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  1. CORE CLINICALISSUES INADOPTION Presented by Joan Normandy-Dolberg, LPC, NCC Family Counseling of Springfield 703-569-1300

  2. Acknowledgements • The Center for Adoption Support and Education (CASE) joined with the Rural Adoptive Family Initiative (RAFI) to offer two 48 hour intensive training programs to 20 therapists who were interested in learning more about the full spectrum of adoption related issues. • The training utilized the Adoption Clinical Training (ACT), developed by Sharon Roszia, MS and Deborah Silverstein, L.C.S.W., leaders in the field of adoption and affiliated with the Kinship Center in California. Over 3,500 clinicians had been previously trained in ACT. • Debbie Riley, Executive Director of the Center for Adoption Support and Education (C.A.S.E.) and Sharon Roszia, MS, led formal lectures, small group discussions and experiential activities. • We continue to meet to staff cases and update our education. • Participants received over 48 continuing education credits, as well as a certification of completion of the training. • Grant #90-CO-0994 to the Virginia Dept of Social Services from the U.S. Dept of Health and Human Services

  3. ADOPTION STATISTICS • More than 135,000 adoptions take place annually. • In the US more than 13,000 adoptions involve babies who are voluntarily relinquished. • Of non-stepparent adoptions, approximately • 59 percent are from the child welfare system, • 26 percent are international, and • 15 percent are voluntarily relinquished domestic infant adoptions. • About half of all infant adoptions are carried out by independent practitioners, who facilitate birthparents' placing their children directly with potential adoptive parents. • Service fees for infant adoptions typically range from $20,000 to $35,000. • The vast majority of adoption agencies, as well as independent practitioners, offer open adoptions, in which identifying information is exchanged. Many of the adoptions they arrange also are mediated adoptions, in which ongoing information is exchanged through the agency.

  4. The Adoption Triad Adoptee Adoptive Family Birth Family


  6. Child • Social isolation • Body & self image • Tentative future relationships LOSS ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Birth Family • Biological, genetic & cultural history • Belonging • Security • “Dream” child • Immortality • Self • Entitlement

  7. REJECTION ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Society’s condemnation • Afraid the child will hate them • Feels “not worthy” • Expects rejection • Not in the “club” • Scapegoats partner • Fear of “selection” process • Potential rejection by or of the child • Not keepable • Self esteem issues • Fear of • abandonment • Fear of exclusion

  8. GUILT & SHAME ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Tainted • A mistake • Different • Defensive/ • angry • Body is faulty • Social view that adoption is 2nd choice • Am I really the parent? • Am I causing the child’s problems? • Party to a secret • How much to share? • Who do I tell? • Fears judgment • Double-bind

  9. GRIEFADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Somatic issues • No permission to grieve • Depression • Acting out • Lack of “fit” • Pushed to “move on” • Denies the experience • Blocked by shame • Anger displacement • Adoption of fantasy child not a fix • Blocks attachment • Impacts parenting • Culture & race differences

  10. IDENTITYADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Am I “real”? • Minimal history impacts self worth • “Borrowed” sense of belonging • Intensifies in teen years • Am I “real”? • Diminished sense of self • Not sure if and how they fit into their child’s life • Am I “real”? • Impacts ability to pass on heritage & legacy • Intergenerational struggle & confusion

  11. INTIMACYADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Fear of getting close • Concerns about incest • Missed being nuzzled & adored in their sweet baby bodies • Intimacy = loss • At risk for multiple relationships • Impacts relationship with other children • Relationship difficulties • Child’s distance triggers fear • Missed early opportunities

  12. MASTERY & CONTROLADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT • Not part of the decision • Being in charge holds loss at bay • Win/lose issues loom large • “Driven” behaviors • Eating & substance abuse issues • “Re-dos” to gain control • No control over their own body • Adoption process makes individual feel even more helpless • Entitlement issues

  13. Recent Research • According to a study quoted in the May 05, 2008 issue of Time magazine, adopted adolescents are at greater risk for behavior or emotional problems • Clinicians from the University of Minnesota interviewed (in person) nearly 700 adopted children and 540 non-adopted children, all ages 11 to 21. Participants had to have a non-adopted sibling within the same age range to help compare behaviors. • This study found that about 14 percent of adopted adolescents are diagnosed with a behavioral disorder or have contact with a mental health professional. The rate for non-adopted teens is about half that. • The study shows that this discrepancy could be due to genetic issues or prenatal care, rather than the fact that adoptive parents are more proactive than the general population about recognizing the signs/symptoms, having their children tested, and seeking care psychiatric care for them. • The study also concluded that children adopted domestically (U.S.) are more likely to have behavioral disorders than those adopted internationally. Children of intercountry adoption are far more likely to internalize their problems (depression and separation anxiety disorders are common), whereas children adopted domestically tend to act out. • Source:Kathleen Kingsbury, “Adoptees More Likely to be Troubled,” TIME magazine, 5/5/08

