Monthly Archives: July 2014

Uncovering counseling’s past

By Bethany Bray July 30, 2014

Counselors are often urging their clients to learn from their past, to reflect on the decisions they have made and to consider how they have grown and changed.

That lesson could – and should — be applied to the profession itself, according to the Historical Issues in Counseling Network.

The 25-member group, one of 17 interest networks open to members of the American Counseling Association, focuses on researching, highlighting and preserving the counseling profession’s history.

Knowing the profession’s full history and identity can help shape its future, contends network leader William “Chris” Briddick.

Briddick, an associate professor of counseling at South Dakota State University, says there is a great deal about counseling’s history that is yet to be uncovered and archived.

The interest network is always happy to welcome fellow counselors who have questions and who are eager to help in the search.

Q+A: Historical Issues and Counseling Network

Responses from group leader Chris Briddick

Why should counselors be aware of and interested in this area?

The field of counseling has a remarkable history, some of which we know, and the rest which is awaiting our discovery. Some of the things we thought we knew about our profession historically have in recent years been reexamined and, in some instances, revised. Other pieces of history have been further illuminated and more clearly defined.

What are some current issues or hot topics you’ve been discussing?

At present, there aren’t necessarily any pressing issues. It is really up to those interested in history to help define topics of interest. Certainly, a few come to mind: counselor education programs and their history; ethics; licensure and accreditation; trends and issues of different decades (what were the major trends and issues and when?).

What challenges do counselors face in this area?

Like just about everybody, counselors are pretty lax in preserving their history. Psychology has archives. I think it is time counseling establishes its own archives somewhere, a place where historical documents, recordings, photos, etc., can be preserved for future generations.

What’s going on in this area?

[When] we look at history, we tend to look at what has gone on and perhaps make some statements about where we have been and where we might like to go. I don’t know [if] a lot is going on, other than looking at what has already happened. As for me personally, I tend to take my time with history. Part of the fun of studying history is the “digging around” you get to do in terms of locating materials. I will say [that] in recent years, technology has proven to be a really good friend in that regard to those of us interested in history.

What are some trends you’re seeing?

The word trend is tricky because by definition it can point to a general direction of movement or it can also be used to talk about what is fashionable at a particular point in time. I would like to think counseling is more concerned with its general direction and destinations and less about looking fashionable. I think there is evidence to suggest that we are wrestling with important issues and still working on identity as individual practitioners but also as a profession.

A trend I have encountered that I really like is a return to talking more about our future as a profession. The recent collaborative effort for the 20/20: A Vision for the Future of Counseling [initiative] is hopefully something that down the road is seen as historically significant in the further growth and development of our profession. I remember a more individualized piece from awhile ago in Counseling Today where Lynne Shallcross pulled together comments from key leaders in the profession providing glimpses of the future in an article entitled “What the future holds for the counseling profession.” I know that sounds odd coming from someone interested in history, but some of our greatest history is achieved when we work hard in the present to get the future right. In our case, that means serving our clients and making a positive difference in the lives of others. Time will tell. I maintain that history, in this case, may well be on our side.

What does a new counselor need to know about this topic?

New counselors need to know that they are a part of a great profession that is trying to catch up on its history. They also need to know that the profession needs help in discovering its history. Part of your identity as a counselor comes with the realization that you are a part of something amazing that is way bigger than you. Personally and professionally, it’s something each of us can celebrate.

What does a more experienced counselor need to know?

See the above response for new counselors.

What are some tips or insights you’d give regarding this area that could be useful to all counselor practitioners?

We have a great history that is awaiting our attention. Think about questions you might have about our profession’s history and then dig in! Go to work seeking answers to those questions, but keep in mind it may take you awhile to discover those answers. Not everybody will choose to do that, but those who do are welcome to join us on our quest.

What makes you, personally, interested in this area?

I have had a couple of incredible mentors along the way — Roger Aubrey and, more recently, Mark Savickas — who taught me the significance of our professional history. Their respect and enthusiasm for the topic were transformational for me. I sat down, started working and made a habit of looking back.

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ACA’s 17 interest networks, from sports counseling and animal-assisted therapy to traumatology and veterans issues, are open to any ACA member.

For more information or to get involved, see counseling.org/aca-community/aca-groups/interest-networks.

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

The complicated mourner

By Helen Nieves July 29, 2014

The first time I met Cynthia (not her real name) was in my office. She was in her late 20s and came to me because of a fear of driving. Initially, I believed her case would require cognitive behavioral work, and having received advanced training in rational emotive behavior therapy, I began formulating an outline of how to handle the case in my head. I thought it would be an interesting case in which to apply the techniques that I usually use with clients who come in with some form of anxiety-related problems.

During intake, I inquired about deaths or other losses Cynthia might have experienced. I usually do this when meeting with new clients to gather information and better assess them. Cynthia told me her sister had died. There was a fresh sadness to Cynthia’s mood and affect when she talked about her sister, which made me think the loss was recent. Her sister was two years older than Cynthia and had lived in another state. Before Cynthia had moved, she and her sister were very close, going shopping together, taking road trips and sharing secrets. After Cynthia moved, they still spoke on the phone with each other every day. Cynthia’s sister was her best friend.

