OT, PCIT, Play Therapy + Seeing a Psychologist

Welcome back!

This is the 2nd of 3 episodes breaking down the vast array of parenting resources we have at our fingertips. Today we’re talking: Occupational Therapy, Parent Child Interaction Therapy, Child Therapy (play therapy) and seeing a Psychologist.

For each, I break down the family that resource is BEST for, the benefits it provides, the unique Pros and Cons of utilizing that support vs. another, and ultimately for some, the way they fall short.

IN THIS EPISODE I SHARED:

• When play therapy would most benefit your child
• Why PCIT is less likely to work with strong-willed kids
• The criteria often necessary in order to get a referral to a psychologist

DON'T MISS:

• A study on childhood anxiety and what treatment style was most effective - the answer may surprise you!

// MENTIONED IN THE EPISODE //

2019 Yale Study on Combating Childhood Anxiety

// CONNECT WITH DANIELLE //
Website: parentingwholeheartedly.com
IG: @‌parent_wholeheartedly
APPLY: parentingwholeheartedly.com/apply

Transcript

Danielle Bettmann  0:04  
Ever feel like you suck at this job? Motherhood, I mean. Have too much anxiety and not enough patience? Too much yelling, not enough play? There's no manual, no village, no guarantees. The stakes are high. We want so badly to get it right, but this is survival mode. We're just trying to make it to bedtime. So if you're full of mom guilt, your temper scares you, you feel like you're screwing everything up, and you're afraid to admit any of those things out loud - this podcast is for you. This is Failing Motherhood. I'm Danielle Bettmann, and each week we'll chat with a mom ready to be real, showing her insecurities, her fears, her failures, and her wins. We do not have it all figured out. That's not the goal. The goal is to remind you you are the mom your kids need. They need what you have. You are good enough, and you're not alone. I hope you pop in earbuds, somehow sneak away, and get ready to hear some hope from the trenches. You belong here, friend, we're so glad you're here. 

Danielle Bettmann  1:14  
Hey, it's Danielle. Your Positive Discipline Certified Parenting Coach for strong-willed kids ages two to 10, I help defeated parents find validation, support, and proven techniques to parent their strong-willed kids with composure, connection, confidence, and cooperation through a four-month group coaching program based on the Wholehearted framework I've developed over years of working with families one on one, and if you've just found the podcast, go to failingmotherhood.com to view a playlist of our most listened to episodes, as well as where to start if you have a strong-willed child.

Danielle Bettmann  1:45  
If you are just finding the podcast now, it is episode 196 and we are making it to 200 to celebrate our five-year anniversary of the podcast, and then we are wrapping up. So I hope that you hang on for the next few episodes. I hope if you've been here for a while, you show your support and your gratitude for all of our guests and all of the amazing vulnerability and conversations we have had by leaving a five-star rating and or review if you haven't yet inside Spotify or Apple podcast. Thank you so much for doing that, if you already have. 

Danielle Bettmann  2:24  
Now this is part two of a three-part series. As a parent in 2025, you have more resources than ever before, and it's incredible that we can connect over states and oceans and have access to the latest research at our fingertips, let alone AI-generated summaries of answers to our questions at a moment's notice. However, as we know, with most good things, too much of a good thing can be a bad thing. So how do you sort through it all, and when you know you need help, where do you start? Last week, we talked about parenting content, parenting courses and books, and local in-person parenting classes. Today, we are going to talk about occupational therapy, PCIT, and child therapy, and then next week in episode three, the third in this series, we will be talking about personal therapy and marriage counseling, one-off coaching, or one-on-one coaching, as well as virtual parenting classes and memberships. So for each resource, we are breaking down the time the place, and the family that that resource is best for, and then we are comparing and contrasting the unique pros and cons of utilizing that support versus another. So let's dive into our first resource for today.

