Psychoanalytic Understanding and Treatment of the Adoptee

Christopher Deeg. 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.

Historically, the adopted person has always been faced with a lifelong dilemma. The adoptee is the central figure in a triad, enveloped within various social strictures, customs, and legal structures that deny a historical and psychological reality—namely, connection to the biological parent. Social and legal attempts to sever the connection of adoptee to biological parent have ostensibly striven to ensure that the machinery of adoption is functional; nonetheless, they portend the underlying negative collective attitudes toward the biological parents and, by extension, the adoptee (Feigelman & Silverman, 1986).

Given the prevailing moralistic sexual attitudes, the institution of adoption has attempted to “protect” the adoptee from the perceived prurience of the biological mother, who is typically unwed. On a deeper level, the practice of permanently separating adoptee from biological parent and legally ensuring that this schism is never forded—by sealing adoption records and falsifying identifying information such as the adoptee’s original name—appears to betray a shared perception and fear of the lifelong connection between adoptee and biological parent (Lifton, 1994).

The Adoptee’s Cathexis of the Lost Object

More recent literature on the psychological challenges to the adoptee (Colarusso, 1987; Lifton, 1994; Verrier, 1993) more explicitly identifies the relationship of adoptee to biological parent as a central feature of the adoptee’s experience. In previous contributions to this subject (Deeg, 1989, 1990, 1991, 2002), I have proposed a psychoanalytic model for representing the inner world and experience of the adoptee. In short, the connection or cathexis of the biological parent representation to the adoptee is the central feature of this model. The question of the origin of the representation challenges the rigors of psychoanalytic theory as well as common sense. How does an individual develop an internal representation without external extrauterine experience? From a drive model perspective, the object is first cathected for a number of reasons: (1) because of its direct drive-gratifying function; (2) because once it is gradually internalized, it provides temporary gratification when the environment fails to do so; and (3) because it directs the organism back to the external source of gratification. Following initial cathexis, libido can be withdrawn from a particular object and become available for new attachments (Greenberg & Mitchell, 1983). This second process corresponds to Freud’s description (1923) of the ego as the aggregate of abandoned object cathexes.

Most object relations theories posit the object as an inherent aspect of drive from the start. Either there are no drives without objects or the drives are inherently object directed and only secondarily libidinal or aggressive (Fairbairn, 1952). Klein (1932) posited inborn, inherent universal “phantasies” of objects, a concept that has been challenged by modern paradigms of cognitive development and in the present discussion is too general to adequately account for the specificity of the adoptee’s fantasy of the biological parent and its related affect.

I proposed that the biological parent is an amalgam of both forerunners of drive derivatives, possibly originating during the uterine period, and displaced or projected aspects of the adoptive parents (Deeg, 1989). In this model, the biological mother enjoys a physiologically elite relationship with her fetus by virtue of the prepatterned “eurthymy” of the neonate’s responses to the mother’s vocal and physiological sounds and overall biological presence. The “prepatterning” would therefore occur in utero and create a prepsychological bond and “dialogue” between neonate and mother. Research findings, such as those of DeCasper and Fifer (1980) and Stern (1985), in which neonates were able to recognize the voices of their biological mothers are not contradictory to this supposition. In psychoanalytic terms, the biological mother may be in a superior position to provide the newborn with drive-neutralizing, auxiliary ego functions necessary for its survival and growth.

This physiological “advantage” does not ensure optimal symbiosis, nor does its absence—in the case of a competent and empathic adoptive parent—denote certain pathology. It does, however, imply that the bond between biological mother and infant predates, at least as a forerunner, the surrender of the infant for adoption. The surrender, then, registers a loss, a disruption, even if this is “experienced” prepsychologically, by virtue of an interference with physiological forerunners of enteroceptive and proprioceptive perception. In short, this model supports the view that the adoptee, in some manner, records the experience of surrender as a loss, and thus it provides a theoretical underpinning for many other works on adoption that describe the adoptee as having suffered a trauma.

Early work on adoption typically focused on perduring negative or traumatic effects for the adoptee (Barnes, 1953; Hodges, 1984; Schechter, 1960). More recent literature (Lifton, 1988, 1994) has detailed the journey of the adoptee vis-à-vis the “trace” of the biological parent. In the model that I have proposed, the connection of the adoptee to the biological parent is given a definite historical referent. Even under optimal conditions, the adoptee’s surrender is registered as disruptive, since the cathexis of the biological parent essentially begins in utero. Trauma, in psychoanalytic terms, refers to an event that overwhelms the ego’s ability to manage the flood of instinctual cathexis in response to a stimulus. From this perspective, the adoptee’s surrender can be understood as traumatic, and the adoptee’s inner connection to the “lost object” (Deeg, 1989) would be presumed to exist in every case.

