CLINICAL CONSIDERATIONS
What you need to know...
*Note: Despite great diversity in the adult adoptee community, research demonstrates a set of strikingly similar adoptee experiences. We can begin our work with adoptees by tailoring interventions to address many of the things they seem to have in common (Dalton et al., 2022)
Adoption-focused assessment is intended to supplement, not replace, a clinician's existing assessment skills. Questions about losses & relationships are especially salient with adoptees.
A review of mental health history must take into account the impact of complex trauma and the potential for misdiagnosis. A current narrative of how the adoptee perceives their adoption experience will also inform intervention.
Building rapport with adoptees can require extra attention to relational trust, a modification of therapeutic boundaries, and reflexivity around therapist bias related to the practice of adoption (Vote & Kasket, 2017).
A discussion of culture includes but is not limited to: age, ethnicity, gender identity, gender expression, geographic location, language, political status, race, sexual orientation, socioeconomic status, tribal affiliation, and religion. For the adoptee, some of these can be complicated and require a "both/and" approach.
Race and ethnicity are particularly relevant for the BIPOC adoptees who were raised in a trans-racial family. The clinician must always address issues of positionality & intersectionality with clients at the outset & throughout treatment.
Clinicians should also take a curious stance toward the client's adoptee status, allowing them to assert choice of language & expertise around their lived experience.
Many adult adoptees refer to a phenomenon called "coming out of the fog". This is described as the emerging awareness of the impact of adoption on many aspects of their lives: emotional, relational, educational, & legal. Other adoptees may acknowledge this experience but prefer not to use the term "coming out of the fog".
For many adoptees, this may not take place until age 30 or even much older. Some life events can initiate this process such as becoming a parent, reuniting with biological relatives, or the death of an adoptive parent.
This process can be an extremely isolating & vulnerable time for the adoptee. It is essential that clinicians be aware of this experience & be prepared to support adult adoptees through this normative process of self-discovery.
The lives of adult adoptees began with significant loss. As young children, some have had to make sense of this loss while honoring their adoptive family narrative.
Adoptees experience many losses including biological relatives, medical information, cultural / racial identity, & citizenship rights just to name a few. This can make the experience of all grief & loss quite complicated.
Pauline Boss' work on "ambiguous loss" is helpful in understanding these issues. Therapists can assist clients in making meaning of their adoptee experience using Boss' guidelines for addressing loss.
There is growing evidence to support that separation from one's biological parent, at any age, is a physiologically & emotionally traumatic experience. For many adoptees, this a pre-verbal trauma that is often misdiagnosed as pathology later in life.
Dalton et al. (2022) report findings that support adoption to be a traumatic experience regardless of pre- and post-adoption circumstances.This trauma can lead to adverse consequences for midlife adoptees. Trauma-informed care should be considered in clinical work with adult adoptees.
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According to Bowlby’s attachment theory, our earliest bonds influence how we experience close relationships in adulthood.
As a result of separation associated with adoption, adoptees can experience attachment insecurity that results in relational challenges. Research has suggested that a disorganized attachment style is present at a rate more than double that of non-adoptees (Juffer & Van Ijzendoorn, 2007).
These issues can play out, not only in an adoptee's social life, but in the therapeutic relationship as well.
Being an adoptee adds complexity to all lifelong developmental tasks & experiences. Issues related to adoption can surface at every life stage. For example, leaving home for the first time, forging intimate relationships, becoming a parent, or the death of adoptive parents.
This can be especially significant when an adoptee has not yet explored their adoptee awareness or may not want to do so (see "Emerging Adoptee Awareness" above).
Therapists must be aware of the potential role adoption plays while allowing the client to inform the pace & flow of therapy.
Genograms are a hallmark of family therapy assessment & intervention enabling clinicians & clients to learn a lot about family relationships, dynamics, & history. These can be an especially powerful tool in working with adult adoptees.
Engaging the client in the process of creating a visual adoption narrative can be useful in the adoptee's journey. Therapy is often the first time that adopted clients are given the opportunity to do this. I offer guidance & resources on how to facilitate this intervention in your clinical practice.
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Adult adoptees have stressed the importance of community for advocacy, activism, education, & emotional support. Many have reflected that adulthood was the first time they were able to connect with people who shared similar lived experience. This support is particularly essential as adoptees "come out of the fog" & begin questioning their adoption-related feelings & beliefs.
Clinicians should encourage & assist adult adoptees in connecting with other adoptees in person or online. There are many options to choose from based on your client's specific needs: support groups, writing groups, prayer collectives.
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Some adoptees choose to pursue search & reunion. Others do not. Both are ok.
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Adoptees may want to search but do not have, and may never have, access to information. This can be a profound & enduring loss.
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There are times when an adoptee receives information or are approached for reunion before they are ready.
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Many adoptees prefer the term "reunion" instead of "meeting" to acknowledge the relationship that was severed by relinquishment.
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Reunion is generally not a one time event but a process that may be filled with ambivalence & trauma for all involved.
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There is rarely a sense of closure for the adoptee. Instead, it can to lead to many more revelations & relationships.