Danielle Bettmann  3:54  
Okay, occupational therapy is defined as occupational therapy interventions that use everyday life activities, which are occupations to promote health, well-being, and your ability to participate in the important activities in your life. They are skilled healthcare professionals who use research and scientific evidence to ensure their interventions are effective, and it typically includes an evaluation, an intervention plan, and an outcomes evaluation. OT is best for people of all ages needing support with a life transition, on the back of a new diagnosis, or when recovering from an injury or illness, it really primarily works on the patient's goals and their ability to function within their daily life and have the skills to be more independent and successful with what they need and want to do to be in that season of life, primarily pediatric OT is best for when kids are struggling with sensory needs and challenges, when they need specific support for extreme picky eating when they need strategic work to improve on their fine and large motor skills, and when they have been experiencing developmental delays, services are primarily for the child, but depending on the practitioner, there can be some supplemental parenting support or homework offered as well. Depending on your plan, you may be able to use insurance for their services. I believe that OT is a fantastic resource, and I've known many, many, many clients and friends and friends of the podcast that have utilized OT in one way, shape, or form for their child's development. And I think it is a fantastic supplement and a fantastic tool. And truly, probably no child would not benefit from going through it for whatever their specific, individualized needs are. And there are parents who realize that they need more than OT, or they need to pair their OT with more services on top of it. So I'm always going to break it down for parents that end up utilizing it and then find where it comes up short. Here are some of the things that they might experience or realize. 

Danielle Bettmann  6:45  
OT is typically a local provider, so that means that you need to work within their accessibility in your area, as well as their availability for the time constraints of commuting to and making the scheduling of the appointments that can be, and again, another challenge logistically for families that have more than one kid or have busy work schedules or really limited availability for evenings and weekends, OT is typically one slice of the pie. It will give you similar tools and insight that nicely complement other programs that are lined philosophy-wise, and there are needed tools that every kid needs, like boosting their emotional literacy, their ability to name their own emotions, their ability to skill build, and finding more coping mechanisms. And there are a handful of clients that I have worked with who are themselves, occupational therapists that have ended up investing in my program and working with me because, again, they realized they needed more. So, emotional literacy and emotion regulation, are the first step. And this work is very multi-faceted. I believe there are always reasons why they are struggling. Are we asking the deeper questions sometimes, and are we actually solving it at the root and not just playing Whack a Mole with what it looks like day to day on the surface of just trying to get back to an acceptable level of functioning? So things like, why are they so angry? Do we know? Why are we finding out and making sure that they are not misunderstood? Still? Can we prevent the situation entirely and not just live within it, helping them to feel and express their emotions? Yes, both things can be true. I believe, that if they are a strong-willed child and their temperament is causing a shame spiral, then only the parent can really remedy and prevent and work around and work with that predisposition and that shame spiral. So that is going to continue to either be a feeling of self-sabotage that continues to come up as you work through OT, or it becomes a limiting factor for some of the outcomes. I believe if the parents approach the rest of the time that the child is not at OT doesn't change fundamentally as a result of those interventions, then the outcomes that they do experience through that work are going to be short-lived. But again, big fan of OT, it has a huge place and time, especially when it comes to emotion regulation and functioning for kiddos who really, really can benefit from that work. 

Danielle Bettmann  10:09  
Moving on to PCIT, which is parent-child interaction therapy. It is defined by pcit.org as an evidence-based treatment for young children with behavioral problems, it is conducted by a therapist through coaching sessions during which you and your child are in a playroom while the therapist is in an observation room watching you interact with your child through a one-way mirror and or a live video feed. You wear a bug-in-the-ear device through which the therapist provides at the moment, coaching on skills you are learning to manage your child's behavior. There are typically two treatment phases. 

Danielle Bettmann  10:50  
The first phase establishes warmth in your relationship with your child through learning and applying skills proven to help children feel calmer, more secure in the relationship with their parent, and good about themselves. The second phase of treatment will equip you to manage the most challenging of your child's behaviors while remaining confident, calm, and consistent in your approach to discipline. In this phase, you will learn proven strategies to help your child accept your limits, comply with your directions, respect house rules, and demonstrate appropriate behavior in public with consistent attention, consistent attendance, and homework completion. PCIT can be completed within 12 to 20 sessions, though. Treatment is not time-limited. Treatment is considered complete when you have become proficient in both sets of skills and rate your child's behavior within normal limits on a behavior rating scale. Sounds great, right? PCIT, I believe is best for families that would benefit tremendously from doing work on their attachment relationship, first and foremost, with the structured support of a practitioner, so the families that I think of being most in that position would be families that have adopted or families that are undergoing foster care. I also really think that when kids are struggling, both at home and at school, and they are considering something even more physically intervention phase, like enrolling them in a behavioral day program, then PCIT can be a great tool and resource to be able to mitigate or prevent that and keep them in their environment that you know they might be struggling in, and be able to give the provider tools to empower both the school and, you know, the parents at home. Another great aspect of PCIT is that depending on your insurance plan, you would be able to use insurance for this provider as well.

