Theresa Porch. Handbook of Adoption: Implications for Researchers, Practitioners, and Families. Editor: Rafael A Javier, Amanda L Baden, Frank A Biafora, Alina Camacho-Gingerich. Sage Publication. 2007.
Adoption challenges us to clarify our meaning of family. In doing so, it raises important social and emotional questions: Who constitutes a family? How do we define family roles and family bonds? How important are genetic and phenotypical factors in our family relationships and our identities? Historically, these questions were all but dismissed for adoptive families in furtherance of a mutually beneficial view of adoption in which children got the families they needed and parents got the children they wanted. Over time, it has become clear that the experience of adoption can be a complicated emotional experience for all members of the adoption triad (the adoptee, the birth family, and the adoptive family). Adoption is now understood to be a lifelong process for those involved, which may vary in salience and in the level of satisfaction or distress it creates for individuals at different points in their lives (Brodzinsky, Schechter, & Henig, 1993).
Because it involves deep-rooted emotional issues that may significantly affect individuals throughout their lives, adoption is very likely to be a focal area for triad members who seek counseling. Therefore, adoption issues are relevant for counseling practitioners of both individual and family counseling. Yet despite the potential importance for clients, adoption generally has not been recognized as a significant area of exploration for counseling practitioners, and many counselors are unaware of the potential impact of adoption on clients (Hartman & Laird, 1990; McRoy, Grotevant, & Zurcher, 1988; Sass & Henderson, 2000). Research has shown that adoption issues are rarely taught in graduate counseling programs, and many counselors feel unprepared to deal with adoption-related issues in practice (Post, 2000; Sass & Henderson, 2000). To competently address the needs of this group of clients, it is necessary for counselors and counseling students to receive training in adoption-related issues. To highlight the need for additional counselor training in adoption, this chapter examines research regarding the therapeutic needs of adoption triad members as well as current levels of counselor training and knowledge regarding adoption. In addition, the chapter presents parallels between adoptive status and personal characteristics relevant to diversity and multiculturalism, such as the Dimensions of Personal Identity (Arredondo & Glauner, 1992), and points to the need for adoption sensitivity and competency in light of multicultural counseling competencies. Examples of some recent adoption training programs for counselors are presented. Implications for counseling practice and for counselor education are discussed.
Statistics of Adoption
While there is no single comprehensive source of adoption statistics in the United States, estimates are typically drawn from a combination of relevant governmental data sources (Stolley, 1993), which suggest that there are between 1 million (Stolley, 1993) and 5 million (Hollinger, 1993) adoptees in the United States. For the first time in history, the 2000 U.S. Census included a category for adopted children. Based on the reported census results, there were an estimated 2.1 million adopted children in the United States in 2000, with 1.6 million of them being less than 18 years old, meaning that approximately 2.5% of the children in the United States are adopted (U.S. Census Bureau, 2003). Based on data compiled from state courts, about 127,000 children were adopted annually in 2000 and 2001 in the United States (U.S. Department of Health and Human Services [HHS], 2004). The number of adoptions of children in foster care has increased dramatically, from 28,000 in 1996 to 51,000 in 2001 (HHS Adoption and Foster Care Analysis and Reporting System, 2002, 2005). Rates of international adoptions have grown steadily as well, with approximately 23,000 “immigrant orphan visas” issued in 2005, up from 7,000 in 1990 (U.S. Department of State, n.d.). Furthermore, a survey conducted by the Evan B. Donaldson Adoption Institute (E. B. Donaldson) found that 58% of Americans have personal experience with adoption, meaning that they or a close family member or friend is an adoption triad member (E. B. Donaldson, 1997).
The past decade has seen a significant shift toward public adoptions (adoptions of children from foster care or the child welfare system) and toward international adoptions and away from domestic private adoptions. In 1992, 77% of adoptions were private. In 2001, more than half of U.S. adoptions were public or international adoptions. In 2001, public adoptions accounted for about 40% of adoptions, up from 18% in 1992 (Flango & Flango, 1995; HHS, 2004), and international adoptions represented 15% of the adoptions in the United States, up from 5% in 1992 (HHS, 2004; U.S. Department of State, n.d.). The rise in public adoptions has shifted adoptive family demographics as those adopting from foster care are more likely to be single females and on average have lower incomes than private adoptive families or nonadoptive families (Barth, Gibbs, & Siebenaler, 2001; Casey Family Services [Casey], 2003; Howard, Smith, & Oppenheim, 2002). Children adopted from foster care are usually older; many are children of color, and many have spent a significant time in foster care prior to adoption. Most of these children have experienced difficult preadoptive life experiences, including abuse and neglect (Barbell & Freundlich, 2001; Casey, 2003). Approximately half of the children adopted internationally in 2001 were infants (defined as less than 1 year old), and half were more than 1 year old (E. B. Donaldson, n.d.-b), suggesting that many international adoptees have spent time in institutions prior to adoption (Grotevant, 2003). Numerous studies have elaborated on the complex special needs of foster care and institutionalized adoptees, and the levels of postadoption support required by their adoptive families, which can be different or more extensive than the needs of families who adopt healthy infants (Barbell & Freundlich, 2001; Casey, 2003; Dubowitz, 1999; Howard et al., 2002).
