Core Clinical Issues in Foster Care and Adoption

Core Clinical Issues in Core Clinical Issues in Foster Care and AdoptionFoster Care and Adoption

Advanced Practice Advanced Practice Certificate Program in Certificate Program in Adoption and Foster Care Adoption and Foster Care

CompetencyCompetency

Baton Rouge, LABaton Rouge, LA

November 18-19, 2010November 18-19, 2010

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

– – Ann HartmanAnn Hartman

Language in the Context of Language in the Context of Foster Care and AdoptionFoster Care and Adoption Members of the Foster Care/Adoption Members of the Foster Care/Adoption ConstellationConstellation

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

- Adopted/Foster Person- Adopted/Foster Person

- Adoptive/Foster Parent/Family- Adoptive/Foster Parent/Family

An Overview of Some Foster An Overview of Some Foster Care IssuesCare Issues

The implications and consequences of The implications and consequences of abuse, neglect, and placement in foster abuse, neglect, and placement in foster care on early brain development; care on early brain development;

The importance and challenges of The importance and challenges of establishing a child's attachment to establishing a child's attachment to caregivers; caregivers;


The importance of considering a child's The importance of considering a child's changing sense of time in all aspects of changing sense of time in all aspects of the foster care experience; the foster care experience;

The child's response to stress, especially The child's response to stress, especially as related to multiple transitions. as related to multiple transitions.


Parental roles and kinship care;Parental roles and kinship care;

Parent-child contact/frequency of visits;Parent-child contact/frequency of visits;


Permanency decision-making/timeliness, Permanency decision-making/timeliness,

Components of comprehensive Components of comprehensive assessment and treatment of a child's assessment and treatment of a child's development and mental health needs.development and mental health needs.

An Overview of Some Foster An Overview of Some Foster Care/Adoption IssuesCare/Adoption Issues

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

Child’s status hidden as were Child’s status hidden as were parent’s infertility issuesparent’s infertility 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 Needs of birth fathers rarely addressedaddressed

An Overview of Some Foster An Overview of Some Foster Care/ Adoption IssuesCare/ Adoption Issues

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

Help the family “claim” the child as Help the family “claim” the child as their owntheir own

Workers had to find the “right” familyWorkers had to find the “right” family

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


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

Foster parents, single parents, non Foster parents, single parents, non married couples, relatives not married couples, relatives not deemed appropriate as adoption deemed appropriate as adoption resourcesresources

Secrecy was key to successSecrecy was key to success


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

Historical ShiftsHistorical ShiftsMyths that ContinueMyths that Continue

Paradigm shift from secrecy to Paradigm shift from secrecy to opennessopenness

Foster Care/Adoption is the same as Foster Care/Adoption is the same as being in a birth familybeing in a birth family

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

Foster/Adoptive Foster/Adoptive Families and Social Families and Social

ServicesServicesWhat 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 need by professionals and parents was for qualified, parents was for qualified, adoption sensitive mental health adoption sensitive mental health professionalsprofessionals

Adoptive Families and Adoptive Families and Social ServicesSocial Services

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 home10% had formal placement outside of home

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;


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

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


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

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

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.

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:

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 about or with Shawn, and never asked about Shawn’s birth family. Shawn was Shawn’s birth family. Shawn was referred to weekly drug testing, 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.

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 How, specifically, did the reality differ from the dream?reality differ from the dream?

What were the consequences of What were the consequences of adopting this child?adopting this child?

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

Context of Adoption in Context of Adoption in TherapyTherapy

When adoption comes into playWhen adoption comes into play

– Presenting problemPresenting problem

– Not presenting problem but primary Not presenting problem but primary issueissue

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

Pitfalls for TherapistsPitfalls for Therapists

All or nothingAll or nothing

Therapist’s counter-Therapist’s counter-transferencetransference

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

Adoption work is short-termAdoption work is short-term

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 relationships- in the spirit of full and open disclosureand open disclosure

Includes all triad members: birth and Includes all triad members: birth and adoptive parents and adopted personsadoptive parents and adopted persons

Includes the family system in the Includes the family system in the processprocess

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

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


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

Issues in AttachmentIssues in Attachment

Identity IssuesIdentity Issues

Mastery and Control IssuesMastery and Control Issues


Adoption is Different Than Adoption is Different Than BirthBirth

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

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

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


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



Central to adoption processCentral to adoption processAdoption is not possible without lossAdoption is not possible without lossAdopted person has loss – genetic Adopted person has loss – genetic identity, loss of relationships with identity, loss of relationships with emotionally significant objectsemotionally significant objectsAdopted family has loss – infertility; Adopted family has loss – infertility; loss of continuity with biological loss of continuity with biological lineage; lineage; Birth parents have loss – surrender of Birth parents have loss – surrender of child; loss of information about the child; loss of information about the childchild



Loss is healed through griefLoss is healed through griefGrief is revisited over timeGrief is revisited over timeDevelopmental tasks trigger loss – Developmental tasks trigger loss – adolescence, marriage, college, adolescence, marriage, college, childbirthchildbirthSome 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


The Effects of Previous The Effects of Previous Maltreatment on Family Maltreatment on Family

FunctioningFunctioningMaltreatment, 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 traumaSexual abuseSexual abusePhysical abusePhysical abuse

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



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


Issues in AttachmentIssues in AttachmentDependency needs may be greater than Dependency needs may be greater than parent’s ability – black hole – sieve parent’s ability – black hole – sieve syndromesyndrome

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



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 occurred with a child born to them.to them.