Danielle Bettmann  13:04  
So families that have ended up needing more than PCIT will find ways that it may end up falling short for their family and their goals and their child. So again, being a local provider, accessibility and availability, and the time commitment and commute to the appointments are going to be an investment in your time, as well as just a logistical challenge in scheduling and making that work for your family. Those 12 to 20 sessions can be very spread out where maybe the first phase is about three months, and the second phase can be four to six months. So it will it will be a time investment for sure. I have worked with several quotes, PCIT dropouts, as in, their family had gone through PCIT, and they never met the criteria to graduate from one intervention phase to the next, or they just kind of stalled out, stayed stuck and weren't able to get to that finish line. So because it is a very clinical approach, then it is constantly evaluated, which is fine, but it's also very regimented, so the finish line is the same for every family, and that becomes challenging when you are essentially hitting a wall and you just keep doing more of the same, hoping for a different result, and it's months down the road, and you're just not seeing the progress that you came for, and are not sure where else to go from there. And those are the families that I have ended up coming across that have really benefited from kind of a much more comprehensive, multi-faceted approach of looking at things from all angles, and that they weren't able to do through this type of a process. Now, I will also say I have worked with families who have gone on to enroll in PCIT on the back end of our work together about like, six to nine months later, and they really benefited from it. However, when I met with them, because I have been in close contact with this family for several years now, they were able to reflect and say the reason why they benefited so much from PCIT at the time that they did it was because of the work that we did together beforehand, laying a stronger foundation, so that when they were going through that first phase of working on the relationship, they already had a lot of behavior modification tools to rely on throughout that time, and then they had already paired with the things that they had learned from me, so they were just able to, like accelerate what they had seen as the progress already, whereas what she described is it feels like almost impossible expectations of the parent to with no foundation, jump into the PCIT approach and work on the connection, first for several months, while all of the challenging behaviors still remain and expecting the parent to really just hold their patience and be a lot warmer and kinder, while still really having no idea or any support with what to do when getting kicked, punched, bit, you know, all of the things that are still happening throughout this time. 

Danielle Bettmann  16:53  
And in my opinion, knowing what I know about, you know, strong-willed kids and how we end up talking about how toxic some of like the emotions back and forth can be when they're really struggling. I relate that a little bit to like going to marriage counseling or marriage therapy and them telling you the wife, you need to have more kinder interactions with your spouse. You need to be having sex with them more often. You need to really nurture your relationship so that you can then start to address the problems three, or four months down the road. And yeah, sure, that would improve things. But is your mental health in a state where you can do that, or even want to do that in the state you're in when you come to marriage counseling? I mean, you really are being told and coached on how to mirror them and how to praise them and play, and then you'll still go home and they will still hulk out on you, and you'll get hit and kicked and punched. And you know, that's not part of the program yet, so you have to wait for those tools. So I think that that's a major way that it falls flat for some families who are not going to be able to progress in the order that they want you to or be able to meet the criteria and the amount of time frame that you want you to or they just want to be able to have a lot more tools, more sooner than later. And you know, it's really regimented, so you have to kind of go through that clinical prerequisite first. 

