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Core Clinical Issues Core Clinical Issues in Adoption in Adoption Advanced Clinical Advanced Clinical Permanency Training for Permanency Training for Massachusetts DCF Massachusetts DCF Supervisors Supervisors Worcester, MA Worcester, MA March 3, 2011 March 3, 2011
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Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

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Page 1: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Clinical Issues in Core Clinical Issues in AdoptionAdoption

Advanced Clinical Permanency Advanced Clinical Permanency Training for Massachusetts DCF Training for Massachusetts DCF

SupervisorsSupervisors

Worcester, MAWorcester, MA

March 3, 2011March 3, 2011

Page 2: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Every clinician is in Every clinician is in post adoption post adoption practicepractice

– – Ann HartmanAnn Hartman

Page 3: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Language in the Context of Language in the Context of AdoptionAdoption

Members of the Adoption ConstellationMembers of the Adoption Constellation

- Birth Parent/Family – Mothers and - Birth Parent/Family – Mothers and Fathers extended family, grandparentsFathers extended family, grandparents

- Adopted Person- Adopted Person

- Adoptive Parent/Family- Adoptive Parent/Family

Page 4: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

An Overview of Some Adoption An Overview of Some Adoption IssuesIssues

Careful matching to avoid “detection”Careful matching to avoid “detection”

Child’s status hidden as were parent’s Child’s status hidden as were parent’s infertility issuesinfertility issues

Birth mother excluded from knowing Birth mother excluded from knowing where her child was placed – where her child was placed – encouraged to “get on with her life”encouraged to “get on with her life”

Needs of birth fathers rarely addressedNeeds of birth fathers rarely addressed

Page 5: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

An Overview of Some Adoption An Overview of Some Adoption IssuesIssues

Adopted parents received very little Adopted parents received very little information about the child or his/her historyinformation about the child or his/her history

Help the family “claim” the child as their Help the family “claim” the child as their ownown

Adoption workers had to find the “right” Adoption workers had to find the “right” familyfamily

Many workers used their “own values” to Many workers used their “own values” to guide this processguide this process

Page 6: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

An Overview of Some Adoption An Overview of Some Adoption IssuesIssues

Deserving Adoptive Parents were Deserving Adoptive Parents were married couples, infertility issues, married couples, infertility issues, financially stable, usually white financially stable, usually white

Foster parents, single parents, non Foster parents, single parents, non married couples, relatives not married couples, relatives not deemed appropriatedeemed appropriate

Secrecy was key to successSecrecy was key to success

Page 7: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

An Overview of Some Adoption An Overview of Some Adoption IssuesIssues

Worker is “expert;” Worker is “expert;”

Birth family is “dangerous or Birth family is “dangerous or deviant;” deviant;”

Adoptive family is “appropriate;” Adoptive family is “appropriate;”

Child is best served as if they were Child is best served as if they were born into the familyborn into the family

Page 8: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Historical ShiftsHistorical ShiftsMyths that ContinueMyths that Continue

Paradigm shift from secrecy to opennessParadigm shift from secrecy to openness

Adoption is the same as being in a birth Adoption is the same as being in a birth familyfamily

Triad members need to be protectedTriad members need to be protected

Everyone should move on Everyone should move on

Win/Win/Win situationWin/Win/Win situation

Genetic information is not relevantGenetic information is not relevant

Page 9: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Adoptive Families and Social Adoptive Families and Social ServicesServices

What happens after finalization?What happens after finalization?

Is permanency a panacea?Is permanency a panacea?

Most commonly cited identified Most commonly cited identified need by professionals and parents need by professionals and parents was for qualified, adoption was for qualified, adoption sensitive mental health sensitive mental health professionalsprofessionals

Page 10: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Adoptive Families and Social Adoptive Families and Social ServicesServices

Services sought in one Illinois study were: Services sought in one Illinois study were:

Individual counseling for the child (68%)Individual counseling for the child (68%) Family counseling (35%)Family counseling (35%) Individual Counseling for the parent(s) Individual Counseling for the parent(s)

(31%)(31%) Parent support groups (15%)Parent support groups (15%) Support groups for children (10%)Support groups for children (10%) 26% of children were hospitalized26% of children were hospitalized 10% had formal placement outside of 10% had formal placement outside of

homehome

Page 11: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Families Report that Helping Families Report that Helping Professionals:Professionals:

View family as pathological, sometimes View family as pathological, sometimes questioning parent’s motivation in questioning parent’s motivation in adoption;adoption;

Imply that the parent is blaming the Imply that the parent is blaming the child for family problems when the child for family problems when the parent raises the need to discuss parent raises the need to discuss adoption as part of the treatment;adoption as part of the treatment;

Lack of awareness of cross racially, Lack of awareness of cross racially, older children and those adopted in older children and those adopted in sibling groups;sibling groups;

Page 12: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Families Report that Helping Families Report that Helping Professionals:Professionals:

Advise parents to avoid talking about Advise parents to avoid talking about adoption as it will only “stir things up;”adoption as it will only “stir things up;”

Address child behavior problems through Address child behavior problems through behavioral methods without exploring behavioral methods without exploring how these behaviors may be connected how these behaviors may be connected to past deprivation, trauma or adoption;to past deprivation, trauma or adoption;

Urge hospitalization without Urge hospitalization without understanding the underlying effects of understanding the underlying effects of separation for children affected by separation for children affected by adoption;adoption;

Page 13: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Families Report that Helping Families Report that Helping Professionals:Professionals:

Failed to understand the child Failed to understand the child welfare system;welfare system;

Suggest that the parents “just got Suggest that the parents “just got a bad one” and urge families to a bad one” and urge families to return the child to the state.return the child to the state.

Page 14: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Shawn’s FamilyShawn’s FamilyAdoptive parents (Pete and Mary Simmons, ages 37 & 39 Adoptive parents (Pete and Mary Simmons, ages 37 & 39 years, married ten years) became foster parents of Shawn years, married ten years) became foster parents of Shawn when he was twelve years-old, he is now 15 years old. when he was twelve years-old, he is now 15 years old. Shawn was born to a young teen-aged mother who left Shawn was born to a young teen-aged mother who left him with her own mother, who cared for him for eight him with her own mother, who cared for him for eight years and then upon her death, he was placed in the years and then upon her death, he was placed in the foster care system. Timothy was neglected by foster care system. Timothy was neglected by grandmother who also abused drugs. Many reports of grandmother who also abused drugs. Many reports of neglect were filed with the parish. At the time of his first neglect were filed with the parish. At the time of his first placement, Timothy was described by the foster parents placement, Timothy was described by the foster parents as depressed, sad, and anxious – unable to tolerate being as depressed, sad, and anxious – unable to tolerate being hugged. Birth mother voluntarily relinquished her hugged. Birth mother voluntarily relinquished her parental rights, and the rights of birth father (who had not parental rights, and the rights of birth father (who had not been involved in Shawn’s life) were terminated. The first been involved in Shawn’s life) were terminated. The first foster parents were unwilling to adopt Shawn, once he foster parents were unwilling to adopt Shawn, once he had been freed up for adoption. The Simmons family was had been freed up for adoption. The Simmons family was identified as a good match for Timothy – they were identified as a good match for Timothy – they were interested in adopting a teen, Mr. Simmon’s knew Shawn interested in adopting a teen, Mr. Simmon’s knew Shawn from the high school where he taught Science and they from the high school where he taught Science and they had a good relationship.had a good relationship.

Page 15: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Shawn’s Family con’t Shawn’s Family con’t

The Simmon’s are concerned about the recent behavioral The Simmon’s are concerned about the recent behavioral difficulties shown by Shawn – initially he seemed to be so happy in difficulties shown by Shawn – initially he seemed to be so happy in his new home, now he is challenging their authority, coming in late, his new home, now he is challenging their authority, coming in late, and possibly experimenting with alcohol and other substances. and possibly experimenting with alcohol and other substances. They are particularly concerned about his recent refusal to go to They are particularly concerned about his recent refusal to go to school. school.

Adoptive Parents’ Brief Report of Recent History:Adoptive Parents’ Brief Report of Recent History:The Simmon’s describe the adoption of Timothy as a “gift” since The Simmon’s describe the adoption of Timothy as a “gift” since they had struggled with fertility issues for ten years before they had struggled with fertility issues for ten years before becoming his foster parents. Mr. Simmon felt that since he knew becoming his foster parents. Mr. Simmon felt that since he knew Shawn before he came to live with them that Shawn would respond Shawn before he came to live with them that Shawn would respond well to their family. They felt that since his life had been so hard, well to their family. They felt that since his life had been so hard, that they would not lay down too many rules for him. that they would not lay down too many rules for him.