As I inquired further, Cynthia told me her sister had died five years ago in a car crash. Her sister was coming home from a party when a drunken driver ran through an intersection and hit her car, turning it over. The driver fled the scene but later was apprehended. Cynthia told me repeatedly that her sister’s car caught on fire, burning her to death. No one knew whether her sister was unconscious when the fire consumed her or conscious and unable to escape the horrible death.

Cynthia didn’t find out about her sister’s death until the following day, after she tried calling her sister, just like she did every other normal day. The call went straight to her sister’s voice mail. Cynthia left numerous messages and waited for her sister to return them. Finally, a couple of hours later, her mother received a call from the hospital where her sister had been taken. The upsetting news was revealed. Cynthia reported to me that she could not believe the news and continued trying to call her sister to leave messages. She told me her family chose not to bury her sister because her body had decomposed from the fire.

As Cynthia continued telling me about her sister’s death, she reported feeling a wave of loneliness every day because she could no longer talk to her sister on the phone. At times, Cynthia even believed that her sister was still alive and continued trying to call her. Cynthia and her mother agreed that nothing should be removed from the room her sister grew up in. Cynthia also reported feeling guilty that she and her family did not hold a funeral for her sister. She acknowledged feeling angry that her sister had died and furious at the drunken driver who had killed her.

At this point, my initial thoughts concerning offering cognitive behavioral treatment for Cynthia’s presenting symptom — her fear of driving — were replaced by my belief that she was in much greater need of grief work. Given the way Cynthia described her feelings and talked about her sister and her death, I realized this was not a case of normal grieving. Rather, Cynthia was experiencing symptoms of complicated grief.

What is complicated grief?

To understand what complicated grief is, it is first important to understand “normal” grief and the tasks a grieving person should address to adapt to the loss. J. William Worden is a pioneer in the hospice movement in the United States. He is a founding member of the Association for Death Education and Counseling and has written on topics related to terminal illness, cancer care and bereavement. In the fourth edition of his book Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (2009), he indicates the four tasks a grieving person should address:

1) Accept the loss.

2) Process the pain of grief.

3) Adjust without the deceased.

4) Live effectively in the world by finding a place for the deceased in your emotional life.

In the first task — accept the loss — the mourner should face the reality that the death happened and that the person is not coming back. Some people refuse to believe that the death happened, causing them to live in denial and get stuck in this first task. In the second task — process the pain of grief — people in mourning need to acknowledge and work through their pain. If they fail to do this, they will carry the pain with them throughout their lives, and the pain can manifest into physical symptoms.

In the third task, three areas of adjusting without the deceased need to be addressed: external, internal and spiritual. External adjustment usually develops approximately three to four months after the loss. It involves coming to terms with being alone and assuming responsibility for the different roles previously played by the deceased. This could mean the person takes on the role of being the breadwinner, accountant, gardener, mother, father and so on. With internal adjustment, it is important for the person to adjust to his or her own sense of self. In other words, how has the death affected the person’s self-efficacy? For the mourner, it is important to ask (and answer), “Who am I now?” Spiritual adjustment simply means addressing the adjustments one has made to the world in the absence of the deceased. It involves searching for meaning within these life changes both to make sense of them and to regain a sense of control of life.

The last task is to live effectively in the world by finding a place for the deceased in your emotional life. This means the person in mourning should find ways to remember the deceased without allowing it to get in the way of continuing his or her life.

Complicated mourning has been given many different names, including unresolved grief, chronic grief and delayed grief. Whatever name you choose, complicated grief is, as described by Worden, when a “person is overwhelmed, resorts to maladaptive behavior or remains interminably in the state of grief without progression of the mourning process toward completion.” In other words, something is impeding the mourning process, and a good adaptation to the loss is negatively affected.

The table below shows the diagnostic criteria for complicated grief as proposed by Katherine Shear, Naomi Simon, Melanie Wall and colleagues in a study published in February 2011 in the journal Depression and Anxiety. The table shows the distress that Cynthia was experiencing at the start of her treatment. The diagnostic criteria are strong enough to produce continuing separation distress. In other words, the symptoms presented are associated with impairment, similar to other psychiatric diagnoses. Cynthia was experiencing impairment in her social and occupational life. She remained in a state of grief, with a healthy, normal progression through the mourning process being impeded.

[CLICK ON TABLE TO SEE IN FULL SIZE.]
Table adapted from “Complicated grief and related bereavement issues for DSM-5” in “Depression and Anxiety,” February 2011.

It was clear to me, having completed advanced training in grief counseling and based on the information Cynthia provided in session, that she was experiencing complicated grief. Complicated grief encompasses difficulties in acknowledging the death on a social, emotional or cognitive level. During our initial therapy session, Cynthia and I explored the lack of resolution to her loss and its relationship to her fear of driving. I explained to her the four tasks of grieving and how she had not processed through the grief work.

