Episode 73 features a discussion between Dr. Elisa Shipon-Blum and Dr. Jenna Blum, Director and lead clinical psychologist at the SMart Center’s Counseling and Assessments department, on the PVC model — a practical, anxiety-lowering framework at the core of the SMart Center’s Social Communication Anxiety Treatment® approach.

Dr. E and Dr. Jenna break down the three components of PVC: Preparing, Visuals, and Choice questions — and why using all three together creates the conditions for real communication progress. They discuss how anticipation anxiety affects children before an exposure even begins, why preparation is the most overlooked part of the process, and how visuals reduce cognitive load in ways verbal preparation alone cannot. They also cover silent goals, SM roadmaps, and how choice questions move a child from responding to initiating.

What the PVC Model Is and Why Anxiety Makes Communication So Hard

Dr. E opens by introducing PVC — Preparing, Visuals, and Choice questions — as a simple, memorable framework built into the S-CAT® model. The goal is practical: give families, clinicians, and teachers terms they can reach for in the moment, whether planning a game, setting a goal, or navigating a real-world exposure.

Dr. Jenna explains the mechanics. Anxiety and processing sit on opposite ends of a seesaw — when one goes up, the other goes down. For individuals with Selective Mutism, an unexpected question doesn’t just feel uncomfortable — it triggers a freeze. PVC works by minimizing what the brain has to do in the moment. When a child has prepared, has a visual, and is offered a choice rather than an open-ended question, anxiety drops and engagement becomes far more likely.

Dr. E frames the bigger picture. Families often ask “how do I get my child to talk?” — and the answer is never just be brave. There is no magic bullet. PVC is one piece of a much larger recipe: sandwich questions, copy-backs, the SM Triangle, silent goals, action plans. What matters is how those tools are assembled for each individual, based on their whys and their stage on the Social Communication Bridge®.

Why Preparation Before an Exposure Matters More Than the Exposure Itself

Dr. Jenna introduces anticipation anxiety — the fear that builds before a child ever walks through the door. Many children rate an upcoming birthday party a 5 out of 5, yet reflect afterward that it actually felt more like a 3. That gap is why preparation is the P in PVC, and why Dr. Jenna calls it the most important component. If a child is already at a 5 before they arrive, the chances of them feeling ready to engage are slim. 

For resistant or overwhelmed children, Dr. E introduces silent goals — where parents set up the world quietly without involving the child directly. A real example: a 13-year-old with a pottery party coming up. Two weeks out, her parents visited the venue on a casual Saturday — no agenda. By the time the party arrived, she knew the space, had picked out what she wanted to paint, and walked in with a friend. She was prepared without ever being told she was preparing.

For children more actively engaged in treatment, Dr. E describes SM roadmaps: step-by-step written plans covering where they’re going, who will be there, what questions might come up, and what to ask in return. Older teens and adults write these themselves. Even the nonchalant version — talking through Aunt Sally’s visit in the car on the way there — is preparation that lowers anxiety before they walk in.

How to Use Visuals to Reduce Cognitive Load in Selectively Mute Individuals

The V in PVC stands for Visuals — and Dr. Jenna is emphatic about why seeing something matters more than hearing it. She notices the same pattern constantly: a family reports that something didn’t go well, she asks if they prepared, and they say yes — “we talked about it.” Then she asks if they wrote anything down. Eight out of ten times, the answer is no.

The restaurant analogy makes it tangible. You’ve decided on the chicken Caesar salad. You’ve repeated it to yourself. Then the server appears mid-conversation — and you blank. You glance at the menu and it comes right back. That’s what a visual does for a child with SM: it removes the need to retrieve information under pressure because it’s already right there.

Visuals take many forms — a laminated card for younger children, a note in a teen’s phone, a poll activity at CommuniCamp where every child can engage by pointing, showing, or reading aloud. Dr. Jenna also highlights on-the-spot visuals: when a child freezes, instead of moving on, she pauses and says write down your answer. Once it’s there, she re-asks. Some kids respond verbally, some point, some use a peer as a verbal intermediary. Many clients simply need 60 to 90 seconds to form their thoughts — the visual gives them that bridge.

 

Dr. E adds two principles. First: repetition. Three familiar restaurants, three familiar stores — the more a child visits the same place and orders the same thing, the less their brain has to work, and eventually they don’t need the visual anymore. Second: ownership. Children should create their own visuals whenever possible. When a child builds it, they own it. And what they own, they can use.

Using the Social Communication Bridge to Meet Every Child Where They Are

A recurring theme is that PVC is never one-size-fits-all. How it’s implemented depends entirely on where a child sits on the Social Communication Bridge® — and Dr. E is careful to make that clear for listeners new to the SMart Center’s work.

The goal is always to encourage a higher stage — to ask a question that would elicit a verbal response. But when a child can’t respond verbally, the answer isn’t to drill or force. It’s to meet them where they are and use transitional strategies to move them forward. A verbal intermediary is one such tool: “Red or blue? Tell Rebecca.” The child doesn’t have to speak to the clinician yet — but they’re on the bridge, moving.

Even CommuniCamp doesn’t require a child to speak to attend. The SMart Center evaluation meets them where they are — and from there, almost 100% of campers progress into speech over the course of the program. The same logic applies in classrooms: calling on the SM child first is the wrong move. Asking others first, having everyone write down their answer before sharing — these are deliberate, stage-appropriate strategies that build participation without building pressure.

Using Choice Questions to Move a Child From Responding to Initiating

The C in PVC stands for Choices — and there is one rule that makes them work: the right answer always comes last. When a child hears “is your favorite season fall or winter?” and the answer is winter, that word is still in the air when they respond. It reduces processing, removes retrieval pressure, and makes a response far more likely.

Choices aren’t just for responding — they’re one of the most powerful tools for building initiation. Most individuals with SM find initiating far harder than responding. Dr. Jenna bridges that gap by writing two possible questions, asking the child to circle which one they want to ask, then supporting them in asking it. They circle season. “What do you want to ask me?” They repeat: season. That’s initiation — scripted, supported, and real.

Dr. E takes it further with the write-and-read approach. For a verbally responsive child who isn’t yet initiating, she writes a question and asks the child to write it too. Then: just read it back to me. And they do — verbally initiative, in under three seconds. Teachers can use this in class, parents can use it with relatives, and it works during board games too. It isn’t spontaneous conversation yet, but it’s a step — and steps are how progress happens.

Key Takeaways from Episode 73

  • PVC stands for Preparing, Visuals, and Choice questions — an anxiety-lowering framework that works at every stage of social communication
  • Anxiety and processing sit on opposite ends of a seesaw — PVC rebalances them by reducing what the brain has to do in the moment
  • Anticipation anxiety is often worse than the event itself — preparation lowers that number before they walk in
  • Silent goals let parents set up the world quietly for resistant children — without making preparation feel like pressure
  • Seeing a visual is more powerful than talking through it — eight out of ten times, what didn’t work is because nothing was written down
  • Children should create their own visuals whenever possible — ownership builds engagement
  • The right answer always comes last in a choice question — that’s what makes it work
  • The write-and-read approach can make a verbally responsive child initiative in seconds

Final Thoughts

PVC isn’t a magic bullet — and Dr. E and Dr. Jenna are the first to say so. It’s one framework within a much larger approach, and how it’s used depends on the individual: their whys, their stage, their setting, and who they’re with. But when preparation, visuals, and choices work together, something shifts. The brain has less to do, anxiety drops, and communication follows — one step at a time.

Related Resources: PVC – Prepare, Visuals, Choices