Core Clinical Issues in
Advanced Clinical Permanency
Training for Massachusetts DCF
Worcester, MA
March 3, 2011
 Every clinician is in post
adoption practice
– Ann Hartman
Language in the Context of
 Members of the Adoption Constellation
- Birth Parent/Family – Mothers and
Fathers extended family, grandparents
- Adopted Person
- Adoptive Parent/Family
An Overview of Some Adoption
 Careful matching to avoid “detection”
 Child’s status hidden as were parent’s
infertility issues
 Birth mother excluded from knowing
where her child was placed – encouraged
to “get on with her life”
 Needs of birth fathers rarely addressed
An Overview of Some Adoption
 Adopted parents received very little information
about the child or his/her history
 Help the family “claim” the child as their own
 Adoption workers had to find the “right” family
 Many workers used their “own values” to guide
this process
An Overview of Some Adoption
 Deserving Adoptive Parents were married
couples, infertility issues, financially
stable, usually white
 Foster parents, single parents, non
married couples, relatives not deemed
 Secrecy was key to success
An Overview of Some Adoption
 Worker is “expert;”
 Birth family is “dangerous or deviant;”
 Adoptive family is “appropriate;”
 Child is best served as if they were born
into the family
Historical Shifts
Myths that Continue
 Paradigm shift from secrecy to openness
 Adoption is the same as being in a birth
 Triad members need to be protected
 Everyone should move on
 Win/Win/Win situation
 Genetic information is not relevant
Adoptive Families and Social
 What happens after finalization?
 Is permanency a panacea?
 Most commonly cited identified need
by professionals and parents was for
qualified, adoption sensitive mental
health professionals
Adoptive Families and Social
Services sought in one Illinois study were:
Individual counseling for the child (68%)
Family counseling (35%)
Individual Counseling for the parent(s) (31%)
Parent support groups (15%)
Support groups for children (10%)
26% of children were hospitalized
10% had formal placement outside of home
Families Report that Helping
 View family as pathological, sometimes
questioning parent’s motivation in adoption;
 Imply that the parent is blaming the child for
family problems when the parent raises the
need to discuss adoption as part of the
 Lack of awareness of cross racially, older
children and those adopted in sibling groups;
Families Report that Helping
 Advise parents to avoid talking about adoption
as it will only “stir things up;”
 Address child behavior problems through
behavioral methods without exploring how
these behaviors may be connected to past
deprivation, trauma or adoption;
 Urge hospitalization without understanding the
underlying effects of separation for children
affected by adoption;
Families Report that Helping
 Failed to understand the child welfare
 Suggest that the parents “just got a
bad one” and urge families to return the
child to the state.
Shawn’s Family
Adoptive parents (Pete and Mary Simmons, ages 37 & 39
years, married ten years) became foster parents of
Shawn when he was twelve years-old, he is now 15
years old. Shawn was born to a young teen-aged
mother who left him with her own mother, who cared for
him for eight years and then upon her death, he was
placed in the foster care system. Timothy was neglected
by grandmother who also abused drugs. Many reports
of neglect were filed with the parish. At the time of his
first placement, Timothy was described by the foster
parents as depressed, sad, and anxious – unable to
tolerate being hugged. Birth mother voluntarily
relinquished her parental rights, and the rights of birth
father (who had not been involved in Shawn’s life) were
terminated. The first foster parents were unwilling to
adopt Shawn, once he had been freed up for adoption.
The Simmons family was identified as a good match for
Timothy – they were interested in adopting a teen, Mr.
Simmon’s knew Shawn from the high school where he
taught Science and they had a good relationship.
Shawn’s Family con’t
 The Simmon’s are concerned about the recent behavioral
difficulties shown by Shawn – initially he seemed to be so happy in
his new home, now he is challenging their authority, coming in late,
and possibly experimenting with alcohol and other substances.