Onset of Problems with Shawn:Onset of Problems with Shawn:The problems began when Shawn felt junior high and entered high The problems began when Shawn felt junior high and entered high school.school.

Therapeutic Intervention:Therapeutic Intervention:

Page 16: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Shawn’s Family con’t Shawn’s Family con’t Therapeutic Intervention:Therapeutic Intervention:

Shawn was referred by a high school Shawn was referred by a high school guidance counselor to a therapist in guidance counselor to a therapist in the community. The therapist had a the community. The therapist had a psychoanalytical orientation, never psychoanalytical orientation, never asked to see the parents separately asked to see the parents separately or with Shawn, and never asked or with Shawn, and never asked about Shawn’s birth family. Shawn about Shawn’s birth family. Shawn was referred to weekly drug testing, was referred to weekly drug testing, after school help, and after three after school help, and after three weeks of sessions refused to go to weeks of sessions refused to go to therapy. therapy.

Page 17: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Family Expectations:Family Expectations:

What was the family’s initial What was the family’s initial experience of adoption?experience of adoption?

What were the parent’s dreams?What were the parent’s dreams? When did the dreams begin to When did the dreams begin to

disintegrate?disintegrate? How, specifically, did the reality How, specifically, did the reality

differ from the dream?differ from the dream? What were the consequences of What were the consequences of

adopting this child?adopting this child?

Page 18: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Family Expectations:Family Expectations:

How did Shawn behave in his How did Shawn behave in his adoptive family?adoptive family?

How did Shawn’s parents originally How did Shawn’s parents originally interpret this behavior?interpret this behavior?

How did the first professional How did the first professional react?react?

How did the parents explain How did the parents explain Shawn’s behavior?Shawn’s behavior?

What help was offered?What help was offered?

Page 19: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Context of Adoption in TherapyContext of Adoption in Therapy

When adoption comes into playWhen adoption comes into play

Presenting problemPresenting problem

Not presenting problem but Not presenting problem but primary issueprimary issue

Additional layer of complexity to Additional layer of complexity to an issuean issue

Page 20: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Pitfalls for TherapistsPitfalls for Therapists

All or nothingAll or nothing

Therapist’s counter-transferenceTherapist’s counter-transference

The best solution is to disrupt The best solution is to disrupt the adoptionthe adoption

Adoption work is short-termAdoption work is short-term

Page 21: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Family-Systems ApproachFamily-Systems Approach CollaborativeCollaborative

Non-pathological modelNon-pathological model

Doesn’t foster secret/collusive Doesn’t foster secret/collusive relationships- in the spirit of full and relationships- in the spirit of full and open disclosureopen disclosure

Includes all constellation members: birth Includes all constellation members: birth and adoptive parents and adopted and adoptive parents and adopted personspersons

Includes the family system in the processIncludes the family system in the process

Page 22: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Behavioral Issues and Underlying Behavioral Issues and Underlying Emotional Issues:Emotional Issues:

Attachment, Separation, & GriefAttachment, Separation, & Grief

Identity Issues and the Need to Identity Issues and the Need to SearchSearch

DepressionDepression

PTSDPTSD

Page 23: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of Adoption

Adoption is Different Than BirthAdoption is Different Than Birth

Adoption is a Life Long ProcessAdoption is a Life Long Process

The Effects of LossThe Effects of Loss

Page 24: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of Adoption

The Effects of Previous Maltreatment The Effects of Previous Maltreatment on Family Functioningon Family Functioning

Issues in AttachmentIssues in Attachment

Identity IssuesIdentity Issues

Mastery and Control IssuesMastery and Control Issues

Page 25: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of Adoption

Adoption is Different Than BirthAdoption is Different Than Birth

Challenges to family functioning and Challenges to family functioning and child well-being – time, biology, historychild well-being – time, biology, history

““Real” parents verses adoptive parentsReal” parents verses adoptive parents

Parents need to be seen as allies in the Parents need to be seen as allies in the therapeutic processtherapeutic process

Page 26: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of Adoption

Adoption is a Life Long Adoption is a Life Long ProcessProcess

A process is not a one time event, A process is not a one time event, the adoption itself is a one time the adoption itself is a one time event, the effects of living with event, the effects of living with adoption are life longadoption are life long

Adolescence, marriage, child Adolescence, marriage, child rearing, separation are huge rearing, separation are huge markersmarkers

Page 27: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionThe Effects of LossThe Effects of Loss

