Tag Archives: adoption

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

Counseling adopted clients: A Q & A with Kara Holt

Heather Rudow December 1, 2012

(Photo:Flickr/stevendepolo)

In conjunction with National Adoption Month, which promotes the awareness of the need for adoptive families for children in foster care, Counseling Today spoke with Kara Holt about how to counsel adopted clients. Holt, an assistant professor in the University of Wyoming counseling program, is a member of the American Counseling Association, the Association for Child and Adolescent Counseling, the Association for Counselor Education and Supervision, the Association for Humanistic Counseling and the Association for Creativity in Counseling. She believes it is important for the adopted individual to understand his or her own unique story and for counselors not to pass any judgment until they have listened to and understood the client’s story.

Is there is more or less stigma for adopted children now? Why?

I do not think it is more or less as much as it is that the stigmas have changed. I think that adoption has become more commonplace in our society and that we do not often try to hide the fact that someone is adopted as frequently. However, I think that children who are adopted are often stigmatized [by mental health professionals] and given automatic diagnoses such as reactive attachment disorder without really getting to know the child.

What are some do’s and don’ts for families with adopted children?

I think some of the do’s are to help the children understand their own unique story and learn how to integrate this into a coherent narrative of their life and sense of belonging. It’s so important to celebrate the unique way that people create families. I think one of the don’ts, although very challenging, is to try to not take personally the struggles and resistance that some adopted children demonstrate.

What are some do’s and don’ts for counseling adopted clients?

I think it is essential to conceptualize the client within the framework of attachment dynamics, trauma and the effects that both of these have on brain development. It is essential to remain patient and remember the therapeutic power of safe and consistent relationships that involve a systemic approach. Remembering the difference between chronological age and emotional age is also key. Counseling should be geared toward the emotional and developmental age of the client, which is often younger than the chronological age. I would say it is important to not automatically label adopted children with a diagnosis without truly getting to know them and their experience and not to isolate treatment to only be between you and the client. I would also be cautious and remember that a behavioral change does not always equate to an emotional shift. This often takes time, and counseling can ebb and flow. It is also important to normalize [the client’s] experience and struggles. Often, adopted parents are reluctant to reach out for additional support and help.

Should parents be involved in counseling sessions with adopted children?

Absolutely, any time that this is an option.

What issues can the subject of adoption raise in clients? How about within clients’ families? What can counselors do to help?

This can often raise question surrounding belonging, abandonment and way to initiate and maintain healthy and supportive relationships. Families also experience anxiety about how to talk to their children about adoption and what language to use. Questions often arise about the open adoption, the status of the birth family or connecting with the birth family, and social situations. Counselors can help parents with activities that are developmentally appropriate to help them talk to children. Counselors can also help facilitate relationship-building therapies between parent and child and help serve as an advocate for the family. Counselors can also help parents understand the child’s behaviors and emotions within the context of the adoption experience that often includes some kind of attachment struggles even when the child was adopted at birth. Many times, parents do not expect struggles with an infant [adoption].

For more information, read Counseling Today’s March cover story, “Fitting together as a family,” which features an interview with Holt.

Fitting together as a family

By Lynne Shallcross March 1, 2012

Kara Carnes-Holt’s daughter had one wish on her fifth birthday. “I wish that this mommy and daddy keep me forever,” the little girl said as she blew out the candles on her cake.

Hearing her wish, Carnes-Holt and her husband assured their daughter they were going to keep her forever. They became foster parents to their daughter when she was 4, and the adoption was finalized when she was 5.

Their daughter is now 11, but reflecting on that wish still breaks Carnes-Holt’s heart. “A child who is not adopted doesn’t have that fear,” says Carnes-Holt, an assistant professor in the counseling program at the University of Wyoming who works with adopted children and families through the university-based clinic. “I wish that my child didn’t have that fear. A child at 5 should never have to worry that they’re not going to have a mommy and daddy forever. No child should have to worry about that.”

In the years since their daughter joined their family, Carnes-Holt says they’ve concentrated on creating new family traditions, taking lots of family pictures and celebrating the anniversary of the day their daughter was adopted.

Although her daughter no longer fears that her parents might leave her, Carnes-Holt says it takes time for foster children and adopted children to heal. “You can tell a child [that you’ll keep them forever], but they also have to live it for a while,” says Carnes-Holt, a member of the American Counseling Association. “It’s just going to take some time for them to believe it. They have to feel that they can be part of the family and that they’re loved. Actions are stronger than words.”