Adoptees and Adoptive Families in Clinical Settings
The question of whether adoptees are more at risk for psychological problems than non-adoptees has generated substantial controversy in the professional literature. Underlying the controversy are valid concerns about how professionals can recognize and acknowledge the very real issues faced by adoptees while not overpathologizing them. As a whole, the body of research suggests that while adoptees may be at increased risk for a variety of behavioral, psychological, and academic problems, the majority of adoptees are well within the normal range of functioning (Brodzinsky, 1987, 1993). Numerous studies have reported that adopted children and adolescents are referred for psychological counseling and residential treatment at a higher rate than that of their nonadopted peers (Brodzinsky, 1987, 1993; Haugaard, 1998; Ingersoll, 1997; Miller et al., 2000; Warren, 1992). While some studies suggest that adopted adolescents may experience more serious problems (e.g., Wierzbicki, 1993) or different types of problems (i.e., more acting-out or externalizing behaviors; Ingersoll, 1997), others have found no significant differences in the psychological problems and outcomes experienced by adoptees and nonadoptees (see O’Brien & Zamostny, 2003, for review), especially when their studies included community or nonclinical populations (Brodzinsky, 1993). In addition, differences found during childhood may not persist into adulthood as no significant adjustment differences were found between adopted and nonadopted adults (Borders, Penny, & Portnoy, 2000; Feigelman, 1997; Irhammar & Bengtsson, 2004). These results have led some researchers to suggest that the overrepresentation of adoptees in therapeutic settings is likely due to professional or parental referral bias, differential use of mental health services by adoptive parents, or other variables in the adoptees’ or adoptive families’ lives (Brodzinsky, 1993; Haugaard, 1998; Miller et al., 2000; Warren, 1992). These researchers suggested possible reasons for higher rates of parental referral, such as preexisting relationships of adoptive parents with mental health professionals, heightened vigilance for or reactivity to potential problems, likelihood of attributing the problem to adoption, and adoptive families’ higher socioeconomic status and/or education levels.
Regardless of the underlying reasons for referral, research consistently suggests that adoptees and adoptive families are seen in therapeutic settings in a greater proportion than their incidence in the general population (see Brodzinsky, 1987; Haugaard, 1998; Warren, 1992; Wierzbicki, 1993, for review). Adoptees make up 5% of the children referred to mental health clinics, and 10% to 15% of the children in residential care and psychiatric inpatient settings (Brodzinsky, 1993). A study of adopted adults noted that more adoptees had sought counseling than their nonadopted friends (Borders et al., 2000). A survey of practicing clinical psychologists found that 5% to 10% of their patients are adoption triad members (Sass & Henderson, 2000). Therefore, most therapists in practice are likely to be working with adoption triad members on a fairly regular basis (Hartman & Laird, 1990; Post, 2000). As Hartman (1991) asserted, “Everyone offering counseling or clinical services under any auspice is faced daily with adoption issues” (p. 149); or, as Smith and Howard (1999) noted, “Every clinician is in post-adoption practice” (p. 26).
Research shows that adoptive parents consistently request that individual and family counseling be included in the array of available postadoption services (Barth & Miller, 2000; Berry, Martens, & Propp, 2005; Casey, 2003; Howard et al., 2002; Smith & Howard, 1999). One study in New York identified counseling as the most frequently requested post-adoption service (Avery, 2004). Two studies elaborated further that the most common need identified by adoptive families was for qualified adoption-sensitive therapists and mental health professionals (Franz, 1993, as cited in Smith & Howard, 1999; Frey, 1986, as cited in Casey, 2003). This has caused researchers to identify postadoption counseling as a significant service requirement and to conclude that a critical need exists for trained professionals who are able to provide these services (e.g., Avery, 2004; Casey, 2003). One focus group of adoptive parents “described community providers as lacking in the understanding and skills needed to address the particular issues of adoptive children and families” (Gibbs, Barth, & Lenerz, 2000, as cited in Barth et al., 2001, Section IV). Another study found that adoptive families sought services from up to 10 practitioners before finding one who understood their unique circumstances, and some families reported never finding such a professional (Frey, 1986, as cited in Casey, 2003). Authors have also expressed concern that too often adoptive families find themselves in the position of teaching therapists about the most basic issues of adoption (Casey, 2003; Sass & Henderson, 2000; Smith & Howard, 1999). Many studies reported high usage of postadoption counseling services by adoptive families; however, they also noted that many of the families were dissatisfied with the services provided, particularly with the counselors’ lack of knowledge regarding unique adoptive family issues (Smith & Howard, 1999). In fact, several postadoption service programs found that few of the adoptive families in their programs actually used the counseling services available even though they had requested clinical services (Barth et al., 2001). This may be due to negative prior clinical experiences such as those described in the foregoing. Another potential explanation was suggested by McRoy et al. (1988), who found that most families sought counseling from a number of clinicians prior to placing their adopted children in residential treatment. However, the families did not seek counseling at the agencies from which the children had been adopted or from other local agencies. The authors suggested possible reasons, including that the families were unaware of available postadoption services, were afraid the agency might take the child away if it became aware of problems, or were afraid that the agency might view them as unfit for adoptive parenthood. These findings suggest that adoptive families may turn more frequently to clinicians in private practice than to agencies, underscoring the need for increased adoption knowledge for all practicing clinicians.
Status of the Counseling Profession: Adoption Knowledge and Competence?
Despite the likelihood that adoption triad members will be encountered in clinical practice, many therapists have little real knowledge about adoption or are unprepared to deal with adoption issues when they surface in a clinical setting. While a small number of therapists identify themselves as specialists in adoption counseling, “many clinicians continue to be unaware of and unresponsive to adoption when it emerges in their caseloads” (Hartman & Laird, 1990, p. 223). Because adoption is often regarded as a function of the child welfare system, therapists operating outside the child welfare system may not see adoption as relevant to their practice (Hartman, 1991). However, even among professional social workers, who are often assumed to receive the most training in this area, the lack of adoption knowledge can be significant. As an executive of a child welfare agency noted, “It is amazing how many graduates of Masters Social Work programs have no sense of the importance of adoption to the emotional psyche of a child or adolescent” (Casey, 2003, p. 70).
In a survey of more than 200 practicing psychologists regarding their level of preparedness for dealing with adoption issues, 51% rated themselves as “somewhat prepared,” 23% rated themselves as “not very prepared,” and 90% reported that they needed more education in adoption (Sass & Henderson, 2000). Furthermore, half of the respondents reported that they did not routinely inquire whether their clients were adopted or were adoption triad members, suggesting that the psychologists did not consider adoption to be a significant factor affecting clients (Post, 2000). This supports previous research indicating that many clinicians in residential treatment centers were not aware of the adoptive status of their residents (McRoy et al., 1988; Miller et al., 2000).