For instance, in task one, the mourner must face the reality that the death occurred and that the deceased will not come back. There were instances when Cynthia could not emotionally accept her sister’s death. She continued to call her sister, believing that her sister would return her call. For Cynthia, the loss of her sister was debilitating and didn’t improve over time. Her emotions were so painful, long-lasting and severe that she had trouble accepting the loss and resuming her life. She refused to acknowledge the loss in order not to grieve. Denial kept her from admitting the loss.

In task two, the person needs to acknowledge and work through the pain of the loss. Cynthia did not acknowledge her sister’s death and thus did not process the associated pain. This resulted in her pain manifesting into anxiety and fear of driving. She reported in our sessions that her fear of driving started about a year after the death of her sister. Cynthia’s heightened symptoms of trembling, choking, dizziness and fear of dying prevented her from continuing to drive.

In task three, Cynthia had a hard time adjusting without her deceased sister. As mentioned previously, her sister had been her best friend, and they had done almost everything together. Cynthia continued trying to call her sister despite knowing her sister had died because the thought of being alone terrified her. The death caused disruption in Cynthia’s social functioning. She refrained from engaging in activities by herself. In addition, she often avoided going out and interacting with peers because being around friends no longer meant anything to her. She made radical changes to her lifestyle following her sister’s death, including excluding her friends and avoiding many of her former activities. Likewise, Cynthia couldn’t function optimally at work and couldn’t trust anyone in the same way she had trusted her sister. She felt lonely and empty and believed that life without her sister was difficult.

Internally, Cynthia did not know who she was anymore. She felt she had lost part of herself when her sister died. Although she denied suicidal ideation, she mentioned that she wanted to be with her sister and missed her terribly. Cynthia said she did not consider suicide because she kept wishing for her sister to be alive rather than experiencing death herself to see her sister again.

Spiritually, Cynthia could not regain control of her life. Prior to her sister’s death, Cynthia had her life in order. She had many friends, socialized, held a great-paying job and wasn’t afraid to drive. After her sister’s death, she lost that sense of control and could no longer find meaning in the things she once enjoyed.

Task four was difficult for Cynthia to process. She could not find an appropriate place in her emotional life for her sister’s death without it interfering with her ability to live her life effectively.

Interventions used with Cynthia

In this case with Cynthia, I had to use different techniques to help her process through normal grief. I first introduced her to normal grief and complicated grief. I described the model of adaptive coping, the building of a satisfying life and her adjustment to the loss. We also discussed her personal life goals, which were to drive again without fearing she would die, to rebuild her social networks and to be successful in her career like she had been before her sister’s accident. We worked on each of the four tasks of grieving until we both felt she was ready to proceed to the next task.

In the beginning of our treatment, I invited Cynthia to have a supportive person attend the therapy session with her. Cynthia chose her mother, with whom she stated she had a close relationship. The reason I did this was to restore Cynthia’s connection with others, because with complicated grief, individuals often lose that sense of connection. In addition, attending one of our sessions allowed Cynthia’s mother to better understand what Cynthia was going through and helped her to provide support throughout Cynthia’s treatment. I provided her mother with an overview of complicated grief and its treatment.

A couple of sessions later, I asked Cynthia to visualize when she became aware of her sister’s death and to recount the story into a tape recorder. I had her tell the story repeatedly and then listen to tapes of the recitation. This was done to introduce her to imaginal revisiting. It was also a way for her to process the death on an emotional level and integrate her emotions with the reality that her sister has died. I then debriefed with her, having her describe what she felt as she told the story of her sister’s death. I also instructed her to listen to the tape every day between sessions.

Other elements that I used throughout the treatment included a grief monitoring diary. I use this diary with clients whose social and occupational functioning is compromised due to the death. I instructed Cynthia to monitor her grief intensity throughout the day (0 = no grief, while 10 = the most intense grief) and the associated situations. We discussed the diary in sessions, exploring both her positive and negative emotions. Discussing her grief levels helped to bring the treatment into her daily life. When exploring her grief levels, Cynthia often confused her feelings of grief with her feeling of anxiety. I helped her to discriminate between her emotions and to work with them differently. We worked on resolving her feelings of guilt, anger and anxiety.

At the start of our treatment, Cynthia mentioned she felt depressed. She had feelings of hopelessness that she would never recover and regain control of her life. This made it difficult for her to come to terms with the loss of her sister and find fulfillment in her own life. In addition to using imaginal exposure and the grief monitoring diary, I asked Cynthia to think about her personal goals and activities to help reawaken her joy and meaning in life. This was a form of restoration work in which I told her to reward herself with pleasant activities each time that she found an assignment distressing but was willing to try it anyway. The purpose was to help her move toward a goal so she could begin visualizing a satisfying life without her sister.

I also felt it would be helpful for Cynthia to talk about pleasant memories and positive characteristics of her sister. I invited her to bring photographs and other mementos to the sessions. I encouraged her to share those happy memories and to hold imaginary conversations with her sister under my guidance. I often use this empty chair technique in my sessions with clients who are experiencing some form of trauma or grief. This experience proved meaningful for Cynthia and helped her gain the closure she needed.