Carnes-Holt says her daughter suffered emotional abuse and was frequently neglected by her birth family. She was in a therapeutic foster home prior to coming to live with the Carnes-Holts and struggled upon joining their family. Carnes-Holt believes rebounding from past trauma and loss of caregivers is a long-term healing process for foster children and adopted children, and she contends that the primary healing comes via new relationships. “In counseling, we focus on interventions and techniques, but the most healing component is a long-standing, unconditional relationship with someone,” she says. “That provides the most healing dynamic of anything we can do [as counselors].”

There are three different “tracks” for children through the foster care and adoption system, Carnes-Holt explains. First is foster care only, in which a child is removed from the home and placed temporarily with a foster family by the child services system. In this scenario, the goal remains to reunite the child with his or her birth family. If that doesn’t work, it becomes a foster-to-adopt situation, Carnes-Holt says. In this scenario, the parental rights of the birth parents are terminated, and the foster family is often given the first chance to adopt the child. With the third track, adoption only, parental rights have already been terminated. The child lives for a period of time with a family in a foster situation until the adoption can be finalized.

Michelle Zeilman works as a counselor with foster children through a nonprofit organization in St. Louis. A few decades ago, permanent foster care was more of the norm, she says. But after the Adoption and Safe Families Act was passed in 1997, the foster care system was tasked with either working toward reunification of children and their birth families or finding adoptive placements, says Zeilman, who is also an adjunct professor at the University of Missouri-St. Louis.

Counselors might encounter or seek out foster children, adopted children and their families as clients in a variety of ways. For instance, Carnes-Holt says, counselors might work with foster children through a community mental health agency, a private practice that accepts Medicaid or a children’s home.

Laura Hoskins, an ACA member who runs a private practice in Brattleboro, Vt., and specializes in working with adopted children and their families, says counselors can first seek out work with agencies that support those families. After gaining the necessary expertise, counselors can consider setting up a private practice and specializing, she says.

Although closely related, working with foster children and their families can be a different experience for counselors than working with adopted children and their families, according to Carnes-Holt. “[With] foster families, you are working more with external systems such as Child Protective Services,” she says. “Oftentimes, the outcome and future for the child may not be determined, so treatment planning and preparing the child for the future can be difficult. You also do not have control over many decisions that are being made for that child, such as visitation, reunification, termination of parental rights, etc. You can make recommendations, but those are not always followed, although you can always try to be the advocate.”

“For adoptive families,” Carnes-Holt continues, “you are working more on developing a strong sense of connection and attachment in the family system, working to create a sense of permanency for the child and integration within [his or her] new setting. You are working to help the parent and child create an attuned relationship that lays the foundation for increased chances of long-term success for the family.”

Wounds from the past

These counselors say both foster children and adopted children often deal with issues of attachment and trauma. As a result of their traumatic histories, Zeilman says, these children sometimes exhibit acting-out behaviors, aggression, withdrawal or hypervigilance. And although focus is often placed on the trauma and abuse history of the child, Zeilman says another important aspect often gets overlooked: the trauma the child experiences being removed from one home and trying to assimilate into a new family system.

Fitting in with a new family can be challenging for many foster children, Zeilman says. For instance, children from abusive backgrounds might have different ideas about how family relationships are defined and look, and they sometimes have developed certain behaviors that helped them survive in the past. Those behaviors can become problematic in their new foster home, Zeilman says. “As a therapist, the view I take is that I should be able to work wherever the needs are at that time,” she says. “I might sit down with the foster family and child and talk about what the expectations are in this new system and how we can help the child understand that things work differently here.”

Likewise, hypervigilance among foster children is also often rooted in their traumatic experiences, Carnes-Holt says, and it can appear similar to attention-deficit/hyperactivity disorder. Peer interaction can also be difficult for foster kids, she says, and they might exhibit oppositional behaviors and an extreme need for control because of the loss of control they otherwise feel in their lives.

It can be difficult for foster parents to see the child struggling, but Carnes-Holt says they shouldn’t take it personally. She explains that the child is simply working to process all of his or her previous experiences. “It’s hard when you try day in and day out to connect [with the child] and you still get opposition and struggles at school and at home,” she says. “[Foster parents] have to learn to make it through the long haul and create the relationship and separate out those behaviors as symptoms of what [the child has] been through. It’s not about them hating you.”