Even when the adoptive status is known, adoption issues are often not raised. Research suggests that family therapists in outpatient settings often do not recognize the potential role of adoption when providing therapy to adoptive family members (McDaniel & Jennings, 1997). Therapists often receive referrals of adopted children who were in long-term inpatient, outpatient, or residential treatment in which adoption issues were never brought up, even though the referring clinician was aware the child was adopted (Rosenberg, 1992). In residential settings, the failure to focus on adoption issues in treatment was found even when staff members were aware of the disproportionately high level of adoptees in treatment (McRoy et al., 1988) and even when staff members identified adoption as an important issue in development and therapy (Dickson, Heffron, & Stephens, 1991). In addition, Dickson et al. (1991) found confusion and disagreement among staff members regarding whether adoption discussions should be initiated by the family or the therapist. The authors concluded that although many staff members viewed adoption as an important issue, adoption was not being addressed in a systemic way in inpatient settings, staff members were not knowledgeable about the impact of adoption on patients, and therapists were uncertain how to approach it in their caseloads.
It seems reasonable to assume that therapists are unlikely to view adoption as a potential issue for their clients if they have not been trained to recognize it as such. The literature is rife with concerns that clinicians are not receiving adequate training regarding the salience of adoption and the nature of issues faced by adoption triad members (Hartman, 1991; Hartman & Laird, 1990; Henderson, 2002; Jones, 1997; Pavao, 1998; Post, 2000; Rosenberg, 1992; Sass & Henderson, 2000). Post (2000) referred to the lack of adoption training for clinical psychologists as “astounding” (p. 370). One study found that 65% of practicing clinical psychologists surveyed reported never taking any courses dealing with adoption in graduate school, and 86% could not recall any courses dealing with adoption in their undergraduate programs (Sass & Henderson, 2000). Researchers have noted that course content is often determined by textbooks (Post, 2000), and several studies have documented the extremely limited coverage of adoption in psychology and family textbooks (Fisher, 2003a; Hall & Stolley, 1997; Stolley & Hall, 1994). A survey of clinical psychology professors (Post, 1999, as cited in Post, 2000) found that while instructors ranked adoption and foster care as relatively important topics for the training of therapists, they reported that these topics were the least taught of all survey topics. These findings suggest that it is highly unlikely that adoption-related issues are being taught in any meaningful degree in the standard curricula of most counseling or clinical psychology graduate school programs.
It is reasonable to assume that without proper professional training, therapists are likely to base their knowledge of adoption on popular media or informal information sources. This may serve to perpetuate misperceptions and stereotypes regarding adoption (Friedlander, 2003). Such a lack of knowledge may also cause therapists to downplay or overemphasize the impact of adoption on triad members (Rosenberg, 1992). Clearly, the literature supports the need for therapists to gain additional knowledge and training in issues that are relevant to adoptive families and the way adoption may affect adoption triad members, to ensure that competent services can be provided to these clients (e.g., Casey, 2003; Dickson, Heffron, & Parker, 1990; Hartman & Laird, 1990; McDaniel & Jennings, 1997; McRoy et al., 1988; Post, 2000; Sass & Henderson, 2000).
Clinical Issues Facing Adoption Triad Members
What are the issues of adoption that counselors need to be aware of to practice adoption-competent counseling? Drawing on the significant volume of research regarding the potential emotional challenges faced by adoption triad members, several themes are briefly mentioned here: loss, identity, variability of experience, acknowledgment of difference, and stigmatization. Loss. For all members of the triad, adoption may be considered a process of integrating things lost and things found (Lifton, 1979; Rosenberg, 1992). Clinicians suggest that one of the primary challenges for the adoptee is coming to terms with the losses of adoption (Brodzinsky et al., 1993). The adopted child loses a sense of his or her genetic identity, his or her extended biological family, and for internationally adopted children, his or her birth culture. Grief is a common reaction to loss, yet it may be difficult for the adoptee to find an outlet for the grief, since his or her loss is generally not acknowledged by society (Brodzinsky et al., 1993; Jones, 1997; National Adoption Information Clearinghouse [NAIC], 2004). The adoptee’s grief may manifest itself in feelings of anger, depression, anxiety, or fear, and these emotions may be experienced during childhood and adolescence and/or later in life, especially during life transitions. In addition, adoptees may feel a loss of control over their lives (Groza & Rosenberg, 1998) as well as powerlessness (Hartman & Laird, 1990).
Adoptive parents also experience loss, especially if they are adopting as a result of infertility: the loss of their hope for a biological child, a genetic legacy, the experience of pregnancy, and childbirth. Adoptive parents often feel defeated and powerless as a result of their struggle with infertility (Pavao, 1998). Issues of infertility may reemerge throughout the life cycle for adoptive parents (Groza & Rosenberg, 1998; Pavao, 1998) and may manifest themselves as generalized anxiety, depression, decreased self-image, difficulties in marital communications, or other forms (Brodzinsky, 1987). Adoptive parents may experience a loss or lack of support and acceptance from family and friends (Brodzinsky, 1987; Kirk, 1964) and may also lack confidence and struggle with issues of entitlement regarding their ability to parent (Brodzinsky, Smith, & Brodzinsky, 1998).
Research on birth mothers suggests that the impact of relinquishing a child may be lifelong (Wiley & Baden, 2005). Birth mothers may experience a powerful sense of loss and isolation on relinquishment and have difficulty getting past the relinquishment (Brodzinsky, 1990; Wiley & Baden, 2005). They may experience reactions to unresolved grief throughout their lives (Brodzinsky, 1990), which may manifest as symptoms of depression, anxiety, and posttrauma (Wiley & Baden, 2005). Even when birth mothers report satisfaction with relinquishment and favorable outcomes, they may also experience continuing grief and loss (Wiley & Baden, 2005). Research on birth fathers is extremely limited (Freundlich, 2002), and, therefore, very little is known about the impact of relinquishment on them. Freeark et al. (2005) suggested that the marginalization of birth fathers permeates the adoptive process and may add to their feelings of powerlessness and disenfranchisement.