Danielle Bettmann  18:34  
The second kind of beef that I have with PCIT is that it is fundamentally built on, and you can go back to the way that they defined it. It's built on the goal of obedience, accepting your no, and using healthy time out as a tool to ignore negative behavior, they say, and this is on the website, when used correctly, time out teaches children to obey more often and more quickly. Time Out works because a child has nothing to interest him or her, and time out teaches children that even when they misbehave, parents will treat them respectfully and consistently. So yes, on that last one, it is better than much worse alternatives, I do agree with that, as opposed to wildly unpredictable, you know, reactions, very volatile, emotional reactions, getting physical reactions. Yes, I fully agree a healthy time out is a step up from, you know, any amount of those types of situations. And if you know anything about a strong-willed child or a neurodivergent child, time out simply doesn't have the same outcomes. You cannot make the same assumptions and go through the same process. It simply does not work that same way. It's not how that works. And not only do I, you know, philosophy-wise, have a problem with obedience, where I could go off on a soap box about obedience versus cooperation and wanting to work with kids in a way that you can compromise and negotiate, to problem solve and teach them critical thinking skills along the way. Time out just doesn't work fundamentally with strong-willed kids. They aren't driven by that external motivation of, oh, I'm bored, I'll connect the dots, I'll do differently later, I'll avoid that next time. They are acting that way for a deeper reason, and they will continue to act out because they feel justified and necessary by their internal motivation of being misunderstood or not getting their needs met of attention and control, and even if with good intentions if you're trying to send one message, it's not the message they receive. So they don't just start obeying more often and more quickly with timeouts. So while that way may work great for some kids, in my experience, it doesn't work well at all for others, and you as the parent are going to feel very defeated and frustrated with yourself if you're not able to get things to work in the way that they're supposed to and do for other kids and families. 

Danielle Bettmann  21:40  
So last one we'll get into is finding a child therapist and or psychologist, and I'll talk to you about the difference between those as well. So big fan of therapy, there's clearly a time and a place when your child seeing a therapist and you seeing a therapist are absolutely valuable and recommended. I'm going to talk about you seeing a therapist in the last episode of this series. So for this, I'm primarily talking about your child seeing a therapist that is best when they have shown symptoms of developmental regression, like they have not been, you know, wetting themselves throughout the night at all. They've been dry, and then now they're having a ton of accidents in the middle of the night again. Or, you know, there's something that they were talking and, you know, walking, and then all of a sudden, you're seeing a huge regression, and they're no longer able to do what they used to be able to do, or even a very jarring change in their personality, where they become extremely withdrawn all of a sudden, or, you know, really animatedly, like a class clown out of nowhere. And it's just they're not themselves, and you don't know what's up.

Danielle Bettmann  23:04  
In addition to that, other reasons would be an extreme change in signs of anxiety depression, or withdrawal. Therapy is fantastic after a big T trauma like grief and loss, a house fire, experiencing prolonged illness and a parent or sibling abuse of any kind, possibly a divorce between their parents, any type of, you know, reconciliation in relationships within the family. All of those are great reasons for your child to be able to see their own therapist. 

Danielle Bettmann  23:48  
When they would need to see a psychologist would be if you're following up on a referral from another specialist, so you might be having a conversation with their pediatrician first about some of your concerns within their behavior, and then they share an agreement that those concerns warrant a further evaluation and or a diagnosis. Typically, that would mean that the concerns and the behaviors that you are observing have been observed by adults in two or more environments for more than six months. So that ensures that it's not a phase and it's not just at home or just at school. You're able to both agree that you see the same types of things and they're causing the same types of problems and functioning across environments, and when you do that's a great time and place for you to follow up on those concerns from school or other medical staff and get a referral to a psychologist, and that psychologist will be able to have much more resources and tools to connect you with, to be able to see if your child meets a certain criteria, if their behaviors and symptoms are at a treatable level, and you're then able to dive into even more resources, like peer support groups, medication, you know, things like that down the road. 

Danielle Bettmann  25:23  
So that is the time and place when you know therapy and seeing a psychologist would be highly recommended and extremely beneficial. Now, there are still some ways that they fall short for parents who end up meeting more. Unfortunately, post-pandemic, in 2025 there are typically, depending on, of course, where you live, many month-long wait lists to be seen by a mental health professional. And while you are waiting, you continue to lose your mind at home. I just talked to a client this last week who is looking to find a local professional for their daughter because they are starting to go through a divorce. She describes the process as next to impossible, and I have been going through a process of getting both of my daughters or, you know, one of them specifically, through a diagnostic process. When I originally reached out with those concerns, and we were able to make an appointment with a psychologist, it was about five or six months out for a wait, and they still said that that was good, that was a good amount of time to wait so it can get much worse, it sounds like. So that can be a huge uphill battle. Doesn't mean that you don't go down this road, but that you keep that in mind and may need, you know, supplemental resources and another plan for the in-between times of waiting to be able to access said resources and support. 

