Interview with Dr. Steven Kurtz

Dr. Steven Kurtz, PhD, ABPP is one of the world’s leading experts on selective mutism and child anxiety—and, as it happens, he was also my childhood doctor. His work helped shape not only my treatment, but the entire landscape of SM care. Dr. Kurtz is a clinical child psychologist and the developer of Parent-Child Interaction Therapy Adapted for Selective Mutism (PCIT-SM), an evidenced-based approach now used around the world for helping individuals with selective mutism.

From his early days as SM clinic director at NYU’s Child Study Center to his current role as a global trainer and advocate, Dr. Kurtz has mentored countless clinicians and treated hundreds of families. Including mine! When he says “you” in this interview, he’s talking directly to me as one of his early SM clients. It’s a true full-circle moment!

1. Could you share a bit about your professional background?

My professional background is as a clinical child psychologist. Early in my career, I specialized in children with disruptive behavior disorders and ADHD. Then my path shifted toward working with kids and families managing diabetes, which is actually what I did my dissertation on.

At one point, while I was at the NYU Child Study Center, I attended a case conference where a child psychiatrist presented a fascinating case: a kid who spoke freely at home but not at all at school. It turned out the family lived near me, so I agreed to take on the case. Before that, I had only treated one other child with selective mutism, and that case was fairly successful—the child even happened to be in the same kindergarten class as my daughter.

I always say, you’d have to be brain-dead not to find selective mutism absolutely fascinating. The idea that a child can be completely verbal in one setting and frozen in another is just so compelling. Becoming interested in it was a natural response to that dilemma.

2. What drew you to SM specifically? Was there a moment that made you realize this was your focus?

Well, the particular moment and case, as you know, was actually you. Working with you and your family led to so many small discoveries that kept pulling me deeper into the world of selective mutism. It was as if everything I’d studied before suddenly clicked into place—learning theory, reinforcement principles, relationship-building, helping kids go outside their own comfort zones—all of it gelled.

As I started seeing success in our work together, word got around at the NYU Child Study Center. One referral turned into three, then five, then thirty. Pretty soon, I was seeing so many kids with SM that it naturally evolved into a subspecialty for me—or as I lovingly say, a sub-subspecialty.

3. Could you describe your general approach when treating SM?

I’d describe myself as the most playful, hardcore behavior therapist I know. Everything I do is grounded in learning theory—how habits are formed, how they’re changed, how reinforcement works. I also pay close attention to child development and make sure everything I do is playful and developmentally sensitive.

The foundation of all of it is the belief that no behavior change happens without a strong relationship first. I was lucky to have trained extensively in Parent-Child Interaction Therapy (PCIT), which is built on the idea that oppositional kids can change—but only after parents learn to reinforce positively and effectively.

So it felt natural to adapt that model for SM, in that if I wanted to help kids who were incredibly anxiety to change those behaviors, the parents and I would have to build this incredibly reinforcing relationship. That’s how I developed Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM), which we now deliver in individual, group, and intensive formats.

4. What’s a common misconception about SM that you often encounter?

The biggest misconception is that kids with SM are simply choosing not to talk—that they’re being oppositional. But if a kid were truly oppositional, you’d see that behavior in many different ways, not just in who they choose to speak to. SM isn’t about defiance; it’s about anxiety. That said, a small subset of kids with SM do have oppositional traits, and we treat those in parallel when needed.

Another big myth is the belief that kids will just “grow out of it.” I wish that were true. Well-intentioned and well-meaning pediatricians, grandparents, friends, relatives, and educators often coach parents: “Let kids be kids. They'll grow out of it.” But from our perspective, every day that goes by without treatment strengthens the habit of avoiding speech. This avoidance becomes more ingrained over time and harder to break.

There’s also the belief that SM is caused by trauma. While trauma is serious and can lead to post-traumatic stress disorder, the behavioral patterns of PTSD and SM are very different. We often have to re-educate people, respecting that trauma is important, but it’s typically not the root cause of SM.

