Monthly Archives: March 2011

Breaking away from the pack

Lynne Shallcross March 15, 2011

Breaking away from the packFor Margie Williams, the goal was always to be her own boss. “In grad school, I knew that I’d have to learn to be a therapist by actually doing it, and that meant putting in the time at the best training site I could talk my way into. The years I spent working at a residential treatment center gave me a solid foundation in every aspect of this field, until there came a point when I was ready to call my own shots.”

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Forging family bonds

Lynne Shallcross March 1, 2011

A simple e-mail makes all the hard work worthwhile for Susan Branco Alvarado. “I may not show it all the time,” an adopted teenage client wrote to Alvarado, “but I really appreciate everything you have done for me. Thanks to you, my relationship with my mom has gotten a thousand times better and my life has also changed for the better. So thank you!”

Alvarado, who runs a private practice in Falls Church, Va., that specializes in adoption issues, had begun working with the client and her mother after individual therapy for the daughter failed to yield improvements in her mood or her connection with her adoptive mother. “Initially, the sessions were not smooth with the family because years of disconnectedness and resentment had built a wall between them,” says Alvarado, a member of the American Counseling Association. “This wall was especially evident in session when the teen would pile several pillows between her and her frustrated mom.”

The teen displayed a high level of anxiety, anxious attachment to her mom and an increasing level of withdrawal and irritability, while the mother felt rejected by her daughter and helpless. After Alvarado tried a combination of narrative and expressive therapies in addition to Theraplay, a form of directive parent-child play therapy, the mother-daughter duo reported progress. “Both excitedly shared that they had a successful disagreement with a healthy repair to reconnect them,” Alvarado says. Helping adopted children and their families has personal meaning for Alvarado, who was adopted herself from Bogotá, Colombia.

The work is equally personal for Suzanne Clark, who runs a private practice specializing in adoption issues in Roswell, Ga. Born in Kentucky and raised by adoptive parents in Florida, Clark says she didn’t have much interest in or understanding of adoption until she went to college and began working as a Big Sister to pregnant teenagers.

“At the time, I didn’t realize why I was so fascinated with this population. I just thought it was a fun community service activity,” says Clark, a member of ACA. “After I graduated from college, I began working within the foster care system, then transitioned to a job at a maternity home. I completely immersed myself in my work with these girls, some of whom were parenting, some of whom were making adoption plans for their children. It was around this time I began to realize that this was the one way I was able to connect with my own birth mother and give back to her. The only thing I had ever known about her was that she was 15 when she had me. I never thought much about it past that.”

Both Alvarado and Clark offer counseling to individuals who have been adopted, birth parents who have chosen to make a plan of adoption for their children and families who have adopted a child. Clark also offers consultations to adoptive families and birth parents who are considering adoptions, as well as group counseling and lectures on adoption issues throughout the Atlanta area. Alvarado, whose clients range from infancy to middle adulthood, also provides workshops to local adoption and child welfare agencies, as well as presentations at adoption conferences.

According to Alvarado, counseling on adoption-related issues relies heavily on family work. It includes normalizing typical adoption-related developmental milestones, such as when children begin wondering why they were adopted or express a desire to meet their birth parents, and involves helping family members learn to trust one another.

“Additionally,” she says, “adoption therapists should be knowledgeable in identifying and treating trauma-related disorders. This can be a factor in situations where a child has been removed from his or her first family because of abuse or neglect or has experienced trauma in institutionalized settings. This type of counseling also includes birth family searching and preparation for birth family reunions and post-reunion relationships.”

Counseling that’s focused around adoption issues requires practitioners to pick up on subtle nuances in complex situations, Alvarado adds. “Therapists must be skilled in identifying the layers of adjustment issues that can stem from prenatal conditions, heredity, parental bonding and child attachment concerns, identity issues, trauma, and grief and loss experienced by both children and adoptive parents within adoptive families.”

Handling loss

Clark points to research showing that even if a child has been adopted at a very early age, grief can still emerge as a by-product later in life. “That grief, even though it’s preverbal, is still imprinted in them and definitely affects how they interact with people and form relationships,” Clark says. Grief can also weigh on adoptive parents, she adds, who might still mourn the biological child they couldn’t have on their own.