The adoptee’s cathexis of the biological parent evolves, as do all internalized object relations, under the influence of psychological maturation and interpersonal and environmental events. The relation of adoptee to biological parent is conceptualized in traditional object relational terms (i.e., as consisting of a self representation and an object representation, and an affective link between the two) (Kernberg, 1976). A multiplicity of adopted self/biological parent units can be conceptualized corresponding to the various fantasy and thematic materials that the adoptee presents. Since the original “layer” of the representation is thought to be developmentally primitive, splitting mechanisms typically regulate the quality of these early representations. Thus, an “all-good” biological parent is linked to an “all-good” adoptive self representation and obversely, an “all-bad” self representation is linked to an “all-bad” object representation. Since the surrender of the adoptee has been registered within as a structural forerunner, the earliest representations of the mother and the corresponding self are often imbued with aggression.

One of the earliest psychological challenges for the adoptee is to contain the aggression attached to the biological parent representation so that the corresponding self representation is preserved and separation is supported (Deeg, 1989). Splitting mechanisms corresponding to nascent ego processes (Jacobson, 1964) are mobilized to facilitate this process. The adoptee’s earliest internal representation of her relation to the biological parent then consists of groupings of good objects and self representations kept separate from bad objects and self representations. As aggressive drive derivatives are contained or metabolized, further integration of internalized object relations become possible, that is, an all-good object representation can be “related to” a bad self representation and vice versa. Certain fantasies are commonly observed during treatment that illustrate and textualize the adoptee’s struggle with this relationship.

The biological parent can be presented as an evil or negligent abandoner of the vulnerable adopted self. In the obverse of this fantasy, the idealized, potentially all-giving biological parent abandons the hated, deformed, or worthless adopted self. Both fantasies are based on splitting mechanisms; they are not mutually exclusive and can, in fact, be seen to oscillate within the clinical material. Their emergence is not restricted to the therapy of adoptees with borderline personality organization. Often, an adoptee with more traditionally neurotic adaptation splits off this particular object relation, thereby removing it from the realm of integration and maturation within which the remainder of the personality functions.

An adult adoptee with a severely strained marriage and a highly ambivalent relationship with his adoptive mother, but generally positive relations with others, initially reported only a vague emptiness when he thought of his biological mother. Eventually, his associations revealed that he imagined her to be narcissistic, cold, and completely unable to love him or anyone else. He appeared to transfer this fantasy to his adoptive mother and wife but not to the men in his life or to women with whom he enjoyed less intimate relationships.

Another fantasy predicated on the idealization of the biological parent presents the all-good birth mother as a lost object, with whom reunion promises the ineffable fulfillment that is only gleaned through merger with a perfect other. In treatment, intensely negative connections to the biological parent representation are more heavily defended and often kept from consciousness. Often, an underlying wish for reunion can be detected even within fantasies of a dreaded birth mother.

A preadolescent adoptee reported a story and caveat that particularly terrified him despite his age-appropriate awareness that there were no ghosts or monsters living in his house. He reported with great trepidation that his friends had told him that if he stood in his bathroom and said the name “Bloody Mary” three times, a ghostly woman would appear in the mirror and demand to know the location of her lost baby. He would only spell the moniker and was too frightened to actually utter it.

Defensive Functions of the Internalized Relation between Adopted Self and Biological Parent

The internalized relationship between adoptive self and biological parent is a dynamic factor within the personality and is both influenced by, and a determinant of, the adoptee’s development (Deeg, 1990). Although beyond the scope of the current exposition, I have previously detailed some of the possible ways in which the connection to the biological parent is used as a defensive function for the adoptee. In general, the object relation is used to maintain psychic equilibrium: Objectionable impulses are warded off, or missing gratifications are provided in fantasy. Six defensive functions that I have described earlier are the biological parent representation as (1) a receptacle for warded-off negative aspects of the adoptive parents, (2) a primitive narcissistic regulator, (3) a fantasy source of libidinal gratification, (4) a defense against (conscious) disruptive aggressive discharge toward the adoptive parents, (5) a defense against disruptive libidinal discharge toward the adoptive parents, and (6) a means of masochistic defense. In general, the biological parent either is projected or displaced onto difficult aspects of the adoptive parents or substitutes for absent gratifications in the environment. In the former function, the biological parent representation becomes more defined and, through projective/ introjective processes, acquires content. In either case, the need of the adoptee for increased form and content in the sphere of the biological parent is emphasized.

