Tag Archives: attachment

Working with foster and adoptive families through the lens of attachment

By Somer George October 4, 2018

“He just got kicked out of his second preschool program! We’re nearing the end of our options here. What do we do?” I could hear the desperation in the mother’s voice as she described the past few months with the 5-year-old she and her family were fostering and would soon be adopting.

“He threw a chair at the teacher and punched a little girl, and nothing we do seems to make it better,” the father explained, describing the detailed behavior plan on which they had collaborated with a well-meaning social worker.

“And it’s not just at school,” the mother continued. “Even when he’s home with us, he often gets out of control. He even peed on his dad’s lap” — her voice lowered to a whisper — “on purpose!”

I nodded my head, empathetic to the immense strain this family had been under for the past several months. The mother and father were friendly and confident, well-educated and sincere. They had wanted to do something good for the world by fostering and adopting children in need. They had so much to offer. And yet here they were, barely surviving each day and feeling the shreds of normalcy slip through their fingers as this little boy pushed every emotional button they had, leaving them exhausted and discouraged.

My years of experience working with the Secure Child In-Home Program and the Virginia Child and Family Attachment Center helped me to frame their experience in terms of attachment. The situation they were in was not unique among parents who had adopted a child or made the decision to provide foster care, the initial good intention and early excitement slowly turning to exhaustion and sometimes regret. Often, these children who need it the most push away every offer of help and comfort that is provided to them.

Where healing happens

So, what do we do when parents who have adopted a child or are providing foster care come to us, asking for advice or counseling for their troubled child? Certainly, there is benefit in providing these children with play therapy, giving them a chance to form a new relationship and to express themselves through their own language of play.

And yet, that strategy speaks to only one side of the coin. Attachment theory tells us that children heal best in the context of secure caregiving relationships. And parents are the ones who provide the day in, day out caregiving, wielding the most influence on the development of new patterns in the child’s relationships and behaviors.

According to attachment theory, a child is biologically wired to turn toward a caregiver in times of distress. When the child’s emotional needs are met, the child develops patterns of soothing and regulation that are essential for healthy development. When these emotional needs are denied or rebuffed, however, or if the child experiences the caregiver as frightening, the child learns dramatically different adaptive strategies. The child may become withdrawn and inhibited or bossy and aggressive. These patterns aren’t quick to change when a new caregiver comes along. Add to this the trauma of abuse and the loss of a biological parent, and you have a situation full of misunderstanding and relational strain.

New caregivers often come into their role with little awareness of the child’s experiences and the patterns necessary for surviving a young life filled with turmoil, anguish and uncertainties. When these coping strategies show up in the new relationship, parents are (understandably) distressed and often seek help to “fix” the child’s confusing and challenging behavior.

What these parents may not realize is that their own ability to read through the confusing signals and meet the child’s emotional need is the place where most of the healing will happen. If the parents can provide both a secure base from which the child can explore the world and a safe haven for the child to return to, the deeply rooted patterns of behavior and interaction will begin to shift. This is not a quick and easy process. It is messy to be sure, often following a pattern of one step forward, two steps back. However, if parents are given the support they need, it is certainly an attainable and worthy goal.

The counselor’s role

So, what is the counselor’s role in helping form new patterns of interaction, leading to more emotional stability and better child behavior? How can we help move these relationships toward greater security, helping each family to become a haven of safety for children who have experienced significant neglect, rejection, fear and loss?

I’d like to offer some suggestions for counselors who desire to help these parents form stronger relationships with their children and experience a reduction in the difficult behaviors that create such chaos.

  • Provide empathy and understanding to parents. Often, by the time parents seek out a counselor, they have already been through a great deal of distress, frustration and turmoil. Yes, they are coming to receive help, but first they need to feel heard and understood without being judged. Parenting is extraordinarily difficult, and parenting a child with extensive emotional needs is even harder. Take the time to empathetically hear these parents’ concerns and welcome their expressions of distress.
  • Educate parents about normal development and the impact of trauma/loss. Sometimes foster and adoptive parents have already successfully raised biological children, so these difficult behaviors on the part of the child they are adopting or fostering don’t make sense to them. What they did with their other kids doesn’t seem to work with this child. Spend time teaching these parents about how their child’s brain may have developed in a dramatically different way due to the impact of neglect, trauma and loss. Talk about the fact that forming new secure relationships takes time and how important their role is in this process.
  • Help parents to practice observation skills. We human beings so naturally take in information and draw conclusions without even realizing we are doing it. Unfortunately, we aren’t always right. Parents who are living in highly stressful situations may have trouble stepping back and paying attention to what is happening in the moment. Help them to slow down and notice their child’s body language, facial expressions and tone of voice before making assumptions about what the behavior means or how to stop it. With foster and adoptive children, parents often say they don’t know what is going on inside the child; this is often the most important place to help them learn. It is essential that they obtain a developmentally accurate view of the child’s inner experience, feelings and thoughts in the context of the child’s earlier experience and relationship patterns.
  • Invite parents to pay attention to their own experience. How does mom feel when the child is screaming that he hates her? What is dad’s experience when his request to come for supper is repeatedly ignored? As parents become better at observing their child, it is important that they also attend to themselves. What are they feeling in these moments, and what is their body language and tone of voice communicating to the child? Help them to consider their own needs and to find ways to regulate their own strong emotions that are activated when the child is pushing them away.
  • Encourage parents to think about what the child is feeling in these difficult moments. So often, the focus of parents is on how to manage the child’s behavior. Traditional strategies that use rewards and punishment are rarely successful with children who have experienced neglect, trauma and loss. Although the child’s behavior doesn’t make sense at first glance, there is often much to be learned if we slow down and pay close attention.

Have the parents set aside quick assumptions and, instead, help them to observe carefully, giving consideration to what the child might be feeling. The child might look and sound angry at first glance, but might he or she instead be feeling scared or sad? The child already has emotional and behavioral sequences established that, once activated, run automatically. These unintentional and automatic patterns need to be shaped into healthier ones.

  • Ask parents to think about what the child needs from them. Does the child need to feel heard and validated? Does the child need comfort, protection and co-regulation of automatic well-learned patterns? Does the child need the parent to stay close by and help him calm down because he feels out of control? If the child is anxious, might she need the parent to provide soothing rather than correction?
  • Encourage parents to try new strategies aimed at fostering connection. Instead of putting the child in timeout, try bringing him in close for a cuddle and some conversation. Instead of sending the child to her bedroom to calm down, try going with her and staying close by. Remind parents that new approaches may not work right away, but with persistence and practice, they can begin to make a significant difference.
  • Facilitate parents’ exploration of their own attachment histories and how this influences interaction with the child. We know from research that a foster child’s initial relationship patterns are often a mismatch for a parent’s natural caregiving patterns. We also recognize that parental patterns of attachment have a strong influence on the child’s patterns. Increased reflection on these experiences can help us become better caregivers.

Invite parents to think about how their own experiences with caregivers have influenced the way that they react and respond to their child. What expectations do they hold? What automatic reactions are happening outside of their awareness? What automatic reactions happen outside of the child’s awareness?

  • Celebrate small (and large) victories. The little moments are the big moments. Provide plenty of affirmation and support for parents as they try new approaches and persevere in the day-to-day tasks of parenting. Acknowledging their efforts and celebrating successes, however small, can go a long way toward giving them the courage to continue through the hard times.

