Therapy for
Adoptees
Adoptee and Adoption Therapy
Adoption is an area where there are many experts but few have lived experience, and those who do have little access to leadership, if they are even asked to speak at all. Many adoptees express that they feel silenced in many spaces and that they feel like they need to “fake” their thoughts, opinions, and feelings in order to make others comfortable. Adoptees also talk about “forced gratitude”, where they feel pressured to continuously talk about the “rainbows and unicorns” of the good parts of adoption and that they are barred from any difficult feelings about their experience. Adoptees are overrepresented in numbers of needing mental health services; we are at high risk of suicidal ideation, depression, anxiety, as well as post-traumatic stress disorder, personality disorder, and anything they may have been diagnosed with as children.
Despite the assumed advantages of adoption, there are few adoptees working as mental health professionals, and even fewer are people of color or immigrants through intercountry adoption. This means that when an adoptee is seeking a therapist who understands their specific needs, they may not have access to one adoptee therapist in their state, let alone the ability to have choice of several. Furthermore, there is little to no coverage of adoption and adoptee needs in many graduate programs, so even with lived experience, therapists are not adequately prepared to work with this large population—even as some therapists go on to work for the Department of Child Services or focus on working with foster youth or adoption. There is a need for adoption- and adoptee-competent therapists to help minor and adult adoptees traverse their feelings and identity development freely in a safe, inclusive, and nonjudgmental environment.
What IS adoption therapy?
Adoption- and adoptee-focused therapy recognizes that adoption is complicated. The separation of first (biological) parents from children—even if there is a justifiable reason for that separation—has lasting effects on the ways children understand attachment, commitment, love, and safety. Some adoptees, regardless of how loving and safe their adoptive homes were, may experience panic/anxiety, depression, longing for someone they can’t remember, and thoughts that they do not belong. These feelings can be exasperated when adoptees do not “match” their adoptive families in look, personality, culture, or other difference. In situations such as intercountry or transracial or transcultural adoption, adoptees may feel as if their identity is incomplete, as though they do not fully fit in with their adoptive family and environment nor do they fit into the culture of their birth ethnicity or race.
Not all adoptees had good experiences with their adoptive families, whether due to abuse, neglect, exploitation, rejection, or simply being treated as an outsider. These adoptees can feel further isolated and dismissed when society at large may respond with, “Well you just had a bad experience.” Adoptees may have to process rejection from their first parents and their adoptive parents, a particular situation that requires empathy and competence from their mental health provider.
Adoptee-focused therapy seeks to help adoptees develop who they are based on who they define themselves to be, so that they can be whole and authentic on their own terms, not the terms set up by anyone else. This therapy also enables adoptees to be free and honest about their feelings, no matter how they were raised nor how complicated those feelings may be. It also seeks to create an environment of trust, as a number of adoptees report feeling that mental health professionals have hurt them or have been unhelpful in the past.
Some adoptees feel that they were misdiagnosed as children and question if they were exhibiting “bad behavior” or if the were experiencing symptoms due to trauma, neurodivergence, or other mental health issues. Some adoptees experience relationship issues both in childhood an adulthood and request attachment and other work to restore relationships as well as setting appropriate boundaries. Some adoptees may also be experiencing trauma symptoms that have been undiagnosed or untreated, either related to the adoption itself or further traumatization throughout their lifespan, and adoptee-focused therapy often offers trauma intervention to help them process their traumatic experiences in a safe environment.
My goal in working with you is to do truly that: We will collaborate and find the best way forward according to your wants and needs, and I will do my best to offer empathy and support through my own lens as a peer as well as a professional.
Adoption Research
Adoptees are overrepresented in mental health, and this requires specialized therapy and care for the population. While there is a lot of research about adoption, many studies have yet to be replicated and many questions are still unanswered. This is a larger problem of funding sources and the ability for adoptees to access degrees and academic resources for research. Below is some of what we do know:
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Adoptees are a significantly more risk of attempting suicide, at a rate of 4 times more than non-adoptees.
They also are more likely to seek mental health counseling related to: anxiety and depression, post-traumatic stress disorder, oppositional defiant disorder, personality disorders, and reactive attachment disorder. (Note: Some of these are childhood-based disorders captured by specific research. Many adult adoptees seek rediagnosis as adults.)