Central to adoption processCentral to adoption process Adoption is not possible without lossAdoption is not possible without loss Adopted person has loss – genetic Adopted person has loss – genetic

identity, loss of relationships with identity, loss of relationships with emotionally significant objectsemotionally significant objects

Adopted family has loss – infertility; loss Adopted family has loss – infertility; loss of continuity with biological lineage; of continuity with biological lineage;

Birth parents have loss – surrender of Birth parents have loss – surrender of child; loss of information about the childchild; loss of information about the child

Page 28: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionThe Effects of LossThe Effects of Loss

Loss is healed through griefLoss is healed through grief Grief is revisited over timeGrief is revisited over time Developmental tasks trigger loss – Developmental tasks trigger loss –

adolescence, marriage, college, adolescence, marriage, college, childbirthchildbirth

Some behavior in adopted persons Some behavior in adopted persons viewed as pathological may actually viewed as pathological may actually be maladaptive grieving – i.e., be maladaptive grieving – i.e., concepts of rejectionconcepts of rejection

Page 29: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionThe Effects of Previous The Effects of Previous Maltreatment on Family Maltreatment on Family

FunctioningFunctioning Maltreatment, trauma, prenatal Maltreatment, trauma, prenatal

exposure to substances, deprivation, exposure to substances, deprivation, lack of stimulation; nutritional lack of stimulation; nutritional deprivation; and many othersdeprivation; and many others

PTSD traumaPTSD trauma Sexual abuseSexual abuse Physical abusePhysical abuse

Page 30: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionThe Effects of Previous Maltreatment The Effects of Previous Maltreatment

on Family Functioningon Family Functioning

““This is my dilemma. When I think of the This is my dilemma. When I think of the abuses heaped on my child by her birth abuses heaped on my child by her birth parents, and all the struggles she had as parents, and all the struggles she had as a result, it is hard for me not to hate a result, it is hard for me not to hate them for the harm they caused. On the them for the harm they caused. On the other hand, if they hadn’t hurt her, she other hand, if they hadn’t hurt her, she wouldn’t have been taken away, and she wouldn’t have been taken away, and she wouldn’t be my daughter. And if it wouldn’t be my daughter. And if it weren’t for them, she wouldn’t look the weren’t for them, she wouldn’t look the way she does, have many of the talents way she does, have many of the talents that she does. It’s complicated.” – that she does. It’s complicated.” – Adopted Adopted MomMom

Page 31: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIssues in AttachmentIssues in Attachment

Cycle of need and responseCycle of need and response

Infant basic needs/keep caretaker Infant basic needs/keep caretaker closeclose

FAS – attachment challengesFAS – attachment challenges

Trust, intimacy, caretaker Trust, intimacy, caretaker dependabilitydependability

Page 32: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIssues in AttachmentIssues in Attachment

Dependency needs may be greater Dependency needs may be greater than parent’s ability – black hole – than parent’s ability – black hole – sieve syndromesieve syndrome

Attachment is on a continuumAttachment is on a continuum

Attachment is a two way streetAttachment is a two way street

Ability to attach complicated by Ability to attach complicated by physical or temperamental differencesphysical or temperamental differences

Page 33: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIssues in AttachmentIssues in Attachment

Adoptive parents with Adoptive parents with attachment issues may attachment issues may believe that such a believe that such a mismatch would never have mismatch would never have occurred with a child born to occurred with a child born to them.them.

Page 34: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIdentity IssuesIdentity Issues

Both adopted parents and adopted Both adopted parents and adopted persons must incorporate “being persons must incorporate “being adopted” into their sense of self.adopted” into their sense of self.

Who am I?Who am I? Where do I come from?Where do I come from? How does this impact on my life?How does this impact on my life? Openness is keyOpenness is key Be comfortable with ambiguityBe comfortable with ambiguity

Page 35: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionMastery and Control IssuesMastery and Control Issues

Basic need for competence and Basic need for competence and personal power in one’s lifepersonal power in one’s life

Control over one’s life; control over Control over one’s life; control over creating family; control over one’s creating family; control over one’s child by birthchild by birth

Control battles are common in Control battles are common in adoptive families as each party seeks adoptive families as each party seeks to gain control over their lives and to gain control over their lives and situationssituations

Page 36: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionLossLoss

Adopted PersonAdopted Person

Fear ultimate Fear ultimate abandonment; abandonment; loss biological, loss biological, genetic, genetic, cultural, history. cultural, history. Issues of Issues of holding on and holding on and letting goletting go