Final thoughts

If I hadn’t inquired about possible losses and deaths during intake, I wouldn’t have known that Cynthia experienced a loss. I would have continued to treat her fear of driving without getting to the core of the problem. Cynthia wouldn’t have processed her grief in a healthy way, and she would have continued living her life with sadness, isolation and anxiety.

Instead, because we focused on the real issue, Cynthia made progress by the end of treatment, no longer meeting the criteria for complicated grief. Although she occasionally experienced moments of sadness, they were neither debilitating nor prolonged. She had stopped feeling guilty and angry and no longer avoided looking at pictures of her sister. She started driving again without the fear that she might die and forged closer relationships with her friends.

Termination with me was an easy process for Cynthia. She expressed gratitude and, although some of the exercises had been hard for her, she was able to acknowledge that they helped her to reduce the pain she had experienced for so many years. She mentioned that she was doing much better and no longer needed counseling services.

Grief is a condition that we all will experience. As counselors, our job is to diagnose and treat mental and emotional disorders. However, some of these disorders may be intertwined with grief. I believe it is important for counselors to pay close attention to what our clients are discussing in session as well as what their presenting symptoms are because there may be other complications that remain unspoken unless we ask. I also think counselors must make it a priority to educate themselves in grief counseling in order to give proper treatment to our clients.

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Helen Nieves is a licensed mental health counselor and certified attention deficit consultant specialist who works in her private practice and at an outpatient mental health clinic in New York. She is on the advisory board at the American Institute of Health Care Professionals. Contact her at hnieves.lmhc@gmail.com or visit counselingadhd.com.

Letters to the editor: ct@counseling.org

Counseling transracial adult adopted persons

By Susan Branco Alvarado July 28, 2014

Kit Myers, a transracial adoptee, in his cover story for Gazillion Voices online magazine, states, “As we grow older … many adoptees slowly begin to understand the complexity of adoption and the violence of separation, secrets and racial difference that accompanies the loving parts of adoption. Rarely is there space for adoptees who have had a ‘loving childhood’ but choose to critique or question certain (or all) aspects of adoption.”

Professional counselors are often challenged with providing the “space” Myers describes to normalize, validate and encourage transracial adult adoptees to explore their pre-adoption histories, their racial identity development and their relationships with their adoptive and birth families. Although we do not have data on the current number of transracial adult adoptees residing in the United States, the 2010 U.S. Census reported 2.1 million adopted children under the age of 18 living in households. A 2007 survey of adoptive parents sponsored by the Department of Health and Human Services indicated that 40 percent of all adoptions, regardless of type (private domestic, foster to adoption or international), were transracial. Specifically, most transracial adoptive families are composed of white adoptive parents with children of color who eventually grow up to become adults. Counselors, possessing a foundation based on a wellness model, are particularly poised to offer multicultural and adoption-sensitive counseling services to adult transracial adopted persons. Even so, it can be easy for counselors to overlook, minimize or misinterpret common clinical presentations of this population.

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Tara (identifying information altered for the purposes of this article), age 26, is a biracial (African American and white) adult adopted person who sought counseling with me to address her ongoing symptoms of anxiety and for assistance with a potential reunion with her birth family. She had previously engaged in counseling services on multiple occasions but had found that although counseling temporarily aided her in times of crisis, the services generally were not helpful in addressing her longer term concerns. Specifically, Tara reported to me that in previous counseling attempts, her counselors had not inquired about her adoptive status or her racial identity. Consequently, she did not feel it was acceptable to bring those topics up herself.

I will describe Tara’s counseling process after each section of this article to better highlight the framework, techniques and structure of counseling that we utilized.

Frameworks

David Brodzinsky, Marshall Schechter and Robin Marantz Henig’s 1992 book Being Adopted: The Lifelong Search for Self describes their research that yielded a developmental stage theory, similar to Erik Erikson’s stages, that is unique to adopted persons. The stages describe tasks such as attaching to one’s adoptive family in infancy, learning one’s adoption story during middle childhood, developing racial and adoptive identities in adolescence and considering a birth family search in adolescence and/or young adulthood.

Some tasks, such as coping with adoption grief and loss, permeate throughout the life span. Sometimes typical young adult and adult milestones, such as launching from the home for college or employment, developing intimate partner relationships, choosing a career or becoming a parent, trigger adoption-related tasks. For transracial adopted persons, launching into adulthood may mean moving away from their adoptive families, who are often white, and exposing themselves to racial/ethnic discrimination or microaggressions.

Amanda Baden, Lisa Treweeke and Muninder Ahluwalia’s reculturation model, published in the Journal of Counseling and Development in October 2012, is a particularly useful framework to assist this population in delineating and determining where they may fall on the continuum of ethnic, racial and adoptive identities. The model can also facilitate discussion on experiences of racial/ethnic discrimination. Reculturation is described as the unique process that some transracial and international adopted persons engage in to reclaim their lost original cultural, racial and ethnic identities. The model illustrates how many transracially and internationally adopted persons lose their connections to their original cultures and racial/ethnic groups when they are adopted and leave their first families. This is especially the case when they are adopted by white parents. The reculturation model includes a phase describing the process by which transracial adoptees seek information about their birth cultures in late adolescence, as young adults or as adults.

