-confidence to interact verbally as well. Through successful interactions, children can develop a sense of social accomplishment, which can positively impact their self-worth and overall well-being.4,5,6

Fostering emotional regulation

Play therapy allows children to deal with their negative emotions in a constructive way. Emotions that are difficult to navigate can be addressed and coping strategies inculcated through structured play can lead to positive behaviours in daily lives.4,5,6


Selective mutism can be a challenging condition to cope with affecting various aspects of the child’s normal development. Play therapy is a safe and healthy way for the child to address the underlying factors causing the condition and transition to healthy patterns of behavioural expression. Play therapy is often used along with other therapeutic methods to ensure a holistic treatment plan for the child. Through a variety of structured and unstructured play techniques, therapists can empower the child to develop confidence in their social skills and learn coping strategies for difficult emotions and behavioural patterns.


  1. Hua A, Major N. Selective mutism. Current opinion in pediatrics. 2016 Feb 1;28(1):114-20. Available from:
  2. Wonders LL. Play therapy for children with selective mutism. Prescriptive play therapy: Tailoring interventions for specific childhood problems. 2020:92-104. Available from:
  3. Bratton SC, Ray D, Rhine T, Jones L. The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Professional psychology: research and practice. 2005 Aug;36(4):376. Available from:
  4. O'Connor KJ, Schaefer CE, Braverman LD. Handbook of play therapy. John Wiley & Sons; 2015 Nov 23. Available from:,+Schaefer+CE,+Braverman+LD.+Handbook+of+play+therapy.+John+Wiley+%26+Sons%3B+2015+Nov+23.&ots=kvqgy-5Ne5&sig=WqfadOWZKBqiYgtM3Z7awjNf5lw&redir_esc=y#v=onepage&q&f=false
  5. Schaefer CE, Cangelosi DM, editors. Play therapy techniques. Rowman & Littlefield; 2002. Available from:,+Cangelosi+DM,+editors.+Play+therapy+techniques.+Rowman+%26+Littlefield%3B+2002.&ots=ZoGmlXhqR8&sig=qm2Uv48knt6AS7A02UeUMNp7shI&redir_esc=y#v=onepage&q&f=false
  6. Hung SL, Spencer MS, Dronamraju R. Selective mutism: Practice and intervention strategies for children. Children & Schools. 2012 Oct 1;34(4):222-30. Available from:

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative
[optin-monster-inline slug="yw0fgpzdy6fjeb0bbekx"]
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Prajakta Choudhari

Postgraduate Degree, Public Health, University of Chester

Dr. Prajakta Choudhari, a public health doctor with a penchant for writing, brings a unique blend of medical expertise and storytelling prowess to the table. With a stethoscope in one hand and a pen in the other, she navigates the intricate realms of healthcare, education, and community engagement with equal parts compassion and creativity. Armed with a PG Certificate in Public Health and an MBBS degree, Prajakta has journeyed from the corridors of clinical care to content creation, seamlessly bridging the gap between complexities of medicine and public understanding. Her passion for driving positive change in healthcare is matched only by her knack for crafting compelling narratives that educate, empower, and entertain. Through her work as a Medical Writer and Health Educator, Prajakta strives to empower individuals with knowledge while destigmatising sensitive health topics. When she's not busy dissecting medical jargon, you can find her creating comics, mentoring aspiring healthcare professionals, or simply enjoying a cup of chai with a good book in hand.

Leave a Reply

Your email address will not be published. Required fields are marked * presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818