Working With Adoptive Parents — Missteps and Guidelines
By Deborah H. Siegel, PhD, LICSW, DCSW, ACSW
Social Work Today
Vol. 17 No. 6 P. 24

A clinician specializing in adoption issues discusses common challenges facing adoptive parents and how competent clinicians can tackle them.

Most adoptive families thrive, are resilient, and successfully raise their children to productive adulthood. Some, as is true too of families formed by birth, encounter the need for professional help managing predictable as well as unanticipated crises along the way. Reaching out for clinical social work services during stressful times is a protective factor, a sign of health, and a coping skill. Since adoption is a lifelong journey, not an event, many adoptive families seek clinical care at stressful times.

Unique Challenges in Adoptive Families
Studies show that adoptees, whether adopted from within the United States at birth, after involvement in the public child welfare system, or from abroad, are disproportionately represented in clinical populations (Tan & Marn, 2013). Many reasons for this have been proposed.

For instance, many adoptees come from original families who have histories of toxic stress, prenatal or postnatal trauma, learning disabilities, substance use, and behavioral health challenges. The parents who gave birth to them, the original parents, may have terminated their parental rights, voluntarily or involuntarily, due to these factors, which also affected the child born to them. The science of epigenesis indicates that the birth parents' pre- or postnatal stress can trigger parental genes that then appear in that parent's offspring. Since most original parents who free a child for adoption do so because of difficult circumstances in their lives, epigenesis may be a factor affecting the child born to them.

Adoptees may be disproportionately found in clinical samples simply because adoptive parents have been desensitized to asking for help, as many become parents after undergoing invasive infertility treatments and preadoption home studies assessing their readiness to parent and teaching them that adoptive parenting is different from parenting a child born to them, and that it may be wise to seek adoption-informed professional help as their child grows.

Effective preadoption education teaches prospective adoptive parents that they will need to manage psychological and practical issues that parents by birth do not encounter. For example, maintaining the child's connections with both the birth family and previous foster families is now recognized as serving the child's best interests. Thus, adoption should build the child's kinship network, not sever it.

It is also now understood that in the age of internet search engines and social networking via electronic media, young adoptees have ample opportunities outside the home to make electronic, and other, contact with their original families with or without their adoptive parents' knowledge and participation. For this and other reasons, it is wise for the child's adoptive and original parents to form cooperative, collaborative relationships with each other before the adoption occurs, and to keep the door to those connections open while cultivating a respectful, caring relationship with each other as they clarify their evolving needs and establish boundaries. Doing this can require self-awareness and interpersonal skills that adoption-competent practitioners can help adoptive and birth families cultivate.

Adoptive parents may need ongoing postadoption support as they manage their child's adoption feelings because, whether or not the child knows or has contact with the original family of birth, even very young adoptees have feelings and thoughts about adoption. While not all adoptees express these feelings and thoughts overtly, adoptive parents need to know how to address them in ways that are helpful to their child and not driven by the parents' vulnerabilities and fears.

Finding Adoption Competent Clinical Care
Sadly, studies show that most masters-level clinicians, be they social workers, psychologists, counselors, marriage and family counselors, or other providers, have had minimal if any specialized training in how to work effectively with adoptive families as they navigate the complex web of relationships and issues that adoption entails (Brodzinsky, 2013).

As a result, most adoptive parents who seek clinical services postadoption report that their clinicians were not well informed about adoption issues (Smith, 2014). In addition, many adoptive parents express keen dissatisfaction with the kind of postadoption services they receive.

In an effort to bolster education efforts, the Center for Adoption Support and Education has developed TAC (Training for Adoption Competency), an evidence-based training program for masters-degreed clinicians. While hundreds of professionals in several states have been trained as of 2016, a majority of mental health providers, including social workers, have not had similar preparation for understanding adoptive families and intervening effectively with them. Hence, clinical mistakes are not uncommon.

Common Clinical Missteps
A clinician may believe that since adoption brings unique issues to families, adoption underpins the issues the adoptive family presents in treatment. However, the only thing that all adoptive families have in common is that they have added a child to the family by adoption. Beyond that, no two adoptive families are alike.

