Therapeutic Help for Adoptees and Families

Sometimes adopted children need help adjusting.  New situations and dealing with having been born into one family and now being part of another family can raise questions best addressed with the help of a therapist.

After Adoption

Adopted children as they grow and mature sometimes need help resolving their feelings about not growing up with their birth parents. Adopted children who were adopted when they were older, who were adopted after they experienced abuse or neglect, or who were adopted from another country, may have other feelings and behaviors that sometimes become difficult for families to manage on their own.  Needing outside help after adoption is normal and many adoptive families seek post-adoption assistance.

The following has been adapted from the Child Welfare Information Gateway (HHS) factsheet.  The factsheet introduces the concept of post adoption services and explains that adopted children, as they grow and mature, sometimes need help resolving the sadness they feel about not growing up with their birth parents. Adopted children who were adopted when they were older, who were adopted after they experienced abuse or neglect, or who were adopted from another country may have other feelings and behaviors that sometimes become difficult for families to manage on their own.

Needing outside help after adoption is normal, and many adoptive families seek post adoption assistance. This factsheet will continue where "Stages" left off and discuss in more detail how adoptive families can get help if they need it. An appendix to the factsheet includes listings of (1) national organizations that provide post adoption services (2) national professional associations, (3) Federal Government adoption information sources, (4) current federally funded post adoption services grantees, and (5) sources for further reading.

Families can find help even if they live in a community with few mental health resources. Generally, there are four kinds of post adoption services available:

• Outpatient psychotherapy;

• Treatment away from home;

• Educational services; and

• Support groups.

The following sections discuss each of these services.

Table of Contents

1. Outpatient Psychotherapy

2. Treatment Away From Home

3. Educational Services

4. Support Groups

5. Areas with Few Post adoption Services: What You Can Do

1. Outpatient Psychotherapy

Outpatient psychotherapy is probably the most common form of professional help that a family can use. Therapy can be provided by a psychologist, psychiatrist, or social worker.

Finding a Therapist

It is important to locate a therapist who understands and is sensitive to the unique dynamics of the adoptive family and who will neither minimize nor overreact to the fact that a child has been adopted. If a child has spent time in the foster care system before being adopted, it may be helpful to find a therapist who is familiar with the typical development of a child who has gone through separation, loss, and rejection.

Adoptive families who have worked with therapists emphasize the importance of finding a therapist with adoption experience. Training of therapists usually does not include specific instruction about the unique dynamics of adoption. However, working with a therapist who knows about adoption often can make the therapy more productive.

To find a therapist who has experience with adoption issues, parents can ask for recommendations from other adoptive parents they know, members of local or national adoptive parent support groups, and reputable adoption agencies. Parents also may inquire at mental health associations, universities, hospitals, or medical schools with psychology and psychiatry departments. In addition, the Clearinghouse maintains a data base of information on adoption experts, which is available by geographic location or by therapeutic specialty area.

A word of advice to families looking for a therapist is to "trust your instincts." It is important to feel comfortable with the chosen therapist. A good therapist strives to help family members better understand each other. The therapist also helps parents to become more effective and helps children to accept responsibility for themselves. If the family members do not feel that they are being understood or cannot develop a rapport with the therapist, the family should think about finding another therapist. Not every competent therapist is a good match for every family.

Here are some questions a family might ask to help determine if a prospective therapist will be a good match for the family's needs:

• What are the therapist's credentials (for example, education and training)?

• Does the therapist have experience in treating children with a history (either known or suspected) of sexual and/or physical abuse?

• If the therapist is not a medical doctor, does he or she have an affiliation with someone who can prescribe medication, if necessary?

• Does the therapist have a commitment to a particular "school" or method of treatment?

Therapists generally work either in private practice or for community mental health centers, which serve residents within a specific geographical area. Every community is served by a mental health center, but families should be aware that there may be a waiting list for health center services.