Adoptive ParentAdoptive Parent

Infertility Infertility equated with equated with loss of self & loss of self & immortality. immortality. Issues of Issues of entitlement lead entitlement lead to fear of loss of to fear of loss of child and child and overprotectionoverprotection

Page 37: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionLossLoss

Birth ParentBirth Parent

Ruminate about lost child. Ruminate about lost child. Initial loss merges with other Initial loss merges with other

life events; leads to social life events; leads to social isolation; changes in body isolation; changes in body

and self-image; relationship and self-image; relationship losseslosses

Page 38: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionRejectionRejection

Adopted PersonAdopted Person

Personalize Personalize placement of placement of adoption as adoption as rejection; issues rejection; issues of self-esteem; of self-esteem; can only be can only be chosen if first chosen if first rejected. rejected. Anticipate Anticipate rejection; mis-rejection; mis-perceive perceive situations.situations.

Adoptive ParentAdoptive Parent

Ostracized Ostracized because of because of procreation procreation difficulties; may difficulties; may scapegoat scapegoat partner; expect partner; expect rejection; may rejection; may expel adopted expel adopted person to avoid person to avoid anticipated anticipated rejection.rejection.

Page 39: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionRejectionRejection

Birth ParentBirth Parent

Reject selves as irresponsible, Reject selves as irresponsible, unworthy because they unworthy because they

allowed adoption; turn these allowed adoption; turn these feelings against self as feelings against self as

deserving rejection; come to deserving rejection; come to expect and causes rejectionexpect and causes rejection

Page 40: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionGuilt/ShameGuilt/Shame

Adopted PersonAdopted Person

Deserving of Deserving of misfortune’ misfortune’ shame of shame of being being different; may different; may take defensive take defensive stance/anger.stance/anger.

Adoptive ParentAdoptive Parent

Shame of Shame of infertility; infertility; may believe may believe childlessness childlessness is curse or is curse or punishment; punishment; religious religious crisis.crisis.

Page 41: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionGuilt/ShameGuilt/Shame

Birth ParentBirth Parent

Party to guilty secret; Party to guilty secret; shame/guilt for placing child; shame/guilt for placing child;

judged by others; double judged by others; double bind; not OK to keep child and bind; not OK to keep child and not OK to place them either.not OK to place them either.

Page 42: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionGriefGrief

Adopted PersonAdopted Person

Grief may be Grief may be overlooked in overlooked in childhood; childhood; blocked by adult blocked by adult leading to leading to depression or depression or acting out; may acting out; may grieve lack of fit grieve lack of fit in adoptive in adoptive family.family.

Adoptive ParentAdoptive Parent

Must grieve loss Must grieve loss of fantasy child; of fantasy child; unresolved grief unresolved grief may block may block attachment to attachment to adopted person; adopted person; may experience may experience adopted adopted person’s grief as person’s grief as rejection.rejection.

Page 43: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionGriefGrief

Birth ParentBirth Parent

Grief is acceptable only for a Grief is acceptable only for a short period but may be short period but may be

delayed 10-15 years; lack delayed 10-15 years; lack rituals for mourning; sense rituals for mourning; sense of shame blocks grief work.of shame blocks grief work.

Page 44: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIdentityIdentity

Adopted PersonAdopted Person

Deficits in identity Deficits in identity may impede may impede integration of integration of identity; may see identity; may see search for search for identity in early identity in early pregnancies; pregnancies; extreme extreme behaviors in order behaviors in order to create sense of to create sense of belonging.belonging.

Adoptive ParentAdoptive Parent

Experiences Experiences diminished diminished continuity of continuity of self; they are self; they are not “real” not “real” parents.parents.

Page 45: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

IdentityIdentity

Adopted Person IssuesAdopted Person Issues

More identities to processMore identities to process Over identifying more with one family Over identifying more with one family Fantasizing, distracted in school, Fantasizing, distracted in school,

angryangry Feeling marginalizedFeeling marginalized Lack of identity markersLack of identity markers Complicates independence phaseComplicates independence phase

Page 46: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

ControlControl

Page 47: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIdentityIdentity

Birth ParentBirth Parent

Child is part of identity and goes Child is part of identity and goes on without birth parent’s on without birth parent’s

knowledge; diminished sense knowledge; diminished sense of self and self-worth; may of self and self-worth; may

interfere with future paternal interfere with future paternal desires.desires.

