Alphabet Soup

Mrs. K’s narrative is overwhelmingly sad. Her son is underperforming in school. Her son won’t listen to her. Her son is smoking pot. Her son doesn’t come home when he says he will. Her son would rather do anything than do what she tells him to do. Her son’s friends are not to her liking. Mrs. K thinks her son might be selling his medication.

He’s such a bright boy, she goes on. I know he could get good grades if he would only do the work. We have tried everything. We had him tested, we has tutors, we have been to every professional. No one can help us.

Thank you for meeting with me, Dr. Altshuler, Mrs. K. continues. You know I have been to see Dr. A. I have to tell you, Dr. A. was a charlatan, incompetent. So, I made an appointment with Dr. B. Terrible. Dr. B. was no help at all. Then I went to Dr. C. The worst. Dr. C. was even worse that those other quacks.

But I know you can help me. I have heard such wonderful things about you. Everyone in the community says you’re great, Dr. Altshuler. You know all the boarding schools. You have visited hundreds of colleges. You are sensitive and insightful into students with learning differences or therapeutic issues. I’m so glad you have taken time out of your busy schedule to help me and my family.

What am I to make of Mrs. K’s compliments? Should I be enthusiastic about the flattery? Should I be excited about being able to provide a service and fulfill a need that none of my colleagues were able to deliver? Should I feel good about myself, that my reputation in the community is strong, that people think well of my professionalism and competence? Should I be excited that this person will be pleased with my expertise and go on to tell other folks that I do respectable work?

Or should I to the contrary be careful? Because I know Dr. A, Dr. B., and Dr. C. Indeed, I have known all three for decades, ever since graduate school. I know for a fact that they are good at what they do. All three of them—the psychologists and the psychiatrist—and I frequently have clients in common. Should I be aware that six months from now, Mrs. K. will have moved on to the next professional on her list and that she will be trashing me to them? Oh, that Dr. Altshuler, she will start. What a maroon. I thought Dr. A, Dr. B., and Dr. C. were bad, but David Altshuler was the worst of all.

As a young counselor 40 years ago, I was taken in by the blandishments of clients. I like to think I am savvier now. The least of the warning flags from Mrs. K. is that she thinks I have a doctoral degree. I don’t.

I feel nothing but sympathy for the Mrs. K’s of our world. Her journey must have been a disappointing one. That she needs to tell one practitioner after another about her sadness is a shame. But parts of her story don’t ring true.

How did Mrs. K’s son come to be one of the best know–and least competent–purveyors of Ritalin, Concerta, Adderall, and Vyvanse in our community? Is it possible that Mrs. K was more interested in her son’s grades than in her son’s learning? How did Mrs. K’s son come to smoke pot every day before going to high school? Did he internalize the message that it’s okay to ingest substances that change behavior and functioning? How did Mrs. K’s son end up in prison for a drug deal gone bad? Did he model his mother’s behavior that you should be able to get something for nothing?

I don’t pretend to have any great insights into Mrs. K or her son. She only came to see me a few times, followed none of my advice. Under no circumstances was she open to “sending her son away” and my suggestion that she reframe her thinking and consider instead “giving her son the gift of treatment” fell on deaf ears. I got the impression that Mrs. K. preferred complaining to changing.

Of course, I’ll never know. Mrs. K made another appointment, didn’t show up, and did not return my call. Presumably, she moved on to tell the story of her imperfect son to Dr. D., Dr. E., and Dr. F. I wish her all the best. And I feel badly about how her son continued to be such a disappointment to her.

I have tremendous respect for parents who do the work, are willing to change, who make the commitment to help their kids rather than just complain. Whereas I wonder if perhaps Mrs. K. planted a crop that she was not prepared to harvest.