A related clinical error is to assume that adopted people are likely to be troubled. This belief grows out of the stereotype of "the bad seed." There is a longstanding cultural bias that original parents who free their children for adoption, either voluntarily or involuntarily, are especially flawed.

Some clinicians assume that the original parents' biopsychosocial profiles predispose adopted children to challenges with academic success, peer relationships, emotional self-regulation, and impulsivity. These clinicians then have a harder time taking the strengths perspective that best serves the adoptee and both the adoptive and original parents, unwittingly conveying to the family pejorative views and assumptions about adoption.

It is tempting to focus on diagnosis and problems rather than on the family's resourcefulness, persistence, resilience, and the wide array of other positive attributes clients possess. For example, when the clinician asks the client, "Why did your natural mother give you away?" the clinician's choice of language suggests that adoptive parents are unnatural and that original parents give away what they do not want; preferable language would be, "What led your original/first/birth mother to make an adoption plan for you?"

On the other hand, and paradoxically, another mistake clinicians make is to minimize the importance that adoption plays in the family. The clinician may overlook the subtle, compelling issues that the adoption experience generates, such as loss, grief, shame, identity uncertainty, anger, and loss of control over one's fate. These issues manifest differently in the adopted person, adoptive parents, and extended family of birth and adoptive kin.

Adoption produces a complex network of genetic and legal family relationships, even among people who do not know one another. This has always been the case, from the days when secrecy characterized adoption, to today when open adoption is the norm and the internet and social media have opened a panoply of unsupervised contacts between even young adopted children and original kin by birth.

Clinicians, similarly, may fail to recognize or address the roles of adoption law and agency policy in shaping the family's clinical issues. They may not recognize the crucial roles that race, class, and ethnicity play in many adoptive families, particularly when children are adopted across national boundaries or into families of a different culture, race, or class.

Not understanding the now well-established importance of maintaining the child's connections to the original family, well-intentioned but inadequately informed clinicians may seek to empower adoptive parents by encouraging them to cut the child's original family members out of the child's life, inadvertently alienating and emotionally isolating the child they wish to protect. It is wiser, instead, to establish workable boundaries.

Due to insurance company billing policies or practitioner beliefs and bias, clinicians may focus on the child, who is the identified patient, not on the adoptive family as a whole or on the intricate network of genetic and adoptive kin. A family systems perspective in work with adoptive parents generally is more clinically useful.

Another clinical misstep is to assume that a child's misbehavior is due to the adoptive parent's lack of parenting skills; hence, the clinician focuses treatment on behavior management methods or on family members' allegedly distorted, faulty cognitions, missing the key roles that attachment and trauma may play in the family's dynamics. The clinician may believe that if the parent behaved differently with the child, the child's behavior would improve. Or the clinician may believe that if the parent saw the child differently, the parent would be in less distress.

These assumptions may come across to adoptive parents as subtle forms of parent blaming, leaving the parents feeling misunderstood, judged, and isolated. In short, cognitive behavioral therapy, an evidence-based approach for many clinical issues, may be unhelpfully applied in situations when a trauma-informed attachment perspective is more helpful.

An Attachment Focus
Every parent's attachment issues intersect with the child's, and this is certainly true in adoption. Hence, it's necessary to assess both the child's and the adoptive parent's attachment history and style, and how these intersect.

An attachment-oriented clinician takes a consistently compassionate, nonblaming stance when addressing the ease of fit between the parent's and child's needs and issues. The clinician's stance is one of a gently curious "coexplorer" or "codiscoverer" who "watches and wonders," seeking to understand the world through both the child's and parent's eyes. The goal is to help both parent and child feel truly seen, heard, and understood in the clinical relationship, thus freeing up the parent's capacity to truly see, hear, and understand the child.

This approach requires keen self-awareness on the clinician's part, as the therapeutic goal is to understand and be empathically present, genuinely affectively attuned with the client, rather than to change the client. The parent who is thus soothed may be better able to explore her or his own insecure or ambivalent attachments, becoming a more consistently and genuinely soothing presence for the child.