They are particularly concerned about his recent refusal to go to
 Adoptive Parents’ Brief Report of Recent History:
The Simmon’s describe the adoption of Timothy as a “gift” since
they had struggled with fertility issues for ten years before
becoming his foster parents. Mr. Simmon felt that since he knew
Shawn before he came to live with them that Shawn would respond
well to their family. They felt that since his life had been so hard,
that they would not lay down too many rules for him.
 Onset of Problems with Shawn:
The problems began when Shawn felt junior high and entered high
 Therapeutic Intervention:
Shawn’s Family con’t
 Therapeutic Intervention:
Shawn was referred by a high school
guidance counselor to a therapist in the
community. The therapist had a
psychoanalytical orientation, never asked
to see the parents separately or with
Shawn, and never asked about Shawn’s
birth family. Shawn was referred to
weekly drug testing, after school help,
and after three weeks of sessions
refused to go to therapy.
Family Expectations:
 What was the family’s initial experience
of adoption?
 What were the parent’s dreams?
 When did the dreams begin to
 How, specifically, did the reality differ
from the dream?
 What were the consequences of adopting
this child?
Family Expectations:
 How did Shawn behave in his adoptive
 How did Shawn’s parents originally
interpret this behavior?
 How did the first professional react?
 How did the parents explain Shawn’s
 What help was offered?
Context of Adoption in Therapy
When adoption comes into play
 Presenting problem
 Not presenting problem but primary
 Additional layer of complexity to an
Pitfalls for Therapists
 All or nothing
 Therapist’s counter-transference
 The best solution is to disrupt the
 Adoption work is short-term
Family-Systems Approach
 Collaborative
 Non-pathological model
 Doesn’t foster secret/collusive
relationships- in the spirit of full and
open disclosure
 Includes all constellation members: birth
and adoptive parents and adopted persons
 Includes the family system in the process
Behavioral Issues and Underlying
Emotional Issues:
 Attachment, Separation, & Grief
 Identity Issues and the Need to Search
 Depression
Core Issues of Adoption
 Adoption is Different Than Birth
 Adoption is a Life Long Process
 The Effects of Loss
Core Issues of Adoption
 The Effects of Previous Maltreatment on
Family Functioning
 Issues in Attachment
 Identity Issues
 Mastery and Control Issues
Core Issues of Adoption
Adoption is Different Than Birth
 Challenges to family functioning and child
well-being – time, biology, history
 “Real” parents verses adoptive parents
 Parents need to be seen as allies in the
therapeutic process
Core Issues of Adoption
Adoption is a Life Long Process
 A process is not a one time event, the
adoption itself is a one time event, the
effects of living with adoption are life
 Adolescence, marriage, child rearing,
separation are huge markers
Core Issues of Adoption
The Effects of Loss
 Central to adoption process
 Adoption is not possible without loss
 Adopted person has loss – genetic
identity, loss of relationships with
emotionally significant objects
 Adopted family has loss – infertility; loss
of continuity with biological lineage;
 Birth parents have loss – surrender of
child; loss of information about the child
Core Issues of Adoption
The Effects of Loss
 Loss is healed through grief
 Grief is revisited over time
 Developmental tasks trigger loss –
adolescence, marriage, college, childbirth
 Some behavior in adopted persons viewed
as pathological may actually be
maladaptive grieving – i.e., concepts of
Core Issues of Adoption
The Effects of Previous Maltreatment
on Family Functioning
 Maltreatment, trauma, prenatal exposure
to substances, deprivation, lack of
stimulation; nutritional deprivation; and
many others
 PTSD trauma
 Sexual abuse
 Physical abuse
Core Issues of Adoption
The Effects of Previous Maltreatment on
Family Functioning
“This is my dilemma. When I think of the
abuses heaped on my child by her birth
parents, and all the struggles she had as a
result, it is hard for me not to hate them for
the harm they caused. On the other hand, if
they hadn’t hurt her, she wouldn’t have been
taken away, and she wouldn’t be my daughter.
