CORE CLINICAL ISSUES IN

ADOPTION

Presented by

Joan Normandy-Dolberg, LPC, NCC

Family Counseling of Springfield 703-569-1300 [email protected]

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 in which identifying information is exchanged. Many of the adoptions they arrange also are

mediated open

adoptions, in which ongoing information is exchanged through the agency.

adoptions,

The Adoption Triad

Adoptee Adoptive Family Birth Family

Seven Core Adoption Issues

REJECTION MASTERY/ CONTROL LOSS INTIMACY GUILT/ SHAME GRIEF IDENTITY

ADOPTED PERSON

•Birth Family •Biological, genetic & cultural history •Belonging •Security

LOSS

BIRTH PARENT

•Child •Social isolation •Body & self image •Tentative future relationships

ADOPTIVE PARENT

•“Dream” child •Immortality •Self •Entitlement

ADOPTED PERSON

•Not keepable •Self esteem issues •Fear of abandonment •Fear of exclusion

REJECTION

BIRTH PARENT

•Society’s condemnation •Afraid the child will hate them •Feels “not worthy” •Expects rejection

ADOPTIVE PARENT

•Not in the “club” •Scapegoats partner •Fear of “selection” process •Potential rejection by or of the child

GUILT & SHAME

BIRTH PARENT ADOPTED PERSON ADOPTIVE 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

BIRTH PARENT ADOPTED PERSON

     Somatic issues No permission to grieve Depression Acting out Lack of “fit”     Pushed to “move on” Denies the experience Blocked by shame Anger displacement

ADOPTIVE PARENT

    Adoption of fantasy child not a fix Blocks attachment Impacts parenting Culture & race differences

ADOPTED PERSON

    Am I “real”?

Minimal history impacts self worth “Borrowed” sense of belonging Intensifies in teen years

IDENTITY

BIRTH PARENT ADOPTIVE PARENT

   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

BIRTH PARENT ADOPTED PERSON

   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

ADOPTIVE PARENT

   Relationship difficulties Child’s distance triggers fear Missed early opportunities

MASTERY & CONTROL

BIRTH PARENT ADOPTED PERSON ADOPTIVE 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

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



Girl Scouts

Eco-Map

Mike Amy Patty Colin Sue School

Adoptive Parents

Time Line

Adopted Children

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 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

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