CORE CLINICAL ISSUES IN ADOPTION
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Transcript of CORE CLINICAL ISSUES IN ADOPTION
CORE CLINICAL ISSUES
IN
ADOPTIONPresented by
Joan Normandy-Dolberg, LPC, NCCFamily Counseling of Springfield
Acknowledgements The Center for Adoption Support and Education (CASE) joined with the Rural Adoptive
Family Initiative (RAFI) to offer two 48 hour intensive training programs to 20 therapists who were interested in learning more about the full spectrum of adoption related issues.
The training utilized the Adoption Clinical Training (ACT), developed by Sharon Roszia, MS and Deborah Silverstein, L.C.S.W., leaders in the field of adoption and affiliated with the Kinship Center in California. Over 3,500 clinicians had been previously trained in ACT.
Debbie Riley, Executive Director of the Center for Adoption Support and Education (C.A.S.E.) and Sharon Roszia, MS, led formal lectures, small group discussions and experiential activities.
We continue to meet to staff cases and update our education.
Participants received over 48 continuing education credits, as well as a certification of completion of the training.
Grant #90-CO-0994 to the Virginia Dept of Social Services from the U.S. Dept of Health and Human Services
ADOPTION STATISTICS
More than 135,000 adoptions take place annually.
In the US more than 13,000 adoptions involve babies who are voluntarily relinquished.
Of non-stepparent adoptions, approximately 59 percent are from the child welfare system, 26 percent are international, and 15 percent are voluntarily relinquished domestic infant adoptions.
About half of all infant adoptions are carried out by independent practitioners, who facilitate birthparents' placing their children directly with potential adoptive parents.
Service fees for infant adoptions typically range from $20,000 to $35,000.
The vast majority of adoption agencies, as well as independent practitioners, offer open adoptions, in which identifying information is exchanged. Many of the adoptions they arrange also are mediated adoptions, in which ongoing information is exchanged through the agency.
The Adoption Triad
Adoptee
Adoptive Family Birth Family
Seven Core Adoption Issues
LOSSLOSS
REJECTION
GUILT/ SHAME
GRIEF
IDENTITY
INTIMACY
MASTERY/ CONTROL
LOSSADOPTED BIRTH PARENT ADOPTIVE
PERSON PARENT
•Birth Family
•Biological, genetic & cultural history
•Belonging
•Security
•Child
•Social isolation
•Body & self image
•Tentative future relationships
•“Dream” child
•Immortality
•Self
•Entitlement
REJECTIONADOPTED BIRTH PARENT ADOPTIVE
PERSON PARENT
•Not keepable
•Self esteem issues
•Fear of abandonment
•Fear of exclusion
•Society’s condemnation
•Afraid the child will hate them
•Feels “not worthy”
•Expects rejection
•Not in the “club”
•Scapegoats partner
•Fear of “selection” process
•Potential rejection by or of the child
GUILT & SHAMEADOPTED BIRTH PARENT ADOPTIVE
PERSON PARENT
•Tainted
•A mistake
•Different
•Defensive/ angry
•Party to a secret
•How much to share?
•Who do I tell?
•Fears judgment
•Double-bind
•Body is faulty
•Social view that adoption is 2nd choice
•Am I really the parent?
•Am I causing the child’s problems?
GRIEF ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT
Somatic issues No permission
to grieve Depression Acting out Lack of “fit”
Pushed to “move on”
Denies the experience
Blocked by shame
Anger displacement
Adoption of fantasy child not a fix
Blocks attachment
Impacts parenting
Culture & race differences
IDENTITY ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT
Am I “real”? Minimal
history impacts self worth
“Borrowed” sense of belonging
Intensifies in teen years
Am I “real”? Diminished
sense of self Not sure if
and how they fit into their child’s life
Am I “real”? Impacts ability to
pass on heritage & legacy
Intergenerational struggle & confusion
INTIMACY ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT
Fear of getting close
Concerns about incest
Missed being nuzzled & adored in their sweet baby bodies
Intimacy = loss
At risk for multiple relationships
Impacts relationship with other children
Relationship difficulties
Child’s distance triggers fear
Missed early opportunities
MASTERY & CONTROL ADOPTED BIRTH PARENT ADOPTIVE PERSON PARENT
Not part of the decision
Being in charge holds loss at bay
Win/lose issues loom large
“Driven” behaviors
Eating & substance abuse issues
“Re-dos” to gain control
No control over their own body
Adoption process makes individual feel even more helpless
Entitlement issues
Recent Research According to a study quoted in the May 05, 2008 issue of Time magazine, adopted
adolescents are at greater risk for behavior or emotional problems
Clinicians from the University of Minnesota interviewed (in person) nearly 700 adopted children and 540 non-adopted children, all ages 11 to 21. Participants had to have a non-adopted sibling within the same age range to help compare behaviors.
This study found that about 14 percent of adopted adolescents are diagnosed with a behavioral disorder or have contact with a mental health professional. The rate for non-adopted teens is about half that.
The study shows that this discrepancy could be due to genetic issues or prenatal care, rather than the fact that adoptive parents are more proactive than the general population about recognizing the signs/symptoms, having their children tested, and seeking care psychiatric care for them.