Clark often starts by telling these families that she understands their desire to be considered a “normal” family, while also encouraging them not to overlook the fact that their family was created on the basis of some type of loss. The parents might have struggled with infertility and not dealt with the grief, she explains, while the adopted child must deal with the loss of his or her original family. “When those two things are overlooked and the family tries to come together and pretend like everything’s OK, everyone’s feelings of loss and grief are still there,” Clark says. “And it comes out in the relationships.”

An important first step, Clark says, is acknowledging that everyone might be experiencing grief. She often recommends allowing parents to admit and deal with their grief alone with the counselor rather than in front of the adopted child. Clark then helps the parents or child pay tribute to the lost relationships.

With parents, she says, the process can begin by having them describe the initial hopes they had for their family or what they think their biological child would have been like. “Depending on what the parents identify as their choice of expression, I have them draw a picture, write a poem, tell a story [or] act out a scenario that depicts these feelings,” Clark says. “Based on this, we decide how they would like to pay tribute to this child. Some people make a memory box, some plant a tree. It’s really about giving them permission and then a voice to express these things.”

The process is similar with the children, although geared toward their age and how they feel most comfortable expressing themselves, Clark says. “Based on this, we decide how they would like to pay tribute to their birth family. If the adopted child is younger or adolescent and still living with the adoptive family, the adoptive family is included in what the child wants to do. We also discuss that the grieving process is a continuum of feelings that will change as the child reaches certain milestones throughout life.”

Clark says building a bridge between the adoptive family and the birth family — even if the adoptive family doesn’t know anything about the birth family — is important so the child will feel connected to everyone. There are ways for adoptive parents to acknowledge the child’s grief and honor his or her relationship to the birth family through talking, Clark says. For example, an adoptive parent might tell the child his ability to play soccer so well must come from his birth parents. Talking openly takes away some of the unspoken shame the child might feel, Clark says.

In session, the counselor can also help children understand why they were “given away,” which is how Clark says many children phrase their adoption. Even if children have a wonderful adoptive family and are functioning well, they still long to know where they came from and why they didn’t remain there, Clark says. She suggests that counselors offer these children space to acknowledge those feelings. Journaling, writing “letters” (not to be mailed) to the birth family and drawing pictures are among the useful techniques that can help adopted children heal and gain insight, she says.

In addition to grief, Alvarado says common issues that adopted children face include feelings of being “different” from their peers, potential discrimination, particularly with transracial or transcultural adoptions, and curiosity about their heritage and birth families. “Counselors can be very helpful to children experiencing these typical concerns by normalizing them, facilitating exploration of their identities within a safe environment and facilitating discussions of these topics within the context of the family system,” she says.

Telling the story

Alvarado points to family therapy as the most effective tool in working with adoptive families. “Regardless of the age of the child, it is very important that the counselor is facilitating increased connections between the child and the parent or parents,” she says, adding that Theraplay is one method that enhances the quality of the attachment. In addition, she says, narrative and expressive therapies such as drawing, sand tray and bibliotherapy are helpful in creating and retelling the story of a child’s adoption journey within the family context. Alvarado also uses cognitive behavioral techniques, relaxation and mindfulness training to reduce anxiety and some trauma symptoms among clients.

Andrea Miller, a registered play therapist in Charlotte, N.C., who has worked with a number of adopted kids during her three years in private practice, says communication between adoptive parents and the children is often a challenge. She sometimes asks the parents and child to take part in an activity, such as drawing individual pictures of the day the child was born. Even though the child can’t remember the event and the adoptive parents most likely were not present, Miller says discussing how each person views that day can serve as a good jumping-off point.

Miller, a member of ACA, also points to “adoptive stories” as a helpful tool, with the child drawing a time line from when he or she was born up through the present. The child can use the time line as a way to identify, verbalize and open up about feelings related to his or her biological parents. “Showing [adoptive] parents that time line and having them involved helps them understand some of the questions that the child might have but may not have asked or didn’t know how to ask,” she says.

Among adoptive parents, a feeling of competition with the birth parents can sometimes surface, Clark says. It’s important for counselors to let the adoptive parents admit that and then give them a comfortable place to talk about it or cry about it. “Not all adoptive parents feel competitive, and there may be varying degrees of these feelings,” Clark says. “It’s offering a space to voice these feelings, acknowledge them, discuss them and maybe even use the topic as a discussion point with their adopted child, depending on the age and maturity of that child.” Group counseling can be helpful, she says, because it allows adoptive parents to see others at different stages of the process who have made it through difficult times.