Working with these families can be immensely rewarding. They are often highly motivated and desperate for support. As counselors, we need to be aware of our impulse to provide a “quick fix” to try and make things better. We can make concrete suggestions, but we also need to recognize that the process of building stronger relationships and changing behavior takes time.

The type of relationship that we build with the child’s parents can itself be a catalyst for change. We can provide a place where the parents feel safe expressing their distress and their shortcomings, knowing that we will support them in their efforts to help guide their child on the path to healing.

A different path

As I continued working with the family mentioned at the beginning of this article, I could see the changes taking place. They began having more positive interactions with their child and seeing new qualities in him that they hadn’t noticed before; they were thinking about him in a different way. Their own self-reflection helped them to catch themselves before they reacted and think more about what he needed from each of them.

“I noticed that the collar of his shirt was often wet from him chewing on it. I stopped reprimanding him for this and realized that it meant he was feeling really anxious,” the mother told me one day.

“Yeah, and this was a sign that we needed to pick him up and give him some reassurance,” the father quickly added. “It really seems to calm him down.”

The mother continued: “I think that before when he was anxious, his behavior would spiral out of control. And the behavior chart was part of what contributed to his anxiety, which just made things worse instead of better. I don’t think we need it anymore.” As she spoke, she glanced at dad and noted his nodding head.

“They still use one at school,” she said, “but we’ve been talking to his new teacher about how to connect with him and what helps relieve his anxiety. Also, I stuck a picture in his book bag of the three of us together so he can get it out and look at it when he is at school. I think it helps him feel more secure. It’s a way for him to carry us with him.”

As I listened to them share these stories, I couldn’t help but smile. They still had a long road ahead of them, but they were headed down a very different path than the one they were on originally. We celebrated each of these moments together and reflected further on their experiences with their child.

I continued to come alongside them to support them in this journey for a little while longer, serving as a secure base and safe haven for them. Soon, however, they decided that they no longer needed counseling. Through a lens of attachment, they saw that their relationship with their son was much stronger, and although his behavior was still challenging at times, they possessed the confidence that they could handle it, moving forward together as a family. Once again, the experience of a healthy attachment proved itself to be a powerful force, propelling another family toward greater health and healing.

 

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Somer George is an adjunct professor at James Madison University and is currently completing her doctorate in counseling and supervision. She also works for the Virginia Child and Family Attachment Center and the Secure Child In-Home Program, where she helps to provide comprehensive attachment assessments, intensive in-home therapy and research-based parent courses. Contact her at somer@george.net.

 

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Related reading, from Counseling Today:

Fostering a brighter future

Through the child welfare kaleidoscope

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

When panic attacks

By Bethany Bray July 30, 2018

Kellie Collins, a licensed professional counselor (LPC) who runs a group private practice in Lake Oswego, Oregon, experienced her first panic attack when she was 14. She remembers suddenly feeling cold, losing sensation in her hands and her heart beating so rapidly that it felt like it was going to leap out of her chest — all for no readily apparent reason.

“I thought I was dying. That’s what it felt like,” Collins says. “It was the worst experience of my life up to that point. It felt like it lasted forever, even though it was just a few minutes. Afterward, I was left with a feeling that I had no control.”

When Collins subsequently experienced more panic attacks, the situation was exacerbated by a close family member who didn’t understand what was happening. The family member suggested that Collins might be having the panic attacks on purpose, to get attention.

Collins’ life changed for the better in high school, when she began seeing a counselor. She learned not only that her panic attacks were manageable but also that she wasn’t to blame for their occurrence.

“Hearing that I didn’t cause this and that it wasn’t my fault set me on the path to get better. It made all the difference,” says Collins, a member of the American Counseling Association. “The biggest thing [counselors can do] is to validate the client’s experience. What they experience is real and not under their control in that moment — and it’s terrifying.”

‘Fear of the fear’

In addition to overwhelming feelings of fear, panic attacks are usually marked by shortness of breath or trouble breathing and a rapid heartbeat. Other physical symptoms can include sweating (without physical exertion), a tingling sensation throughout the body, feeling like your throat is closing up or feeling that you’re about to pass out, explains Zachary Taylor, an LPC and behavioral health director at a health center in Lexington, Virginia. Symptoms vary, however. “I’ve never had two patients describe it the same way,” he says. (Taylor refers to patients instead of clients because he works at a medical health center.)

According to the National Institute of Mental Health (NIMH), an estimated 4.7 percent of adults in the United States experience panic disorder at some point in their lives. The past-year prevalence was higher among females (3.8 percent) than among males (1.6 percent).

Panic disorder is marked by recurring, unexpected panic attacks (or, as NIMH describes, “episodes of intense fear” that are “not in conjunction with a known fear or stressor”). People who experience panic disorder typically worry about having subsequent attacks, even to the point of changing behavior to avoid situations that might cause an episode.

“It’s such a jarring and uncomfortable experience, and it feels so much like a real medical emergency, that they begin to fear the sensations themselves. This fear of the fear is what drives panic disorder,” explains Taylor, a member of ACA. “If it gets too bad, they begin to arrange their life around trying not to experience anything that might resemble or trigger any of those feelings that are associated with a panic attack, and it becomes a vicious cycle.”

At the same time, panic attacks can occur in people who do not have a panic disorder diagnosis. Although panic attacks are often coupled with stress, trauma or anxiety-related issues, they can also occur in clients without complicating factors, says Collins, who notes that she has seen clients who experienced their first panic attack in their 50s or 60s.

“They can happen even when life is going well and have no apparent reason. … Some people have them for a period of time in life and then never have them again, while others will have them throughout life,” she says. In addition, significant life changes, such as getting married, starting retirement or having a child, can trigger recurrences in clients who previously were able to manage their panic attacks, Collins adds.

Among clients with mental illness, panic attacks can co-occur with depression, anxiety, bipolar disorder, posttraumatic stress disorder, obsessive-compulsive disorder, specific phobias (particularly emetophobia, or fear of vomiting) and other diagnoses. Taylor says they can also be associated with a medical or physical issue.

“One of the most overlooked problems that can lead to developing panic is chronic sleep deprivation or insomnia,” he says, explaining that a lack of sleep can overexaggerate the fearful thoughts related to panic. When treating panic attacks, counselors should ask clients about their sleep habits within the first few sessions, Taylor advises. Counselors can also remember the acronym CATS and ask clients about their consumption of caffeine, alcohol, tobacco and sugar — all of which can worsen the feelings associated with panic attacks, he adds.

Learning coping skills and identifying triggers

Clients who come to counseling after experiencing a panic attack may start therapy without understanding the complexity of panic attacks or harbor feelings of shame or embarrassment about succumbing to panic seemingly out of the blue, Collins says.

It is sometimes helpful to explain to clients that during a panic attack, their body is launching into the fight-or-flight mode that is part of their biological wiring, Collins says. However, in this case, there is no tiger chasing them.

“I like to say that [a panic attack] is tripping the sensor, like when a leaf falls on your car and the alarm goes off. It trips the sensor, but your car doesn’t know” that there isn’t any actual danger, she explains. Collins says it also can be helpful to assure clients that “it will never be as bad as those first few times when you didn’t know what was happening to you.”