There are overall higher lifetime rates of substance use disorder and seeking treatment for addiction.
There is growing evidence of a connection of neurodivergence and adoption.
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Forms of adoption, kinship, and foster care have always existed.
In 2019, adoptions from foster care reached all-time high at about 66,000 finalized that year.
Intercountry adoptions decreased since the 1990s but thousands of adoptions still occur every year.
In 2019, there were about 3,000 intercountry adoptions finalized.
At the height in 2004, there were about 23,000 intercountry adoptions finalized.
Since we have been tracking intercountry adoptions, there have been about 281,000.
Numbers on private domestic adoptions are tough, since there are so many ways this scenario can play out, and it is not possible to track them all correctly.
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While children adopted in infancy show more secured attachment than institutionalized peers, this population also shows more disorganized attachment than low-risk, non-adopted peers.
While rates of secure attachment among children adopted out of institutions are promising, 33% continued to show insecure attachment regardless of parental intervention.
Other issues include externalizing emotions and behaviors, issues in relationship building with adopted mothers, communication problems with new caregivers.
Regarding adult adoptees:
May struggle with interpersonal, familial, and romantic relationships due to unaddressed insecure attachment.
Adults adopted in infancy had higher rates of avoidance and anxiety in peer relationships.
In romantic relationships, avoidance through peacekeeping, conformity, or emotional distancing.
Issues with abandonment and rejection fears and developing trust and commitment.
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Adotpees and researchers have concerns about incorrect or overdiagnosis of reactive attachment disorder (RAD) or disinhibited social engagement disorder (DSED)
There is a lack of specialist assessment/intervention during diagnosis.
There is some evidence of assessors not accounting for trauma or neglect as better explanation for behavior.
Adoptive and foster families are overrepresented in those seeking diagnosis for conduct issues (meaning they are more likely to seek professional help and thus be tracked, but this does not mean only adoptees have these behaviors).
Education provided by some agencies focus on solving conduct/behavior issues rather than trauma-informed parenting.
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Atkinson, A.J., Gonet, P.A., Freundlich, M., & Riley, D.B. (November 2013). Adoption competent clinical practice: Defining its meaning and development. Adoption Quarterly 16(3-4): 156-174. https://doi.org/10.1080/10926755.2013.844215
Barnett, E.R., Jankowski, M.K., Butcher, R.L., Meister, C., Parton, R.R., & Drake, R.E. (August 2017). Foster and adoptive parent perspectives on needs and services: A mixed methods study. Journal of Behavioral Health Services & Research: 1-15. DOI 10.1007/s11414-017-9569-4
Barroso, R., Barbosa-Ducharne, M.B., Coelho, V., Costa, I.S., & Silva, A. (January 2017). Psychological adjustment in intercountry and domestic adopted adolescents: A systemic review. Child and Adolescent Social Work Journal 34: 399-418. https://doi.org/10.1007/s10560-016-0485-x
Behle, A., & Pinquart, M. (July 2016). Psychiatric disorders and treatment in adoptees: A meta-analytic comparison with non-adoptees. Adoption Quarterly 19(4): 284-306. https://doi.org/10.1080/10926755.2016.1201708
Branco, S.F., Jones, C.T., & Stella, S. (September 2020). Substance use disorders and adoption status: Implications for counseling practice. The Family Journal 29(1): 109-114. https://doi.org/10.1177/1066480720956639
Bureau of Consular Affairs (2020). FY 2019 annual report on intercountry adoption. U.S. Department of State. https://travel.state.gov/content/dam/NEWadoptionassets/pdfs/FY%202019%20Annual%20Report%20-%20NEW.pdf
Byrne, J.G. (September 2003). Referral bias and diagnostic dilemmas. Attachment & Human Development 5(3): 249-252. https://doi.org/10.1080/14616730310001593983
Children’s Bureau (2020). Trends in foster care and adoption: FY 2010 – FY 2019. U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/cb/trends_fostercare_adoption_10thru19.pdf
Domyancich-Lee, S.C. (November 2021). The yin & yang of belonging: A phenomenological study of adult Korean adoptees’ attachment styles in romantic relationships. Adoption Quarterly. DOI:10.1080/10926755.2021.2005729
Feeney, J.A., Passmore, N.L., & Peterson, C.C. (2007). Adoption, attachment, and relationship concerns: A study of adult adoptees. Personal Relationships 14(1): 129-147. doi:10.1111/j.1475-6811.2006.00145.x
Field, J., & Pond, R. (2018). How adoption affects the experience of adult intimate relationships and parenthood: A systematic review. New Zealand Journal of Counseling 38(2): 24-55.
