Clinical Social Work with Adoptive Parents: Issues and Guidelines

Editor’s note: This text-based course is an edited transcript of the webinar, Clinical Social Work With Adoptive Parents: Issues and Guidelines, presented by Deborah H. Siegel, PhD, LICSW, DCSW, ACSW.

Learning Outcomes

After this course, participants will be able to:

• Identify some challenges adoptive parents encounter when seeking adoption competent care from clinical social workers and other mental health care providers.
• List some assumptions and mistakes many clinicians make when working with adoptive parents and their families.
• Identify some guidelines for adoption competent clinical intervention with adoptive parents.

Introduction

I will be focusing on adoptive parents, as well as the adoptive family and the child of those adoptive parents. Whatever brings the majority of adoptive parents to clinical social workers for pre-and post-adoption attention is concerned with how they are functioning as a parent of the child they adopted.  

How much focus should the clinician put on the adoption vs. the presenting problem?

How much focus should the clinician put on the adoption versus whatever the presenting problem is that brings the parent to treatment? There are two diametrically opposite foresights that the clinician might take, and also that the adoptive parent may have about the role of adoption in their family. There is the denial of difference. This means that families are families, parents are parents, and kids are kids. Adoption is perhaps tangentially related to the presenting problem. On the other hand, there is insistence on difference. This means that all adoptive families are different, so we must be focused on the underlying issue. 

One of the first challenges the clinician has is figuring out a particular family’s stance. What is this parent's stance on an issue with denial of difference versus insistence on difference? This is important because where the parent lies may have something to do with what the focus of treatment should be. 

To what extent does the clinician assume that adoption means trouble?

There is a widespread belief that adoption means trouble. There is the saying that goes, “why would I adopt somebody else's problems?” This misconception is fed by research that shows that adoptees are disproportionately represented among clinical populations. Estimates range from 25 to 40 percent of kids in residential treatment have been adopted. Why is that? If it is inaccurate for us to assume that adoption equals trouble, why is it that there is a disproportionate representation of kids who have been adopted in clinical populations? 

There are many hypotheses about why this is. One may be about how the children have to expose themselves so intimately to many providers in order to be approved for adoption. Therefore, they are desensitized to the whole process of asking for help. They are more likely to ask for help when their family runs into snags in the parenting experience. Another hypothesis is that adoptive parents have the resources to access services compared to families that are formed by birth. 

There is then the theory about how environmental stress in the birth parent’s life triggers characteristics that are then passed on to their offspring genetically. Generally speaking, the birth parent does not make an adoption plan or have an involuntary termination of parental rights unless there is major stress in their life. That stress might trigger genes that are then passed on to the child. Another hypothesis is that the experience of being adopted itself is traumatic. Human beings are typically raised by the people who birth them and not having that opportunity can become a primary wound or form of trauma. There is also the hypothesis that some birth parents do not have access to prenatal care, which affects the adopted person.

Basically, we do not know why adoptees are disproportionately represented in clinical populations. The guideline that I propose to you is being aware of the bad seed assumption. Be aware of the assumption that adoption means trouble because that deficit perspective can weigh heavily on the adoptive family. 

Guideline: Beware of Pathologizing Adoption

Be aware of pathologizing adoption. We need to understand that there are normal, predictable issues in families formed by adoption. We need to embrace these issues as a normal part of the process instead of taking a deficit perspective on them. Predictable issues come up in different ways that affect the adoptive parent, the adopted child, and the child's birth family. 

These are some of the normal issues that can emerge:

• Loss and grief
• Identity confusion
• Bewilderment 
  • Why me? How could God let this happen?
• Anger 
  • How could you do this to me?
• Rejection, unworthiness, guilt, and shame
• Adoption issues re-emerge at transition points in the life cycle

These issues are more likely to move from the back burner to the front burner at points of stress in the adoptive family’s life, particularly with transition. 