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Tara’s self-referral for counseling was ignited by new information about her adoption story and considerations for search and reunion. She described lifelong issues with anxiety, feelings of detachment from family and romantic relationships, and struggles with her racial identity. Tara indicated that she felt reasonably trusting that this newest counseling experience might prove more helpful than past experiences. Specifically, she cited my advertising materials and biographical information that used “adoption-friendly” and welcoming language.

Assessment

Assessment and evaluation of transracial adult adopted persons for treatment planning purposes requires the same ethical standards of practice that are applied when collaborating with any client population. Careful and thorough clinical interviews and consultation with former providers and current medical providers (with appropriate releases of information, of course) are crucial.

When considering the diagnoses, evaluations and assessments given by previous providers, it is important that counselors ascertain how, if at all, the client’s adoptive and racial/ethnic identities and background were incorporated into those evaluations. Unfortunately, far too often, mental health providers have misdiagnosed or overdiagnosed adopted persons on the basis of adoption stigma or a lack of adoption and multicultural competency. Counselors following best practices will strive to balance previous evaluations and assessments with their own knowledge of the context and background of the client’s adoptive, racial and ethnic identity status so that a pathological or inaccurate diagnosis is not maintained.

For assessment purposes, counselors also need to be mindful that many adopted persons, both transracial and same race, may have missing information regarding family medical and/or mental health histories, as well as prenatal and perinatal care and circumstances. For persons adopted after infancy, major gaps in childhood development information may exist. In such cases, it is important to acknowledge any grief, loss or anger the client feels regarding lack of access. It is also important to validate the social justice aspect of this person being deprived of basic information that most nonadopted persons have by default.

If the client does have information available — for example, child welfare records, orphanage/institution reports and/or foster family records — counselors should ask if the information may be reviewed together in session. Records and information from prior caretakers and institutions, although not always entirely accurate, can be useful guides in helping the client piece together a narrative of his or her early life history.

John Bowlby’s attachment theory is based on the trust developed in relationships between the parent(s) or caregiver(s) and the child. This theory is often utilized with adopted populations because it also examines the impact to the attachment process when a child is separated from his or her caretaker or parent. Unfortunately, along the way, some adoption professionals grossly mischaracterized this theory to endorse unethical and harmful therapeutic practices that are most often referred to as “attachment therapy.” Counselors should be alert to and aware of their clients’ experiences with any type of attachment therapy so they can assure these clients that they will not be subjected to this kind of treatment in their current counseling situation. In addition, counselors should determine the extent of trauma, if any, experienced by these clients during previous treatment episodes.

Despite the negativity associated with so-called attachment therapies, there remain valid and credible attachment-related clinical assessment tools that can be useful in counseling. In 1985, Mary Main and her colleagues developed a 19-item questionnaire, the Adult Attachment Interview (AAI). Later on they created a coding system that has been empirically validated to show that the AAI reliably determines a person’s attachment-seeking strategies. The questionnaire, which asks about a client’s relationships with family members, experiences with loss and trauma, and caregiving experiences from a young age to young adulthood, often can aid the client and counselor in determining how the client’s attachment strategies may be affecting his or her current relationships (usually intimate partner relationships). It can also identify incidents of trauma and loss that need reparation.

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Tara’s assessments included a clinical interview, multiple in-session reviews of her foster care records and the AAI. One of Tara’s previous providers had diagnosed her with reactive attachment disorder (RAD) during her teenage years. This diagnosis had not been explained to Tara previously, and it was uncertain how, other than Tara’s adoptive status, the clinician had arrived at that conclusion. The RAD diagnosis was not part of Tara’s current clinical picture because she did not meet the diagnostic criteria. Instead, it highlighted an example of a potentially inaccurate diagnosis that was likely based on bias or stereotypes of persons from foster care backgrounds.

During the beginning of Tara’s treatment, we reviewed her records from the child welfare system. This information provided Tara with the groundwork needed to develop her treatment plan. Her records mainly highlighted the neglect and poor quality care she had received from infancy until her first foster home placement as a toddler. They also described basic details about the challenges her birth mother experienced while attempting to parent Tara and provided information about possible older siblings of whom Tara had previously been unaware.

Finally, Tara’s responses to the AAI offered information on how her attachment strategies, characterized by intense anxiety and fear of losing important relationships in her life, developed throughout her lifetime. The AAI also revealed trauma she had experienced in relation to being one of the only persons of color in her community. These experiences included multiple incidents of racial teasing as well as more subtle microaggressions.

The beginning treatment sessions were powerful for Tara. They represented the first time she had been offered a nonjudgmental space in which to explore her adoption story, including those elements that did not fit with the dominant adoption narrative she grew up with that highlighted only the “happy” and “fortunate” aspects of her story.