To identify triggers, Collins suggests walking clients through the months, days and hours that led up to their first panic attack — but only when the individual is ready to relive the experience, she adds. Some triggers can be easily identifiable, such as a spike in work-related stress or the loss of a loved one. Other triggers may be less obvious, meaning more work will need to be done to unpack the experience later in therapy.

“I like to make sure clients have really solid coping skills before they work on the underlying stuff that might be contributing” to their panic attacks, such as trauma, Collins says. “Spend the first few sessions identifying what’s been going on. Once they’re confident and capable of managing and getting through an attack, then ask about what might be contributing” to the attacks occurring.

Outside of session, counselors can encourage clients to devote time to journaling, relaxation, deep breathing and counting exercises that can boost self-reflection and change negative thought processes, Collins suggests.

Counselors can also equip clients with coping mechanisms such as mindfulness to help them remain calm and feel more in control in the event of a panic attack. Collins often gives her clients a small stone to carry with them and hold in their hand when a panic attack strikes. She tells them to focus on the stone and describe it to themselves — is it rough, smooth, cold, heavy? This can help divert their attention from the panicky sensations, she explains. The same technique can be followed using car keys, a coffee mug or whatever else clients can hold in their hands that wouldn’t readily draw undue attention from others, she adds.

Clients can also develop mantras to remind themselves in the moment that even though a panic attack feels all-consuming, it is a finite experience. Among the phrases Collins suggests as being helpful:

  • “I’ve gotten through this before.”
  • “This is only temporary.”
  • “Even though this feels like it’s going to last forever, it will end; it always does.”

Collins acknowledges, however, that “once it gets to a certain point, these things don’t work. You have to accept it for what it is when you’re in the middle of an attack. You have to ride the wave, accepting that it will be temporary and it will go away.”

“Sometimes, even getting angry at the panic attack can help,” she adds. “When [people] allow themselves to accept that anger, it takes away some of the power of the attack itself. Admit that it stinks but it’s something you can get through.”

Uncomfortable but not dangerous

Thinking that a panic attack can be halted or avoided by using breathing or relaxation techniques is a misconception, according to Taylor. Those methods are often the first choice of well-meaning practitioners, but Taylor argues that “it sends a subtle message to the patient that what you’re experiencing is dangerous and we need to do something to prevent it.”

“The first thing you need to do is teach [clients] that what [they are] experiencing is uncomfortable but not dangerous,” he says. “It’s your avoidance of the uncomfortable feelings, and trying to stop it, that has unintentionally made it worse. When it comes to symptoms of panic, trying to suppress or avoid those symptoms is the exact opposite of what you want to do.”

Diaphragmatic breathing and other relaxation techniques can be helpful to manage anxiety, Taylor clarifies, but they won’t stop the symptoms of a panic attack altogether. “The only way to truly stop it is to become accustomed to the feelings” and to understand that a panic attack is not dangerous, he adds.

Taylor finds the DARE method developed by author Barry McDonagh particularly helpful. The technique focuses on overcoming panic with confidence rather than employing futile attempts to calm down, Taylor says. The four tenets of DARE are:

  • Diffuse: Using cognitive diffusion, counselors can teach clients to deflect and disarm the fearful thoughts that accompany panic attacks. The thoughts that flood people’s minds during these episodes are just that — thoughts — and are not dangerous, Taylor explains. “Teach them to say ‘so what?’ to their thoughts: ‘What if I embarrass myself or pass out or throw up? So what?’ Take the edge off that thought by not only demoting it but separating ourselves from the thought: ‘It’s not me. I didn’t put it there.’ Teach patients to say to themselves, over and over, ‘This sensation is uncomfortable but not dangerous.’ Think of it like a hiccup. It’s uncomfortable but not dangerous. There’s nothing medically wrong. The more you focus on it, the more uncomfortable it gets.”
  • Allow for psychological flexibility: It is more important that individuals allow and become comfortable with their negative associations than it is to try to get rid of them, Taylor says.
  • Run toward the symptoms: Moving toward feelings of discomfort is antithetical to human instinct, but in the case of panic attacks, it can actually be an effective tactic. Taylor teaches people who deal with panic attacks to tell their bodies to “bring it on. Ask your heart: ‘Give me more. Let’s see how fast you can beat.’ One of the fastest ways to stop a panic attack, ironically, is to ask for more and try and make it worse. It’s the resistance to the sensations that makes it stick around.”
  • Engage: Teach clients to engage in the moment once the panic attack has peaked and is starting to wind down. This is when grounding and mindful exercises can be helpful, Taylor says. “What’s important is to focus on right here and right now. That will help you continue to move forward and get unstuck,” he adds.

An attachment approach

All of the counselors interviewed for this article noted that cognitive behavior therapy (CBT) is an effective, tried-and-true method to support clients who experience panic attacks by helping them refocus the fearful and overexaggerated thoughts that accompany the experience.

Linda Thompson, an LPC and licensed marriage and family therapist in Florida, finds that using CBT through the lens of attachment theory can be particularly helpful in addressing panic attacks. That holds especially true for clients who struggle with feelings of abandonment or rejection or have experienced attachment trauma, including the loss of a loved one or caretaker. Counselors can identify clients who might benefit from attachment work by asking questions at intake regarding past relationships and loss, Thompson says.

“If they are the kind of person who is very relationship-oriented and attachment is very important to them or there is trauma there, that has to be brought into the conversation,” says Thompson, an associate professor at Argosy University with a private practice in the Tampa area.

Thompson suggests that counselors invite someone to whom the client is attached, such as a partner or a spouse, into the therapy sessions (with the client’s consent). The practitioner can prompt discussion that helps the client share some of the inherent fears that he or she is harboring. Often, Thompson says, the partner’s response to this sharing is “I had no idea you felt that way. How can I help?”

From there, counselors can introduce techniques that the client and the client’s attachment figure can use together when the client is feeling anxious, Thompson says. Eye contact, hand holding and other physical connections can be particularly helpful. “It’s making it about connecting,” she explains.

Once they understand that their loved one’s worry and panic are spurred by issues related to relationships or a fear of isolation, friends and family members can be better prepared to respond differently when the person begins to struggle. If the client is willing, counselors can play a role in training the individual’s support system to help with attachment-oriented responses. For example, if a client wakes up in the middle of the night feeling panicked, a spouse or partner could respond by rubbing the person’s back or whispering affirmations such as “You’re not alone,” “I’m here” or “We’re going to get through this together,” Thompson says.

Attachment-oriented clients may also benefit from learning to do breathing techniques with someone to whom they are attached, Thompson adds. For example, a client may start to feel the symptoms of a panic attack while driving. Relying on techniques learned in session, the client would pull the car over and focus on their child in the backseat — holding the child’s hand, making eye contact and breathing together. The physical touch will boost oxytocin, a hormone connected to social bonding and maternal behavior, Thompson explains.

Thompson also suggests that these clients try yoga to help with relaxation and self-control. She says the practice is more beneficial if it involves a social aspect, so she recommends that clients practice yoga in a class with other people instead of alone at home.