Danielle Bettmann  27:07  
Now, typically, these types of practitioners are going to be the experts on medication, dosages, changes, different medications and things, and they may make suggestions that you are not comfortable with or ready for or agree with, but hopefully, you as the parent, have a very loud voice in this matter, and you can advocate for them, and they will work with what you are ready for or avail comfortable with offering. In the meantime, they also may or may not see, quote, unquote, or see some of the problems that you see. And so a lot of my clients will really struggle because other adults in other environments describe their child as a quote, unquote Angel. And while you know that's great that they don't have a problem in Pre K right now, that can be really challenging, and you feel a little bit crazy because then your child won't be eligible and be able to meet, you know, treatable criteria for things if other adults aren't able to confirm the same types of struggles that you experience with your child. So if they are a quote angel for other adults, then they're not going to essentially see what you see. And sometimes that might be just a waiting game where you know, a couple of years later, you know, the elementary school is definitely going to start seeing the same things you are, but in the meantime, you're just kind of left high and dry, I guess, like waiting, I guess, until it gets worse. And a lot of parents aren't ready to settle for that. They know that they're struggling enough that it is detrimental to not only their sanity and mental health but also these really, really critical core relationship-building years and they want more help in the meantime. 

Danielle Bettmann  29:08  
And two more things, most mental health practitioners, psychologists, and child therapists, absolutely fundamentally agree the most impactful influence on a child, especially under eight, is their parent. They also agree that a parent's mental health, a parent support system, and a parent's tool kit of approaches and reactions are huge, huge, huge catalysts in their child's success outcomes and functioning. Some mental health practitioners will walk away from child therapy because they're not able to make any progress without a parent's involvement or without them signing on and being able to really understand the interventions and own them at home. And so they want to help the child, but they really can't, because their hands are tied, because the parent is still, you know, the primary one driving the boat and the ship at home. And that can be really frustrating for mental health practitioners. 

Danielle Bettmann  30:19  
They'll also agree, that diagnosing typically a child under the age of five is challenging. Some practitioners won't be comfortable with it at all, because the lines are blurred between what is developmentally appropriate for that age and what is an exception to that rule, especially if it's simply aggression or, you know, struggles with impulse control and emotion regulation. So if you're looking for the diagnosis, sometimes you still have to play the waiting game. In the same vein, therapy that is one-on-one with a child that hasn't had that external reason of that big T trauma to see their own therapist, typically, a practitioner will agree that it's more beneficial for the child's parents to be the ones getting that support, rather than that child themselves if they are under the age of five.

Danielle Bettmann  31:16  
In 2019 there were studies done that were able to prove that counseling parents through a group, coaching-type support group atmosphere was as effective in treating childhood anxiety as cognitive behavioral therapy for the child. This particular study was done with middle school-age kids, but they essentially had two groups, one where the kids went to therapy, and the other where just the parents were coached on how to support their child from home differently, and the outcomes both the parents surpassed the outcomes of the kids that were in therapy, and to me, that just completely doubles down and affirms why I do what I do, which is work with parents because they are the primary influencers and the biggest catalyst for change. It changed outcomes from home, and sometimes they really do need other resources and practitioners and support to be able to know what to do differently at home. But the biggest change is seen when the parent changes at home, which leads us to what I do and how it's a little bit different. So at the end of every one of these episodes, I'm going to compare and contrast what I offer through my program, Wholeheartedly Calm, and the pros and cons as well, when compared to things like OT, PCIT, child therapy, and working with a psychologist. 

Danielle Bettmann  32:58  
So I work with families who are experiencing a lot of the same symptoms at home that you would go see those professionals for, your child experiencing high highs and low lows, emotionally struggling to self-regulate, needing more coping mechanisms for big emotions, experiencing a lack of impulse control, overall defiance, acting out, aggression, overall lack of cooperation, and most importantly, you would report that your experience of parenting is overall skewing more negative than positive. Of course, you love your kid and you have great moments, but the bad outweighs the good right now, and you are feeling exhausted, defeated, starting to be resentful, starting to disengage, and starting to lose hope. That is the biggest reason why I know that what we would do together would be the game changer that would make the biggest difference in the behaviors that you're seeing with your child because again, every five-year-old struggles with those things. But what's going to make the difference at your house? I work with families that know that they have those things going on at home, and they really want to transform their relationship with their child for years to come, not waiting years and years and years for it to get worse before getting any help. They want to take down the meltdowns at their house from typically 10 a week to two. They want to strengthen their confidence, and their family's resilience in their marriage along the way, my program just a little bit more about it, and I'll go into more of the benefits. It's a time commitment of about an average of 30 minutes a week that you devote to audio modules. There are two to three opportunities a week to join in on Live Recorded Q and A Zoom calls. It includes an extensive, 125-page color workbook filled with cheat sheets, printable scripts, and other visual sources. It includes access to unlimited written support via the Q and A resource library community feature within the app. You get access to my proven framework of 12 modules that go through a process of elimination to get down to the root of the need for control and attention that your strong-willed child desperately is using their behavior to communicate they need and help you get proactive and preventative and one step to five steps ahead of them, so that you can eliminate those reasons why those behaviors are there, while changing the way you communicate and strengthening your capacity for your patience and resolve, while solidifying your mindset, the most underrated part of parenting in the process. 