Beware of assuming you have the needed clinical expertise 

Another guideline is that we have to be aware of assuming that we have the needed expertise. Since we are experienced practitioners, we think that we have the advanced knowledge we need to work in an informed way with adoptive parents. However, research shows that the majority of adoptive parents who seek clinical care for themselves are unable to find a clinician who knows how to work with them effectively. Our lack of advanced training in this area becomes a burden for the adoptive parents in two ways. The adoptive parent ends up having to educate the clinician in addition to getting help. They also have to convince the clinician that these issues are embedded in the adoption experience and are not evidence of a lack in parenting skills or unresolved psychological issues.  

Open versus Closed Adoption

Another area of challenge for the clinician is their approach with whether traditional closed adoptions grounded in secrecy are better, or if some form of openness is better. The dial on this issue has moved considerably due to most adoptions involving some kind of openness today. We have discovered that secrecy and cut-offs create all kinds of problems for people. 

When I began my research on open adoption over 30 years ago, it was with my own naive belief that openness would be a panacea. We know that this is not true because there is no adoption without loss and loss is painful. Open adoption is a vast array of options and it is not one thing. Each path to adoption has its own issues and needs a different kind of openness based on the unique features of each individual situation. There is some panacea with the pain of loss. People can learn to live with loss and it does not have to be your central issue, but it is still in the background and we can learn to live with it. 

One thing we need to know about secrecy today is that it is virtually impossible. Computers are everywhere and even young children have access to smartphones. There are different vehicles of access for social media as well.

When families start to think about adoption, the child is not going to have access to their birth family or people who know their birth family until the child is 18 years old. This is a naive expectation to hold today. We have a lot of information about how young children are either stumbling into or seeking digital access to members of their birth families. We also know that living with secrets creates problems. Secrecy and cutoffs are infeasible and do not work well for kids. Adults may seek secrecy because they do not feel comfortable with themselves and some degree of openness in adoption. 

Does open adoption work? Based on my research, I would say it does work. This is because openness, when handled well, includes a wide range of options with the understanding that one size of openness does not fit every adoption. Each family involved should determine what works best for everyone.

What does work is communicative openness. This is when adoptive parents end up with kids who are comfortable with whatever form of contact they have with their birth parents. Comfort family is when the adoptive parents have been able to create a culture in which anything can be talked about. It is done respectfully for the purpose of being heard and acknowledged. What the clinician needs to do is try to help adoptive parents enhance their capacity for creating a culture of communicative openness within their family.

Help Families Plan for On-Going Contact

What we also want to do with adoptive parents is help them plan for some kind of ongoing contact with the child's birth family. It is often that families come to us without having had the opportunity to develop a plan. The family then tries to figure out what to do with the contact that has already started because the child either created that contact or stumbled into it. As clinicians, we need to know how to help adoptive parents create a plan with the child's birth parents on how to manage contact either digitally or face-to-face. 

Know What Goes Into the Plan

Clinicians need to know what should go into the plan. We also need to know how to move back and forth between the child's adoptive parents and the birth parents in figuring out what kind of open adoption plan is going to work best. 

We want to help the two sets of parents figure things out in a warm and respectful way. What kind of contact makes sense for this adoption? Here are the ways to help everyone figure things out together:

• What kind of contact (snail mail, phone, text, email, Instagram, etc.)?
• How often will contact occur?
• Who will participate in the contact?
• Where will the contact take place?
• Set boundaries.
• Agree on a plan for renegotiating as people’s needs change.

Recognize the Child’s Universal Need for Human Connection

Another guideline is recognizing that every person has a need for human connection. This also applies to children who have experienced adoption. What we need to do is not cut them off from where they came from, but somehow build an extended family around that child. 

However, there are some situations where parents may want to reevaluate the level of contact. Birth parents may say they are coming for a visit, but do not show up and fail to let anyone know that they were not coming. An adoptive parent would understandably be inclined to cut off contact. Instead of slamming the door shut, what we need to do is keep the door ajar. This is because we do not want cutoffs. You may not want to plan another visit like this because of how upsetting it was to the child but stay in touch in a way that feels safe. 