Similarly, Thompson suggests helping attachment-oriented clients build a “tribe” or circle of support beyond the counselor. This is especially important for those who have lost a spouse or partner and those who are more susceptible to isolating themselves. Counselors can guide clients in finding connections that are personally meaningful to them, whether that is through participation in spiritual or religious activities, volunteer work or other community groups such as a book club. Focusing on relationships rather than the physical symptoms of a potential panic attack can help these clients feel less vulnerable, says Thompson, a past president of both the Pennsylvania Counseling Association and the International Association of Addictions and Offender Counselors, a division of ACA.

Thompson recalls one client who struggled so acutely with panic attacks and a fear of losing her loved ones that it kept her from leaving the house for two years. CBT alone wasn’t helping, so Thompson added attachment techniques to their therapy work together.

After a substantial amount of in-session exploration, Thompson discovered that the client’s panic attacks were tied to family-of-origin issues. The physical feelings the client experienced during her panic attacks were in the same part of the body where one of her parents had experienced a significant health problem.

In addition to conducting one-on-one therapy, Thompson included the client’s husband in sessions. They worked together on attachment-focused techniques, and, eventually, the couple was able to go outside of the home for the first time in a long while to celebrate their anniversary.

To prepare, they created notecards with attachment-focused feelings and reminders, such as what their first date felt like. They referred to the notecards throughout the evening and connected consistently via holding hands and making eye contact.

After the date, the client reported to Thompson that instead of thinking of where the exits were in the restaurant, as she would have done previously, she remained focused on the man — her husband — in front of her.

Thompson urges counselors to remain open to adding attachment theory or other complementary methods on top of go-to techniques such as CBT to reach clients who are experiencing panic attacks. “Expand your toolbox,” she says. “A person’s fear, the fear that is triggering panic, can have multiple origins. Help the client to find the source of their fear, and work on that. … Broaden your perspective to recognize that human beings have to be attached with people, no matter what the disorder. Ask, ‘How do I make sure the social needs of my client are being met?’”

Controlled exposure

Taylor knows firsthand how terrifying a panic attack can feel. He began experiencing anxiety in his teens and early 20s that intensified to the point of daily panic attacks.

When things were at their worst, he would often go to the emergency room of his local hospital. He wouldn’t register as a patient but would simply sit in the waiting room, knowing that those uncomfortable, uncontrollable feelings would eventually overtake him again. “Sometimes [I would go] because I was having a panic attack, or other times it was just because I felt I might have a panic attack,” Taylor recalls.

Eventually, Taylor did check himself into the hospital, and a doctor explained that he was going to be OK. That was the life-changing encounter that put him on the path to getting help; he credits medication and therapy for helping him overcome his panic attacks. The experience also inspired him to become a counselor.

This personal history plays into his work with clients. As a specialist in treating chronic anxiety and panic, he often emphasizes to clients that feelings of fear and excitement share the same neurological pathways. “It’s just our perception that makes them different. … You have to be able to ride the waves of panic without resisting it,” he says.

In addition to teaching clients to tolerate and deflect the invasive thoughts and physical symptoms that accompany panic attacks, Taylor finds exposure therapy to be a powerful treatment for panic. In fact, Taylor believes that exposure, or intentionally bringing on a panic attack in a controlled setting (such as the counselor’s office), must necessarily play a large role in overcoming the episodes.

“Patients are not moved by information; they’re moved by what they believe is possible, and they’re moved by new experiences. Just giving them the information [that panic attacks are survivable] is about as good as baptizing a cat,” he says. “If you give them the experience of exposure work in your office, they walk out a changed person. The focus should not be on staying calm but [on knowing] that no matter how hard their heart beats or [how much] they feel a sense of doom, they’re actually safe. It’s just a brain hiccup.”

Inducing a panic attack in the safety of a counselor’s office can prove to clients that what they might experience is uncomfortable but far from fatal, Taylor says. “When a counselor is doing exposure therapy with a patient and inducing panic-like symptoms in the office with them, we as counselors need first to be confident that a panic attack truly is not dangerous to the patient,” he explains. “If they start to panic and then we get scared and try to calm them down, the exposure will fail. We have to be able to stay with it, let the panic attack fully develop and subside on its own, so the patient learns that their fear of having a heart attack, passing out or losing control won’t happen. And unless we can really allow them to go all the way through a panic attack and come out the other side, the exposure just won’t work. They will continue to believe that a panic attack is dangerous and continue to try to suppress and avoid them.”

A good amount of therapeutic work may be required before clients are ready for exposure techniques, Taylor says. Once they are, counselors should begin the experience by asking clients to verbalize the worst thing they can imagine happening to them as the result of a panic attack, he says. Fears that clients typically voice include passing out, vomiting or even having a heart attack.

Taylor says the counselor’s response could be, “OK, are you ready to test that out” in the safety of the counselor’s office?

To induce the elevated heart rate and rapid breathing that accompany panic attacks, the counselor might suggest that the client do jumping jacks, run up and down the stairs or breathe through a straw for an extended period of time. As the panic symptoms swell and peak, the counselor will remain close by to remind the client of the cognitive diffusion and other techniques previously mentioned by Taylor.

Afterward, the counselor can talk about how the things the client feared happening as the result of a panic attack did not actually come to pass. The moment clients realize that they can endure panic attacks without their worst fears materializing is the moment they can begin to overcome the attacks, Taylor says.

Conquering avoidance

Individuals who have experienced panic attacks will sometimes start avoiding situations or places where a prior attack occurred. Often, this includes public places such as shopping malls. If this inclination is left unchecked, it can spiral into the person missing work and social engagements or engaging in other isolating behaviors, Collins says. On top of that, avoidance will serve only to make things worse, she notes.

“That fear of having another panic attack can be crippling,” she says. “One of the fears a lot of people have is having an attack in front of people or being in a place where they can’t escape, such as an airplane or a meeting at work.”

When Collins broaches this subject with clients, she frames it as taking their power back and not letting panic attacks control their lives. “We talk about starting small and [taking] baby steps, especially if they’ve been terrified of a place for a while,” she says.

Counselors can begin by having clients visualize in session the place they have been avoiding. Ask them to describe it and talk about how their body feels as they think about that location, Collins suggests. This process may need to be repeated several times before clients feel comfortable and confident enough to make a plan to actually go to the places they have been avoiding, she adds.

When they do go, make sure the client takes a friend or other trusted person with them for support. Clients should also be directed to stick to the plan they have created and talked through in their counseling sessions, Collins says.

For example, if a client has been avoiding going to a shopping mall out of fear of having a panic attack, a first step in the client’s plan might be simply driving to the mall, parking the car and sitting inside it for five minutes before leaving. The client might even need to repeat that step of the process multiple times, Collins says.

After that, the client can move on to walking through the doors of the mall and then leaving immediately. On the next visit, the client might enter the mall and go into a store, and so on. The idea is to continue going until the client no longer associates that place with feelings of fear.

Often, after repeated visits, “people will say, ‘OK, I don’t need baby steps. I want to go now,’” Collins says.

Above all, compassion

Counselors can provide a holistic approach to addressing panic attacks that clients might not have experienced previously with medical professionals or other mental health practitioners. Most of all, Collins says, counselors should offer empathy to clients who are confronting such a distressing, overwhelming and, often, seemingly unexplainable experience.

“That validation is the most powerful thing I’ve seen that helps people,” she says. “Clients get better with the relationship, the validation, the compassion. Compassion: That’s the No. 1 thing to remember.”