Page 48: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIntimacyIntimacy

Adopted PersonAdopted Person

Fear getting Fear getting close and risk re close and risk re enacting earlier enacting earlier losses; concerns losses; concerns over possible over possible incest; bonding incest; bonding issues may issues may lower capacity lower capacity for intimacy.for intimacy.

Adoptive ParentAdoptive Parent

Unresolved grief Unresolved grief over losses may over losses may lead to intimacy lead to intimacy or marital or marital problems; may problems; may avoid closeness avoid closeness with adopted with adopted person to avoid person to avoid loss.loss.

Page 49: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionIntimacyIntimacy

Birth ParentBirth Parent

Difficulties resolving issues Difficulties resolving issues with other birth parent may with other birth parent may

interfere with future interfere with future relationships; intimacy may relationships; intimacy may equate with other losses. equate with other losses.

Page 50: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionControlControl

Adopted PersonAdopted Person

Adoption alters Adoption alters life course’ not life course’ not party to initial party to initial decisions; decisions; haphazard nature haphazard nature of adoption of adoption removes cause removes cause and effect and effect continuum. continuum. “Control Freak”“Control Freak”

““Victim”Victim” ““Being Stuck”Being Stuck”

Adoptive ParentAdoptive Parent

Adoption Adoption experiences lead experiences lead to learned to learned helplessness; helplessness; sense of mastery sense of mastery connected to connected to procreation. procreation.

Super Parent Super Parent IssuesIssues

Page 51: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Core Issues of AdoptionCore Issues of AdoptionControlControl

Birth ParentBirth Parent

Relinquishment seen as out Relinquishment seen as out of control; interrupts drive of control; interrupts drive

for self actualization. for self actualization.

Page 52: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Divided LoyaltiesDivided LoyaltiesAdopted Person IssuesAdopted Person Issues He/she does not feel free to talk He/she does not feel free to talk

about birthparentsabout birthparents May want to connect with May want to connect with

birthparentsbirthparents All adopted persons searchAll adopted persons search Search and reunion and separate Search and reunion and separate

functionsfunctions

Parent IssuesParent Issues Create loyalty issues by denying Create loyalty issues by denying

significance of birth parentsignificance of birth parent

Page 53: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Entitlement & GratitudeEntitlement & GratitudeAdopted Parent IssueAdopted Parent Issue Infertility issuesInfertility issues Can’t assume they know their childCan’t assume they know their child Have to prove they are worthy or Have to prove they are worthy or

“perfect” parents“perfect” parents Existence of birthparentsExistence of birthparents Plays out in discipline, boundaries Plays out in discipline, boundaries

or lack thereofor lack thereof DepressionDepression

Page 54: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Entitlement & GratitudeEntitlement & Gratitude

Child IssuesChild Issues

May not feel he/she may show May not feel he/she may show negative traits or behavior negative traits or behavior

May feel compelled to try to May feel compelled to try to be “perfect” & full of be “perfect” & full of gratitudegratitude

Page 55: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Behavioral Issues and Underlying Behavioral Issues and Underlying Emotional Issues:Emotional Issues:

Attachment, Separation, & GriefAttachment, Separation, & Grief

Identity Issues and the Need to Identity Issues and the Need to SearchSearch

DepressionDepression

PTSDPTSD

Page 56: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

We Never Thought it Would be Like We Never Thought it Would be Like This! Problems Identified by This! Problems Identified by

FamiliesFamilies Behavior problems of childBehavior problems of child 89%89% Emotional problems of childEmotional problems of child 72%72% Child-Parent relationshipChild-Parent relationship 61%61% Child’s relationship w/ peersChild’s relationship w/ peers 48%48% Financial problemsFinancial problems 46%46% Child care problemsChild care problems 37%37% Emotional problems – parentEmotional problems – parent 26%26% Job problemsJob problems 25%25% Marital problemsMarital problems 24%24% Unresolved infertilityUnresolved infertility 21%21%

Page 57: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

We Never Thought it Would be Like We Never Thought it Would be Like This! Problems Identified by This! Problems Identified by

FamiliesFamiliesCommon ThemesCommon Themes

Limited Emotional Range – Limited Emotional Range – anger/sorrowanger/sorrow

Marital TensionsMarital Tensions

Sibling IssuesSibling Issues

Page 58: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

We Never Thought it Would be Like We Never Thought it Would be Like This! Problems Identified by This! Problems Identified by