Another significant issue that may emerge for the adoptee is identity or the “lifelong search for self” (Brodzinsky et al., 1993, p. 12). Most researchers agree that the task of identity development is more complex for adoptees than for nonadoptees (Brodzinsky et al., 1998; Grotevant, 1997; Lifton, 2002; NAIC, 2004). Adoptees often experience a need for a biological link that can contribute to their sense of identity (Jones, 1997). Lack of information regarding their origins, including the identity of their birth parents and the reasons for their relinquishment, can complicate the formation of a complete and stable identity (Brodzinsky, 1987). Adoptees may struggle with feelings of duality regarding their identity and strive to consolidate a dual identity (Brodzinsky et al., 1993). They often feel a “split in the self” in accepting the identity of the adoptive family and effectively abandoning their birth mother and their “true” self, which may result in feelings of anxiety, isolation, and helplessness (Lifton, 2002). Identity issues also affect self-esteem, and studies have shown that adoptees may score lower on measures of self-esteem and self-confidence (Borders et al., 2000; Sharma, McGue, & Benson, 1996), often related to feelings of being different from their nonadopted peers (NAIC, 2004). Researchers have defined adoptive identity as an individual’s sense of identity as an adopted person (Grotevant, Dunbar, Kohler, & Esau, 2000, p. 381). In describing the developmental process of adoptive identity, Grotevant (1997) noted that all identity development “becomes increasingly complex as layers of ‘differentness’ are added” (p. 4), primarily because the dimensions of differentness usually involve things the person has not chosen. Thus, the adoptee must integrate the adoption into his or her total identity and “come to terms” with himself or herself in the adoptive family and cultural context. Such identity development may be especially complicated for transracial adoptees, compounded by a lack of physical similarity to their parents and their developing racial awareness and experience of discrimination (Brodzinsky et al., 1993). While many researchers describe identity development as a significant challenge for transracial adoptees, studies have found great variability in the racial and ethnic identity development and adjustment of transracial adoptees (Baden, 2002; Lee, 2003).
Variability of Experience
Another thematic issue of adoption surrounds the variability of experience of adoptees, due in part to different adoptive and preadoptive experiences, as well as individual differences in temperament, resilience, personality, and perception. In many cases, it is not only the experience of adoption per se that affects children but their preadoption experiences, the nature of the transition from their pre- to postadoption lives, and their ability to integrate themselves into the life and culture of their adoptive families. Therefore, it is important that therapists do not overgeneralize the experience of some adoptees to all adoptees. In addition to individual differences, as in any family, the family structure and dynamics of the adoptive family will contribute to variability in the adjustment of the adoptee (Brodzinsky et al., 1998). Variability of experience is also true for the other members of the adoption triad. Friedlander (2003) notes that the variability of the experience and resulting emotional impact of adoption are as great within each of these three groups as they are among the three triad groups.
Acknowledgment of Difference
Kirk (1964) was the first to suggest that adoptive families benefit from maintaining communication styles that acknowledge the differences between adoptive and biological families rather than rejecting or denying the difference. Subsequent research suggested that extreme styles of either “denial of difference” or “insistence of difference” were less likely to promote healthy adjustment (Brodzinsky, 1987, 1993). Brodzinsky (1987) also noted that parental styles may change over time to adapt to the child’s developmental stage and family life cycle. Wegar (2000) noted that Kirk’s original study found that adoptive parents’ communication patterns developed as a means of coping with society’s view of them (parents and children) as different; yet this reference to social context was disregarded in the subsequent literature.
Adoption is generally viewed as a second-best means of forming a family (Bartholet, 1993; Friedlander, 2003; Pavao, 1998; Wegar, 2000). Numerous studies have noted society’s ambivalence toward and stigmatization of adoption triad members, which may be rooted in the dual stigma of infertility and illegitimacy (Grotevant et al., 2000; Henderson, 2002; Leon, 2002; Wegar, 2000). For example, Brodzinsky et al. (1998) noted the common assumption that adoptees have less desirable genetic backgrounds. In addition, the structure of closed adoption contributes to a sense of secrecy and shame for those involved (Jones, 1997; Leon, 2002; Lifton, 1994). These societal attitudes affect adoption triad members in profound ways. The literature has described many ways in which adoptive family members experience and internalize social stigmatization in their lives (Leon, 2002; Wegar, 2000). In one study of adoptees, two thirds reported thinking that adoptive families were perceived as different and inferior to biological families; another study found that young adoptees may feel “different” or “bad,” based on people’s comments or behaviors (Rosenberg & Horner, 1991). Miall (1987) found the following stigmatizing themes: Adoptive families are seen as second-best because biological ties are assumed to be important for bonding and love; adopted children are seen as second-rate because of their unknown genetic past; and adoptive parents are not seen as “real” parents because of the lack of a biological tie. Wegar (2000) stressed the importance of recognizing the potential impact of marginalization and stigmatization of adoption triad members in both research and clinical work with triad members. Similarly, the development of the stress and coping theory of adoption adjustment (Brodzinsky et al., 1998; Smith & Brodzinsky, 1994) recognizes the impact of social stigmatization on adoptive families.