 

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Contact the counselors interviewed for this article:

 

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Learn more:

ACA Practice Brief on panic disorder: counseling.org/knowledge-center/practice-briefs

 

Zachary Taylor recommends these resources for counselors who want to learn more about the treatment of panic attacks:

  • DARE: The New Way to End Anxiety and Stop Panic Attacks by Barry McDonagh
  • Anxious Kids, Anxious Parents: Seven Ways to Stop the Worry Cycle and Raise Courageous and Independent Children by Reid Wilson and Lynn Lyons
  • Interview, “Maximizing Exposure Therapy for Anxiety Disorders” with Michelle Craske, professor of Psychology, Psychiatry and Biobehavioral Sciences and director of the Anxiety and Depression Research Center at the University of California, Los Angeles: sscpweb.org/craske
  • Article, “Get Excited: Reappraising Pre-Performance Anxiety as Excitement” by Allison Brooks, assistant professor, Harvard Business School: apa.org/pubs/journals/releases/xge-a0035325.pdf
  • Dr. Andrew Weil’s 4-7-8 Breathing Method: drweil.com/videos-features/videos/the-4-7-8-breath-health-benefits-demonstration/

Linda Thompson recommends these resources for counselors wanting to learn more about attachment-focused responses:

 

 

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

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The lingering influence of attachment

By Laurie Meyers June 25, 2018

A few years ago, American Counseling Association member Lisa Bennett took a trip to Southeast Asia. While there, she thought it would be fun to visit an elephant sanctuary where sick and injured animals had been sent to heal. What she saw fascinated her. The elephants engaged in attachment behavior.

Among herds, young elephants are raised not just by their mothers but by an older female who has already had babies and “retired,” moving on to another tribe. These older females return to their original herd, however, to serve as nannies to the young elephants. Bennett noticed that the nanny elephants seemed to be teaching the mother elephants how to connect with their calves.

“Nannies will literally push the mother toward the calf when the calf is in need and will model to the mother the actions to take to secure the calf’s safety and security,” Bennett says. The calves still viewed the mothers as their primary attachment figures but also displayed an attachment to the nanny elephants.

Of course, as a professor and director of clinical mental health counseling at Gonzaga University in Washington state, Bennett knows that attachment theory has even bigger ramifications for counselors and the clients they serve. All humans are born with the need for engagement with and responsiveness from other humans, says Bennett, who studies and gives presentations on attachment theory. People need to be touched, to be stimulated, to feel safe and to believe that someone — usually their primary caregiver or caregivers — will provide things for them. In other words, people need to be “attached.” If children don’t feel as if they have reliable attachment figures — a source for stability and safety — they are more likely to experience anxiety and have difficulties trusting others and forming relationships, Bennett says.

Bennett recently took a group of students from various programs, including clinical mental health, marriage and family therapy, and school counseling, to a wildlife park containing elephants. She wanted them to observe attachment in action in the animal kingdom and apply what they saw to human behavior.

Interestingly, Bennett’s group also observed that elephants can transfer their attachments to humans. In the park, there was no way for retired females to return to their old herds. As a result, there were no elephant nanny figures. However, whenever the human trainer appeared, the calves responded to him as if he were a nanny. Bennett believes that because human attachment is analogous to that of other animals, the elephants’ consistent attachment to a nanny figure showed that secondary attachment figures play an essential role in well-being.

Attachment theory is derived from the combined work of John Bowlby, a British child psychologist and psychiatrist, and Mary Ainsworth, a Canadian psychologist. The theory posits that infants have an instinctual survival-based need to form an emotional bond with a primary caregiver. This attachment provides a sense of safety and security. If children receive consistent attention and support from a caregiver, they are more likely to develop a “secure” attachment style. Children who do not receive consistent attention and support develop insecure — avoidant or anxious — attachment styles. Attachment style affects a person’s sense of self and shapes his or her ability to regulate emotions and form relationships.

Bennett notes that neurological research shows that humans are wired to make attachments, but these connections need to be reinforced, optimally between birth and age 2. However, children can become attached at an older age if they receive the right care and connection, she says. In addition, if a primary caregiver does not cultivate attachment in a child, another caregiver can provide that crucial link by responding to the child’s emotional and physical needs with “connection and delight,” Bennett says.

As children develop, they form a working model of the world and themselves, Bennett says. Children who have secure attachments tend to believe that they are lovable and likable and that other people are safe and kind and will meet their needs, she explains. Children whose needs are not being met generally develop one of two beliefs about themselves and the world. Those who have formed an avoidant style of attachment often believe that they are OK but that the world and the people in it are bad. Children who have developed an anxious style of attachment usually think that other people are generally benign but that they themselves are bad or unlovable, Bennett explains.

ACA member Joel Lane previously worked with children, adolescents and young adults and now supervises counseling trainees who work with this same population. He says that attachment issues often play a significant role in clients’ presenting concerns, either as the primary difficulty or as a complicating factor. With children and adolescents, much of Lane’s work consisted of helping these clients and their parents or caregivers understand one another’s needs better.

Attachment styles — and the interpersonal behaviors they engender — can form a lifelong emotional template. People with secure attachments know they can depend on those to whom they are attached to be available for support and vice versa, says Christina Schnyders, an assistant professor of counseling and human development at Malone University in Ohio and a frequent researcher and presenter on attachment issues. In contrast, anxious attachment creates fear that an attachment figure will not be dependable, she explains. In response to this fear, people with the anxious attachment style can become co-dependent and may also become frustrated or angry because their relational needs are not being met. People with avoidant attachment create distance from others to prevent having to depend on anyone or having anyone depend on them.

Each of these attachment behaviors affects how people function in crucial life areas such as family, peer and romantic relationships, Schnyders says. Attachment style can even influence a person’s career choice and interactions in the workplace.

Leaving the nest

Lane, an assistant professor in the counselor educator department and coordinator of the clinical mental health counseling program at Portland State University, studies attachment, particularly as it relates to the population known as “emerging adults” (those in their late teens to late 20s). Emerging adulthood is a time of tremendous interpersonal transition that usually involves an individual leaving the parental household, forming new friendship groups and getting more attachment needs met by peers — and particularly by romantic partners — rather than by family members or caregivers, he says.

Transferring attachment needs from parents or caregivers to peers is a process that typically begins in a person’s teens, says Schnyders, an ACA member and part-time college counselor at Malone. Parental attachment doesn’t become any less vital at this time; it’s just that peers are placed higher on the attachment hierarchy, she explains. In fact, having a secure attachment to parents or caregivers is critical to adolescents’ ability to make connections with their peers, says Schnyders, a licensed professional clinical counselor formerly in private practice.

“Attachment beliefs inform our sense of self and others, particularly during times of distress,” Lane says. For example, in stressful situations, people with attachment insecurity may believe they are incapable of dealing with the problem, he says. Stress may push those with anxious attachment to rely solely on other people rather than deploying their own problem-solving skills, whereas people with avoidant attachment may believe they cannot count on others to provide emotional support, causing them to withdraw from the support system and creating greater isolation, Lane explains.

In contrast, emerging adults who have formed secure attachments to peers and parents are more resilient and better able to handle changes, both good and bad, Schnyders says.

“Put simply,” Lane says, “attachment plays a major role in understanding our emotional needs and getting those needs met. And in emerging adulthood, it can be especially important since our emotional needs evolve, as do the groups of people whom we hope or expect to meet those needs.”