As for the birth parents in a foster situation, Carnes-Holt says they need to take some ownership of what has happened and work to reestablish the child’s trust because that link has been damaged. It takes a lot to say, “I messed up, and I can do better,” she notes, but just because parents apologize doesn’t mean that the level of trust will be rebuilt immediately. A counselor might work with the birth parents to deal with their own issues, to avoid placing blame on external systems and to prove themselves trustworthy to their child again, Carnes-Holt says.

When working with foster children, understanding child development is critically important, Zeilman says. “As these children reach new developmental phases, they tend to reprocess their situation — the abuse/neglect, removal from the birth family, placements, identity, etc. This may bring new issues and problems that these children will need to work through. Therapy may need to be revisited at different times as the child develops.”

In Carnes-Holt’s view, the primary role of the counselor when working with a foster child is to be the advocate for the child, working with the child services system to secure whatever he or she needs to live a safe and happy life. Depending on the plan the system dictates for the child, a counselor might conduct individual counseling with the child or conduct family counseling with the birth family and child, the foster family and child, or the potential adoptive family and child.

Settling into a new home

It’s commonly thought that children adopted as infants are more likely to have an easier time adapting and attaching to an adoptive family, Carnes-Holt says. But even for those children adopted almost immediately after birth, an attachment had been formed while the biological mother carried the baby, Carnes-Holt points out, meaning there was also a break in the attachment between the child and the primary caregiver.

Although older children who are adopted are often considered more at risk for issues such as learning disabilities, attention issues and attachment struggles, Carnes-Holt says it’s not necessarily their age but more so their experiences that dictate how they will manage in a new family. A 5-year-old who lived in a stable family with the same mom and dad but gets adopted after her parents die in a car accident might fare better than a 2-year-old who has been in multiple foster homes, Carnes-Holt says. She acknowledges, however, that the older children are, the more chances they have had to experience traumas.

Echoing Zeilman’s thoughts concerning foster children, Hoskins says that during typical developmental stages of growth, the prospect of adoption can add a wrinkle to what is already a challenging time. “The easiest example to illustrate this is the task of teenage adolescents to individuate and determine who they are and where they fit in — in their family, the world, anywhere,” says Hoskins, who has two adopted children. “For a child who may have had no contact with birth parents while growing up, this can be a particularly challenging time period.”

Another hurdle for children who have been adopted, particularly internationally, is the potential stigma or challenge of being the only person in their family, school or even town with a particular skin color, Hoskins says. “While this is not usually a difficult issue for preschool-age children, it can become a more significant issue as the child matures and he or she begins to notice the difference and becomes confused about whether this is their family. And peers may use [the difference] to taunt.”

Carnes-Holt says adopted children can struggle with the idea of the difference between adopted and biological children. Counselors can support the family by helping the parents understand how best to explain the difference, she says. For example, the parents might tell the child that there are many ways to make a family and that they are connected by their hearts. She says it’s important not to tell a child, “We couldn’t have a baby, so we decided to adopt,” because this can imply adoption was the less-favorable option.

One welcome difference Hoskins notices now in comparison with years past is that the stigma of adoption has decreased and more parents are being open with their children about their histories. “A generation ago, it was not uncommon for parents to keep from their child the fact of their adoption,” she says. “The child may not have learned about it until an extended relative said something unknowingly, the child discovered their adoptive state when needing to produce their birth certificate for legal purposes of some kind or even [found] documents revealing the truth of their adoption after their adoptive parents had died. Being adopted was considered a much greater stigma in generations past than it is now. Much of the adoption literature encourages parents to begin telling their child their adoption story at a developmentally appropriate level as soon as the child joins the family. Creating an adoption book or a life story book is another way families today are encouraged to celebrate the fact of their child’s adoption.”

The issues faced by adoptive parents can vary based on the circumstances surrounding the adoption of their child, Hoskins says. If the adoption is classified as “open,” meaning the potential exists for a continuing relationship with the birth parent or parents, determining how close that relationship will be is a challenge for everyone involved, Hoskins says. If the adoptive parents were unable to have children biologically, they may also be struggling with feelings of shame or unworthiness, even after an adopted child has joined their family, she says.

When the child is acting out, it can be isolating and scary for foster or adoptive parents, Carnes-Holt says. These parents have a tendency to feel ashamed, to question whether they are providing a good enough home and to believe that they are the only family struggling, she says. On top of that, they often don’t know where to go for help, Carnes-Holt adds. If counselors are working with prospective adoptive or foster parents, it is important to validate that it is a wonderful thing that they are considering doing, Carnes-Holt says, but at the same time, to prepare them to potentially encounter some negative behaviors on the part of the child.