Clinical Implications of Therapists’ Lack of Adoption Knowledge
Missing, neglecting, or misunderstanding a core issue for a client is a highly undesirable outcome for any therapeutic relationship. The clinical and popular literature on adoption contains numerous accounts in which adoptees’ underlying issues were not addressed in therapy because of therapists’ lack of adoption knowledge (e.g., Andersen, 1993; McDaniel & Jennings, 1997; McRoy et al., 1988). Smith and Howard (1999) noted that when encountering issues related to adoption in their work, many clinicians
will fail to understand the significance of adoption in the lives of clients … and its connection to other aspects of clients’ struggles. They will miss the opportunity to help clients come to terms with this fundamental human issue. (p. 26)
In discussing loss, Brodzinsky et al. (1993) stated, “The result of loss is usually grieving, and adoption-sensitive clinicians see much of what has been called pathological in an adoptee’s behavior is little more than the unrecognized manifestation of an adaptive grieving process” (p. 11). In discussing practice changes that resulted from increased adoption training at their facility, one agency leader reported, “Now we spend less time on the specific behavioral issues that brought the child into care and more time on the families’ sense of loss, guilt about their ambivalence, and fear that they made a mistake” (Christine Gradert, personal communication, in Casey, 2003, p. 70). Gradert added,
So often we hear adolescents say, “I don’t want to be adopted,” and we believe it. How different the lives of those children might be if we heard those words, and also heard the unspoken words, “I don’t want to ever experience loss again—so I won’t let myself get close to anyone.” (p. 71)
Sass and Henderson (2000) cautioned that psychologists who do not consider adoption a serious issue may not be able to understand triad members’ life experiences, which may hinder the psychologists’ ability to competently treat these clients. In addition, they express concern that triad members may undergo inadequate treatment before a therapist recognizes adoption issues. Post (2000) warned, “The apparent lack of therapist training regarding the specific issues of adoption triad members puts these people at risk of being misunderstood and worse, misdiagnosed” (p. 371).
These concerns should give clinicians pause to assess their competence to treat adoption triad members. There are so many client-centered reasons for clinicians to be trained in adoption-related issues that further justification may seem unnecessary. However, there are also significant reasons based on the requirements and standards of the counseling profession that should compel us to seek adoption training. These reasons are related to the profession’s commitment to multicultural competence.
Multicultural Competencies and the Relevance to Adoption
It is somewhat surprising how significantly issues of race, gender, socioeconomic status, ability status, sexual orientation, and so forth are inextricably linked to the adoption process (Bartholet, 1993). These factors affect which children are relinquished for adoption, which families will be allowed to adopt them, and which children may or may not be chosen to be adopted. Because of these links, adoption forces people “to think on a personal level about discrimination” (p. xvii). Given how closely adoption touches on elements of multiculturalism and diversity, and how some of the salient challenges of adoption such as identity and stigmatization are also multicultural challenges, it seems worthwhile to examine adoption in light of multiculturalism, especially as it relates to clinical practice and counselor competencies.
In general usage, the terms multiculturalism and diversity are often used interchangeably and in the broadest sense refer to race, ethnicity, culture, language, gender, sexual orientation, age, physical ability status, class, socioeconomic status, education, and religion, all of which are considered critical aspects of an individual’s ethnic, racial, and personal identity (American Psychological Association [APA], 2003). In the professional literature of U.S. psychology and counseling practice, the terms have been further clarified. In this context, multicultural refers primarily to ethnicity, race, and the culture related to the five primary cultural groups in the United States—African/Black, Asian, Caucasian/European, Hispanic/Latino, and Native American or indigenous peoples (Arredondo et al., 1996)—and the interaction between individuals of these cultural groups and those of the dominant European American culture (APA, 2003). Diversity refers to other individual differences, including age, gender, sexual orientation, religion, physical ability status, “or other characteristics by which someone may prefer to self-define” (Arredondo et al., 1996, p. 43). To further explain diversity, the Dimensions of Personal Identity Model (Arredondo & Glauner, 1992) was put forth as a means of describing and discussing the individual differences and shared identity-based affiliations which help provide “a reference point for recognizing the complexity of all persons” (Arredondo et al., 1996, p. 44; see also Baden & Steward in Chapter 7 of this book). Inherent in discussions of the dimensions of personal identity is the recognition that these are characteristics a person is born with or born into, are not in the individual’s control, and are fixed or relatively unchangeable. There is also recognition of the individual in context—how external forces affect personal life experiences. The model encourages counselors to acknowledge various dimensions of their own and clients’ identity along three categories: A dimensions, which are fixed and out of the individual’s control, such as race and gender; C dimensions, which include the social, historical, political, and economic context of the individual’s life; and B dimensions, which are more individually determined but which may also be seen as a result of the interactions of A and C, such as educational experience, marital status, and other nonvisible attributes.
The parallels between the Dimensions of Personal Identity and adoptive status are significant. For adoptees, adoption is something that is chosen for them and which is rarely, if ever, in their control. In this respect it can be compared with gender, race, ethnicity, and sexual orientation as “an assigned feature of the self that must ultimately be integrated into the person’s larger sense of identity” (Grotevant, 1997, p. 16). Research shows that adoptees often feel a lack of control in their lives based on the central fact of their adoption (Hartman & Laird, 1990). Like the Dimensions of Personal Identity, adoption often plays a significant role in identity development and presents specific challenges to individuals as they try to integrate their adoptive identity with other elements of their identity. Research on adoptive identity development (e.g., Brodzinsky et al., 1993; Grotevant, 1997; Grotevant et al., 2000; Lifton, 1998) suggests that for many adoption triad members, adoptive status may play a significant role in how they define themselves and in how they perceive they are defined by others. Adoption triad members experience stigmatization and discrimination based on their adoptive status (Fisher, 2003b; Wegar, 2000). The level of “visibility” of this dimension of identity varies depending on the phenotypical differences between adoptees and adoptive parents and may range from same-race adoptees who do not closely resemble their adoptive parents to transracial adoptees, whose adoptive status is obvious and inescapable. For trans-racial adoptees, the dimensions of racial and adoptive identity interact in complex ways and may vary at different points in an individual’s life cycle (Baden, 2002; Freundlich, 2002; Lee, 2003). As with race, gender, physical ability status, sexual orientation, and other dimensions of identity, adoptive status is an aspect of identity that is influenced not only by how individuals feel about their status but by how they are perceived by others. Furthermore, the social, historical, and political context of adoption is interwoven into the experience of adoption throughout the lives of adoption triad members.