Counseling goals

The assessment process offers valuable data when the counselor and client collaborate to develop a counseling plan. When working with a transracial adoptee, these goals may center on:

Further exploring adoption-related developmental tasks for review and repair purposes
Examining racial identity development through the lens of transracial adoption, which often requires incorporation of both adoptive and birth family racial/ethnic heritage
Understanding and repairing early life trauma, including abuse and neglect, and the subsequent impact on attachment strategies
Beginning or continuing the process of search and reunion

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Tara’s counseling goals reflected her assessment outcomes. Her goals included reviewing her development in the context of adoption-related tasks; examining her racial/ethnic identity using the reculturation model; exploring and repairing instances of neglect, trauma and attachment disruptions; and preparing for reunion with her birth family.

Counseling interventions

Psychoeducation: Effective interventions often start with basic psychoeducation on normative adoption-related developmental tasks using the stage theory from Brodzinsky and colleagues.

For transracial adoptees, the reculturation model is also valuable as a starting point in treatment. It offers a flow chart depicting an adopted person’s removal from his or her birth family and culture and subsequent adjustment into the client’s adoptive (often white) family. The model also offers descriptors of identity-seeking activities that many transracial adoptees engage in as adolescents and young adults to gain integration of their original birth culture and racial/ethnic heritage. Some examples of these activities include touring a birth country or having extended visits, learning their original language, attending college or living in communities with others who share their racial/ethnic heritage, and participating in religious practices related to their racial/ethnic background.

The model includes categories for transracial adoptees who:

Have reclaimed their original racial/ethnic background
Balance both their original and adoptive family backgrounds
Remain identified with their adoptive family’s racial/ethnic identity
Identify with the transracial adoptee culture

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Tara and I used the adoption-related developmental tasks to better determine which aspects of the stages she had completed and where she might need further exploration. For example, as a child, Tara experienced periods of grief related to her adoption and transracial identity. These periods often centered on birthdays, certain holidays or the rare occasions when she saw other families who reflected her racial background. She had not shared these feelings with her adoptive parents because she was afraid it would hurt their feelings and she would be considered ungrateful for having been adopted. While examining the reculturation model, Tara was excited to discover that her various activities to engage with the racial and ethnic group of her birth, such as attending a historically black college and moving to a more diverse community, were important parts of her racial identity development.

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Interactive timelines: Timelines that use large, floor-length paper serve as useful visual tools for the counselor and client to highlight significant events in the adopted person’s life. These events can be charted using drawings, words, symbols or photos. Significant events might include birthdates (actual or estimated), moves from foster care placements, times spent in institutions or orphanages, developmental milestones, racial/ethnic identity experiences (for example, awareness of differences from adoptive families and incidents of discrimination or microaggression) and reunions with birth families.

Family narratives: If a client consents and if appropriate in the counseling process, family members may be asked to participate in counseling as well. One effective technique is to ask family members to describe their experience of choosing to adopt, their feelings before meeting the child (now adult) they adopted, what the first meetings were like and what unique traits the person they adopted brought to their family.

Seeking this information builds on the family narrative to include the client’s adoption and integration into the family. The process can also provide valuable observations related to the client’s earlier behaviors, particularly those to which the client would not have memory access. Including the family in the counseling process can also model and facilitate discussion about adoption, racial/ethnic differences and challenges the family faced (and perhaps still encounters) as a transracial adoptive family.

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As Tara and I created her timeline, listing important developmental milestones and including adoption-related tasks, we realized more information was needed regarding her initial adjustment into her family. Tara indicated she thought it would be helpful to ask each family member to share his or her memories and observations of first meeting her as a toddler. Tara also used this opportunity to let her family know she was working on figuring out her “adoption and identity” in counseling.

Tara’s family emailed their accounts and memories of when they first met her. Tara found these messages helpful. They offered important information about how frightened she was as a young child and highlighted all of the survival strategies she employed to feel safe. For example, she initially hid food in her room, rocked herself to sleep and would not engage in physical contact with her new family. All of these behaviors are typical safety-seeking strategies that younger children may use to protect themselves in the absence of predictable and nurturing caretaking.

Tara’s timeline now reflected her “survivor toddler” self and highlighted the inner strengths she possessed even as a very young child.

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Bibliotherapy/cinematherapy: Counselors can offer clients a significant number of quality books, memoirs, magazines and documentaries, many of which were created by transracial adopted persons, as supplemental work outside of session. Counselors can encourage clients to journal about their emotional reactions to these creative works, and this feedback can be used further in sessions. Many transracial adopted persons grew up isolated from others like them, so gradual exposure to those with shared experiences can be a powerful and healing counseling tool.

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Tara read multiple books on transracial adoption and adoptee identity development. In addition, she found documentaries depicting the life experiences of other transracial adoptees, including some that featured reunions with birth families. She found these outside-of-session activities helpful in further normalizing her experiences.

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Reunion preparation and maintenance: Ideally, reunions require preparation and planning to manage the myriad emotional reactions that are often experienced by the adopted person, birth families and adoptive families. Counseling can be effective in offering psychoeducation on the possible emotional responses to reunion as well as its potential impact on the client’s family systems.