We also need to keep the trail warm, which means that we do not want to disappear. The adoptive parents and birth parents need to agree about how this will happen. If this does not occur directly, there needs to be an intermediary that will provide information about where they are and how to get in touch with them. It is important for clinicians to work with adoptive parents to help them develop the honesty needed to communicate respectfully with the birth parent. They can also coach people on how to agree upon boundaries. We want them to be aware of how the parent's feelings may lead them to believe that what they are doing is best for the child, when in fact it is most comfortable for the parent. We need to empower a parent with the child's needs at least at an equal level as the parent's needs.  

Is It An Adoption Triad?

Clinical social workers need to remember the idea of an adoption triad being a reductionistic and outdated conceptualization of the adoption experience. The notion of an adoption triad is that there is a child, a birth parent, and the adoptive parents. Instead, we need to think in terms of an extended family formed by adoption, including all of the biological relatives, fictive kin, and significant others in the birth family and the adoptive family. 

We want to think about it being a circle of adoption. The extended family is only one part of that circle. It also involves the laws and policies in each state that shape adoption, the practice of adoption agencies and attorneys, and the role that teachers, clergy, and neighbors play in the child's adoption experience. All those members of the adoption circle have profound impacts on the adoptive parents as well. 

Help Families Avoid Secrets in Adoption

Another guideline is in regards to trying to avoid secrets in adoption. Secrets can come out by accident and in ways that blind-side the adopted person. This can lead to the adopted person feeling mistrusting and betrayed. 

There is also the issue of the adoptive parent planning to disclose all kinds of information to their child once the child is 18. However, we need to remember when the child launches into adulthood, which is an explosive transition point for families. On top of that, there is the anticipated moment of exposure. Due to all of this, it is best to tell the child’s full story at the moment they enter the family. 

There is also the notion that secrets reverberate throughout a family system in ways that lead to everybody knowing the secret except the adopted child, which is an isolating experience. The child may always feel that something is off and when the secret comes out, it creates distress for them. 

Help Families Tell the Truth

If you do not want secrets, how do you tell children the difficult truths? There are some difficult truths that you will need to share with the child. There are all kinds of understandable reasons why adoptive parents will withhold disturbing information about the birth family from the child: 

• Protect the child from pain and bewilderment.
• They do not know how to tell the child.
• They do not know how to handle the child’s possible reactions
• The parent feels threatened by the truth
• Will my child love me less? 
• Will the child choose the birth parent over me?

All of these points are areas for clinical exploration with the adoptive parent. Clinicians need to remember that every human being has a fundamental right to access the truth about themselves. Any truth can be told in age-appropriate, nonjudgmental language to a child. The clinician's role is to help parents figure out what language to use with the child at different points in the child's development. A wonderful quote from Sharon Roszia Kaplan says, “Where facts flounder, fantasies flourish.” This means if we do not give the child their story, they are going to make up a story that may be infinitely more horrific. 

Use a Strengths Perspective

Every step of the way, we need to use a strength and empowerment perspective with adoptive parents. This takes tremendous management of our countertransference. Adoptive parents tend to be an honest group of parents. They had to prove themselves over and over again to authority figures in order to become parents through adoption. They also had to prove themselves to birth parents in order to be chosen. 

With all clients, we need to work with whatever is right with them. With adoptive parents, there may be some particular vulnerabilities that require us to use the strengths and empowerment perspective. 

Some adoptive parents may feel that they are not entitled to be the parent of a child who was born to someone else. They may be concerned that they are not good enough because they need the parenting skills that any parent needs. As a result, they may be particularly sensitive to having their parenting skills criticized because of these other feelings that they bring with them to the adoption experience. Children who have been adopted are disproportionately represented in clinical populations. It is usually child behaviors that are hard for adults to manage. Parents may feel particularly rejected by the child's misbehavior. Therefore, it is important for the clinician to focus consistently with the parent and what the parent is doing right. A parent seeking help is a strength that can be highlighted in the treatment. 

Use an Attachment Perspective

Another guideline for us is to use an attachment perspective. We need to focus on the adoptive parents’ attachment style based on their own experience in their family of origin. We need to focus on the adoptive parent-child attachment in therapy. 