An adolescent adoptee described his fantasized biological mother as warm, nurturing, and possessing the ability to quell his anxiety. He experienced his adoptive mother as relatively cold and unaffectionate. Analysis of this latter fantasy suggested that when he was younger, the adoptive mother was better able to “fit” with him physically and thereby provide less ambivalent affection and warmth. The fantasy of the biological parent contained the lost contact with the adoptive mother. Obversely, the exaggerated portrayal of the adoptive mother as “cold as ice” was a projection of a defended representation of a depriving biological mother who cruelly had left her infant and had abandoned a baby defenseless to the elements.

As the internal biological parent imago becomes layered with nonmetabolized, idealized, and devalued aspects of the adoptive parents, the adoptive self also evolves and becomes more “knowable” by virtue of increased content. This idea is brought into relief when one conceives the concept of “identity” as always involving the relationship of internalized “selves” to objects. The overall experience of a continuous, relatively seamless “self-feeling” is based on the gradual intrapsychic separation and differentiation of self and object representations, initially through the process of splitting. Eventually, these representations are reintegrated into larger, more inclusive, depersonalized self and object representations. This lends to one’s overall feelings about one’s place among other people. In general, an overall but not exclusively positive or libidinal cathexis of the representations helps to support this cognitive/emotional process. Kernberg (1976), borrowing from Erikson (1950), designated the product of this process “ego identity.”

The splitting off, disassociation, disavowal, or repression of the biological parent/ adoptive self dyadic representation, even in cases where overall object relations and ego functioning are not severely impaired, interferes with the consolidation of identity (Deeg, 1991). The central significance of the issue of identity and identity consolidation in exploring the experience of the adoptee is generally obvious in treatment work with adoptees. The questions “Who is my mother?” and “Who am I?” are critical in the psychotherapy of adoptees (Hodges, 1984). This can be explained from the vantage point of the centrality of the underlying cathexis of the biological parent (Deeg, 1991).

From an object relational perspective, questions pertaining to personal identity are always in relation to object representations. “Who am I?” is thus reframed as “Who am I in relation to whom?” The experience of identity is therefore not uniform across relationships. Nonadopted patients frequently report feeling a regressive shift in their identity as adults when visiting a parent. A patient may report, “I always feel like I’m a little kid again when I stay with my mother.” For the adoptee, the relation to the biological parent is often the least integrated sector of personal identity. Since external experience with this figure has been prevented, typical drive-neutralizing, affective, and cognitive maturational processes do not have an opportunity to bring this relation into the evolved level of maturity and adaptation of the rest of the personality. The adoptee’s focus on the issue of identity can also be seen as a feature of the adaptational pull to correct this disunity.

The Adoptee in Psychoanalytic Therapy

The adoptee brings to treatment a specific dynamic that represents all the vicissitudes and iterations that having an internal relation with biological parents with whom one has had little or no extrauterine contact engenders. This circumstance requires a clinical sensitivity to specific treatment configurations that arise under these conditions. This, however, is not a substitute for diagnosis. The adoptee’s ego functioning, general quality of internalized object relations, and degree of adaptation still require study and some attempt at initial formulation. The relationship of diagnosis to treatment is somewhat theory bound, but in classical psychoanalytic therapy, generally, parameters of technique (Eissler, 1953) that modify one’s emphasis, and perhaps therapeutic goal, are determined by one’s conception of the patient’s functioning. It is not enough to identify a patient as “adopted,” nor can this fact be ignored. The adoption of the patient can be seen as vital idiographic data; the question of the patient’s diagnosis, however, remains.

By first addressing diagnosis, the issue of technique in treating the adoptee raises questions such as “Are the conflicts generally neurotic within the context of generally stable good inner object relations?” and “Is the adoptee’s personality organization borderline?” and “Has reality testing been permanently impaired or merely compromised as a result of ongoing external crisis or intersystemic conflict?” (Deeg, 2002). Second, the therapist must attend to the specific manifestation of the issue of adoption as it unfurls within the treatment matrix. In my view, the leitmotif of the adoptee’s experience—namely, the relation of adopted self to biological parent—will be displayed both within and outside of the transference. The issue of identity and the particular ambiguity regarding inner and outer reality (as expressed by Hodges’s [1984] report of two central questions of the adoptee, viz., “Who am I?” and “Who is my mother?”) are brought into relief by both technical adjustment and emphasis—a point to which I will return below.