Fitton, V.A. (2012). Attachment theory: History, research, and practice. Psychoanalytic Social Work 19(1-2): 121-143. doi:10.1080/15228878.2012.666491
Groza, V., & Muntean, A. (April 2016). A description of attachment in adoptive parents and adoptees in Romania during early adolescence. Child and Adolescent Social Work Journal 33: 163-174. https://doi.org/10.1007/s10560-015-0408-2
Keyes, M.A., Malone, S.M., Sharma, A., Iacono, W.G., & McGue, M. (October 2013). Risk of suicide attempt in adopted and nonadopted offspring. Pediatrics 132(4): 639-646. https://doi.org/10.1542/peds.2012-3251
Lionetti, F. (2014). What promotes secure attachment in early adoption? The protective roles of infants’ temperament and adoptive parents’ attachment. Attachment & Human Development 16(6): 573-589. doi:10.1080/14616734.2014.959028
Purvis, K.B., Razuri, E.B., Hiles Howard, A.R., Call, C.D., DeLuna, J.H., Hall, J.S., & Cross, D.R. (2015). Decrease in behavioral problems and trauma symptoms among at-risk adopted children following trauma-informed parent training intervention. Journal of Child & Adolescent Trauma 8: 201-210. https://doi.org/10.1007/s40653-015-0055-y
Pylypa, J. (2016). The social construction of attachment, attachment disorders and attachment parenting in international adoption discourse and parent education. Children & Society: 1-11. doi:10.1111/chso.12159
Slap, G., Goodman, E., & Huang, B. (August 2001). Adoption as a risk factor for attempted suicide during adolescence. Pediatrics 108(2). https://doi.org/10.1542/peds.108.2.e30
Van den Dries, L., Juffer, F., van Ijzendoorn, M.H., & Bakermans-Kranenburg, M.J. (March 2009). Fostering security? A meta-analysis of attachment in adopted children. Children and Youth Services Review 31(3): 410-421. https://doi.org/10.1016/j.childyouth.2008.09.008
Westermeyer, J., Yoon, G., Amundson, C., Warwick, M., & Kuskowski, M.A. (April 2015). Personality disorders in adopted versus non-adopted adults. Psychiatry Research 226(2-3): 446-450. https://doi.org/10.1016/j.psychres.2014.12.067
Woolgar, M., & Baldock, E. (January 2014). Attachment disorders versus more common problems in looked after and adopted children: Comparing community and expert assessments. Child and Adolescent Mental Health 20(1): 34-40. https://doi.org/10.1111/camh.12052
Woolgar, M., & Scott, S. (April 2013). The negative consequences of over-diagnosing attachment disorders in adopted children: The importance of comprehensive formulations. Clinical Child Psychology and Psychiatry 19(3). https://doi.org/10.1177/1359104513478
What are your qualifications?
I started working with adoptees and educating adoptive parents through online communities in 2015. I have a background in curriculum creation and teaching about race history and colonialism, and this education helped me to work specifically with the intercountry and transracial adoption communities. In 2016, I began running an Indian adoptee support group for my peers to discuss freely their feelings about the Kolkata child trafficking scandal.
In 2019, I became president of People for Ethical Adoption Reform (PEAR, formerly Parents for Ethical Adoption Reform), and I was invited to join Intercountry Adoptee Voices (ICAV) to the Adoption Symposium held by the Department of State to represent the interests of adult adoptees. I also participated as an invited observer in the special meeting of the United Nation’s Hague Convention in 2022, as well as an invited speaker at a Department of State townhall for adult adoptees. The focus of my advocacy is access to mental health services for adoptees across their entire lifespan.