“Adoptive parents may be dealing with the challenging behavior of a child with reactive attachment disorder (RAD) or posttraumatic stress disorder (PTSD) due to their early life experiences,” Hoskins says. “To attempt managing these challenging behaviors on their own would likely only lead to frustration and an unhappy family. Counselors can best help these families by, at most, obtaining training regarding adoptive parenting, RAD and PTSD in adopted children and, at least, reading recommended books on these issues. Encouraging families to become involved in or actually offering a support group for adoptive parents can be extremely helpful.”

For her part, Carnes-Holt believes RAD is a rare diagnosis that at times can be overused by mental health professionals. Being pulled away from a primary caregiver disrupts an attachment and is traumatic, but having a normal reaction to those events doesn’t necessarily indicate a disorder, she says.

Helping children heal

According to these counselors, many of the same counseling techniques work with foster children and adopted children. Zeilman points to cognitive behavioral therapy (CBT) techniques as being supported by research. Once the child is in a more stable situation, trauma-focused CBT can also be helpful, she says. Many counselors also use solution-focused techniques, Zeilman adds, because the counselor and child can pick a problem and figure out a solution for it, which helps to stabilize the child’s environment.

Carnes-Holt, a child-centered play therapist, says the model of child-parent relationship therapy is helpful in teaching parents the basic skills and philosophy of child-centered play therapy so they can use it with their children. Parents learn reflection of feelings, therapeutic limit setting, esteem-building statements, choice giving and more, she says. Child-centered play therapy offers an unconditional relationship with the child, Carnes-Holt explains, and the goal of child-parent relationship therapy is to encourage parents to offer that kind of relationship as well.

The reason child-centered play therapy is so effective both with foster children and adopted children is because these children have lost a substantial amount of control in their lives, Carnes-Holt says. This mode of therapy allows the child to be in control and allows for therapy to happen at the child’s pace. “Children have it within themselves to heal,” she says. “They’ll take the counselor where they need to go.” Theraplay, parent-child interaction therapy and dyadic developmental psychotherapy are three other commonly used techniques with this population, according to Carnes-Holt. All three, however, are more directive than child-centered play therapy, she says.

Hoskins points to a handful of clinicians who have written books, conducted research or offer trainings relevant to working with adopted and foster children. Dan Hughes has authored several books on working with attachment-disordered children and families and also leads workshops and trainings for parents and clinicians. Hoskins also recommends Nancy L. Thomas’ book When Love Is Not Enough: A Guide to Parenting Children With RAD-Reactive Attachment Disorder. Bruce Perry is another well-known expert who has done research on the effects of trauma on early brain development. He founded the ChildTrauma Academy in Houston.

Carnes-Holt says more and more research is being done to understand what trauma and attachment do to the brain. As answers continue to surface, she believes counselors and parents will come to recognize that these children are not intentionally trying to be difficult, but that their brains have been shaped differently because of past experiences. Many of these children’s behaviors are fear-based, she says, not based in willful defiance or manipulation. And although it takes time to heal the brain, Carnes-Holt says stable, ongoing relationships can go a long way in doing just that.

It’s crucial that any counselor working with this population also learns to work systemically, Carnes-Holt says. Counselor education programs often prepare counselors to focus on individual and family therapy, she says, but counselors working with foster and adopted children and their families must know how to collaborate effectively with agencies, schools, doctors and many other variables in the equation.

It can be challenging for counselors when they feel pressure to produce results in a certain period of time, Carnes-Holt adds. For instance, the foster care system might decide a child should begin having visits with his or her mother again even though the counselor doesn’t think the child is ready for that step yet. “Somehow, you have to collaborate to move forward,” she says.

Training is a must for any counselor working with foster and adopted children and their families, Hoskins says. “Please have focused training or supervision in this field, because it is not simply counseling with the added flavor of adoption,” she emphasizes. In addition to reading recommended books, it is even more helpful to take workshops and earn continuing education from trainings provided by clinicians who are respected in the field, Hoskins says. “Knowing adopted families personally can make a huge difference, and actually being an adopted parent gives one experience you can’t gather even from all these other sources,” she adds.

Zeilman agrees that training is critical. “This population has traditionally been provided service by social workers, so LPCs (licensed professional counselors) seem to be newer to this population,” she says. “My formal educational training as an LPC provided an excellent foundation, but it was absolutely necessary to seek professional training outside of my formal educational training to increase my competence.”