What may bring adoptive parents to us for clinical attention is their feeling of distress because things are not going well and they want to change the child's behavior. This could help bring down the tension in the family. Another reason is an excessive focus on our part to change the child's behavior. Teaching parenting skills and so forth may be an important component of clinical intervention. Excessive focus on that may lead us away from what fundamentally needs to happen, which is strengthening the adoptive parents’ relationship with their child and the adoptive parents’ relationship with their co-parent. That is the focus of treatment because when the parent-child attachment is nurturing and characterized by communicative openness, that is the foundation on which other work will happen. 

If parents adopt a child and they split up and get another partner, you then have four sets of nurturing parents. It can also get complicated and that is not unusual. However, when we are focusing on the quality of the attachments, we have the groundwork. 

Attachment 1

Maintaining this attachment approach requires keen self-awareness on the clinician's part. The therapeutic goal is for the clinician to understand and be empathically present with the client. The goal is not for us to change a parent. When the parent feels deeply soothed in the therapy, they may become better able to explore their own attachment issues and be a consistently soothing presence for the child. 

Attachment 2

Our countertransference can interfere with this process. A typical example of this is when the clinician may feel frustrated with the overwrought parent bearing down on the misbehaving child. We identify with the misbehaving child because we feel that the child is being poorly parented through scolding and punishing. We find ourselves coaching and correcting the parents about what to do. However, what we are unintentionally doing is dysfunctionally paralleling in the therapy. The empathic failures empower control dynamics that are plaguing the family. We need to stay out of that trap. 

Attachment 3

Even though cognitive behavioral therapy (CBT) is an evidence-based practice, there are mountains of data telling us that CBT is a treatment of choice and I do not minimize it. At the same time, it is not always what the adoptive parent needs. Using CBT excessively as our focus can actually be a form of empathic rupture in the treatment. This is because the parent will feel unheard, judged, and end up having the family's attachment challenges replicated in their experience of therapy. 

Attachment 4

What the attachment-oriented clinician does is to take a compassionate, non-blaming stance when reframing problems as an uneasy fit between the parents and child's issues and needs. This way the problem is not about a bad child or an ineffective parent, but as an uneasy fit. What one is trying to do is find an easier fit. How does the clinician do this? 

Attachment-oriented clinicians take the stance of being a curious co-explorer or co-discoverer with the parents. This helps them seek to understand the world through both the child's and parent's eyes. If we are a co-explorer, we take ourselves out of the position of being the wise expert who knows what the parent should be doing. The goal is for the parent to feel heard in the clinical relationship, thus freeing up the parent's ability to hear and accept the child. That is a tall order for both the clinician and the parent because when you have a child whose behavior is chronically problematic in the family, you want to stop the behavior. 

Understand the Role of Trauma in Adoption

One way for us to take a strengths perspective or an attachment perspective is for us to take a trauma-informed perspective in our work with adoptive parents. We need to understand that trauma is rampant. There is trauma with watching airplanes crash into buildings, living through a pandemic, experiencing economic meltdown, witnessing police brutality, and so on. We need to assume that trauma has affected adoptive parents in the ways that it has affected the rest of society. 

We know from studies that adverse childhood experiences in and of themselves are rampant. Many parents enter adoption through the infertility process, which can be invasive. Going through the adoption process itself can be traumatizing. People who adopt through the child welfare system often have a long and hard road. Those who adopt through virtue of infertility may have gone through all kinds of invasive medical treatments and losses with failed adoption attempts and so forth. Parenting a child who is neuropathy typical, has mental health issues, comes in a complex sibling group, or is in a transracial family can be forms of trauma. 

Use trauma-informed practices

We need to use trauma-informed practices. This means putting safety in the clinical relationship at the top of the agenda. You want to honor the client's voice and choice. That means before moving forward with an intervention. We need to pause and ask the adoptive parent for permission. For example, parents yell and scream at their child, they crawl under the bed, then they yell and scream even more to try to get the child out. However, this leads the child to curl up even tighter under the bed. I have other ideas about how those situations might be handled, but I do not want to go there if that does not make sense for the moment. You can say, “Is it okay if I toss some of those ideas out with the understanding that you can reject any and all of them?” That is what voice and choice means. It means being non-coercive and matching the client's pace. We need to see problematic behavior as an attempt at problem-solving, coping, or form of adaptation. 