It seems clear that the Dimensions of Personal Identity are highly relevant to work with adoption triad members and that this framework can help counselors understand and conceptualize the potential impact of adoption on a client. It also seems clear that the spirit and intent of the Multicultural Counseling Competencies apply to work with adoption triad members. Increasing practitioners’ knowledge of adoption by providing additional training in adoption for psychologists and counseling professionals would certainly seem to be in keeping with the Multicultural Counseling Competencies adopted by the American Counseling Association, as well as the APA Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change (APA, 2003). While it is not the purpose of this chapter to urge that adoptive status be formally included in the list of Dimensions of Personal Identity, the strong similarities between adoptive status and the other identity dimensions suggest that adoptive status may be a dimension of personal identity that has thus far been ignored.
Even a cursory review of the counseling literature and counseling graduate programs reveals that the profession has embraced the understanding that competent counselors must be multiculturally competent. Sue (1998) defined multicultural competence as “the belief that people should not only appreciate and recognize other cultural groups but also be able to effectively work with them” (p. 440), an aim that seems self-evident for therapists. Given the current consideration in the counseling field for culturally sensitive counseling, it may be helpful for practitioners to consider adoptive status as an aspect of diversity and personal identity. This will provide counselors with a framework for approaching adoption in a way that allows them to be sensitive to the potential impact on their clients. It will also help them examine their own assumptions and biases regarding adoption and to evaluate their level of competency in working with adoption triad members.
Post (2000) noted that providing adoption training for psychologists in graduate psychology programs is in keeping with, and required by, program accreditation guidelines of the American Psychological Association (APA, 1995) under Domain D: Cultural and Individual Diversity. In a separate context, Hall (1997) described how people of color; women; and gay, lesbian, and bisexual individuals historically have been excluded from psychological research, practice, and education and training and called on the profession to rectify this neglect, in part by increasing education and training about diverse populations in graduate psychology curriculums. Post (2000) drew an analogy between the neglect of diverse populations and the neglect of adoption triad members and echoed Hall’s (1997) remedy by urging that adoption topics be included in psychological research, practice, and education and training. In addition, Post (2000) and others (e.g., Jones, 1997) suggested that the exclusion of adoption topics in psychology programs and the professional literature parallels the adoptive family and societal fantasy that adoption does not exist and perpetuates unconscious biases against adoptees by maintaining secrecy and silence toward adoption.
Elements of Adoption Training
While many books have been written about the experiences of adoption triad members, little has been written about specific training for counselors desiring to work with adoption triad members (Janus, 1997). Authors calling for increased adoption training come from many different points of the adoption spectrum, from child welfare workers providing an array of public postadoption services, to adoptive parents of special needs children, to counseling psychologists teaching in graduate programs, to therapists encountering adoption-related issues in their clinical practice, and many others. Despite the variety of perspectives covered, a review of the literature reveals surprising consistency in what professionals and adoptive families believe is necessary for mental health professionals to know to provide adoption-sensitive counseling.
At the most basic level, counselors need to recognize that adoption is another means of forming a family and that the ways in which adoptive families form is different from biological families and has ramifications for adoptive family members. Counselors should understand that adoption is a lifelong process and that the importance of adoption in the life of a triad member may vary for individuals at different stages of their lives. Because of this, adoptive families may need episodic assistance at various points in a child’s development or at periods of life transitions (Casey, 2003). Counselors should know that the meaning and importance of adoption will vary greatly from individual to individual. It is most important that counselors understand the role of loss and grief in adoption, and the ways in which unresolved grief may manifest itself for triad members. They should recognize the “normative crises” (Pavao, 1998) that may be experienced by adoption triad members, how adoption losses can reciprocally affect developmental tasks, and how transitions, life events, anniversaries, and so on may trigger a renewed sense of loss. It is important for counselors to approach these issues with the recognition that such reactions are normal and understandable responses to the losses experienced by the triad member and to provide appropriate support (Brodzinsky, 1987, 1993; Pavao, 1998).
Counselors need to understand the ways in which adoption may affect the identity, self-worth, and relationships of each member of the triad. They should acknowledge the impact of societal attitudes on adoption and recognize the ways in which subtle or overt stigmatization can affect adoption triad members (Wegar, 2000). It is very important to be aware of the challenges faced by transracial and international adoptees, who may be subjected to stigmatization on several fronts and whose identity challenges are even more complex (Baden, 2002; Lee, 2003). It is very useful for counselors to understand the legalities of adoption (Grotevant, 2003; Janus, 1997) and the legal choices that are made by triad members as well as to recognize the frustrations, fears, or helplessness that adoption triad members may experience by being exposed to the legal process, including the legal prohibition against adoptees obtaining information regarding their own birth and heritage. Knowledge of closed and open adoption, including varying levels of openness, the impact of secrecy on closed adoption, and potential benefits and detriments of degrees of openness can be significant for a counselor’s understanding and guidance of clients. Counselors should also know what postadoption supports are available for adoptive families and be ready to help them access these supports (Barth et al., 2001; Casey, 2003). Counselors should also understand the complex emotions surrounding search and reunion activities for adoptees, birth parents, and adoptive parents to be able to provide appropriate guidance and support (Janus, 1997).
It is important that counselors recognize the overall resilience, strength, and positive coping abilities of adoptees and adoptive families, especially in light of the generally positive outcomes demonstrated through research (Borders et al., 2000; Friedlander, 2003; O’Brien & Zamostny, 2003; Zamostny, O’Brien, Baden, & Wiley, 2003). This will help the counselor to focus on the strengths and potential of adoptive families as the best resource for helping their adopted children (Casey, 2003) and may help mitigate the often sensational and negative media portrayals of adoption (Fisher, 2003b). Counselors should recognize that adoption is a highly successful way of forming a family and that for many children and parents it is the best alternative or solution for their collective circumstances. That recognition will help them focus on strengthening and supporting the adoptive family rather than blaming them for challenging outcomes (Smith & Howard, 1999). Counselors should accept adoptive parents as the people who know their children best and as the experts on their children (Howard et al., 2002). As Friedlander (2003) stated, “A major pitfall in working with children and adolescents is overlooking the need to strengthen the child’s emotional bonds with the adoptive family and the community” (p. 747) or to strengthen the adoptive family system (Pavao, Groza, & Rosenberg, 1998). Finally, Rosenberg (1992) and others have cautioned therapists about the danger of either exaggerating or minimizing the relevance of adoption issues. A clinician must be well-informed about the complexities of adoption, yet careful not to “view all feelings and behavior through an adoption lens” (Rosenberg, 1992, p. 147). Rather, the clinician can try to understand the individual personality and lifelong development of each triad member as well as the context of his or her family and social systems.