One is immediately confronted with countertransferential difficulties. As with any patient who is “identified” with a prominent idiographic issue, in this case adoption, one must remain open to allowing therapeutic attention to evenly drift into areas that may not be a part of these narratives. Derrida’s (1974) notion of “interiority” is relevant here. Material that does not appear to be derivative of the adoption can be seen as secondary, not as relevant, or “exterior” and therefore given reduced therapeutic concentration. This is particularly likely in cases where a patient seeks treatment with a therapist who is known to have expertise in the area of adoption. A tacit collusion can evolve in which the patient is “adopted” as “special” because of his or her adoptive status by an idealized adoptive parent/therapist. Conversely, the therapist’s unacknowledged narcissistic or dependency needs can be gratified by a patient who specifically sought the therapist out for his or her specific prowess. If the collusive fantasy comes into analytic focus, the patient may experience re-abandonment, while the therapist may worry that he or she has been emotionally unavailable or unnecessarily depriving (Deeg, 2002).

The fact of the patient’s adoption can be seen as vitally important and uniquely relevant idiographic information that will place the treatment in a specific context and increase the likelihood of specific dynamic configurations. This approach does not, however, demand a radical departure, either in diagnosis or in treatment, from broad ego psychological or object relational parameters.

The Binary Transference

The very existence, let alone its analysis, of transference in the treatment setting is confusing. The patient’s reality testing is challenged by the interpretation that feelings experienced as connected to one person are also reflections of currently nonexperienced feelings for a person from the past. Transference interpretation is an immediate assault on the patient’s construction of reality that provides the means for the ultimate acquisition of increased insight and for an opportunity to experience and work through in vivo conflicts. Part of the analytic work consists of a reconstruction of the patient’s reality testing with an improved differentiation between inner and outer reality.

For the adoptee in treatment, the situation is strikingly complex. The adoptee’s transference to the therapist typically consists of affects connected to both sets of parents. The existence of two sets of internalized parental representations (in addition to attendant self representations) creates a transference situation that ranges from multilayered amalgams of biological/adoptive parental representations to chaotically undifferentiated representations, where differentiation between biological and adoptive is largely absent.

To some extent, “complete” differentiation of the biological from the adoptive parent representation is impossible; the biological parent representation is already an amalgam of prepsychological forerunners of affect, fantasy contents, and aspects of the adoptive parents that have been incorporated through the defenses noted above (Deeg, 2002). In cases where the relationship with the adoptive parents is ongoing, the representation of the adoptive parent that emerges in treatment can be checked against current experience. Questions about the past can be asked, and narratives can be gathered. Ultimately, some degree of differentiation can be achieved. The analyst in effect offers this observation:

The image of your adoptive parent appears to differ from the way you currently experience him or her, or is quite different from the information you now have about your childhood. It is possible that your image is at least in part, a reflection of your feelings about the image you have of your biological parent.

The analysis of the binary transference inevitably brings to the fore the real limitation that adoption, particularly closed adoption, has for the adopted patient. The nonadopted patient can legitimately ask, “Which parent from my past do these particular set of feelings appear to identify, on the basis of my recollection of that parent’s personality and behavior?” (Deeg, 2002). Furthermore, an ongoing relationship with the parent or someone who knew the parent permits further cross-checking and exploration. In the typical adoptive case, the analysis of transference brings into relief the absence of these avenues of interaction; the adoptee is once again faced with the presence of a relationship to a mother and father who are absent in the everyday world. Sometimes, this exploration may serve as an impetus for a search for the biological parent. Regardless, the unfolding of the binary transference confronts the adoptee with real loss and is typically met with any of a full spectrum of affect and affect-infused object relational derivatives.

A female adolescent adoptee in treatment continually complained about the excessive regulations imposed on her by her adoptive mother whom she regarded as distrustful, rigid, and repressive. The patient frequently referred to her as “not my real mother.” She described a preferred mother who was more physically attractive than her adoptive mother (the patient herself was quite attractive), tolerant, and able to weather the patient’s desire for increased contact with her male peers. The adoptive mother in consultation revealed considerable anxiety that the patient would become sexually active and impregnated or afflicted with venereal disease. These fears appeared to have originated as reactions to the daughter’s evolving feminine beauty and sexuality, and represented compromise formations that suppressed her own sexual conflicts as expressed by the fear and wish that the patient would emulate her birth mother’s sexual history. Earlier in the life of the patient, the adoptive mother seemed less anxious and less conflicted in her emotional and tactile interchanges with her daughter. The likelihood, therefore, was that the fantasy of the desired mother was based in part on actual childhood experiences with the adoptive mother, and on a cathexis of intrauterine forerunners. The therapeutic work then focused on the patient’s gamut of reactions and defenses to her recognition that this ambiguity could not be fully resolved, and the resulting feeling that another bit of full adult access and privilege had been denied to her. (Deeg, 2002, p. 197)