We also need to go beyond behavior modification and psychoeducation. Provide a corrective and emotional experience for the adoptive parent in therapy by being nonjudgmental. Parenting children who are special in some way typically means that parents have to let go of long-held hopes and dreams about what their child is going to be like. Adoptive parents need to accept and celebrate the child they have. This can be difficult when the path to parenthood took years with many traumatic experiences. It can be a spiritual crisis that includes letting go and accepting the unacceptable with an open heart. This requires deep compassion. 

Understand that the parent’s trauma and the child’s trauma intersect

We need to understand that the parent's trauma and the child's trauma intersect in what is called the circular process of mutual causality. If the child is dragging their feet through getting up in the morning, the parent typically rushes and urges them. The more the parent admonishes, the slower the kid goes and vice versa. They are caught in this circular process of mutual causality and neither one of them can seem to get out of it. This dynamic happens all the time in marriages and between parents and kids. The clinician needs to focus on the dynamics in that circular process. When a parent becomes aware of what that process is, that opens up other possibilities for managing the situation. 

Practice Cultural Humility

Another important guideline is for clinicians to practice cultural humility. It is called cultural humility instead of cultural competence because competence suggests that we can master something. When it comes to culture, there is an infinite array and it is impossible for any person to master what any one culture looks like. The reason for this is that the variations within any cultural group are greater than variations between cultural groups. 

This is relevant when we are working with adoptive families because many of them have cultural complexities embedded in them. You may have a relationship between an affluent adoptive family and a low-income birth family. There are cultural differences embedded in economic inequality like that. You also may have inter-country adoption. When we deny the importance of these cultural differences within the adoptive family, we are putting the burden of these complexities solely on the adopted child. Instead, we need to create a transcultural family in which those qualities are the family's identity.

Use Adoption Competent Language

Another important issue is using adoption competent language. For example, we have used “real mother” or “natural mother” in the past. Today, the preferred terms are “birth parent” or “original parent.” Originally, we moved away from “real” or “natural” parents in an effort to get away from the implication that there is something unreal or unnatural about raising a child to whom one could not at birth. The term “birth parent” started to get distorted, so some birth parents started a movement to call themselves the “original parent” or the “first parent.” 

You can see that language in adoption is loaded. Our choice of language can create or perpetuate difficult messages about adoption that do not need to be difficult. It is important that as clinicians we use adoption competent language or a job option neutral language as opposed to language that conveys pejorative ideas about adoption. We need to honor the language that the adoptive parent or the child of adoption is using. That is a tender balance. A child may be saying “my real mother” and I might be saying “your birth mother.” In this case, I will say “your real mother,” even though I do not agree with that language because it has meaning to the child. 

I often hear the phrase, “The birth mother gave her child away.” Birth parents typically do not give children away. They made an adoption plan or they had their parental rights involuntarily terminated. In my 37 years of working in adoption, I have yet to meet a birth parent who feels that the phrase “gave the child away” is language that fits. 

Adoptive parents might say the child’s birth mother did not want them. That language communicates painful messages to a child. Instead, it is preferable for clinicians and adoptive parents to say, “Your birth parents were unable to parent any child born to them at that time.” This way it is not personal to the child who was adopted. 

The last point is that we sometimes talk about how the child was “abandoned.” For example, say the child was placed at the bottom of a dumpster and then found. That can be framed as abandonment, but it could also be framed as, “Your birth parents did not know what to do with the child born to them at that time. They did the only thing they could think of.” It is often that children who were adopted from China are told they were abandoned. However, the birth parent was using the only system available to them at the time. In no way did the birth mother abandon the child. 