Representative Training Programs and Partnerships
A review of the clinical and popular literature reveals some recent training programs that are attempting to address the critical need for adoption-competent professionals. These programs can be examined as potential models for training curriculum content and delivery. Examples were found through literature and Internet searches, and the list is not intended to be comprehensive. Programs identified range from state-run training programs for employees, training programs offered by adoption-competent agencies, university-based training programs and courses, and collaborations and partnerships between the three groups. While a number of sources are cited, a significant amount of information was found in a publication by Casey Family Services (Casey, 2003), which has contributed greatly to the literature regarding adoption-sensitive training.
Most states offer some form of direct postadoption support services, and some training information can be gleaned from a limited number of studies that examined outcomes and satisfaction levels of adoptive families using state-provided postadoption services. Studies were conducted for programs in Illinois, Iowa, Missouri, New York, and Oregon (Berry et al., 2005). All programs reportedly included some form of adoption training for professionals, but little specific information on that training was provided. One study (Berry et al., 2005) included an analysis of adoption preservation projects using Intensive Family Preservation Services in Illinois and Missouri. In both states, the content of the training programs for adoption preservation workers was said to be significantly enhanced by the inclusion of information relevant to adoptive families, such as grief and loss, attachment, parental expectations, and other topics. In Missouri’s program, supplemental training topics were available to practitioners throughout the year, including a 2-day session focusing on the specific strengths, challenges, and issues of adoptive families. Based on positive outcomes of the Missouri and Illinois programs, the study recommended (among other things) that ongoing training should be emphasized for practitioners working on adoption preservation teams.
Colorado’s Mental Health Assessment and Services Agencies were tasked with providing adoption-related services to the public, and in response, the agencies instituted a training program funded by an Adoption Opportunities Grant to increase the adoption competence of staff members. Practitioners were trained in issues related to attachment, loss, and grief that were significant for children in the child welfare system. The training model was also shared with the state of Utah. Casey (2003) noted that a valuable aspect of such training programs is that the adoption competence of those traines continues long after the grant has expired and the training program has ended.
In New York, a coordinated postadoption services program was launched in 2000 to serve adoptive families eligible for assistance under Temporary Assistance to Needy Families (TANF). Thirteen community-based agencies were given funding to allow them to provide services and training to adoptive families intended to strengthen the families’ coping skills and avoid adoption dissolution and disruption. One of the agencies did not provide direct service to families but received funding specifically to provide training to the other participating agencies (Avery, 2004).
Collaboration among professionals can help advance adoption competence. In addition to providing direct adoption services, some agencies also provide training to other agencies or to state employees through consultation or training partnerships. One example of this is the Center for Adoption Support and Education (CASE) in Silver Spring, Maryland, which provides direct agency services as well as consultation and training to other child welfare and mental health programs to increase the adoption competence of their practitioners. Within the agency, CASE therapists are trained to use interventions with adoptive families to address the grief, loss, abandonment, and identity issues of the adoptive child and family. CASE therapists “are trained to look at child behavioral issues through a developmental lens … and to provide an intense therapeutic focus on ways to understand and manage feelings of grief and loss” (Casey, 2003, p. 40). The agency’s Adoption-Centered Therapeutic Approach treatment model is specifically geared for work with adoptive families. CASE training programs for professionals cover a variety of adoption topics, such as children’s and adolescents’ perceptions about adoption, how to talk to children about adoption, the role of loss in adoption, and providing therapy to adoptive families. Programs range from 2-hour presentations to full-day workshops. CASE also provides consultation and educational programs for school systems and develops materials for publication (CASE, n.d.-a).
Casey Family Services provides comprehensive postadoption services in Connecticut, New Hampshire, Maine, Rhode Island, and Vermont. Each division offers professional adoption training, typically through a collaboration of experienced staff members and adoptive families. Personnel from Casey Family Services Post-Adoption Programs and the Casey Center for Effective Child Welfare Policies serve as consultants to assist public and private agencies in postadoption service policy and practices, including adoption-competent training for professionals (Casey, 2003).
The Center for Family Connections in Cambridge, Massachusetts, offers training programs for adoptive families and professionals through its Family Connections Training Institute, Summer Intensives programs, and customized training programs. Center personnel are involved in adoption-training activities across the country in both public and private settings. In addition, the Center runs periodic training conferences, such as a 2005 full-day training conference in New York in conjunction with the Hunter University School of Social Work (Center for Family Connections, 2005, n.d.).
In Baltimore, Maryland, the Center for Adoptive Families (CAF), a program of Adoptions Together, Inc., developed an interview process to assess the adoption competency of its clinicians and required staff participation in an adoption training program. The training curriculum covers what CAF regards as core elements of adoption-competent practice, including (a) understanding children’s reactions to separation, loss, and grief and the relationship to attachment; (b) understanding the individualized emotional issues of the adoptive family; (c) working with community systems to ensure that adoption-related concerns are understood and addressed; (d) sharing knowledge of developmental stages and expectations of children who have a history of neglect or abuse, separation, loss, and grief; (e) providing readings on adoption for adoptive families; (f) using children’s and parents’ support groups to normalize experiences; (g) shadowing by new staff members at home visits; (h) requiring participation in groups where children share their experiences; and (i) requiring exposure to the language and concepts of postadoption services (Casey, 2003). CAF awards continuing education units to participating Maryland social workers. CAF training materials have been used at Catholic University and the University of Maryland to introduce adoption issues to social work graduate students.