Adoptive parents can also bear the burden of feeling that they’re expected to meet a higher standard of parenting, both before and after an adoption. “For lack of a better term, adoptive parents have many hoops to jump through before they are able to adopt,” Clark says. “In addition, they typically have to endure long periods of time while they are approved and matched with a child. These experiences alone set them apart from families who are able to conceive biologically. You add to this having to navigate an open or semi-open adoption gracefully without any signs that they maybe feel tired and frustrated by the process, and you have a family who is already having to meet a higher standard than non-adoptive families. Simply acknowledging or suggesting that this might be the case and offering a place for the family to voice their frustration, or just exhaustion, can be very healing.”

In extreme cases, Alvarado says, some parents can experience post-adoption depression (PAD), which can be similar to postpartum depression. “In these situations, parents can experience extreme levels of depression and anxiety, may report a desire to disrupt or dissolve the adoption and even harm their child,” says Alvarado, who recommends screening clients for symptoms of PAD. She believes counselors can be most helpful to parents by educating them about normative adoptive family milestones, normalizing grief and helping them find coping mechanisms and community resources.

In recent years, Clark says, the trend has been toward doing more open adoptions, in which the adoptive and birth families stay in contact. This can present a host of challenges, such as determining when to include the birth family in events and how much freedom to give the child when it comes to contacting the birth family. Talk is often the answer, Clark says, and counselors can help adoptive parents and children (if they are old enough to be part of the conversation) identify the issues by encouraging them to share their fears, wants and expectations with one another. In many instances, this serves to decrease each family member’s anxiety level.

Even when counselors help adoptive families open the lines of communication, the prospect of search and reunion can present a major hurdle. The issue is more prevalent now that e-mail, the Internet and social networking sites are making it easier for birth families and those who have been adopted to find each other, Clark says.

“Adoptive families have varying degrees of comfort with the topic,” Clark says. “Some are totally open to it and are just waiting for the day that their child decides to make contact or to offer the information to their child without hesitation. Others feel that their child should have all of [his or her] needs met by the adoptive family, and there is no need to discuss it. Regardless of where the family is on the continuum, it’s really key to open up the topic for discussion and acknowledge that it is something to consider when everyone feels comfortable.”

Out of crisis, a new push for advocacy

Richard Yep

Richard Yep

After Jared Lee Loughner allegedly pulled out a weapon and started shooting in Tucson, Ariz., on Jan. 8, discussion and debate quickly began on a wide range of issues, including gun control, elected officials’ safety and the need for civility and respect during political debate. There were also constant updates: daily reports about Rep. Gabrielle Gifford’s medical condition; stories about those who lost their lives as well as those who helped to save lives; analysis of Loughner’s “behavior” in court; intense scrutiny of the community in southern Arizona previously known for its natural beauty and its attractiveness to people with active lifestyles, its identity now usurped by three words: “Tragedy in Tucson.”

Of all the topics that emerged after that fateful day in Tucson, the one many of us followed most closely was how the mental health system had failed and what could be done to prevent a repeat of such a horrific event. Let me reiterate: I wrote that the system failed; I did not say that mental health professionals failed. The overlapping and convoluted laws in Arizona (which, unfortunately, are also present in many other parts of the country) allowed Jared Loughner to fall through any type of safety net that might have foreseen and perhaps prevented the rampage of which he is accused.

One thing I did not hear in the ensuing discussion was an acknowledgment of the actions that mental health systems in communities nationwide take each and every day to prevent hundreds, perhaps thousands, of other Jared Loughners from carrying out such atrocities. Daily, there are hundreds of thousands of mental health professionals providing services to ensure the safety of our communities. Those of you who are mental health professionals, counselor educators and graduate student interns are doing an amazing job of helping the tens of thousands of others who might have the potential, and perhaps the intent, to do what Jared Loughner allegedly did. I want to thank and congratulate you for the work you do, the commitment you have made and the dedication you have shown to your students and your clients.

Let’s face it — Jared Loughner appears to have been a time bomb waiting to go off and, unfortunately, he did slip past all of the services and warning systems designed to alert officials and professionals to impending disaster. Some will use the incident to argue the appropriateness of the death penalty for such a heinous crime. Others will engage in discussions that will put our elected officials in some type of security bubble. Still others will question what type of parenting Loughner received. Rather than looking to place blame, I think we need to find ways to fund services that ensure the provision of adequate crisis mental health services for those who would carry out such terrible acts.