Danielle Bettmann  35:53  
Now, the biggest con to this is that it's also a time commitment and an investment financially, and you are not able to use insurance to be able to commit to this program. However, there is no waitlist. You apply, schedule a call, and then enroll with immediate access and begin jumping into bonuses calls and Week One right away and live calls depending on your schedule. There's no commute to speak of because it is right on your phone or on your work computer. There is no direct child involvement. So if you don't want your child to feel like they are labeled or have a stigma or be able to feel any more self-conscious, then you do not have to involve them in the process at all. It is you that is changing, and they change as a result. There's no pressure to medicate or label until absolutely necessary or recommended or you feel comfortable down the road, we work on stress management first and mindset helping to deactivate your triggers and have a much healthier understanding of your child's behavior so that you feel safer to be able to be with them and enjoy being with them and have more patience for their behaviors so you can show up and work on your relationship with warmth while working on those problem behaviors every step of the way, so that you really build confidence and momentum every single day, day after day, week after week, you, as the parent, are in control of progress. You know exactly what it looks like whether or not you're on track, you have recognition of your wins keeping you going on this marathon. You're able to grade yourself by a self-assessment and not rely on your child's behavior as your report card. You're able to customize and adapt the journey at any time by accessing the needed bonuses and asking your most pertinent questions each coaching call no questions, a bad question if it affects your ability to parent and it affects your child's well-being, it is on the table for you to be able to have someone hold your hand and walk you through the nuance of the troubleshooting and tweaking that you need. It's designed to maximize your time and effort through digestible, repeatable, micro modules. It includes only critical game changers, not a whole lot of baggage and backstory and philosophy. It is offered to you in back-to-back weeks that create momentum and accountability, making it much more likely that you complete it, and you can ride on the curtails of others, momentum and hope on the hard days or weeks to come. It teaches you specific strategies for your exact goals struggles and strong-willed child in front of you. It also equips your partner alongside you the whole way, which is so rare and so critical. It crowdsources invaluable insight, validation, and support from a tight-knit small group that is as committed as you are to learning this language in this immersive process alongside you. It provides unlimited individualized solutions and a community like no other. And the combination of this committed, safe environment, the fostering of relationships with like-minded people who get it, and the vulnerability that they bring forth are absolutely transformational. It's simply the last resource you'll need for your parenting. 

Danielle Bettmann  39:37  
So if you are curious that is what you need right now. Then start first by watching the Master Class with your partner. Calm and Confident master the kind and firm approach your strong-willed child needs without crushing their spirit or walking on eggshells at parentingwholeheartedly.com. Then apply to learn more. 

Danielle Bettmann  39:57  
I'll see you next week as we chat through the last three in our series, which are individual therapy and marriage counseling, one-off, one-on-one coaching, and virtual parenting classes and memberships. See you there. 

Danielle Bettmann  40:16  
Thank you so much for tuning in to this episode of Failing Motherhood. Your kids are so lucky to have you. If you loved this episode, take a screenshot right now share it in your Instagram stories, and tag me. If you love the podcast, be sure that you've subscribed and leave a review so we can help more moms know they are not alone. If they feel like they're failing motherhood on a daily basis, and if you're ready to transform your relationship with your strong-willed child and invest in the support you need to make it happen, schedule your free consultation using the link in the show notes. I can't wait to meet you. Thanks for coming on this journey with me. I believe in you and I'm cheering you on.