Identity 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 keyBe comfortable with ambiguityBe comfortable with ambiguity


Mastery and Control IssuesMastery and Control IssuesBasic 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 Control over one’s life; control over creating family; control over over creating family; control over one’s child by birthone’s child by birth

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

Core Issues of AdoptionCore Issues of AdoptionLossLoss

Adopted PersonAdopted Person

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

Adoptive ParentAdoptive Parent

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

Core Issues of AdoptionCore Issues of AdoptionLossLoss

Birth ParentBirth Parent

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

other life events; leads to other life events; leads to social isolation; changes social isolation; changes in body and self-image; in body and self-image;

relationship lossesrelationship losses

Core Issues of AdoptionCore Issues of AdoptionRejectionRejection


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


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

Core Issues of AdoptionCore Issues of AdoptionRejectionRejectionBirth ParentBirth Parent

Reject selves as irresponsible, Reject selves as irresponsible, unworthy because they allowed unworthy because they allowed adoption; turn these feelings adoption; turn these feelings

against self as deserving against self as deserving rejection; come to expect and rejection; come to expect and

causes rejectioncauses rejection

Core Issues of AdoptionCore Issues of AdoptionGuilt/ShameGuilt/Shame


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


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

Core Issues of AdoptionCore Issues of AdoptionGuilt/ShameGuilt/ShameBirth ParentBirth Parent

Party to guilty secret; Party to guilty secret; shame/guilt for placing shame/guilt for placing child; judged by others; child; judged by others;

double bind; not OK to keep double bind; not OK to keep child and not OK to place child and not OK to place

them either.them either.

Core Issues of AdoptionCore Issues of AdoptionGriefGrief


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


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

Core Issues of AdoptionCore Issues of AdoptionGriefGrief


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

Core Issues of AdoptionCore Issues of AdoptionIdentityIdentity


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


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

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

ControlControl

Core Issues of AdoptionCore Issues of AdoptionIdentityIdentityBirth ParentBirth Parent

Child is part of identity and Child is part of identity and goes on without birth parent’s goes on without birth parent’s knowledge; diminished sense of knowledge; diminished sense of

self and self-worth; may self and self-worth; may interfere with future paternal interfere with future paternal

desires.desires.

Core Issues of AdoptionCore Issues of AdoptionIntimacyIntimacy


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


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.

Core Issues of AdoptionCore Issues of AdoptionIntimacyIntimacy


Difficulties resolving Difficulties resolving issues with other birth issues with other birth

parent may interfere with parent may interfere with future relationships; future relationships;

intimacy may equate with intimacy may equate with other losses. other losses.

Core Issues of AdoptionCore Issues of AdoptionControlControl


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 and removes cause and effect continuum. effect continuum. “Control Freak”“Control Freak”““Victim”Victim”““Being Stuck”Being Stuck”


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

Core Issues of AdoptionCore Issues of AdoptionControlControl


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

drive for self drive for self actualization. actualization.

Divided LoyaltiesDivided LoyaltiesAdopted Person IssuesAdopted Person IssuesHe/she does not feel free to talk He/she does not feel free to talk about birthparentsabout birthparentsMay want to connect with May want to connect with birthparentsbirthparentsAll adopted persons searchAll adopted persons searchSearch and reunion and separate Search and reunion and separate functionsfunctions

Parent IssuesParent IssuesCreate loyalty issues by denying Create loyalty issues by denying significance of birth parentsignificance of birth parent

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, Plays out in discipline, boundaries or lack thereofboundaries or lack thereof


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

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


PTSDPTSD

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

Identified by FamiliesIdentified by FamiliesBehavior 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%


Identified by FamiliesIdentified by FamiliesCommon ThemesCommon Themes

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

Marital TensionsMarital Tensions

Sibling IssuesSibling Issues


Identified by FamiliesIdentified by FamiliesCommon ThemesCommon Themes

IsolationIsolation

Exhaustion and HopelessnessExhaustion and Hopelessness

Running on EmptyRunning on Empty

Strategies for Adoptive Parents Strategies for Adoptive Parents By Developmental StageBy Developmental 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 Start the adoption story from --when you were born, your birth Mom . . . . you were born, your birth Mom . . . . Not when we adopted you . . .Not 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


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 every once in a while is adequate. Tell the story positively, but realistically.story positively, but realistically.

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


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

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


Early 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 Establish clear consequences for broken rules.rules.

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


Late 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.

Therapeutic TechniquesTherapeutic Techniques

Parent education - BibliotherapyParent education - BibliotherapyNarrative workNarrative workParenting that fosters Parenting that fosters attachmentattachmentPlay therapyPlay therapyReframingReframingThe Adoption storyThe Adoption storyLifebooksLifebooksLetter Writing by parent/ by Letter Writing by parent/ by child or teenchild or teenJournalingJournaling

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

Documents

Core Clinical Issues in Foster Care and Adoption