The cost of therapy varies and may be covered in part by health insurance or special needs subsidies. Some therapists, and most community mental health centers, provide services on a sliding fee scale based on income. Families should be sure to ask what the costs are and when payment is expected (after each session, at the end of the month, or after reimbursement by the family's insurer). For more information, please read our factsheet, Tips on Selecting an Adoption Therapist.

Approaches to Therapy

There are as many approaches to therapy as there are practicing therapists. Some therapists prefer to work with the child alone; others see the parents or the whole family. If the therapist is child focused, the therapy may concentrate on the child's particular behavior problems, such as stealing or lying. A competent therapist will recognize that adjustment difficulties for a child often are related to unresolved grief. In addition, the child may be dealing with identity, self-esteem, or peer relationship problems.

Other therapists may want to work with the parents alone. After the long, sometimes arduous process of applying to adopt and waiting for a placement, parents may need help in adjusting to the everyday realities of raising a child. Tensions also may surface in the marriage as a result of the challenges of parenting.

Because adoptive families often confront issues of belonging, loyalty, entitlement, and attachment, many therapists experienced with adoptive families prefer to work with the whole family. These therapists see the family as a system in which each member has an impact on every other member. An example of such a system is a hanging mobile-when one part moves, every other part also moves. Family therapy thus acknowledges that everyone in the family has some responsibility for how the family functions. Such therapy avoids placing blame on a single person. Whether each session includes all family members can be determined by the therapist, in consultation with the family.

Whether concentrating on the individual child, the parents, or the entire family, a therapist might employ several different methods of psychotherapy. Below are descriptions of those most commonly used today.

• Play therapy-Therapists customarily use this form of therapy with very young children, who may not be able to express their feelings and fears verbally. The therapist will engage the child in games using dolls and other toys. Through gentle probing, the therapist will try to draw the child out. In this way, the child may be able to act out feelings and reveal deep-seated emotional trauma.

• Individual psychotherapy. This therapy may take many forms. Often the therapist will work to help the child first express problems verbally and then find ways to manage them. This type of therapy tends to stress that children should assume responsibility for their own actions and ultimately for their emotional well-being. The therapist will offer challenges, interpretations, support, and feedback to the patient.

• Group therapy- Therapists usually favor this therapy for a group of patients with similar problems. This type of therapy allows a small group of patients to discuss problems in an organized way. Group therapy is an efficient use of a skilled therapist's time and offers the extra advantage of feedback from peers. Occasionally family members may be asked to join the group. Group therapy frequently is used with adolescents and usually is the treatment of choice for substance abusers.

• Family therapy- Increasingly popular over the past two decades, family therapy is based on the premise that all psychological problems reflect a dysfunction in the "family system." The term "dysfunction" means that members of a group or system are working together in a way that is harmful to some or all of its members. The therapist requires the active participation of as many family members as possible and focuses on gaining an understanding of the roles and relationships within the family. Family therapy seeks ways to achieve a balance between the needs of the individual and those of the larger family system.

• Behavior modification- A commonly used form of therapy, behavior modification has many practical applications. The basic approach in behavior modification is to use immediate rewards and punishments to replace unacceptable behavior with desirable behavior. The therapist will identify specific changes desired and will establish a system of rewards and punishments. The reasons behind objectionable behavior are seen as irrelevant; the focus is on change. This therapy is especially useful with children who may not be inclined or able to examine and understand their inner feelings. The therapist may suggest that rewards be given to children even for little things such as talking with their adoptive parents or becoming involved in activities instead of withdrawing to their rooms. Most children respond enthusiastically to getting these rewards.

2. Treatment Away From Home

Occasionally problems may escalate to the point that a short stay away from the family home is warranted. In general, there are two options available to families in this situation: a psychiatric hospital or a residential treatment center.

Psychiatric Hospital

Most children's problems do not become serious enough to require psychiatric hospital treatment. But sometimes children with serious emotional problems that cannot be modified through outpatient therapy may need to be hospitalized. Hospitalization may be necessary especially for children who become suicidal or dangerous to themselves or others. In these cases, it is important that parents stay involved; in fact, most child and adolescent units of psychiatric hospitals insist that parents participate in family meetings or therapy. It is essential, of course, to share with the hospital staff that the child has been adopted.