  14. COMMON PRESENTING ISSUES • Lack of understanding/anger • Parenting struggles • Lack of “goodness of fit” • Low self esteem & identity issues • Feelings of loss of control • Grief due to loss • Inability to develop & maintain intimate relationships

  15. WHERE TO BEGIN • Establish rapport • Assess mastery & understanding of adoption experience • Assess attachment issues • Normalize feelings & behavior • Provide psycho-education for all members of the family • Increase self esteem through various activities


  17. SELF ESTEEM • Cornerstone of mental health • Professionals must recognize constellation members’ vulnerabilities • Parents must be empowered and taught how to build their child’s self esteem

  18. FOSTERING SELF ESTEEM • Provide opportunities to try new things • Allow chances to feel “in charge” • Balance expectation & ability • Allow for mistakes • Validate feeling & thoughts • Model appropriate behavior & attachment • Use filial therapy

  19. Genogram Symbols


  21. …are graphical representations that show all of the systems at play in a client’s life. Eco-maps are used as a way of demonstrating Systems Theory so that both the counselor and the client can refer to it during a session. At the center of the eco-map is the client (this can either be a family or individual). Family connections and connections to all of the relevant systems that are at play in the clients life are represented by lines Thicker (darker) lines mean stronger relationship Crossed or red lines mean that the system is a stressful relationship; dashed lines indicate an uncertain relationship Arrows pointing to the client mean that the system primarily influences the client Arrows pointing to the system mean that the client primarily influences the system Arrows pointing both direction depicts a two direction flow of influence ECOMAPS

  22. Relationship Symbols • A stressful, conflict-laden relationship ++++++ • A tenuous, uncertain relationship - - - - - - - - - • A positive relationship or resource _________ • The direction of the giving & receiving exchange or a relationship or resource 

  23. Eco-Map Community Resources Schools, Doctors, Therapists Employment/ Volunteer Positions School Mike Amy Patty Sue Colin Support Networks Friends, Church Community Activities Girl Scouts

  24. Time Line Adoptive Parents 4/96 5/97 2/95 5/98 1/94 2/97 12/92 2/88 2/90 6/85 Married Parents Separated Family Assessment process First child born Miscarriage Parents reunited Initial Meeting between adoptive parents and both children Moved to California Children’s adoption finalized Children’s foster care placement Adopted Children 2/97 5/97 10/94 2/95 3/95 3/92 1/96 9/96 5/98 6/96 8/96 Anna born Michael born Reunited with birth mother Moved to new foster family Removed from parents & placed with emergency foster family Moved to new foster family Removed from birth mother & placed in emergency foster family Children separated, placed in new foster family


  26. LIFE BOOKS BOXES • Tangible & truthful • Compilation of events • Reality based • Non-verbal access to feelings • Incorporates child’s view of events • Container for mementos and photos • “Road trips” & internet searches might be needed to fill them in • Drawings and representations are included

  27. Birth family and history Reasons for placement Foster care and adoption history Feelings Explanation of past events The future LIFE BOOK ELEMENTS

  28. Non-confrontive Private & gentle Validating Helps children make sense of their adoption Normalizes fear and confusion Helps parents understand their children’s feelings BIBLIOTHERAPY

  29. When Love Is Not Enough: A Guide to Parenting Children with RAD by Nancy L. Thomas Twenty Things Adopted Kids Wish Their Adoptive Parents Knew by Sherrie Eldridge Raising Adopted Children, Revised Edition: Practical Reassuring Advice for Every Adoptive Parent by Lois Ruskai Melina This is Me - Memories to Gather and Keep by Susan L. Pierce Parenting the Hurt Child : Helping Adoptive Families Heal and Grow by Gregory Keck, Regina M. Kupecky Attaching in Adoption: Practical Tools for Today's Parents by Deborah D. Gray Adopting the Older Child by Claudia L. Jewett Help for the Hopeless Child: A Guide for Families by Ronald S. Federici Toddler Adoption: The Weaver's Craft by Mary Hopkins-Best The Waiting Child: How the Faith and Love of One Orphan Saved the Life of Another by Cindy Champnella Our Own: Adopting and Parenting the Older Child By Trish Maskew Adopting the Hurt Child: Hope for Families With Special-Needs Kids : A Guide for Parents and Professionals By Gregory C. Keck, Regina M. Kupecky Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice by Vivien Prior, Danya Glaser Parenting With Love and Logic (Updated and Expanded Edition) by Foster W. Cline, Jim Fay Taking the Stress Out of Raising Great Kids by Jim Fay, Charles Fay, Foster Cline Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children by Daniel A. Hughes Facilitating Developmental Attachment: The Road to Emotional Recovery and Behavioral Change in Foster and Adopted Children by Daniel A. Hughes Parenting Books

  30. National Adoption Information Clearinghouse TEL (888) 251-0075 FAX (703) 385-3206 RESOURCES