Structural analyses of members' relationships in a selective mutism family: A single case study

Background: Patterns of relationships between family members of children with Selective Mutism (SM) may play a central role in the aetiology and maintenance of the disorder. However, little is known about SM family structure, style, competence, role's distribution and attributions given to the symptoms. Methods: Structural analyses of SM family relationships of T's case study have been carried out. SM Diagnosis was made according to the Diagnostic Manual of Mental Disorders-IV (DSM-IV). Qualitative and quantitative family assessment tools, such as the Elective Mutism Interview Schedule, Over-involvement/Lack of commitment questionnaire, Beavers' Systems Model of Family Assessment (BSMFA), and Symbolic Drawing of the Family Space (SDFS) have been utilized. Results: T's family was adequate as regards competence and moderately centripetal concerning style. Common among members was the perception of the external environment as threatening. T's family members showed the tendency to interiorize negative feelings, incompetence in divergences negotiation, and difficulties in communication. Mother and T are in close relationship, while the father appeared as a peripheral and passive figure. Conclusion: A family relational homeostatic hypothesis of SM onset and maintenance is suggested and discussed from a systemic-relational perspective.