The question becomes, how can counselors help “fix” an attachment style that may be having a negative impact on multiple aspects of a client’s life?

Lane doesn’t believe it’s a matter of changing clients’ attachment styles. Rather, he says, counselors can help clients better understand and anticipate their attachment needs, which can lead to increased attachment security over time.

“I believe that the counseling relationship provides clients with corrective attachment experiences,” he says. “When we feel heard, seen and understood, insecure attachment beliefs are challenged, and secure attachment beliefs are reinforced. Over time, this can have a powerful impact on how we view ourselves and how we view others. We can also help our clients learn to better understand their attachment needs and communicate those needs to others.”

Schnyders uses psychoeducation to teach clients the differences between secure and insecure attachment. She then uses cognitive behavior therapy to help clients understand how their insecure attachment has created core, irrational beliefs. Schnyders and the client then work together to reframe and restructure these beliefs. This allows clients to acknowledge and address the insecurities and fears that drive their behavior, better enabling them to modify their personal interactions.

Schnyders says that narrative therapy can also be useful, particularly with emerging adults. She guides clients as they create a narrative riddled with problems connected to their attachment style. Once that narrative is constructed, Schnyders and the client work to create an alternative storyline that focuses on elements of secure attachment and talk about how to work toward that story.

Attachment and romantic relationships

“Attachment drives the way we experience ourselves and our significant others,” Bennett says. “It provides a lens for how we see and interpret them.”

There is no consensus on whether attachment styles influence the selection of people’s romantic partners, says Bennett, who works with couples in her private practice. At the same time, she can’t help but noticing the number of anxious and avoidant pairings in her office.

“Put simply, one keeps pushing or nagging at the other to be present, and the other is a great escape artist,” Bennett says. “Both [are] driven by their styles and both [are] really chasing the other off, even though that is not what either one wants.” The doubts and fears that drive such behavior are barriers to real intimacy, she adds.

To help couples identify and break the patterns that are sowing discord, Bennett teaches them about attachment theory and how their individual styles can affect the relationship. She then helps couples develop secure attachment behavior by teaching them how to be more available, accessible and responsive to each other.

Bennett says she often finds that couples don’t know what a nonsexual warm connection looks like, so she teaches them how to greet, touch and talk in nonsexualized ways that express love and care. Vulnerability is also a big issue. Couples need to be willing to be vulnerable with their partners and, conversely, to react gently, she says.

Bennett also frequently works with couples on how to change their “demands” to “requests” and how to respond to each other’s requests with warmth. In addition, relationship partners often need to learn how to apologize to each other, how to talk about their fears and anxieties with each other, how to listen to each other and how to turn to each other for support, Bennett says. Finally, she advises couples to get in the habit of immediately repairing any relationship “ruptures” rather than allowing them to fester and build.

People with attachment issues often have difficulty expressing themselves, which can lead to frustration and misunderstanding. Partly for that reason, Schnyders does a good deal of assertiveness training with couples to improve their communication. Learning to be assertive allows clients to communicate their needs without discounting the feelings of their partners.

When teaching assertive communication, Schnyders instructs clients to use “I” statements such as I want this. I believe this. I need this. In the process, she strives to change the way clients see themselves.

Schnyders tells the story of a 60-something female client with a pattern of insecure attachment. Schnyders had been focusing on self-esteem with the client, encouraging her to believe that she was a person of value and worth. The client was also having problems communicating with her husband, who had a habit of speaking at her rather than to her and treating her dismissively.

One day, the client came in and told Schnyders about a breakthrough. A recent encounter with her husband had devolved, as it usually did, to him speaking disrespectfully to her. All of the sudden, the woman found herself exclaiming to her husband, “You can’t speak to me like that. I am a person with value and worth!”

Her declaration stopped the husband in his tracks and, soon thereafter, their relationship dynamic began to change. With the client standing up for herself and beginning to believe that she was worthy of respect, Schnyders asked her to consider what she needed from her husband. The woman said she wanted to be able to hear and understand his needs without diminishing her own. Schnyders and the client then talked about how she and her husband could work together rather than following their previous pattern, which involved the woman placating him rather than standing up for herself.

Sometimes, just slowing down an interaction can improve communication. In couples and family therapy, rather than letting clients have rapid back-and-forth exchanges, Schnyders will slow the conversation and have participants tell their partners or family members what they need from them. Schnyders will then ask the partners or family members to repeat what they have heard because sometimes conflict arises from an inability to listen to what someone else is saying.

Attaching to a career

Like all areas of life that involve interacting with others, work can sometimes be tricky for those with insecure attachments. As Schnyders explains, if a person doesn’t trust their co-workers and can’t communicate and interact with them effectively, that person’s performance is going to be hampered, perhaps even putting them at risk of losing their job.

But attachment style can also play a role in the job search itself, says Stephen Wright, a professor of applied psychology and counselor education at the University of Northern Colorado. Wright, an ACA member, studies how attachment style affects career choice and decision-making in college students.

When it comes to considering careers, people who are securely attached have an advantage because they are less likely to perceive career barriers, according to Wright. In other words, they have more confidence in their innate strengths and their ability to cope with challenges. Those with secure attachment also are more likely to have a stable support system of people who bolster their confidence and may even have contacts that will assist in the career search, Schnyders says.

In contrast, those with insecure attachment are more likely to perceive many reasons that they will not succeed in a particular career field or in the career search itself, Wright says. These individuals are also less likely to have a support system in place.

That’s one area where professional counselors can come in. Counselors not only serve as a secure base for clients but can also boost their feelings of self-efficacy in various areas, which can diminish the effects of insecure attachment, Wright says.

By providing a strong sense of support, counselors may help insecurely attached clients perceive fewer barriers. Setting and completing specific goals — even small ones, such as researching a new profession — can help strengthen these clients’ sense of accomplishment and confidence, Wright says. If clients have shown interest in a particular career area, helping them learn more about it and explore the various jobs available in the profession can increase their sense of self-efficacy in that area, he says. If clients lack the required skills for a specific job, counselors can assist them in developing a plan to acquire those skills rather than let them perceive their current situation as an insurmountable barrier, Wright says. He also suggests that counselors use career models to assist these clients with decision-making and identifying their job-related strengths and weaknesses.

Recovering from child sexual abuse

Research indicates that people with secure attachment style find it easier to recover from child sexual abuse, says Kristina Nelson, an assistant professor in the Department of Counseling and Educational Psychology at Texas A&M-Corpus Christi who studies and works with survivors of child sexual abuse. Having secure attachment provides these individuals with a safe base from which to explore and process their experiences, leaving them better able to regulate their emotions, she says. The feeling of security from healthy attachment serves as a form of support in and of itself, adds Nelson, who was previously a private practitioner in Florida.

Survivors with insecure attachment styles have typically received inconsistent or limited support throughout their lives, and this leaves them feeling unsure of whom to trust, Nelson says. In addition, they often don’t know how to regulate their emotions or how to begin the process of recovery.

Counselors can offer the support that those with insecure attachment styles have lacked throughout their lives, Nelson says. “Counselors can actually serve as a secure base for a client. [They can] be that consistent presence by providing that constant positive regard, allowing them to explore and make sense of their experiences.”