The study also concluded that children adopted domestically (U.S.) are more likely to have behavioral disorders than those adopted internationally. Children of intercountry adoption are far more likely to internalize their problems (depression and separation anxiety disorders are common), whereas children adopted domestically tend to act out.
Source:Kathleen Kingsbury, “Adoptees More Likely to be Troubled,” TIME magazine, 5/5/08
COMMON PRESENTING ISSUES
Lack of understanding/anger Parenting struggles Lack of “goodness of fit” Low self esteem & identity issues Feelings of loss of control Grief due to loss Inability to develop & maintain intimate
relationships
WHERE TO BEGIN Establish rapport Assess mastery & understanding of adoption
experience Assess attachment issues Normalize feelings & behavior Provide psycho-education for all members of
the family Increase self esteem through various
activities
PRACTICE INTERVENTIONS &HEALING OPPORTUNITIES
Self Esteem Eco-Maps Time Lines
Life Books Genograms Bibliotherapy
SELF ESTEEM Cornerstone of mental health Professionals must recognize
constellation members’ vulnerabilities Parents must be empowered and taught
how to build their child’s self esteem
FOSTERING SELF ESTEEM Provide opportunities to try new things Allow chances to feel “in charge” Balance expectation & ability Allow for mistakes Validate feeling & thoughts Model appropriate behavior & attachment Use filial therapy
Genogram Symbols
COMPLETED GENOGRAM
ECOMAPS …are graphical representations that show all of the systems at play in a
client’s life. Eco-maps are used as a way of demonstrating Systems Theory so that both the counselor and the client can refer to it during a session.
At the center of the eco-map is the client (this can either be a family or individual). Family connections and connections to all of the relevant systems that are at play in the clients life are represented by lines
Thicker (darker) lines mean stronger relationship
Crossed or red lines mean that the system is a stressful relationship; dashed lines indicate an uncertain relationship
Arrows pointing to the client mean that the system primarily influences the client
Arrows pointing to the system mean that the client primarily influences the system
Arrows pointing both direction depicts a two direction flow of influence
A stressful, conflict-laden relationship ++++++
A tenuous, uncertain relationship - - - - - - - - -
A positive relationship or resource _________
The direction of the giving & receiving exchange or a relationship or resource
Relationship Symbols
Eco-Map
School
Girl Scouts
Sue
AmyMike
Patty Colin
Time Line6/
85Adoptive Parents
2/88
2/90
12/9
2
1/94 2/95 4/9
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Ma
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TIME LINE
LIFE BOOKS BOXES Tangible & truthful Compilation of
events Reality based Non-verbal access
to feelings Incorporates
child’s view of events
Container for mementos and photos
“Road trips” & internet searches might be needed to fill them in
Drawings and representations are included
LIFE BOOK ELEMENTS Birth family and history Reasons for placement Foster care and adoption history Feelings Explanation of past events The future
BIBLIOTHERAPY
Non-confrontive Private & gentle Validating Helps children make sense of their
adoption Normalizes fear and confusion Helps parents understand their
children’s feelings
Parenting Books When Love Is Not Enough: A Guide to Parenting Children with RAD by
Nancy L. Thomas
Twenty Things Adopted Kids Wish Their Adoptive Parents Knew by Sherrie Eldridge
Raising Adopted Children, Revised Edition: Practical Reassuring Advice for Every Adoptive Parentby Lois Ruskai Melina
This is Me - Memories to Gather and Keep by Susan L. Pierce
Parenting the Hurt Child : Helping Adoptive Families Heal and Grow by Gregory Keck, Regina M. Kupecky
Attaching in Adoption: Practical Tools for Today's Parents by Deborah D. Gray
Adopting the Older Child by Claudia L. Jewett
Help for the Hopeless Child: A Guide for Families by Ronald S. Federici
Toddler Adoption: The Weaver's Craft by Mary Hopkins-Best
The Waiting Child: How the Faith and Love of One Orphan Saved the Life of Another by Cindy Champnella
Our Own: Adopting and Parenting the Older ChildBy Trish Maskew
Adopting the Hurt Child: Hope for Families With Special-Needs Kids : A Guide for Parents and ProfessionalsBy Gregory C. Keck, Regina M. Kupecky
Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice by Vivien Prior, Danya Glaser
Parenting With Love and Logic (Updated and Expanded Edition) by Foster W. Cline, Jim Fay
Taking the Stress Out of Raising Great Kidsby Jim Fay, Charles Fay, Foster Cline
Building the Bonds of Attachment: Awakening Love in Deeply Troubled Children by Daniel A. Hughes
Facilitating Developmental Attachment: The Road to Emotional Recovery and Behavioral Change in Foster and Adopted Children by Daniel A. Hughes
RESOURCES www.genopro.com/genogram http://www.adoptionsupport.org/ http://www.barkerfoundation.org/ National Adoption Information Clearinghouse http://naic.acf.hhs.gov
TEL (888) 251-0075 FAX (703) 385-3206 http://www.adopting.org/adoptions/post-adoption-resources-2.html http://www.childrensdisabilities.info/attachment-links.html www.ldonline.org http://www.familyhelper.net/ad/adnlu.html http://www.adoptivefamilies.com/loismelina http://www.adoptioninstitute.org/index.php