So, as if you didn’t have enough to do already with your caseloads, counseling courses or direct service work, I am asking you to do still more. We need mental health providers who will consistently and determinedly advocate for clients, promote more funding for services and encourage the hiring of more professional counselors in a wide range of facilities, schools and community agencies.

Please get involved. Go to the American Counseling Association website, find out what we are doing in public policy and advocacy (, then pick up that phone, or get online, and let your elected and appointed officials know what our country needs now. We all understand the need to live within our means, but as budget battles continue to heat up in Congress, in state legislatures and at all levels of local government, let’s make sure that those representing us know what the true return on investment is when funding for preventive and crisis services is made a priority. ACA will walk hand-in-hand with you in this effort. You can count on that. We owe it to all those who face challenges in their pursuit to live full, healthy, happy and fulfilling lives.

I look forward to visiting with many of you at the ACA Annual Conference & Exposition in New Orleans later this month (March 23-27). More information about the conference is at As always, I hope you will contact me with any comments, questions or suggestions that you might have. Please contact me via e-mail at or by phone at 800.347.6647 ext. 231.

Thanks and be well.

Saying thank you in New Orleans

Marcheta Evans

Have you ever been on the verge of having a dream fulfilled? You can see it, feel it in your bones and taste it. It is right before your eyes, and you are waiting with great anticipation. You know it will be wonderful — one of those times in your life that you will look back on with such fond memories.

As March arrives, that is exactly how I am feeling. As a basketball fan, I normally associate this time of year with March Madness. What also comes to mind when I think of March is spring break, which means vacation time. This year, however, neither of those is the reason for my anticipated joy. Instead, I’m excited because this is the month we will all come together in New Orleans, one of my favorite cities in the world, for the American Counseling Association Annual Conference & Exposition. This is the month we will speak as one voice and be in one place celebrating what it means to be a professional counselor. We will also remember the significance of what has transpired in this city throughout the past six years, from Hurricane Katrina to the Deepwater Horizon oil spill. This will be a time for us to personally thank all of the wonderful counselors who have volunteered to sacrifice their time and efforts to rebuild this great city.

Reflecting back to August 2005 and Hurricane Katrina, this nation experienced the costliest natural disaster in its history. More than 1,800 people lost their lives as the result of the hurricane and subsequent flooding. As I sat and watched what was transpiring in New Orleans on television, I recalled my many experiences as a child in Mobile, Ala., where I prepared for hurricanes with my grandmother and then waited for the storms to hit land. My most vivid memory was of Hurricane Camille in 1969. As I sat there listening to the wind and falling trees, my grandmother kept saying to me over and over again, “Be still child,” as if this would protect me from the unseen power making its presence felt all around me. Still, the helplessness and fear I felt on that day were nothing compared with the horror of what was happening in New Orleans in late August 2005.

Nor did it come anywhere near the horrors of the aftermath of Katrina as we received thousands of hurricane evacuees in San Antonio. I so clearly remember an older gentleman saying to me, “I need to find my wife. They took her from me. Please help me.” I had been working for many hours and was totally exhausted. Seeing the look of total desperation on his face, I just wanted to break down and cry. Then his daughter approached, informing me that her two brothers had died in the storm and her father was on the verge of total panic. Please help. Acquiring energy from some unseen force, I left what I had been doing to go in search of the man’s wife.

You see, there was so much confusion at KellyUSA, which served as one of the main evacuation sites. We had never dealt with something like this before, and we were so unprepared. I was finally able to find the man’s wife in our medical unit, where she had been taken for observation. When I went back to tell him, he held my hands and wouldn’t let go. As I looked into his eyes, I broke into tears. Reflecting on that moment, I must say I am crying again now as I write this. Please know these are tears of sadness but also tears of joy and thankfulness. As I looked around me at that time, I saw hundreds of volunteers giving so much of themselves for their fellow brothers and sisters. Finding a spot on the floor where I eventually crumpled, I witnessed the amazing spirit of all those who sacrificed days and days of their lives to help others. I also learned a new term: compassion fatigue. I could see and feel the fatigue all around me, but at that time, I did not know what it was. Now, I do.

Many of you have your own personal stories to tell or know of someone who gave of themselves during that horrific time. I want you to come to New Orleans so that I can personally thank you. I also lived in New Orleans for a while, and this is like going home for me. Join me there in formally thanking all the wonderful volunteers. And on a personal note, join me in the fulfillment of one of my dreams.