Working with foster children and adopted children offers counselors unique opportunities to witness and learn from the resilience that these children demonstrate, Zeilman says. She recalls working with one child who had been physically and emotionally abused by family members before being placed in a wonderful foster family. After seven months of therapy, the girl no longer needed any psychotropic medications.

“Her birth father had filed an appeal to the Termination of Parental Rights ruling,” Zeilman says. “This client had moved forward so much by the time court arrived that she asked to address her birth father, expressing that she loved him, that he would always be her father, but that she wouldn’t accept his behavior. She asked him to let her go — all unscripted and unprompted. This was a child who was still in elementary school. As much as we work to help our clients, we often forget how much we can also learn from them. I learned much from her strength, her courage and her ability to remain hopeful.”

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Related reading

See Counseling Today‘s online exclusive: Reading up on adopted and foster children

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Letters to the editor: ct@counseling.org

Reading up on adopted and foster children

By Laura Hoskins February 22, 2012

Laura Hoskins, who runs a private practice in Brattleboro, Vt. and specializes in adopted children and their families, offers some recommended reading for counselors working with adopted and foster children:

For clinicians and parents:

Creating Capacity for Attachment by A. Becker-Weidman
Twenty Things Adopted Children Wish Their Parents Knew by Sherrie Eldridge
Affect Regulation, Mentalization and the Development of Self by P. Fonagy, G. Gergerly, E. Jurist and M. Target
The Transforming Power of Affect by Diane Fosha
Attaching in Adoption by Deborah Gray
Nurturing in Adoption: Creating Resilience After Neglect and Trauma by Deborah Gray
Toddler Adoption: The Weaver’s Craft by Mary Hopkins-Best
Attachment-Focused Family Therapy by Daniel Hughes
Facilitating Developmental Attachment by Daniel Hughes
Building the Bonds of Attachment by Daniel Hughes
Brothers and Sisters in Adoption by Arleta James
Rebuilding Attachments with Traumatized Children by Richard Kagan
A Love Like No Other: Stories from Adoptive Parents by Pamela Kruger and Jill Smolowe
A General Theory of Love by T. Lewis, F. Amini and R. Lannon
Making Sense of Adoption: A Parent’s Guide by Lois Ruskai Melina
The Boy Who Was Raised as a Dog and Stories from a Psychiatrist’s Notebook: What Traumatized Children Can Teach Us About Loss, Love and Healing by Bruce Perry and Mara Szalavitz
Born for Love by Bruce Perry and Mara Szalavitz
Adoption Nation: How the Adoption Revolution Is Transforming America by Adam Pertman
Affect Regulation and the Origin of the Self by A.N. Schore
Affect Disregulation and Disorders of the Self by A.N. Schore
Affect Regulation and Repair of the Self by A.N. Schore
The Developing Mind: Toward a Neurobiology of Interpersonal Experience by Daniel Siegel
The Mindful Therapist by Daniel Siegel
Adolescent Girls in Crisis by Martha Straus
When Love Is Not Enough: A Guide to Parenting Children with RAD by Nancy L. Thomas
Real Parents, Real Children by Holly van Gulden
Secret Thoughts of an Adoptive Mother by Jana Wolff
Maternal Deprivation Reassessed by Mary Ainsworth
Healing Power of the Family: Illustrated Overview of Life with the Disturbed Foster or Adopted Child by Richard Delaney
Troubled Transplants: Unconventional Strategies for Helping the Disturbed Foster or Adopted Child by Richard Delaney
Treating Explosive Kids: The Collaborative Problem-Solving Approach by Ross W. Greene and J. Stuart Abon
No-Talk Therapy by Martha Straus
Adolescent Girls in Crisis by Martha Straus

For children:

The Mulberry Bird by Anne Braff Brodzinsky
How I Was Adopted by Joanna Cole
Tell Me Again about the Night I Was Born by Jamie Lee Curtis
Mama, Do you Love Me? by Barbara M. Joose
A Mother for Choco by Keiko Kasza
Over the Moon by Karen Kats
I Love You Like Crazy Cakes by Rose Lewis
All About Adoption: How Families Are Made and How Kids Feel About It by Marc Nemiroff and Jane Annuziata
We Belong Together: A Book About Adoption and Families by Todd Parr

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Related Feature: Fitting together as a family

Letters to the editor: ct@counseling.org