Working with adopted people

In a society where adoption is seen as a problem-solving event filled with joy, adoption-related losses are difficult to both mourn and express. Grief is disenfranchised in a myriad of ways and often conducted in secret. Professional services have also mirrored this silence and secrecy. There is a lack of training about the impact of adoption in university curriculums and in professional development (Post, 2000; Zomostny, O’Brien, Lee, & Baden 2003; Porch, 2007). Furthermore, there is a dearth of clinical literature documenting models of appropriate intervention using case studies. Primarily, the literature discussing adoption intervention has come from psychoanalytical thought, anecdotal accounts or is characterised, apart from a few exceptions, by poorly designed research.

This article provides a brief overview of the primary practice issues for clinicians to consider when working with clients who have been adopted¹. For a more detailed discussion please refer to the work of Conrick (2014) and Green (2014). It is important to appreciate that the impact of adoption ripples throughout families and generations, and there are many other individuals affected by adoption, namely mothers, fathers, spouses and adoptive parents, as well as intergenerational effects on subsequent children and members of the broader extended family. It has been estimated that in Australia well over 1 in 15 people are affected by adoption (Winkler, Brown, van Keppel, & Blanchard, 1988).

The overview presented in this article has relevance not only to domestic adoptions but also when working with inter-country adoptees and those conceived through a range of alternative reproductive technology procedures, such as donor conception. Publications examining current research and practice issues in these areas are available from the Evan Donaldson Adoption Institute (http://adoptioninstitute.org/publications/) and the Australian Journal of Adoption (www.nla.gov.au/openpublish/index.php/aja).

Practice considerations when working with adoptees

Practitioner self awareness

Adoption is an emotionally laden topic and surrounded by many myths such as ‘adoptees can’t grieve for someone they have never known’ or ‘only adoptees who are unhappy with their adoption will search for their parents and relatives’. It is essential for clinicians to be aware of how their own attitudes and values about adoption may affect their assumptions, the questions they ask and their responses when an adoptee presents for therapy.

Understand the seven core issues in adoption

Seven issues have been identified that logically evolve out of the nature of adoption and are commonly confronted by adoptees over the life course. These are: loss (both primary and secondary losses); rejection; guilt and shame; grief; identity; intimacy; and mastery and control (Silverstein & Kaplan, 1988).

Recognise adoptees are not a homogenous group

Although most adoptees will have to deal in some way with the issues (such as the seven identified above) at different points of their lives, variability exists among the cohort in terms of their personal adjustment and their adoption experiences. Some individuals engage in a great deal of intense feeling and thinking about their adoption as an organising theme which consumes considerable emotional energy, whilst others devote relatively little thought to their adoption. Thus the perceived salience of adoption to the individual’s life falls along a continuum (Penny, Borders & Protnoy, 2007). As adoption has a lifelong impact, the meaning of adoption for any one individual will also differ over the life course (Brodzinsky, Smith & Brodzinsky, 1998) and will be influenced by the way they were parented, other specific psychosocial variables (Passmore, 2007) and their adoption narratives (Dunbar & Grotevant, 2004).

Use a range of adoption support options

Bibliotherapy.There is a range of books written by adoptees, some of whom have had an adoption experience and are trained therapists. Bibliotherapy can be a useful adjunct to conventional therapy. It is advisable that clinicians become acquainted with terminology that is specific to adoption, read the research and analyse how the underpinning theory fits with their applied practice models.

Support groups. Professionally and sensitively run support groups provide a useful means of reducing isolation and can help validate the thoughts and feelings of adoptees. Groups can also link people to other services for search and counselling.

Post-adoption services. In each State and Territory there are post-adoption services that provide general information about adoption, as well as information about the eligibility and processes for accessing adoption records. These services can also provide advice and support about embarking on search and contact, and in some cases provide individual counselling for a range of adoption-related matters.

Issues to consider in providing therapeutic services

Presenting concerns

Adoptees may or may not identify adoption-related issues when they present with mental health concerns. Adoption-related matters are often relational, and issues of trust and safety need to be sensitively managed throughout the therapeutic process.

Adoption-related matters may include:

• Hurt from secrecy, inaccurate information or untruths surrounding their adoption and a subsequent sense of betrayal. This is particularly pertinent when adoptees discover their adoptive status later in life.
• Feelings of isolation, loneliness, abandonment and low self-worth stemming from a sense of not belonging or fitting within their family
• Feeling obligated to show gratitude throughout their lives and significant loyalty conflicts with their adoptive family, particularly when discussing the personal impact of adoption and when search and contact is considered
• Identity challenges or compromised sense of self – ‘Who am I and where do I fit?’
• Difficulties in relationships with others.

Characteristics of adoptees may include:

• Learned patterns of interaction that fall along a continuum of over-compliance and over-achievement to rebellion and isolation
• Different attachment styles related to their experiences prior to adoption, for example, a dislike of being held, or an adoptive parent’s difficulty in meeting the child’s needs due to either a poor fit between the child’s needs and the parent’s own attachment/parenting style or a lack of knowledge by parents about the needs of an adopted child
• Varying experiences in their adoptive home of opportunities to ‘make sense’ of their adoption story as well as access to support and validation from others.

Triggers or precipitating factors

Precipitating factors are varied and may appear unrelated to adoption, such as life stage issues, relationship challenges, another loss or trauma, overwhelming emotional pain, and/or psychiatric presentation. They may also be directly adoption related including complex challenges associated with search for or contact with relatives.

Engagement and assessment

Engagement is an essential stage when beginning work with an adopted person. It is a time when the therapeutic relationship will be tested to determine the level of trust and containment that a clinician can provide.

Below are possible predisposing factors related to adoption. These factors are intended as prompts and clinicians need to ask questions sensitively and at the individual’s pace to uncover this history. This is not an exhaustive list of possibilities and the range of perpetuating and protective factors are not included here.

Case conceptualisation and intervention

The following practice recommendations are provided.

• Do not over-emphasise and see every difficulty as a result of adoption, nor under-emphasise and miss critical connections between adoption experiences and presenting difficulties where these do exist (Passmore, 2007)
• Recognise and acknowledge adoption matters as having a lifelong impact and address these directly, empathetically and consistently within the context of the adoptee’s experience and salience of the impact of adoption
• Acknowledge and validate the losses felt by the adoptee
• Normalise experiences, emotions, thoughts and behaviours as logically evolving out of the context of adoption rather than being atypical
• Understand, respect and sensitively use the adoptee’s defence systems to progress growth in relation to the false self, use of splitting within the self, ambivalence and/or exaggeration and attack and altered affect
• Work with the adult attachment style of the adoptee and his or her patterns of intimacy and distance
• Consider the use of narrative, cognitive/schema, attachment and trauma-based therapies and approaches.

Acknowledgement

Thanks to Jenny Conrick, Counselling Co-ordinator at VANISH, for her professional expertise and assistance with the preparation of this article.

Please contact [email protected] for the provision of book lists, training events and assistance with searching, counselling and support groups.

The author can be contacted at [email protected]