And if it weren’t for them, she wouldn’t look
the way she does, have many of the talents
that she does. It’s complicated.” – Adopted Mom
Core Issues of Adoption
Issues in Attachment
 Cycle of need and response
 Infant basic needs/keep caretaker close
 FAS – attachment challenges
 Trust, intimacy, caretaker dependability
Core Issues of Adoption
Issues in Attachment
 Dependency needs may be greater than
parent’s ability – black hole – sieve
 Attachment is on a continuum
 Attachment is a two way street
 Ability to attach complicated by physical
or temperamental differences
Core Issues of Adoption
Issues in Attachment
Adoptive parents with
attachment issues may believe
that such a mismatch would
never have occurred with a child
born to them.
Core Issues of Adoption
Identity Issues
 Both adopted parents and adopted persons
must incorporate “being adopted” into
their sense of self.
 Who am I?
 Where do I come from?
 How does this impact on my life?
 Openness is key
 Be comfortable with ambiguity
Core Issues of Adoption
Mastery and Control Issues
 Basic need for competence and personal
power in one’s life
 Control over one’s life; control over
creating family; control over one’s child by
 Control battles are common in adoptive
families as each party seeks to gain
control over their lives and situations
Core Issues of Adoption
Adopted Person
Fear ultimate
abandonment; loss
biological, genetic,
cultural, history.
Issues of holding
on and letting go
Adoptive Parent
Infertility equated
with loss of self &
Issues of
entitlement lead to
fear of loss of
child and
Core Issues of Adoption
Birth Parent
Ruminate about lost child. Initial
loss merges with other life
events; leads to social isolation;
changes in body and self-image;
relationship losses
Core Issues of Adoption
Adopted Person
placement of
adoption as
rejection; issues of
self-esteem; can
only be chosen if
first rejected.
rejection; misperceive situations.
Adoptive Parent
Ostracized because
of procreation
difficulties; may
scapegoat partner;
expect rejection;
may expel adopted
person to avoid
Core Issues of Adoption
Birth Parent
Reject selves as irresponsible,
unworthy because they allowed
adoption; turn these feelings
against self as deserving rejection;
come to expect and causes
Core Issues of Adoption
Adopted Person
Deserving of
shame of being
different; may
take defensive
Adoptive Parent
Shame of
infertility; may
childlessness is
curse or
religious crisis.
Core Issues of Adoption
Birth Parent
Party to guilty secret;
shame/guilt for placing child;
judged by others; double bind;
not OK to keep child and not
OK to place them either.
Core Issues of Adoption
Adopted Person
Grief may be
overlooked in
childhood; blocked
by adult leading to
depression or
acting out; may
grieve lack of fit
in adoptive family.
Adoptive Parent
Must grieve loss of
fantasy child;
unresolved grief
may block
attachment to
adopted person;
may experience
adopted person’s
grief as rejection.
Core Issues of Adoption
Birth Parent
Grief is acceptable only for a
short period but may be
delayed 10-15 years; lack
rituals for mourning; sense of
shame blocks grief work.
Core Issues of Adoption
Adopted Person
Deficits in identity
may impede
integration of
identity; may see
search for identity
in early
extreme behaviors
in order to create
sense of belonging.
Adoptive Parent
continuity of self;
they are not “real”
Adopted Person Issues
More identities to process
Over identifying more with one family
Fantasizing, distracted in school, angry
Feeling marginalized
Lack of identity markers
Complicates independence phase
Core Issues of Adoption
Birth Parent
Child is part of identity and goes on
without birth parent’s knowledge;
diminished sense of self and selfworth; may interfere with future
paternal desires.
Core Issues of Adoption
Adopted Person
Fear getting close
and risk re
enacting earlier
losses; concerns
over possible
incest; bonding
issues may lower
capacity for
Adoptive Parent
Unresolved grief
over losses may
lead to intimacy or
marital problems;
may avoid
closeness with
adopted person to
avoid loss.
Core Issues of Adoption
Birth Parent
Difficulties resolving issues with
other birth parent may
interfere with future
relationships; intimacy may
equate with other losses.