Reunion maintenance involves using counseling to help adopted persons manage the multiple new relationships in their lives. In particular, counseling helps the adopted person explore issues related to “divided loyalties” between birth and adoptive families. A reunion may represent the first time that a transracial adopted person is incorporating another person of color into his or her adoptive family system. Counseling based in the multicultural competencies can assist the adoptee in acknowledging issues related to privilege, social class and racial/ethnic differences during reunion maintenance.

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While in counseling, Tara located and reunited with two of her birth siblings via social media. After the initial excitement of the reunion, she struggled with integrating her newly found siblings into her adoptive family. Issues related to race, social class and privilege were continually explored in counseling. This helped to alleviate and normalize the push and pull she experienced as she navigated the complexities of her new family system.

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Adult adoptee support groups: These groups can be helpful adjunct components of the counseling plan. These groups, particularly if diverse in their racial/ethnic makeup, can offer normalization and validation to transracial adoptees via shared experiences. If in-person support groups are not available, then offering online resources, including Facebook groups, may be an acceptable supplemental alternative.

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An adoption agency in Tara’s community did offer a monthly adult adoptee meeting. She found this support helpful, particularly because she was able to meet other transracial adult adoptees who were also in various stages of reunion.

Counseling outcomes

The counseling process may represent one of the first times that transracial adult adoptees experience a safe, nonjudgmental environment where they can actively explore, critique and examine the impact of adoption and transracial identity on their development. The desired counseling outcomes will be unique to each individual. However, counseling offers a structure through which clients may begin the reparation process of examining their adoption stories (including pre-placement circumstances), identifying their attachment strategies, integrating the realities of their differing racial/ethnic heritages (adoptive and birth families) and beginning or adjusting to reunion scenarios.

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Tara worked with me for approximately 14 months. During that time, she was able to repair her adoption narrative by understanding and acknowledging her pre-adoptive circumstances; began working on strengthening her attachment strategies with her family, her romantic partner and her friends; and gradually integrated her birth family and adoptive family. Throughout the counseling process, her identity as a biracial (African American and white) person was examined within the context of social class and privilege and its impact on her development as an adult.

Recommendations for all counselors

Counselors who work with transracial adopted persons can build their skills by considering continuing education course work in adoption, multicultural counseling and family systems. All counselors can implement basic alterations to their practice that will be helpful to this population. These include the following suggestions.

Include “adoptive status” during the intake assessment. Clients are not often asked about adoptive status during intake. This omission can send the message that counseling is not a place where adoption-related concerns can be explored. Add this category in the demographic section of the intake assessment to suggest that the topic of adoption is welcome in your counseling practice.

Include racial/ethnic categories in the “family of origin” section. It is easy to assume that the client’s racial background is similar to that of his or her family of origin. Adding individual categories describing racial/ethnic demographics for the client and important family members welcomes discussion and exploration of racial identity in particular and multicultural issues in general.

“Broach” the topic of transracial adoption as a clinical area to be explored. Norma Day-Vines and colleagues’ 2007 research on broaching described the process by which counselors can effectively attend to racial/ethnic differences between counselors and their clients. The same concept can be used with transracial adoptive status. This status in and of itself may not be the presenting issue in counseling. However, it is important that counselors acknowledge the context and its impact on the client’s overall experience.

Examine the stereotypes or myths held about adoption, adopted persons, birth/first parents and adoptive families. Despite generally evolving sentiments, stigma related to being adopted or making an adoption plan as a birth parent still exists. Additionally, adoption is often portrayed solely as a happy solution for parents and children without also acknowledging the inherent losses that accompany it. To build self-awareness, counselors should examine their own experiences with adoption (in their families, among friends and within their communities) and then consider the stereotypes, myths and beliefs that they hold.

Explore adoption-sensitive resources to provide supplemental support. Research the post-adoption resources available in local family services departments to provide supplemental support for adopted persons. Counselors can also research post-adoption services offered by private adoption agencies in their communities. Finally, the online transracial adoption community is plentiful and can offer support to those clients beginning the process of engaging with others.

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Knowledge Share articles are adapted from sessions presented at American Counseling Association conferences.

Susan Branco Alvarado is a licensed professional counselor in independent practice and a doctoral student in the counselor education and supervision program at Virginia Tech in the National Capital Region. She is also a 2014 fellow in the National Board for Certified Counselors Minority Fellowship Program. Contact her at salvarado@adoptiontherapist.org.

Letters to the editor: ct@counseling.org

From the president

By Robert L. Smith July 25, 2014

Robert L. Smith
ACA President 2014-2015

My first column in Counseling Today mentioned collaboration. I emphasized intentional collaboration that, when combined with effective communication, accentuates empowerment. The cover story in this issue of CT also highlights collaboration, and collaboration will play a major role in the action plans discussed below.

At ACA’s 2014 Conference & Expo in Hawaii, the Governing Council approved several collaborative activities for Fiscal Year 2015. Identified as investments in our future, these activities represent action plans for the year. The seven projects continue the efforts of former presidents of ACA and the Governing Council while addressing ACA’s strategic plans. The seven projects are:

1) Assessing the future. An anonymous quote encapsulates this project: “The only truly sustainable competitive advantage is the ability to learn and adapt faster than your competition.” One of the most cost-effective ways to learn about an organization and its future is to gain insight from others. Thus, a Counseling Vision Advisory Task Force will be charged with examining ACA’s future.