An example of adoption training in a residential care setting is the Nashua Children’s Home in Nashua, New Hampshire (Casey, 2003). As the number of adoptees in care increased, the facility recognized the need for additional training in adoption issues. Staff members received training in how loss and grief affect the behavior of adopted children and the reactions of adoptive parents. Staff members began to ask questions at intake regarding the child’s adoptive status and the family’s perception of how adoption may be affecting current family situations. Staff were trained to address early traumatic experiences and unresolved birth family concerns. Staff members also began to inquire about the family’s prior attempts to seek help in an effort to assess the impact of prior adverse experiences with mental health professionals.
Iowa’s Family Resources, Inc., program was restructured in an attempt to make the organization better integrated and more adoption sensitive. As a result, “Every program now assesses for the impact of adoption on the behavior of the child and addresses adoptive family issues from a different systemic framework than they assess birth family issues” (Casey, 2003, p. 70). Interdisciplinary teams deliver services, and adoption-sensitive professionals are fully integrated into all aspects of the process.
Some states have also teamed with university graduate programs as a logical venue for professional adoption training programs. In addition, some university graduate adoption training has been initiated independent of state social service agencies. New Jersey’s Division of Youth and Family Services’ (DYFS) Adoption Program teamed with the School of Social Work at Rutgers University in New Jersey to develop the Adoption Practice Certificate Program for child welfare workers and mental health practitioners. The program includes nine full-day courses that meet once a month. Participants receive 5 continuing education hours per course. Participants earn an Adoption Practice Certificate from Rutgers’s Continuing Education Program on completion of the 45-hour coursework. The curriculum is aimed at increasing practitioner knowledge of the core issues facing adoptive families and to “expand their clinical skill regarding attachment-focused, family centered and culturally-sensitive therapeutic interventions” (Casey, 2003, p. 52). The core curriculum courses include the psychology of adoption; issues of adoption with older children; life cycle experience of adoption for children adopted as infants; life cycle experience of adoption for older children; attachment-focused therapy for international or postinstitutionalized children; management of behavior problems and discipline for the traumatized child; individual and group therapy with adopted children, teens, and families; and special clinical issues in adoption (Rutgers University, n.d.).
The Northwest Adoption Exchange and Antioch University in Seattle, Washington, jointly developed a Post-Graduate Certificate in Foster Care and Adoption Therapy. Classes meet once a month for 9 months, for 10 hours on Friday and Saturday. The names of therapists who have completed the certificate program are provided to the Washington State Adoption Support Program for distribution to adoptive families seeking adoption-sensitive professionals. Course topics include foster care and adoption from the child’s and parents’ perspective; normal versus abnormal child psychological development; child sexual development and impact of sexual abuse; fetal alcohol syndrome/effect and other neurological issues; attachment and the assessment and diagnosis of reactive attachment disorder; trauma and the assessment and diagnosis of posttraumatic stress disorder; childhood disorders and other mental health issues; learning development and attention deficit hyperactive disorder; and adapting theoretical perspectives to work in foster care and adoption therapy (Antioch University, 2002; Casey, 2003). A similar program is offered in Oregon by Portland State University, the Oregon Post Adoption Resource Center, and the Oregon Department of Human Resources, which collaborate to sponsor the Therapy with Adoptive Families Postgraduate Certificate Program (Portland State University, n.d.).
In Maine, a partnership was developed between the state, Casey Family Services, and the University of Southern Maine’s Maine Child Welfare Training Institute, which uses adoption-competency training materials from the Adoption Support and Preservation curriculum, developed with a federal Adoption Opportunities Grant by the National Resource Center for Special Needs Adoption at Spaulding for Children in Southfield, Michigan. The 3-day training is team-taught by an adoptive parent, an adoption-competent postadoption clinician, and an adoption caseworker. Practitioners are educated about the normal range of experiences of adopted children and their families as well as ways of helping to strengthen adoptive family relationships (Casey, 2003).
Montclair State University in New Jersey ran a semester-long seminar course in adoption issues titled “Counseling Adoption Triad Members” in spring 2005, as part of its graduate-level counseling course offerings (Montclair State University, 2005). Case Western Reserve University’s graduate social work curriculum includes a course titled “Adoption: Practice and Policy” (E. B. Donaldson, n.d.-a). Gallaudet University’s department of social work offered a graduate course titled “Adoptive Family Systems” in fall 2005 (CASE, n.d.-b). Antioch University of Los Angeles reportedly offers a graduate-level course on adoption (E. B. Donaldson, n.d.-a). These courses are a welcome and necessary addition to the training opportunities for students and professionals and may be able to serve as models for course offerings at other institutions. It is clear that many more courses of this nature will be necessary for meeting the need for adoption-competent clinicians and therapists.
Finally, some adoptive families have proactively worked to identify and assess the level of adoption competency of counseling professionals. Together as Adoptive Parents in Harleysville, Pennsylvania, created an interactive Web site that provides data on therapists statewide. The information was obtained from a survey developed by adoptive families and sent to prospective adoption therapists. Questions included how many adoptive families the therapists work with on a regular basis; where they obtained their training; whether they have presented at any training conferences; what they consider to be the most significant issues facing adoptive families; and a description of their most effective intervention strategies. The Web site information is intended to help adoptive parents evaluate the adoption competency of therapists in their area (Casey, 2003) and may be indicative of future questions that clinicians will be asked by informed clients.
Even a brief look at the issue of adoption training makes apparent the need for providing better training in adoption to counseling professionals. A sizable population, including significant numbers of children and adolescents, is affected by this lifelong issue, which will not go away, but may change in salience and affect individuals differently at various points in their lives. For a variety of reasons, the members of this population are proportionately more likely to use counseling services than are the general public. If they do receive counseling, they run a significant risk of being misunderstood or misdiagnosed if their core issues are not properly addressed. If their core issues are properly acknowledged and addressed, outcomes for these clients are very good, and the benefits to the individuals and their families are significant. It is hard to imagine why the counseling profession would not choose to take immediate action to enhance counselor training in adoption-related issues, to ensure at least minimal levels of adoption competence across the profession. As Friedlander (2003) states, “As professionals, we should at least be knowledgeable enough to do no harm. At most, we can make a tangible contribution to the lives of this too vulnerable population of children and parents” (p. 751).