Countertransference can interfere with this process. For example, the clinician can feel frustrated when a chronically overwrought parent continues to bear down on a misbehaving child. Identifying primarily with the oppressed child, the clinician continues to coach and correct the parent, dysfunctionally paralleling in the clinical relationship the empathic failures, power and control, and frustrating dynamics in the family.

A Trauma Focus
Adoptive parents, like the children they adopt, have experiences of trauma. Going through failed infertility treatments; the invasive, disempowering preadoption process; and parenting a child who has experienced foster care or prenatal or preadoption abuse can all have traumatizing effects on an adoptive parent. The child's behaviors may traumatize the parent who has no previous traumatic experiences, or evoke the parent's own childhood history of trauma.

These traumas can affect how the adoptive parent perceives and interacts with the child, whose behavior can be relentlessly oppositional, surly, and hostile without apparent provocation; physically dangerous; and seemingly unresponsive to parental warmth, empathy, and affection. The parent then feels victimized by the child, rejected, unwanted, incompetent, hopeless, helpless, dispirited, fearful, anxious, and emotionally exhausted. It is not uncommon for a parent living with these issues to feel chronically overwhelmed, traumatized by the experience of being a parent.

Parents may then feel like hurting or rejecting the child they treasure and love, and withdraw emotionally in order to cope with the child's persistently hard-to-manage behaviors. The child may perceive the parent's nonverbal signs of emotional withdrawal, and the two become unwittingly engaged in a self-perpetuating process of mutual causality that leaves both parent and child feeling frustrated, rejected, and alone.

A trauma-informed clinician attends to the parent's bodily sensations and mental images rather than focusing solely on the parent's self-talk, cognitive distortions, and use of consequences to manage the child's behavior. This clinician understands neuroplasticity, recognizing the roles that safety and corrective emotional experiences in therapy play in creating new neural pathways that enable parent/child attachment. The trauma-informed clinician is better able to respond with nonjudgmental compassion to the adoptive parent's "stuckness" in repeating unhelpful interactions with the child.

Other Useful Therapeutic Guidelines
Effective clinical work with adoptive parents can also help parents modify their expectations of the child. All parents enter parenting with hopes, and when the child's abilities and inclinations do not match parents' dreams, parents need to mourn that loss as they accept the child they have without reservation.

Parents can also be helped to take the long view, recognizing that the child whose behavior is difficult, or the child who overtly rejects the adoptive parent, may over the years come around. Parents can be helped to separate their identities and self-esteem from their child's accomplishments or failures. Learning to pick one's battles as a parent can be very useful. So is learning to tolerate ambiguity and uncertainty. A skilled clinician may be able to help a parent focus on nurturing a warm, compassionate relationship with the child rather than on getting the child to become the person the parent would like the child to be.

Addressing spousal discord can be fruitful, enabling parents to get and stay on the same page as they collaborate on the child's behalf. Connecting adoptive parents of struggling children with one another can be helpful too. As in all of social work practice, advocacy at the mezzo and macro system levels to create, fund, and evaluate needed programs and services is key.

— Deborah H. Siegel, PhD, LICSW, DCSW, ACSW, is a professor in the School of Social Work at Rhode Island College, a clinician specializing in adoption issues, an adoption researcher, and an adoptive parent.

References
Brodzinsky, D. M.; The Donaldson Adoption Institute. (2013, August). A need to know: Enhancing adoption competence among mental health professionals. Retrieved from https://www.adoptioninstitute.org/wp-content/uploads/2017/03/2013_08_ANeedToKnow.pdf.

Smith, S. L.; The Donaldson Adoption Institute. (2014, March). Keeping the promise: The case for adoption support and preservation. Retrieved from https://www.adoptioninstitute.org/wp-content/uploads/2014/05/Keeping-the-Promise-Case-for-ASAP1.pdf.

Tan, T. X., & Marn, T. (2013). Mental health service utilization in children adopted from US foster care, US private agencies and foreign countries: Data from the 2007 National Survey of Adoptive Parents (NSAP). Children and Youth Services Review, 35(7), 1050-1054.