Core Issues of Adoption
Adopted Person
Adoption alters life
course’ not party
to initial decisions;
haphazard nature
of adoption
removes cause and
effect continuum.
“Control Freak”
 “Victim”
 “Being Stuck”
Adoptive Parent
experiences lead to
helplessness; sense
of mastery
connected to
Super Parent Issues
Core Issues of Adoption
Birth Parent
Relinquishment seen as out of
control; interrupts drive for
self actualization.
Divided Loyalties
Adopted Person Issues
 He/she does not feel free to talk
about birthparents
 May want to connect with birthparents
 All adopted persons search
 Search and reunion and separate
Parent Issues
 Create loyalty issues by denying
significance of birth parent
Entitlement & Gratitude
Adopted Parent Issue
 Infertility issues
 Can’t assume they know their child
 Have to prove they are worthy or
“perfect” parents
 Existence of birthparents
 Plays out in discipline, boundaries or
lack thereof
 Depression
Entitlement & Gratitude
Child Issues
 May not feel he/she may show
negative traits or behavior
 May feel compelled to try to be
“perfect” & full of gratitude
Behavioral Issues and Underlying
Emotional Issues:
 Attachment, Separation, & Grief
 Identity Issues and the Need to Search
 Depression
We Never Thought it Would be Like
This! Problems Identified by Families
Behavior problems of child
Emotional problems of child
Child-Parent relationship
Child’s relationship w/ peers
Financial problems
Child care problems
Emotional problems – parent
Job problems
Marital problems
Unresolved infertility
We Never Thought it Would be Like
This! Problems Identified by Families
Common Themes
 Limited Emotional Range – anger/sorrow
 Marital Tensions
 Sibling Issues
We Never Thought it Would be Like
This! Problems Identified by Families
Common Themes
 Isolation
 Exhaustion and Hopelessness
 Running on Empty
Strategies for Adoptive Parents By
Developmental Stage
Infancy (0-3)
 Talk comfortably about adoption from the time
the child arrives
 Start the adoption story from --when you were
born, your birth Mom . . . . Not when we
adopted you . . .
 Model correct adoption language
 Gather as much info about the child’s history
when the trail is fresh
Strategies for Adoptive Parents By
Developmental Stage
Pre School (3-7)
 Encourage questions and answer concretely and simply.
 Listen for cues about misperceptions when the child is
playing or talking with peers.
 Don’t assume that telling the adoption story every once
in a while is adequate. Tell the story positively, but
 Reassure the child that they will not lose their adoptive
Strategies for Adoptive Parents By
Developmental Stage
School Age (8-12)
 When children are not talking about adoption don’t
assume they aren’t thinking about it.
 Learn to be alert for anniversary reactions – trigger
times – mother’s day, birthdays, holidays, loss.
 Let children know that they can love two sets of
 Don’t force discussions, look for opportunities, i.e., on
a drive in the car, anniversaries
Strategies for Adoptive Parents By
Developmental Stage
Early Adolescence (12-15)
 Allow the child to exercise control whenever possible.
 Be firm in limit setting.
 Try to keep from responding to the child’s anger with
more anger.
 Establish clear consequences for broken rules.
 Maintain a sense of humor.
Strategies for Adoptive Parents By
Developmental Stage
Late Adolescence (15 - 20)
 Make it clear that the child may remain home for a
time following graduation, i.e. attend college nearby.
 Be alert for overreactions when relationships with peers
 Talk openly about dating, intimacy, relationships.
 Be aware that leaving home, even for college can feel
like abandonment all over again.
Therapeutic Techniques
Parent education - Bibliotherapy
Narrative work
Parenting that fosters attachment
Play therapy
The Adoption story
Letter Writing by parent/ by child or
 Journaling
Techniques continued
Kid’s Group Parent’s Group
Mentoring for kids and parents
Guided Fantasy
Search (inside and outside)
Facilitated Reunions

Session Two Core Clinical Issues in Adoption Power Point