When a child enters the hospital, he or she will be evaluated, and treatment goals will be set. Parents should ask to see their child's treatment plan and ask clear questions about how it will be accomplished.

Residential Treatment Center

Sometimes a child does not need hospitalization but can best be treated with the firm limits and structured environment that a residential treatment center provides. Behavioral therapy often is practiced in such residences; that is, the child's good behavior will bring him or her appropriate rewards and privileges.

Residential treatment usually is provided in community homes where 8 to 12 children live with "house parents." The children usually attend a community school and have regular visits with their parents. Sometimes a campus setting-cottages located in a cluster and run by house parents-is preferable. Children may go to a school run by the residential treatment center or to a school in the community.

No matter what the physical layout of the facilities, when a child is in a residential treatment setting parents need to stay involved. Family connections are critical to a child and help motivate a child's behavior so that he or she can return home.

3. Educational Services

There are many opportunities for adoptive parents who want to learn more about a particular aspect of adoption or who want to keep abreast of the most current adoption information. Below are descriptions of some of these opportunities.

Conferences

Local and national conferences on adoption are held each year. Some target specific groups. For example, Resolve, an infertility support group, holds an annual conference in the Philadelphia, Pennsylvania, area for prospective adoptive families. The North American Council on Adoptable Children (NACAC) sponsors a national conference every August covering many topics. The Clearinghouse publishes-and you may order-the National Adoption Training and Education Directory, which lists all the national and regional adoption conferences that are held each year.

Workshops

Adoption agencies, family service agencies, hospitals, and parent groups often offer evening or weekend workshops on different subjects, including "Living With Adolescents," "Parenting the Sexually Abused Child," or "Adoption and School Issues." Keep your eyes and ears open and you are bound to hear of opportunities to learn more about adoption through workshops in your community.

Books

There are many helpful books on adoption for children and adults. Many of the children's books explain the "whys" of adoption. Some may help children begin to question and discuss their own adoptions as they understand that adoption is one of the many ways that families are created.

A wealth of informative adoption books exists for parents as well. Some of these books help parents look at the unique aspects of adoptive parenting. Others are written specifically for those who have adopted children with special needs or who are parenting children from other cultures. The books and articles listed in the appendix are some of the most widely used sources for this kind of help.

4. Support Groups

Parent groups and children's groups are the two typical kinds of support groups related to adoption that you will find. They operate on the age-old concept that people with common circumstances often can provide the most help to each other.

Adoptive Parent Groups

Adoptive parent groups are a valuable resource. Through such groups the family can find a support system, friendship, and a base for group action, if any is felt to be needed. Parents can relate easily to the advice and experience of those who have "been there."

Adoptive parent groups usually focus on a variety of social, educational, and support activities. A group's focus is determined by the interests and needs of its members. In some cases, groups include only single parents or parents of children from a certain country.

Parent groups often offer specialized services to prospective adoptive parents and to those who have already adopted. Some of these services include the following:

• Telephone warm lines.- Telephone warm lines allow parents to call a special telephone number and speak with another adoptive parent. Parents take turns answering the calls. Adoptive parents can ask for advice on a wide range of adoption-related topics and receive support if they are dealing with a difficult situation.

• Buddy system-. Some parent groups offer a "buddy family" to a new adoptive family seeking advice and support. The more experienced family shares what it has learned from its own adoption experience. For many families new to adoption, having such a family available for support is a help and comfort. Occasionally a more experienced adoptive family that is having a crisis also may request a "buddy family" that has gone through a similar situation.