As the adoptee encounters a more complex and ambiguous lost object both within and beyond the treatment setting, the wish for reunion with and love from an idealized birth parent, as represented by the attainment of actual knowledge or reunion, becomes frustrated. In nonadoptive cases, the patient often experiences the pleasure of experiencing a renewed relationship with a parent following transference exploration or the satisfaction of acquiring the ability to experience an old memory differently. The patient’s increased tolerance for ambiguity is often suggested as a central element in these new experiences. Without actual knowledge, or eidetic memory of the birth parent, the adoptee’s representation of the lost object retains an impermeable degree of ambiguity and tentativeness. This outcome, despite the best of attempts to discern the adoptive from the biological parents, illuminates the real loss and permanent disadvantage that is inherently part of being adopted. The provision of empathy in working with this situation, along with the working through of the transference, is critical.

On occasions where treatment is permitted to run a long-term course and is not abbreviated, evidence of displacement from the adoptive parent onto the representation of the biological parent can be discerned. It is here that the various “defensive mechanisms” that use the adoptee’s cathexis of the biological parent (Deeg, 1990) are typically clarified. The portrait of the adoptive parent may reflect warded off, fantasized elements of the biological parent, or more often, the “content” of the biological parent representation may represent projected or displaced aspects of the adoptive parent. As reconstruction of the adoptive parent proceeds, the various “borrowed” aspects of the adoptee’s fantasy of the biological parent may become less nebulous and more available. Initially, the displacement satisfied two needs at once: (1) the relationship to the adoptive parent was protected by sanitizing the representation’s undesirable aspects and (2) the representation of the biological parent acquired real, although often negative, content. That the adoptee unconsciously prefers negative content to a contentless, inchoate, shadowy figure is the typical clinical situation.

An adult male adoptee was surprised by the nurturing and supportive portrait of his adoptive mother that emerged in his treatment. He had perceived her as “off in her own world” and indifferent to his needs and sensibilities. This perception screened an early childhood fantasy of his biological mother as a self-absorbed, although talented and attractive, woman who had been circumstantially unable to love him and with whom he had symbolically sought reunion in the various relationships he endured with emotionally unavailable women. This insight enabled him to experience less ambivalent loving feelings for his adoptive mother. (Deeg, 2002)

As will be discussed below, the revelation of this mechanism does not reverse the trend of accruing content and making the biological parent more discernable. The therapeutic goal is to increase the availability of numerous, well-developed, and affectively enriched fantasies, thus enabling the adoptee to enjoy a widening laterality of emotional discharge and enlivened interchange with the biological parent representation.

The ambiguity that is confronted in the treatment through the emergence of the binary transference extends to the question of identity. For the nonadoptee, real eidetic and visceral memories of self interacting with the birth parent reference, imbue, and demarcate the self representation with cognitively and affectively processed content. In many ways, the absence of the birth parent in memory signals an experience of the absence of self. Therapeutic focus on the reflection of the adopted self and birth parent in the here and now of current exchanges between patient and therapist and patient and contemporaries can provide some succor to the patient who feels condemned to bear a permanently nebulous self representation under the shadow of a lost birth parent. The analyst must declare to the patient,

Although you cannot see yourself through memories of interaction with your birth mother, let us not focus on the revelation of your self vis-à-vis others and here with me. Let us also encounter you in deciphering your fantasies of the birth mother you wish for, and the birth mother you dread. (Deeg, 2002, p. 198)

The self representation in toto of the adoptee is under construction, as it would be in any analysis. The absence of early experience with the birth parent, or the denial of access to information about the birth parents, and all vicissitudes of loss that accompany these facts, are recognized and empathized with by the therapist but not accepted as an impermeable block to full identity consolidation. The therapist brings to the adoptive patient the message that “the uniqueness and completeness of your self can be reclaimed in our work here.”

