CORE CLINICAL ISSUES

IN

ADOPTIONPresented by

Joan Normandy-Dolberg, LPC, NCCFamily Counseling of Springfield

703-569-1300jdolberg@cox.net

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

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.

The Adoption Triad

Adoptee

Adoptive Family Birth Family

Seven Core Adoption Issues

LOSSLOSS

REJECTION

GUILT/ SHAME

GRIEF

IDENTITY

INTIMACY

MASTERY/ CONTROL

LOSSADOPTED BIRTH PARENT ADOPTIVE

PERSON PARENT

•Birth Family

•Biological, genetic & cultural history

•Belonging

•Security

•Child

•Social isolation

•Body & self image

•Tentative future relationships

•“Dream” child

•Immortality

•Self

•Entitlement

REJECTIONADOPTED BIRTH PARENT ADOPTIVE

PERSON PARENT

•Not keepable

•Self esteem issues

•Fear of abandonment

•Fear of exclusion

•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

GUILT & SHAMEADOPTED BIRTH PARENT ADOPTIVE

PERSON PARENT

•Tainted

•A mistake

•Different

•Defensive/ angry

•Party to a secret

•How much to share?

•Who do I tell?

•Fears judgment

•Double-bind

•Body is faulty

•Social view that adoption is 2nd choice

•Am I really the parent?

•Am I causing the child’s problems?

GRIEF ADOPTED 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

IDENTITY ADOPTED 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

INTIMACY ADOPTED 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

MASTERY & CONTROL ADOPTED 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

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

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

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

PRACTICE INTERVENTIONS &HEALING OPPORTUNITIES

Self Esteem Eco-Maps Time Lines

Life Books Genograms Bibliotherapy

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

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

Genogram Symbols

COMPLETED GENOGRAM

ECOMAPS …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

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

Relationship Symbols

Eco-Map

School

Girl Scouts

Sue

AmyMike

Patty Colin

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TIME LINE

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

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

BIBLIOTHERAPY

Non-confrontive Private & gentle Validating Helps children make sense of their

adoption Normalizes fear and confusion Helps parents understand their

children’s feelings

Parenting Books 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 Parentby 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 ChildBy Trish Maskew

Adopting the Hurt Child: Hope for Families With Special-Needs Kids : A Guide for Parents and ProfessionalsBy 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 Kidsby 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

RESOURCES www.genopro.com/genogram http://www.adoptionsupport.org/ http://www.barkerfoundation.org/ National Adoption Information Clearinghouse http://naic.acf.hhs.gov

TEL (888) 251-0075 FAX (703) 385-3206 http://www.adopting.org/adoptions/post-adoption-resources-2.html http://www.childrensdisabilities.info/attachment-links.html www.ldonline.org http://www.familyhelper.net/ad/adnlu.html http://www.adoptivefamilies.com/loismelina http://www.adoptioninstitute.org/index.php