• Respite ca re.- Respite care is a service that offers parents a temporary break from their parenting responsibilities. It is meant for families with children who have special needs and require more skilled care than a babysitter can provide or for parents going through a crisis of their own. Respite care can be in-home, meaning the respite worker comes to the house and stays with the child(ren) while the parents go out. Out-of-home respite, where the parents take the child to a designated place, also may be available. Respite care can be provided for a few hours every week or for a whole week once a year. Other arrangements also can be made as needed. Some adoptive parents exchange respite care with one another on an informal basis.

• Lending library-. Some parent groups maintain a library of adoption-related books, newsletters, and other materials for sharing. Other groups arrange for parents of older children to share with parents of younger children the clothes, toys, furniture, books, etc., that the older children have outgrown.

Adolescent/Children's Groups

In some communities there are peer groups available for adopted children and adolescents. These groups may be run by adoption social workers, mental health professionals, adoptive parents, adult adoptees, or any combination of the above. The groups help to reduce a child's or adolescent's feelings of isolation by providing a chance to meet with other adoptees and discuss mutual concerns. Groups for younger children usually involve play activities that are both fun and geared to encourage understanding and discussion of adoption. There are also some groups available with a specialized focus-groups for sexually abused children, children adopted from other countries, or birth and adopted siblings.

5. Areas with Few Post adoption Services: What You Can Do

Adoptive parents living in a city or metropolitan area of any size may not find it too difficult to locate some of the post adoption services discussed above. However, parents who live in a rural or sparsely populated area may indeed have some problems finding help. Even in a major metropolitan area, convincing an adoption agency to provide post adoption services may be difficult.

If you have investigated your area and found no active adoptive parent support group, start one! The following two large national adoptive parent groups can provide you with materials and technical assistance to get you going:

NACAC
970 Raymond Ave., Ste. 106
St. Paul, MN 55114
Phone: (651) 644-3036
Fax: (651) 644-9848

Adoptive Families of America (AFA)
2309 Como Avenue
St. Paul, MN 55108
(612) 535-4829 or (800) 372-3300

If you are already a member of a group, your group may want to sponsor an educational workshop or conference or find other local groups with which to form a coalition in order to sponsor such an event. NACAC and AFA can advise you on this subject also.

If you have tried unsuccessfully to find a therapist with expertise in adoption issues in your area, there are several courses of action you can take. You can work with local chapters of the national psychiatric, psychological, and social work organizations to sponsor a workshop or conference to train interested mental health professionals in adoption issues. A selling point to make this idea attractive to mental health professionals is the chance to increase their incomes. Call the national headquarters of these organizations, listed at the end of this article, for names of local contacts. The Adoption Opportunities Branch of the Children's Bureau also provides grant money for such training to organizations that apply for it through their regular annual discretionary grants process. You can encourage appropriate adoption or mental health agencies to apply for these grants. The address and telephone number of the Adoption Opportunities Branch are provided at the end of this article. A third strategy is to contact the Clearinghouse for the names of therapists who are willing to give brief telephone consultation to your child's therapist to help him or her get on the right track in therapy. These therapists also might know of a colleague in the field in your area whom you did not know.

If you really want to hone your advocacy skills, you can lobby your State legislature for monies to enable your local public agency to provide post adoption services. You also can raise money from private businesses or philanthropists. Think creatively and you may find other sources for funding. NACAC and AFA can help you in your search for training funds as well.

Your State Adoption Specialist may know of either public or private adoption agencies in your area with post adoption programs. Contact the Clearinghouse for his or her name, address, and telephone number.

Conclusion

Because so many services are available for families created through adoption, no family needs to feel that it is "on its own" when confronted with perplexing or worrisome issues. And families need not wait until a major problem has occurred before asking for help. Post adoption services are not an "extra"-they are a critical ingredient of a successful adoption. Parents should use them freely and productively.

The CWIG website referenced above provides additional resources including a bibliography and a list of national organizations that provide post adoption services.

Additional Information

If you need or want some specific personal advice, contact your agency social worker, your pediatrician, clergy, or your local mental health center, or your local family service agency for recommendations of appropriate professionals.  If you want additional information and help, please contact our adoption agency.