Published: 20 October 2016

‘If the job you would love to do does not exist, then create it’

Lucy Nathanson graduated with a BSc Applied Psychology and Sociology in 2012. Since then she has found her passion in working with children with Selective Mutism, sparked by her year on placement.

Here she explains the challenges and rewards of her work.

Selective Mutism (SM) is an anxiety disorder which affects approximately 1 in 150 children. It is essentially a phobia of talking – children with SM want to talk but they can’t.

Children often report feeling like their voice is ‘stuck’ or that their throat feels tight and the words cannot come out. These children often talk comfortably at home, are often described as loud and confident in their home environment but completely freeze when they go to school.

SM is place and person-dependent; children can speak in certain places but not others, and, similarly, they can talk to certain people but not to others. Therefore, interventions for SM focus on reducing the child’s anxiety levels, helping them to relax, while gradually exposing them to talking – a form of systematic desensitisation.

John was the first child with Selective Mutism I worked with (and it was during my placement year at Surrey). John was five years old, had been at his school for two years and had never spoken to any child or adult at school.

I was to spend three weeks in John’s school – I had never worked with a child with Selective Mutism, in fact I hadn’t heard of it. But I could see that John had an anxiety disorder – he had an intense fear of talking. My primary aim was to build a rapport with John to help him to feel comfortable in my presence. I never once asked him to talk but instead helped him to feel at ease with me. I also gave him a lot of positive reinforcement.

Once John was noticeably comfortable with me, I began to encourage him to make sounds. Initially I played games in class where the children blew through a rolled up paper. We then moved on to making other sounds through the paper – the intervention was ‘hidden’ within game. As with all my interventions, the focus was not on John speaking but on him feeling at ease and having fun.

When John was comfortable making various sounds, I read an animal book with him and stopped on the word ‘bear’ – I broke the word down and repeated calmly and slowly “be-ar, be, be…” John repeated ‘Be’ and I then repeated the same procedure until he said ‘’ and we then merged the sounds so he was saying the first word he had said at school ‘bear’.

Luckily, with John generalisation was relatively straightforward and after we repeated this procedure with other animals in the book he was soon answering my questions and talking to me and other children in the class.

Following this experience, I decided to reach out and help more children with SM – I developed my website and started making Youtube videos and finding more and more parents who had children with SM. I now work in schools implementing interventions, gradually exposing children to their fear of talking. I also micro-manage school-led interventions and deliver staff training.

In addition to this, my YouTube videos on the topic of SM have had over 31,000 views. I also run workshops for parents of children with SM with the aim of bringing parents together and to share knowledge and experience as well as to advise on interventions and techniques that the parents can implement with their children.

In April 2016, I was a speaker at a conference (organised by the University of Silesia) held in Katowice, Poland. In August 2016, I worked on the Brave Buddies programme (an intensive therapeutic programme for children with SM) delivered by the Child Mind Institute in New York City, USA. On an international level, I offer Skype consultations, and have spoken to and advised parents the UK, South Africa, Sweden, the UAE and more.

I was lucky that I found my passion in working with children with Selective Mutism and have turned this into my full-time work. My advice to university students is to expose yourself to as many work experiences as possible and to find something that you really love to do. Also, don’t feel like you need to find a ‘job’ – if the job you would love to do does not exist then create it.

Lucy Nathanson

Child Therapist and Selective Mutism Specialist

Founder of

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