If the adoptive self is retrievable, what of the biological parent representation? In attempting to differentiate birth mother from adoptive mother, the adoptee often reveals a tacit metapsychological bias: that the “self” of the self-object dyad is present and evident, while the object is only represented or signified. The adoptee’s analyst may share in this bias as well by perceiving that the lost maternal or paternal biological object is not as available to reformulation and reconstruction as the adopted self; the object may then, more or less, be left out of the treatment endeavor. This bias probably derives from the traditional Western metaphysical axiom that the presence of the self is both constant and evident. In psychoanalytic treatment, an unexamined assertion may be discerned: The self representation somehow stands closer to the thing-in-itself, the self, and is therefore more central or real than the object representation. When the historical confusion between the terms self and self representation is added, the analyst may well foster an assumption that the self is more knowable, experience-near, and therefore malleable than the object. For the adoptee, this reinforces the fear that the biological parent will remain alien and nonmetabolized within the psychic system.

Derrida’s (1974) contention that the linguistic form, “the signified,” which in traditional Western metaphysical thought is granted axiomatic self-evident presence, is merely a signifier—referring not to actual presence, but instead to a web of other linguistic signifiers—is relevant to this issue. In this view, the analyst and patient are always dealing in the currency of signifiers. There is no “real” self that underlies and supplants all self representations. The self is yet another narrative contrivance, a metaphor, signifying another link in the web of signification. This web is not discovered as being out there; it is written and edited by human beings struggling to express meaning. A multitude of selves and objects are deconstructed and constructed as the “text” of the analysis is written and rewritten—selves as equally substitutive as objects. This perspective yields a particular freedom with which the patient’s texts can be decoded and new, mutually constructed selves and objects are coalesced and integrated, all of which better contextualizes and codifies the patient’s history and experience. The internalized representation of the other, in this case the biological parent representation, is rendered no less real or present than the representation of the abandoned self or any variation on the adoptive theme. In fact, the biological parent representation can enjoy equal analytic status with any other representation or content and therefore fully participate in the treatment. For the adoptive patient in particular, this affords critical therapeutic advantages.

While fully validating the register that the visceral, tactile, sexual, and interpersonal absence of the birth parent has left on the patient, the sense that the psychic world of the adoptee must perforce sustain an experiential sense of unreality can be metapsychologically and clinically rejected by the analyst and interpreted to the patient in drive/defense, interpersonal, or transferential terms. In essence, the patient is given the hope of a more complete and integrated phenomenology. Second, the tacit assumption that therapeutic construction and reconstruction of the birth mother representation cannot take place because the exterior “signified,” real origin of the imago is absent can be dismissed, for the adoptee’s sake and often for the therapist as well. Frequently, the adoptee enters treatment with a silent hopelessness regarding the prospects of inner exploration and change because the real object “was never there.”

Although the analyst may support the work of mourning the absence of the birth parent, particularly when the patient’s ego is temporarily overwhelmed with the burden of deprivation and frustration of drives not gratified by the birth parent, tacit collusion with the patient’s resistance to examining the representation of the biological parent is reinforced by sharing the patient’s perception that the representation is infused with a shadowy unreality and immutability. When both patient and therapist consciously or unconsciously believe that the distance of the birth mother representation from the “actual” mother renders it clinically irretrievable, the therapeutic work is necessarily limited and goals corrupted. By conceptually creating a level playing field in which all intrapsychic objects are considered constructions, object representations can be regarded as highly condensed narrative residues subject to process, modification, fantasy, enactment, and interpretation. The metaphysical bias deconstructed places the representation of the biological parent squarely back into the therapeutic field, its shadowy unreality and immutability viewed as only one possible narrative theme. In short, a central figure in the adoptee’s inner world becomes valid grist for the mill.

An adopted woman in psychoanalytic treatment presented a scarcity of associations or other manifest material relating to her adoption. She clearly stated that fantasies regarding her birth parents were “pointless” because she had no actual contact with them. She presented a sharp dichotomy between inner and outer reality and only valued the former if it accurately represented the “real” objects of her environment. This was part of a deeper distrust and rejection of fantasy in general. Her rejection of fantasy portrayed an enactment of her need to reject her unreliable biological mother and simultaneously gratified a desire for revenge that expressed her pained representation of the abandoned infant self. (Deeg, 2002, p. 200)

The Adoptee’s Need for Content

As defenses are analyzed and countertransferential issues resolved or consciously integrated into the treatment, the adoptee’s need to fill the vacuous image of the birth parent with content often takes center stage. Borderline or severely regressed adoptive patients often construct a rigidly idealized representation designed to permanently restrict the emergence of overwhelming sadistic or annihilation fantasies. Adoptive patients with greater ego strength will also frequently offer up an initially idealized image of the birth parent as a tentative first step in allowing hitherto inaccessible fantasy elements a free rein. In the latter case, the need to “keep things positive” is less draconian and more susceptible to interpretation.

