Three weeks ago, I did an intake with a mom who I'll call Amy. She wanted to talk about her son, who we’ll call Miles, whose behavior at home had become increasingly hard to manage. He was defiant and oppositional. He argued for the sake of arguing and picked fights that didn't need to be fights at all. Minor slights and small inconveniences set off huge, explosive reactions.
Amy told me Miles had been a temperamental baby and an active, stubborn toddler, so in some ways none of this was new. But things had really gone downhill over the past three years. She first noticed a real problem when he started kindergarten. She received weekly calls from the teacher who reported that Miles was disruptive in class, and she got wind that a few parents of Miles’s classmates were encouraging their kids to stay away from him on the playground. Now he was in third grade, and it was all really getting out of hand.
As I do in most intakes, I asked Amy what she had already tried, and what had and hadn't worked.
Everything, she said. She'd read the books, listened to the podcasts, and followed every parenting Instagram account that anyone recommended to her. Along the way, she'd attempted gentle parenting, French parenting, jellyfish parenting, conscious parenting, and probably a few more I've never heard of. None of it worked.
I must admit that my gut reaction was ungenerous. I judged her pretty harshly. She had been dealing with this for at least three years and was only now looking for professional support? We could have addressed this ages ago with real, expert-provided care and maybe nipped it in the bud. Instead she had tried to handle it on her own, armed with advice from influencers and quacks, while the problem grew and metastasized.
So I told her about Parent Management Training, an evidence-based therapeutic approach that I thought could really help. PMT teaches parents concrete skills, like how to give clear commands, how to praise the behaviors you want to see more of, and how to use tools like planned ignoring and time-outs, all with the goal of reducing children’s disruptive behavior. I gave her the contact information for a few clinicians I know and trust who offer it, and I told her to call me back if she had any trouble getting an appointment.
The recommendation seemed so obvious that I was honestly shocked no one had made it before. Then she told me someone had.
In fact, she had tried several times over the years to get into PMT. Her pediatrician had suggested it. So had a friend of hers who's an occupational therapist. She even called two of the clinicians on the list I'd just given her. The problem was usually money: insanely high session fees combined with out-of-network mental health coverage that was basically nonexistent. And on the rare occasions when the fees were manageable, the waitlist was months, sometimes years, long.
No wonder she turned to Instagram.
I left the intake feeling pretty humbled. Amy had done exactly what we tell parents to do. She asked her pediatrician, she listened to people she trusted, and she made the calls. Every time, she hit a wall.
Our mental health system is broken. If you're super rich, you can get good care on a reasonable timeline. Everyone else ends up on a waitlist that never seems to move.
Those of us in the field feel frustrated about parents getting their information from dubious sources online. But we are operating in a system where care is inaccessible to most families, and then we act surprised when they go looking for help wherever they can find it. A parent watching their kid struggle is not going to sit quietly for two years waiting for a call back. They're going to pick up their phone and start scrolling. What other choice do they really have?
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