We will draw upon the knowledge, experience and diversity of a group of counseling professionals to help us prepare for the future. Emerging societal issues affecting the counseling profession, and thus ACA, will be examined. The vision group will help ACA fulfill its mission heading into its “second hundred years” (which begins in 2052).

2) Investing in students and new professionals. This project would support those who are preparing to become counselors or counselor educators. Scholarships are proposed for recently admitted graduate students, while Emerging Leadership grants are proposed for new professionals.

3) Investing in practitioners. The practice briefs from the ACA Center for Counseling Practice, Policy and Research and the emerging leadership programs will both be enhanced and made more accessible to practitioners. ACA materials, including research-based findings, will be further disseminated to members who are providing direct counseling services.

4) Investing in ACA divisions, regions and branches. Divisions, regions and branches comprise three significant parts of ACA. The funding of joint projects between ACA and its divisions, regions and branches is proposed. High priority will be given to collaborative efforts resulting in membership growth and innovative ideas.

5) Investing in research. Research projects will be solicited and reviewed by the ACA Research and Knowledge Committee and the ACA Center for Counseling Practice, Policy and Research. Findings from national surveys and mental and behavioral health studies will be disseminated to national and international outlets, resulting in ACA being recognized as a leader in producing and disseminating research.

6) Investing in global activities. ACA leadership and staff have explored outreach programs with counseling communities across the globe. The next phase involves using data acquired to create culturally appropriate services and resources for international colleagues.

7) Investing in leadership development. Increased participation in and support of the ACA Institute for Leadership Training (ILT) is being emphasized. The ACA Governing Council convened during the ILT in July, and Governing Council members also used the institute to network with division, region and branch leaders, and to meet with legislators.

Important task forces and work groups are in place. The Social Justice Strategic Planning Task Force is examining ACA’s role related to social justice issues and advocacy. It will recommend systematic and strategic approaches to address social justice issues. A Professional Identity and Membership Employment Work Group is compiling data on ACA membership to determine how ACA can best serve its members. A Task Force on Governance, Organizational Affiliates and Divisions is examining best governing practices that are inclusive in nature.

I look forward to the many challenges and opportunities while serving as your president. Your support and involvement are important. By working together, I know we can make a difference.

Peace,

Robert L. Smith, Ph.D.

Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

CEO’s Message: Changes, changes and more changes

By Richard Yep

Richard Yep
ACA CEO

For several months (years really), I have occasionally shared news in this column that ACA would be developing and launching products and services designed with our members’ needs in mind. The goal has always been to tap into what members said they wanted and to deliver those products and services in the format members desired. During this time, we also wanted to ensure that we spent your membership dollars in a manner that demonstrated prudent stewardship.

Not to sound trite, but I think that the proof is in the pudding (and I love pudding). Let’s take a quick inventory of the past few years. Members have been introduced to: a new website; ACA Connect (our online community where members gather to discuss issues affecting them); numerous podcasts and webinars; a Free CE of the Month; social media communities on Facebook, LinkedIn and Twitter; a conference program app that is scalable for your smartphone, tablet or laptop; professional liability insurance included in the membership benefits for students pursuing their master’s degrees; a live chat feature with our member services unit via our website; full digital access to all ACA journals (back to volume one, issue one); a more robust career services information center; and many other products, services and features.

And to think, I remember how cool it was when ACA got a fax machine. As Bob Dylan sang, “The times they are a-changin’.”

To deliver what members need and want, as well as to demonstrate our value to you, ACA will continue to look at the best ways we can help you as clinicians, practitioners, researchers and academics. We also want to make sure that we go beyond your work setting and meet your professional needs as students, midcareer professionals or retired members.

All those members for whom we have an email address have now received two issues of the ACA Member Toolkit (with a third on its way in early August). This arrives in your e-mailbox at the beginning of each month and is packed with useful information — plus a link to your Free CE of the Month. I encourage you to take a few moments to read through this valuable digital publication that we have started providing to ACA members.

As we enter the month of August, the beginning of a new academic year will have an impact on many of you. Whether you are a counselor educator, a graduate student, someone who works in an educational setting or simply the parent of a child starting a new school year, I hope you will enjoy the year ahead. Regardless of your role, I wish you the very best. If the staff or I can do something for you, please let us know.

Some of us have recently put away our “gear” from summer vacation and are back on the job. Still, I hope you will mark your calendars now for the ACA Conference & Expo in Orlando, Florida, from March 11-15. The call for programs resulted in what will surely be a stellar lineup of full-day and half-day Preconference Learning Institutes (March 11-12) and Education Sessions (March 12-15) tailored just for you. More information is available at counseling.org/conference.

As always, I look forward to your comments, questions and thoughts. Feel free to contact me at 800.347.6647 ext. 231 or via email at ryep@counseling.org. You can also follow me on Twitter:
@RichYep.

Be well.