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"Normal" people sometimes need help to cope with everyday problems that affect their happiness, jobs, and relationships. Therapy treats short-term problems before they become long-term and severe. Treatment can be just one visit to "talk out" a situation or a series of sessions over the course of several months. Some people like to go to group meetings led by a trained professional.
Research shows that adoptive families seek out mental health assistance on a higher basis than other families. Perhaps it is because it was so difficult to become parents in the first place that adoptive parents work harder to become the best parents they possibly can.
Why Parents Seek Out Therapists
Awareness of the developmental process of adoption is a major reason why use of therapists by adoptive families has recently increased. In the past much of the service of adoption was providing a child for an infertile couple. Not much attention was given to the child under the assumption that a warm and loving home would meet most of the child's needs. Now researchers report that even children adopted as infants have adjustment difficulties related to adoption.
David Brodzinsky, in his book The Psychology of Adoption (1990), explains that prior to age six or seven, children really have very little understanding of adoption even if they have been told about their adoption. Young children tend to be very positive, almost unrealistic about adoption. Parents are lulled into believing the child's understanding of adoption is okay, when it really is distorted. For example, the child placed as an infant may believe that all children are "chosen" by parents who go to a hospital to pick out their babies. The adoption process is confused for these children.
By age six or seven, children usually know the difference between birth and adoption. This is part of their growing social awareness as they go to school with other children. Previous positive feelings about adoption decrease. Now the child tends to be ambivalent more than negative about adoption.
Developmentally the process at this time is:The child may also feel a change in family status because of a lack of connection with birthparents. Grieving for the past when they felt secure and wondering about unknown birthparents varies in intensity for children. Many children will show no outward indicators that they are thinking about such things. Especially for the child who genuinely loves his or her parents and wants to please them, there may be absolutely no questions about adoption. As the child continues to try to internally resolve concerns about adoption, parents may see changes such as moodiness or oppositional behavior that they will not necessarily connect with adoption.
Adolescence
Moving into adolescence, rapid changes occur. Most obvious are the physical attributes which are part of the child's genetic history. This widens the gap between the adoptee and other family members. Even if there is a physical similarity to the adoptive family, teens know there are unknown people somewhere who look exactly just like them.
More significant is the internalizing of the adoptive process. The teenager has a cognitive ability to do abstract thinking. Unlike the younger child, he or she can combine logical thinking with a wider breath of options. All issues become magnified. The adolescent is involved in intensive self-reflection during this time period. Teenagers think the world is staring at them. No one else can feel how they feel.
The most important part of adolescence is developing a sense of self confidence that allows teens to progress toward being independently functioning adults. This is often described as identity formation. Creating an identity is a conscious choosing of the parts of the family system they wish to keep. They know their adoptive family, but what about those unknown parents? The young person who reflects the values and influence of even the most caring family uses this time to test those values.
Teens may act out the behaviors they think reflect the values of their birthparents. This is a common way of trying to connect with their genetic history, regardless of how much is actually known about the birthparents. This activity may be no problem for some families but for others it can have almost disastrous results. What about the teen who views the birthparent as irresponsible and promiscuous because of an unplanned pregnancy? "If my real mom was a ****, you gotta expect it from me! " Other teens may process the idea of a poor, lonely teen mom who is living in poverty. There may be feelings of great depression. Such teens may be concerned about their birthparents and feel anxious or unhappy that they can not help them. They also don't want to hurt the adoptive parents they have now by asking too many questions. Another extreme are the teens who vocalize a desire to search for their family of origin.
The end result may be a great period of conflict in the family. This conflict can often spill over into other areas not related to adoption. Rebellion over curfews, friends, homework and just about any issue you can think of may occur. A common refrain is "I wish you'd never adopted me! ! ! " The parents become angry and frustrated. This is the time when many parents seek out professional help because the adoption which was doing so well now seems to be blowing up in their face. They love their child so much. What's going wrong?