For the therapist, it is important to regard the biological parent as a representation in statu nascendi and to convey this attitude to the patient. To patients who regard their image of the birth parent as an empty, psychic “black hole,” this may seem farcical, counterintuitive, and on a deeper level, frightening—a possible symbol for uncontrolled or irreversible regression. Sometimes, the patient’s insistence that a “real,” knowable person stand behind the fantasy person discussed in therapy may be discerned as a demand that the lost object return and nurture the abandoned self. The adoptee in essence states, “No, I will not entertain an examination of my feelings and ideas about an inner person, unless that person is also external, and reciprocates by considering me as well” (Deeg, 2002, p. 200).

The adoptee’s fear of regression in doing this work is understandable. By fantasizing about a person he has never met, the adoptee’s hard-won differentiation between inner and outer reality is blurred. As the adoptee is asked to report his feelings about the biological parent as though engaged with an external object with the promise that reality testing will in the end be fortified, he may report that he feels “strange” or “silly,” like children entertaining conversation with an imaginary friend or toy. These affects signal the emergence of conflicts with the biological parent.

Just as the biological parent is ultimately contemporized within the level of the patient’s overall relationships to others both internal and external, the representation of the adopted self is also revisited and revised. The patient’s question “Who am I?” is therefore addressed as identity formation is supported. The patient gains access to the various aspects of the adopted self as narrative texts regarding the biological parent are explored and tolerated.

A Specific Resistance to Exploration of the Biological Parent Representation

No patient wants to lose something valuable by virtue of analytic treatment. In the most general terms, this can apply to intrapsychic objects, symptoms, or contents of any sort. The fear of loss can be one motivation for resistance, defined by Fenichel (1945) as “everything that prevents the patient from producing material derived from the unconscious.” The fear of losing the experience of love of the analyst through interpretation was described by Greenson (1967). The fear that treatment generally or interpretation specifically “takes away” can have various meanings, including anal (the robbing of valued internal contents) or oedipal (as a reaction formation to the wish to be penetrated by interpretation). When the adoptee fears that treatment will take away or ruin the love experienced as flowing from the good biological parent, themes of abandonment or a reliving of the surrender of self by the mother may be remobilized. The adoptee essentially pleads, “Please do not violate the security I experience from the image of my all-good birth mother loving my infant self.” Conversely, the counterwish—to abandon the mother in retaliation—is supported by this resistance. The patient basically states, “Now that I have filled this representation with good content, let’s just let it be and talk about something else.”

The patient’s fear of mourning or re-abandonment can be assuaged by the eventual realization that the fantasy of the “good” birth parent does not have to be destroyed. The rewriting and cocreating of various internal scripts acquires increasing latitude as more affects are tolerated linking self to biological parent. The “good birth parent” becomes one among possibly many alternatives. No one true fantasy becomes enshrined as the “real” relationship to the birth parent. As a result, the patient’s store of fantasy, means of interior discharge, and overall inner life become more vibrant. As affects and fantasies regarding the birth parent become more easily expressed in the treatment, both the biological parent representation and the adopted self become enriched, less threatening, and better integrated into the adoptee’s identity.

The Adoptees’s Overall Gestalt of the Analysis

Given a treatment situation that is not prematurely interrupted, the adoptee integrates the various thematic and affective transference elements into a superordinate gestalt roughly corresponding to the transference neurosis (Fenichel, 1945). Despite the variations in the ebb and flow of the treatment, the patient often reports that the therapy experience as a whole tends toward a particular theme. The patient reports feeling abandoned, surrendered, or reunited with the therapist or reverses the roles. The superordinate theme generally, at least in part, retells important historical elements as well.

The therapist, once again, works with the overall transference not as an absolute truth, but as a signified, co-constructed interplay, which allows for increased insight, emotional availability, and reparation. The choreography of interaction is observed by both participants. The therapist’s invitation to “join me in this endeavor” mobilizes an ego that is interested in overcoming passivity, repression, or splitting as a means of coping. The experience of becoming active modifies the adoptee’s inner experience of passive abandonment.