FamiliesFamiliesCommon ThemesCommon Themes

IsolationIsolation

Exhaustion and HopelessnessExhaustion and Hopelessness

Running on EmptyRunning on Empty

Page 59: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Strategies for Adoptive Parents By Strategies for Adoptive Parents By Developmental StageDevelopmental Stage

Infancy (0-3)Infancy (0-3) Talk comfortably about adoption from Talk comfortably about adoption from

the time the child arrivesthe time the child arrives

Start the adoption story from --when you Start the adoption story from --when you were born, your birth Mom . . . . Not were born, your birth Mom . . . . Not when we adopted you . . .when we adopted you . . .

Model correct adoption languageModel correct adoption language

Gather as much info about the child’s Gather as much info about the child’s history when the trail is freshhistory when the trail is fresh

Page 60: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Strategies for Adoptive Parents By Strategies for Adoptive Parents By Developmental StageDevelopmental Stage

Pre School (3-7)Pre School (3-7)

Encourage questions and answer concretely and Encourage questions and answer concretely and simply.simply.

Listen for cues about misperceptions when the Listen for cues about misperceptions when the child is playing or talking with peers.child is playing or talking with peers.

Don’t assume that telling the adoption story Don’t assume that telling the adoption story every once in a while is adequate. Tell the story every once in a while is adequate. Tell the story positively, but realistically.positively, but realistically.

Reassure the child that they will not lose their Reassure the child that they will not lose their adoptive familyadoptive family

Page 61: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Strategies for Adoptive Parents By Strategies for Adoptive Parents By Developmental StageDevelopmental Stage

School Age (8-12)School Age (8-12)

When children are not talking about adoption When children are not talking about adoption don’t assume they aren’t thinking about it.don’t assume they aren’t thinking about it.

Learn to be alert for anniversary reactions – Learn to be alert for anniversary reactions – trigger times – mother’s day, birthdays, trigger times – mother’s day, birthdays, holidays, loss.holidays, loss.

Let children know that they can love two sets of Let children know that they can love two sets of parents.parents.

Don’t force discussions, look for opportunities, Don’t force discussions, look for opportunities, i.e., on a drive in the car, anniversariesi.e., on a drive in the car, anniversaries

Page 62: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Strategies for Adoptive Parents By Strategies for Adoptive Parents By Developmental StageDevelopmental StageEarly Adolescence (12-15)Early Adolescence (12-15)

Allow the child to exercise control whenever Allow the child to exercise control whenever possible.possible.

Be firm in limit setting.Be firm in limit setting.

Try to keep from responding to the child’s Try to keep from responding to the child’s anger with more anger.anger with more anger.

Establish clear consequences for broken rules.Establish clear consequences for broken rules.

Maintain a sense of humor.Maintain a sense of humor.

Page 63: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Strategies for Adoptive Parents By Strategies for Adoptive Parents By Developmental StageDevelopmental StageLate Adolescence (15 - 20)Late Adolescence (15 - 20)

Make it clear that the child may remain home Make it clear that the child may remain home for a time following graduation, i.e. attend for a time following graduation, i.e. attend college nearby.college nearby.

Be alert for overreactions when relationships Be alert for overreactions when relationships with peers fail.with peers fail.

Talk openly about dating, intimacy, Talk openly about dating, intimacy, relationships.relationships.

Be aware that leaving home, even for college Be aware that leaving home, even for college can feel like abandonment all over again.can feel like abandonment all over again.

Page 64: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Therapeutic TechniquesTherapeutic Techniques

Parent education - BibliotherapyParent education - Bibliotherapy Narrative workNarrative work Parenting that fosters attachmentParenting that fosters attachment Play therapyPlay therapy ReframingReframing The Adoption storyThe Adoption story LifebooksLifebooks Letter Writing by parent/ by child Letter Writing by parent/ by child

or teenor teen JournalingJournaling

Page 65: Core Clinical Issues in Adoption Advanced Clinical Permanency Training for Massachusetts DCF Supervisors Worcester, MA March 3, 2011.

Techniques continuedTechniques continued

GenogramsGenograms Kid’s Group Parent’s Group Kid’s Group Parent’s Group Mentoring for kids and Mentoring for kids and

parentsparents Guided FantasyGuided Fantasy RitualsRituals Search (inside and outside)Search (inside and outside) Facilitated ReunionsFacilitated Reunions