5. Can you share a breakthrough story that’s stuck with you?

One that really sticks with me happened in Dubai, where I was working with a young girl who had SM. We were going to a weekly family gathering, and when we arrived at the grandparents’ house, there were about 20 people in the living room.

As we walked in, they all came to the door—excited, greeting her, throwing questions her way. I lovingly said, “I love you all, and I love what you're trying to do, but here’s the plan: please go back to the living room and wait for us while we warm up a bit.”

So the girl, the parents, and I went upstairs and did some warm-up activities. Then we created a pretend restaurant game. One by one, each family member was invited into our “restaurant,” where she played the waitress and took their orders using a pad and play food.

In that one session, she managed to interact with all these extended family members—including her grandparents—for the very first time. It was certainly an incredible breakthrough moment.

6. Have you changed your mind about any aspect of SM treatment over the years?

Honestly, I would say in the past five years, I have not changed my mind. I think because I'm doing this so long and heading towards retirement, some things are solidifying for me, such as the importance of first building a warm, fun, and trusting relationship. Then making sure that everybody understands that treatment is a marathon, not a sprint. You can only go so fast, and response to treatment varies incredibly. Some kids will respond to the same treatment protocol super fast, and others will need to take a lot longer.

I would say the other thing that has solidified for me is that while we have a fantastic behavioral treatment, not every child and family will respond to it. Some kids and families will truly need to consider medication as an adjunct or an add-on if they're not getting a good enough response to the behavioral treatment. And that's no fault of the child or the parent.

7. If you could wave a magic wand, what’s one thing you’d change about how SM is treated or understood?

This is a fairly easy question to answer, and it has to do with access to treatment. It makes me sad that we have not yet evolved to free, accessible public health care. It is unfortunately true that high-quality care from the limited number of experts is expensive. That leaves the vast majority of people unable to access such care. In my practice and other group or university-based practices, we can sometimes meet that need by offering reduced-fee care using trainees, but it's unfortunate that it is still so limited.

8. What’s one piece of advice you wish more parents knew about SM?

I want all parents and caregivers to internalize that every single interaction is an opportunity for growth. The strategies we teach need to be embedded in what I call an “exposure lifestyle.” That means you’re helping your child practice brave behavior in everyday places: the bakery, the gas station, the cleaners, the library. Families who embrace this mindset see phenomenal growth because they’re constantly reinforcing approach rather than avoidance. Every opportunity can be thought of as a chance to chip away at an over-learned history of not speaking and replace it with brave talking.

9. Beyond therapy, what else do you recommend for kids with SM?

I’m a big fan of getting kids to do physical challenges where they can take great risks and see the benefit of pushing themselves out of their comfort zones, for example rock climbing or gymnastics. These kinds of physical risk-taking build confidence and a growth mindset, which generalizes to anxiety work.

10. If you could recommend just one resource for learning more about SM, what would it be?

This is the easiest question you've given me to answer unequivocally. The starting point for every family, every therapist, every educator, and every professional should be the free online course that we call Selective Mutism University. It's at www.selectivemutismlearning.org.

Since we started that course in 2015, we've had over 19,000 people register for the course. We know from research that people come out significantly more knowledgeable and a bit more skilled. And that's a free online resource. I'm also excited to share that we're on the verge of launching a free online game to help kids and families in their SM journey.

11. Fun fact—What’s something people might be surprised to learn about you?

I've been playing guitar since age 12. I love bluegrass music and will go almost anywhere to hear it.

I'd love to hear from you!

If you found this interview helpful, or if you have a story about your own SM journey, I’d love to feature it in a future post. Feel free to reply to this email and share your thoughts.

To the next first,
Jonathan

Looking for more trusted resources on selective mutism?
I keep a running list of my favorite books, articles, courses, and tools for parents, educators, and individuals here: 👉 My Favorite SM Resources