Counselors can also help these clients learn how to regulate their emotions. Nelson often recommends deep breathing techniques to her clients and adds that some people find meditation helpful. She cautions, however, that because meditation involves closing one’s eyes in a dark room, it may be a trigger for sexual abuse survivors, so counselors should proceed carefully.

Psychoeducation about attachment styles can also help clients gain awareness about why they react the way they do and how they developed their coping mechanisms, Nelson says.

Permanently attached?

So, is everyone stuck with their childhood attachment styles for life? Not necessarily, say Bennett and Lane. Although attachment style is usually pretty stable, there are cases in which it can change.

“The idea here is that we have core perspectives that tend to drive core styles,” Bennett says. “I’d venture that friendships and workplace relationships can have an impact, but our primary home styles are more likely to set the tone.”

“If impacted by social and work settings, we can repair by going home, by changing up friendships, by moving jobs,” she continues. “If stuck in an unhealthy work environment or social setting without recourse or the capacity to go home and mend, it makes sense that we’d alter to a less secure base, sadly.”

This is also true in relationships, Bennett says. For example, if a spouse repeatedly behaves in ways that erode the person’s trust in the spouse or in themselves, then that person’s attachment style can warp into a less secure one, she says.

Lane says there is some evidence that insecure attachments can become more secure throughout adulthood. He believes this may happen as people shift their attachment needs to people of their own choosing rather than the families they were born into or the caretakers they were placed with.

“I think that important interpersonal experiences influence and are influenced by one another,” he says. “When we regularly experience our needs being met as infants, we are more likely to be able to form healthy interpersonal relationships throughout life. However, adverse life and interpersonal experiences can still disrupt our attachment system, especially after multiple significant adverse experiences. The reverse also seems to be true — insecure attachments in childhood decrease the likelihood of healthy attachment relationships later in life. However, when those healthy relationships occur, they can influence our attachment orientations toward being more secure.”

 

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Related reading

To learn more about issues related to attachment, read the following articles previously published in Counseling Today and available on the CT Online website at ct.counseling.org:

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Viewing fathers as attachment figures

By Ashley Cosentino September 5, 2017

The role of fatherhood has changed over the years. Hundreds of years ago, the father was the most important parent for raising the children, then he became the breadwinner, and today an expansive volume of research details a general lack of involvement by fathers in their children’s lives. Plenty of fathers want to be a part of their children’s lives and do whatever they can to stay involved. However, many fathers encounter barriers created by myths that limit, or in some cases prevent, their ability to engage with their children.

Many people may believe some common myths about fathers. These myths include:

  • Fathers are not interested in being involved.
  • Fathers do not have the capability to be involved.
  • Fathers are harmful if they are involved.
  • There is little to no effect if a father is not involved (or, relatedly, the hassle of dealing with the father is worse than any negative effects that his lack of involvement might have on children).

In reality, both fathers and mothers are important, and not just as a means of feeding, bathing and sheltering their children. Their importance extends beyond meeting the family’s physical and safety needs.

All of us likely know someone who has either grown up with a single parent or been a single parent, or perhaps we fall into one of those categories ourselves. A faulty assumption that people often make is that married fathers are always present, whereas divorced fathers (or unmarried fathers) are always absent. This assumption is based on the faulty idea that a father is only involved if he is present in the home and that when a man doesn’t live with his child, the father then becomes disinterested.

Research has shown that children who grow up without consistent father involvement commit more crimes, become teenage parents more frequently and are unemployed more often than are children who grow up living with both of their biological parents full time. This is regardless of the parents’ race, educational backgrounds, whether they were married at the time of their children’s births or if a parent remarries. According to the research, children growing up without father involvement were also found to perform more poorly in school, use drugs more frequently and have other social problems even when controlling for generally lower income.

The prevalence of single fatherhood has doubled in the United States throughout the past decade, and the number of nonresident households is growing. A residential household is the parental home where the child spends the majority of his or her time, whereas a nonresident household is the home where the child stays when spending time with the other parent. Escalations in divorce and nonmarital reproduction during the past 30 years have preceded escalations in the percentage of children living separately from their biological fathers. Between the 1970s and 2000, the percentage of children living with a single parent grew from 12 percent to 20 percent. In 2002, 69 percent of children younger than 18 lived with both biological parents, whereas 23 percent lived with their mother and 5 percent lived with their father. Fifty to 60 percent of children born in the 1980s and 1990s lived with only one parent for at least a year before reaching age 18.

These statistics help to illustrate the lack of attachment that many children have with their fathers. An attachment is characterized by intense feelings of intimacy, emotional security and physical safety in association with an attachment figure. Attachments are significant throughout one’s life, and they can vary over time. When established in early childhood, attachments can continue, but new ones can also be formed during later childhood or in adulthood, and current attachments can be reinterpreted with new perspective and conditions. The goal of attachment is to have a secure relationship with several caregivers to improve normal social and emotional development.

John Bowlby established attachment theory in the 1950s and 1960s as an addition to psychoanalytic theory. Attachment theory is a secure base from which to explore close relationships that can accommodate an extensive variability of methods and findings. Attachment theory proposes that affectional bonds are essential to the survival of humans. It has a protective function (e.g., a mother keeping her child safe in times of danger) and an instructive function (e.g., a mother providing a secure base so her child can explore the surroundings). Attachment occurs if there is closeness and active shared interaction between the child and the attachment figure. Attachment theory is the prevailing theory for understanding early social development in children.

Attachment styles

Mary Ainsworth and her associates experimentally defined three subgroupings of attachment associations: secure, anxious-avoidant and anxious-resistant (or ambivalent).

Secure attachments: A secure attachment is categorized by passionate feelings of intimacy, emotional security and physical safety in the company of an attachment figure. Features that accompany a secure attachment include remarkably good communication abilities, the use of productive coping tactics and the capability to assimilate inconsistent emotions, normalize negative emotions and resolve conflicts cooperatively and constructively. Secure children show little anxiety when separated from a caregiver and develop a sense of self-worth and belongingness. Secure attachment relationships provide a safe base from which to explore the world and an affirmative model of self in relation to others.

Insecure attachments: Insecure attachment relationships occur as the result of trauma or neglect. They create noteworthy shortfalls in the child’s development of self and his or her capacity to relate to others. These effects can have enduring negative psychological concerns such as not being able to compromise or form meaningful relationships. Forty to 45 percent of children in the United States and Great Britain are classified as insecurely attached based on research done in both countries.

Children with anxious-avoidant attachments are characterized by their insignificant need to receive physical contact from their parent(s) when united after a separation. Anxious-avoidant children use defense mechanisms such as having a low need to accept physical contact from caretakers. As adults, people who are anxious-avoidant withdraw in relationships and are emotionally distant.

Children with anxious-resistant (ambivalent) attachments demonstrate a lack of inclination to explore, a lack of precociousness and a lack of self-protection, while also showing intensification in irresponsibility and accident proneness. These children are characterized by intense misery at their caretaker’s parting and an inability to be pacified upon return of the caretaker. Children with an anxious-resistant attachment style appear to show infrequent amounts of inner conflict concerning the apparent physical and emotional accessibility of their parent. Research on the concerns of this attachment style signifies that anxious-ambivalent children experience developmental interruptions that are not typically experienced by securely attached children.