There was one poignant moment in my college office where a student asked me some questions. She then started to cry and told me that she had been abandoned. When I asked her to tell me about that, she said she was of Chinese origin. She told me the story that she had been told by her adoptive parents. I answered, “I know that you have been told you were abandoned, but I would like to offer you another way of looking at this.” As I reframed it, she said, "Maybe my birth mother did not abandon me." That is another example of how adoptive parents need adoption-informed clinical support at the front end and along the adoption process with parenting.

Get Training to Become Adoption Competent

The bottom line of this course is we need advanced training in what adoption competence and clinical practice consist of. Research shows that master of social work (MSW) programs and other clinical training do not offer specialized education in providing therapy to adoptive families. This would be a matter for continuing education once one has a graduate degree. There are resources available for clinicians to become adoption competent. One of them is called the Training for Adoption Competency (TAC) curriculum, which is put together by the Center for Adoption Support and Education. 

Summary

I now want to summarize what we have learned in this course: 

• There are predictable issues in adoptive families. Don’t pathologize. Use a strengths perspective.
• Be aware of your beliefs and assumptions.
• Adoptive families have one thing in common: They adopted a child.
• Communicative openness matters.
• Promises of secrecy and cut-offs are infeasible. Plan for how to manage adoptive/birth family relationships. Know what goes into a contact plan.
• Keep the door ajar and the trail warm. Human connections matter. Adoption forms an extended family system, whether we want that to be true or not.
• Tell the truth using age-appropriate, non-judgmental language.
• Use an attachment perspective. Focus on the parent-child, spouse/spouse relationship.
• The clinician’s goal is to understand and be emphatically present with the client, accurately and effectively attuned. The goal is not to change the client. It’s to be a co-explorer. Use of CBT should be built on that foundation.
• Be aware of your countertransference so you do not parallel in the therapy an unhelpful family dynamic.
• Use a trauma-informed approach.
• Recognize circular processes of mutual causality.
• Use adoption competent language.
• Get advanced training in adoption competent practice.

Remember that there is a tremendous amount of diversity in adoptive families. We have to avoid our inclination to have certain beliefs that we superimpose on families. I tend to put my beliefs right upfront with families. We want to help nurture human connections across the adoptive family and the birth family. Recognize that the birth family is important to the adoptee, whether we know them or not.

Questions and Answers

How would you advise or guide a parent when they are preparing to tell a child that they have been adopted?

If I have the opportunity to talk with parents before the adoption is finalized, I work with the parents so they know to tell the child's adoption story from the time the child enters the family. For example, if the parent is adopting an infant, that is easy because the infant is not going to know what the parent is saying. It gives the parent ample opportunity to practice the story. 

It is more complicated when the child is older. There are scripts available in the literature that parents can use. Different scripts are age-appropriate depending on the child. They will understand it differently as the child grows and has developing cognition. That is the building block upon which the child can ask questions. If an older child has been abused and neglected, the story would be different. 

We want to avoid the idea that the original parents are somehow deficient because then what the child hears is that there is something deficient about them. That would be a quick and simple answer to a deep and complex question. 

When the child turns 18 years old, what do you suggest if the family wants to tell the child that they are a product of rape?

My advice for clinicians is to explore this with the adoptive parent. You want to find out their reasons for wanting to share this information now and what is propelling them to struggle with the issue. What are their concerns about sharing it? What do they think will happen when you share it? 

Depending on who the adoptive parent is and the clinical relationship with them, I may or may not offer an opinion. My inclination would be to not offer my opinion because this is explosive. Fundamentally, it was probably a mistake based on inadequate pre-adoption education that the parent waited until the child was 18. 

There are compassionate ways to convey to a young child that the birth mother did not know the birth father, or that the birth father made a mistake and had sex with the birth mother without her permission. You would also want to talk about how it is always important for two people to talk with each other before they have sexual relations. For a parent to have a child for 18 years and never have disclosed that suggests a failure of pre-adoption education. Given the reality that the parent is now in that situation, my stance would be one of parental education, empowerment, and exploration. This will help the parent make what they feel is the best decision for the child as opposed to the best decision for themselves. That can take some in-depth, trauma-informed, and strengths-based work.

Resources and References

Refer to course handout for complete resource and reference list.