Special Needs/Older Children
Other adoptive families have a special need for therapy because more and more parents are adopting children with traumatic histories. Children who used to linger in foster care after serious abuse or neglect are being given warm, caring permanent homes. New families can not erase the past. These children may&127; have vivid memories and often have mixed up value systems. They're not fully willing to trust new parents because the old ones were not able to care for them properly. These children may require intensive therapy on a long term basis.
Fortunately the current trend in post adoption services is to support therapeutic services. Arrangements for financial subsidies (regardless of the parent income) are made prior to adoptive placement of special needs children. Subsidies can often be renegotiated after placement as well. Most such arrangements provide for therapy up until the child is 18 or leaves school.
Attention Deficit Disorder
Researchers have discovered that hyperactivity and attention deficit disorder (ADD) are significantly more common among adopted than non-adopted children. ADD youngsters often have social and academic problems needing professional intervention. One study in 1982 found a 17% rate of non-relative adoptions among 200 children identified as having ADD. Another study even estimates that the incidence of ADD among adopted children may be as high as 25-40%. One explanation given by researchers is that ADD adolescents, who may be impulsive and have lower self-esteem, are at higher risk for unplanned pregnancies. Their children, who may be adopted as infants, are more likely to be at risk for ADD as it appears to be a genetic trait.
Getting Help
Parents should consider "preventative" therapy as part of their post-adoption plan. At various developmental milestone check points, it is appropriate to seek out assistance to check out how your child is processing the adoption story. Many therapists now have a peer counseling curriculum for elementary school children which was developed by the North American Council on Adoptable Children (NACAC). It provides 6 to 8 group sessions, usually for a nominal fee. NACAC has a similar curriculum for adolescents.
Other types of adoption groups are available from individual therapists. Family and individual therapy is also available from a number of highly qualified therapists. Remember you are buying a service and have the right to interview several therapists in order to find the best one for you. Not everyone needs the same kid of assistance.
Here are some typical questions parents might ask:What is the treatment method? Is the child seen alone or with the family? What is the expected number of visits?
How will treatment goals be determined? How will you and the therapist know that the goals are being met?
Do the therapists have experience with adoptive families? Do they attend ongoing training in this area? Are they a member of adoption organizations or work in adoption related agencies? Can they give a reference from an adoptive family?
What is their general philosophy about adoption? For example, at what age do they think children should be told about their adoption? What do they think about open adoption or transracial adoptions? What are their views about search and reunion issues? Do they have any experience with infertility issues?
What kinds of degrees, specialized training, license or certification does he/she hold? More doesn't necessarily mean better. A social worker or mental health counselor can help with parenting and relationship issues, while a psychologist may be needed to provide specialized testing expertise.
Are the therapists in an internship or residence program? If so, who is the supervisor and when does the internship end? If therapy is still needed after the therapist is gone, what will happen?
To which professional organizations do the therapists belong? Has he/she ever been sued for malpractice? What references can be provided?
Does he/she offer daytime, evening, or weekend appointments? Will sessions be at a convenient time so you don't have to miss work and your child doesn't have to miss school? Does their practice qualify for the type of insurance you have or will negotiate for lower rates if no insurance is available? Will they accept direct state adoption subsidy medical payments or MEDICAID? IMPORTANT: IF YOU CAN NOT PAY THE FULL FEE, ASK ABOUT "SLIDING FEES. " If you feel uncomfortable with the answers or if the therapist seems reluctant to answer them, do not hesitate to look for another therapist.
Finding a therapist doesn't have to be difficult. Most adoption agencies have consulting psychologists or actual counselors on their staff. The Adoption Therapy Coalition in Maryland and Virginia offers statewide referrals of mental health professionals. You can also ask for a referral among friends who have an adoption similar to yours. Although your experience with a particular therapist may be unique, chances are that one of these recommendations will turn up a satisfactory match with a professional who will meet your needs.
Amy Stevens, a family therapist and educational consultant, is Founder/President of the Adoption Therapy Coalition, P. O. Box 1392, Rockville, MD 20850. This article is updated from her 1991 Guide to Mental Health for Adoptive Families, FACE Publications,
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