A fourth type of attachment, disorganized, could also be added. Disorganized attachment is a combination of anxious-avoidant and anxious-resistant. Regardless of the attachment style, children create an attachment blueprint for future interactions that will guide them throughout their lives.

Fathers as attachment figures

Bowlby’s original construction of attachment theory proposed the role of the father as ambiguous, but he later recognized that fathers are imperative as attachment figures. Bowlby’s philosophy about the role of fathers as attachment figures developed over time with the publication of applicable research findings.

The infant-father attachment turned out to be prevalent while Bowlby was working on his second, more clearly defined version of attachment theory, published in 1969. He found that the father’s reactions to the child form the pattern of the child-father attachment relationship. Bowlby’s son, Richard Bowlby, who has also lectured and written on attachment theory, has said that he suspects his father’s initial concentrated focus on mothers and their attachment role may have ended up prejudicing subsequent research and distorting cultural values.

Bowlby added fathers as significant attachment figures because two distinct attachment roles seemed to exist for two separate but equally important functions for a child’s development. One attachment role is to deliver love and security, and the other role is to participate in exciting and challenging practices. In other words, the bond of attachment is more than keeping children safe from danger, which is often seen as the mother’s role. Attachment is also a bond that promotes exploration and gives confidence to venture forth, which is often the father’s role.

For children to grow into proficient adults, it is recommended that they first need to develop psychological security, which consists of both secure attachment and secure exploration. Researchers have defined this as confident, attentive, eager and resourceful exploration of materials or tasks, especially in the face of disappointment. Secure exploration implies a social orientation, particularly when help is needed.

Understanding the difference between secure attachment and secure exploration helps us see how fathers have a distinct impact on the raising of children. A father’s behavior should create a feeling of safety for the child as the child explores new understandings. These instances will allow the father and child to become familiar.

Humans have an instinctive need for enjoyment, discovery and a sense of achievement. Bowlby considered play to be an important aspect of the father-child relationship. The role of father-child play is alleged to be critical for child development and adds to the expansion of attachment relationships. A father’s role becomes noticeable in child development later; consequently, the impact of father involvement may be progressively more important and observable as the child grows older. A father’s awareness of his child’s exploratory behaviors will contribute to the child’s sense of safety during difficult tasks and increases the chances for the child to focus, follow his or her curiosity and master new talents in an emotionally unhindered way.

Parents’ roles: Separate but important

Both parents are considered attachment figures in attachment theory, and the child-father attachment is autonomous from the child-mother attachment. Whereas mothers are commonly involved in caregiving and providing emotional refuge, fathers are particularly involved in play and exploratory undertakings. Healthy development depends on a child’s positive attachment to both parents because the parents provide separate but equally important secure bases for the child’s attachment needs.

In families in which two parents are raising children, one parent serves as the main attachment figure for providing a lasting secure base and refuge for safety in periods of distress, whereas the other parent serves as the primary attachment figure for providing opportunities for exploration and excitement. There are fluctuating amounts of commonality between the two attachment roles; however, each parent will offer one type or the other. Scholars have established that individuals who excel in social situations as young adults typically had mothers who delivered a stable secure base and a positive model for intimate relationships within the family and fathers who shared in exhilarating play and interactive encounters.

To optimize the chances of a child being successful, two distinctive systems need to be in place: a secure base for the child to come back to when the action ends or goes wrong, and a trustworthy confidant to show the child the way. Children can use their parents as a secure base in diverse ways, and each parent can attend to a child’s needs differently. For instance, fathers generally take part in more physical play, inspire more risk-taking and induce a greater assortment of excitement and stimulation in play than mothers do. Fathers typically encourage competition, challenge, initiative and independence. Parents who compete for their child’s love and devotion are more likely to have offspring who are insecurely attached to both parents.

Little is known with certainty about the behavioral correlates of secure child-father attachment. Measures of this attachment should include the assessment of warm, supportive and sensitive challenges during joint play. These are indicators of an activation relationship. If we begin to view men as primary attachment figures, a change might take place in the importance we ascribe to fathers.

Need for father involvement

The issue of fatherlessness is discussed in many books and articles, but it is primarily prioritized as a financial problem. These children are considered worse off because they may not have the same level of monetary resources that can give them a better life. Most of the initial early research concentrated on the regularity of contact with the father and payment of child support. The financial assistance of fathers is unquestionably a vital resource for children in all forms of families. However, if children truly are to “profit,” fathers also need to be obtainable and involved in their children’s lives.

There is a need to reevaluate the significance of fathers and to recognize that their worth in their children’s lives is equal to that of mothers. Regardless of the eminence of the mother-child bond, children who are close to their fathers are happier, more fulfilled and less anxious. According to the research, it is important to position the father within the larger context of family relationships. When nonresident fathers maintain parentlike contact, partake in an assortment of activities with their children and spend holidays together with their children, the children’s welfare is sustained. Positively involved fathers reduce their children’s probability of externalizing and internalizing difficulties, limit children’s school failures and avert children’s self-image problems during puberty. The social interactions between fathers and their children who are raised by a single parent are important predictors of healthy functioning in children in both cognitive and behavioral realms.

The transference of social capital between nonresident fathers and their children is calculated by the quality and quantity of involvement. High-quality father involvement is essential for children’s security because fathers who cultivate close relationships with their children are more effective in observing, teaching and communicating. When children sense love and care from their fathers, their sense of emotional security is reinforced. Emotional security helps children cope with stress and makes them less susceptible to anxiety and depression. When both parents are involved, children are more likely to respect and obey parental rules and imitate parental behavior.

Studies of nonresident fathers often indicate positive correlations between father involvement, regular payment of child support and children’s behavioral adjustment, psychological welfare and academic achievement. Frequency of noncustodial father visits has been found to be linked to greater academic achievement, self-esteem, social competition and overall well-being of children. Father involvement is also positively related with children’s social capability, internal locus of control and capability to empathize. A father’s involvement in making key decisions that impacted his children also led to grown children looking to him for support. A longitudinal study of 12th-graders in divorced families found that children with recurrent contact with their fathers received more guidance and provision and were less depressed.

According to the literature, the lack of a father in a child’s life can have damaging effects on both boys and girls. Male and female adolescents from divorced and remarried families exhibit higher rates of conduct disorders and depression, and they are more likely to become teenage parents.

Boys whose biological fathers do not live with them have increased chances of conduct problems and acting out more frequently at home or school, whereas girls are more likely to become depressed. Many researchers believe that boys respond longer and further to the separation from their father attachment figure. Boys, more so than girls, can suffer from lack of contact with a father attachment figure, causing them to struggle in school.

Bowlby’s attachment theory presents that both parents are needed as attachment figures in a child’s early development. We have a long way to go before our society considers fathers to be just as important as mothers, but each step is a step closer. A successful future depends on children having secure relationships with their fathers. This means fathers being able to see their children often and being regarded as more than just financial support. Fathers are attachment figures who challenge their children and are right there with their children to explore the scary world ahead of them.

 

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

Ashley Cosentino is an assistant professor in the Counseling Department at the Chicago School of Professional Psychology. She is a licensed clinical professional counselor and a national certified counselor. Contact her at acosentino@thechicagoschool.edu.

Letters to the editor: ct@counseling.org

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

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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 Family_brandingresiding 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

 

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