An adopted male patient feared that his ridicule and scorn of his analyst would undermine the latter’s confidence in himself as a professional and as a person. The patient’s adoptive father was a passive, schizoid man whose frequent verbal excoriation by the patient’s mother occurred nakedly within the center arena of the family. The father would then scornfully criticize his son when the mother was away. Mirroring his reluctance to retaliate against a castrated adoptive father, the patient also feared that he would unwittingly participate in his biological father’s emasculation and humiliation (also in the person of the analyst). Together, these binary transference elements comprised the central dynamic of the treatment and also explained the patient’s general inhibition of masculine aggression toward his peers. (Deeg, 2002, pp. 200-201)


For the adoptive and nonadoptive patient alike, termination typically symbolizes loss; active libidinal ties are severed, self and object representations are separated, fantasies that connote an act of aggression inflicted on either patient or analyst are common. For the adoptee, the universal meanings of loss are necessarily colored and imbued with particular meanings and affects. Thus, the impatient adoptive analyst re-abandons the patient because the latter cannot elicit love, the biological parent analyst abandons the patient because of the latter’s inherent badness, or the adoptive self is punished by the adoptive analyst in retaliation for the autonomy and independence that has been gleaned through the treatment but now threatens the latter’s belief that emotional ties to the birth parents are dead.

A late-adolescent adoptive patient unconsciously feared termination and began missing sessions in an attempt to postpone the event. The patient eventually recalled a similar childhood fear that his proficiency in art would cause his adoptive mother to say, “You think you’re so talented and better than us, why don’t you go and live with your biological mother?”

Specific ideographic elements of each case will largely determine the heuristic context that the termination mobilizes, but in general the ending of the therapy bespeaks the resurgence of fantasies of loss, abandonment, salvation, or reunion.

Resistance to termination often is expressed by a resurgence of symptomology (Dewald, 1966; Firestein, 1969; Kernberg, Selzer, Koenisberg, Carr, & Appelbaum, 1989). Langs (1974) described the specific fantasies regarding birth and death that are often generated in all terminations. For the adoptee, it is prudent to expect a pronounced reaction to termination, as one would with any patient whose unconscious leitmotif is inextricably linked to experiences of irrevocable separation or loss (Deeg, 2002). Resistance to termination does not alter the therapeutic goal: to facilitate a verbal expression of the associated affects, drive derivatives, and internalized object relations that emerge through associations, enactments, fantasy, or symptom. The reemergence of symptoms should not be automatically considered a failure of treatment but, again, as a resistance to full conscious experience and expression.

A resistance specific to the adoptee who is ending treatment while simultaneously beginning a search for birth parents may emerge. The patient may tacitly equate the search with activity, mastery, and control while devaluing the treatment as a passive “spinning of the wheels,” unconsciously equated with the original abandonment. The adoptee frequently becomes impatient with the passivity of talking and yearns for the reality of a search. The therapist may be seen as helpful and kindly but incontrovertibly substitutive for the real world, for the birth parent. The patient is saying yet one more time, “I’ve had enough substitution (adoption), give me the real thing” (Deeg, 2002). In this fantasy, the intolerable passivity of the infant self is irrevocably undone by the motility and activity of the search for the birth parent.


An outline of a psychoanalytic approach (Deeg, 1989, 1990, 1991, 2002) to understanding and treating the adoptee has been presented. At the heart of this model lies the identification of the adoptee’s internal relationship to the psychic representation of the birth parent. This relationship is presented as a leitmotif for the adoptee, determining and influencing in various ways many subsequent internal and external object relations. The origin of this relation is presented within hypothetical parameters, since treatment and observational data cannot be accessed so early in development. Nevertheless, an explanation for the identification of surrender/adoption is postulated. The reciprocal relation to fantasy is described in which the relation of adopted self to biological parent both determines and is determined by fantasy. Specific defensive uses of the relation are described, documenting the manner in which the object relation operates as a personality determinant throughout the life cycle. The relationship of the object relation to the issue of identity formation is described. Finally, the technique of psychoanalytic psychotherapy with the adoptee is described—diagnostic issues, treatment parameters, and specific modes of transference and countertransference are described. A radical deviation from technique is not prescribed.

The adoptee in psychoanalytic treatment is adopted, surrendered, abandoned, and reunited as the protean, nonlinear affective flow of internal object-relational dynamics demand. The therapist is called upon to acknowledge the particular thematic and textual idiosyncrasies of the adopted patient, while avoiding the temptation to perceive an abandoned infantile self as “special,” and therefore requiring perduring “empathic” departure from the analytic position. This caveat heeded, the analyst avoids a promise that cannot be fulfilled, and thus paves the way for reacceptance by the patient of the abandoned self whose object is irretrievably lost-beyond the love, but not the understanding that empathy can offer. (Deeg, 2002, p. 204)