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Sunday, August 24, 2008

Choosing an Adoption Competent Therapist

The need for adoption-competent mental health services is critical to the ongoing wellbeing of adoptive families. Feedback from adoptive families reflects a struggle to meet the mental health needs of their children due to a failure of some mental health providers to understand the unique issues of adoption that are related to mental health. Health and behavioral health care providers need to have expertise related to adoption in the same way that a provider might specialize in substance abuse treatment or in a specific diagnosis such as autism.

The following list of characteristics related to adoption-competence can serve as a gauge in choosing a therapist:
• Knowing that adoption is a lifelong process that includes universal experiences as well as unique individual feelings and perceptions.
• Recognizing the therapeutic importance of parenting relationships and family connections for the child.
• Addressing developmental challenges that are common to adoption.
• Helping families promote secure attachments and healthy relationships, no matter what developmental challenges arise.
• Viewing adoption from a culturally competent family perspective and understanding the power and complexities of adoptive and birth family dynamics.
• Treating adoptive families as team players, reaching towards the mutual goal of healing for the child.
• Avoiding blaming adoptive parents for their children’s behaviors; reframing everyone’s goal as being part of the solution.
• Helping adoptive parents honor their child’s past and achieve a comfort level that allows their child to address separation, loss and feelings about birth family.
• Supporting adoptive parents in assuming parental entitlement, fully empowering them as decision-makers and “experts” in the parenting journey.
• Recognizing and respecting the unique characteristics and skills that make adoptive families successful and that assist families in developing and practicing those skills.
• Striving to provide in-home and outreach services to families to meet them “where they are.”
• Recognizing that temporary out-of-home treatment is not an adoption failure but may ultimately keep the child and family connected and reunified.

This list is used by permission of Spaulding for Children and the National Consortium for Post Legal Adoption Services, based on the research of Howard, J and Livingston-Smith, S. (1997) Strengthening Adoptive Families: A Synthesis of Post-Legal Adoption Opportunities Grants,

1 comment:

lavendergardener said...

How do I find a therapist who is qualified with adoption and foster care issues?
Selecting a therapist who understands adoption and foster care can be an important component to your child’s mental health. Several ways to start the process are:
1. Talking to other adoptive/foster families who have had a good experience with a therapist.
2. Asking your primary care physician or other health professional. Tell your doctor that a background in adoption is important to you in choosing a therapist so he or she can make appropriate suggestions.
3. Yellow page listings can be valuable if you take the time to call and discuss your needs briefly with the therapist. Often, you can get a feel for whether or not this person serves other adoptive/foster families and you can schedule an introductory session without charge.
4. Consider the gender of therapist and the gender of the child, particularly with a child exhibiting special needs. Some children with fragile backgrounds interact and trust one gender more than another.

What do I ask a therapist that I am considering using?
Call and request 5 minutes of a potential therapist’s time on the phone or preferably 15 minutes in person. This time will be utilized to ask some questions which will help you make your
decision as to the best therapist for you. Some questions that you might choose to ask include:
1. What type of license(s) do you hold?
2. What is your approach to therapy?
3. What kind of and how much experience in dealing with grief and loss associated with adoption do you have?
4. Do you specialize in the diagnosis and treatment of a particular condition that you suspect your child may have? (ADHD/Fetal Alcohol Disorder/Attachment Disorder,
Oppositional Defiant Disorder?)
5. How long will it take to get an appointment and how often do you normally expect to see clients?
6. What are the standard fees for service, insurance, and payment arrangements?

What can I expect from my therapist?
1. An understanding of adoption and how it impacts families
2. A diagnosis, if appropriate and indicated, of any condition affecting your child, or referral to appropriate diagnosticians
3. The ability to ease and help in a crisis
4. Availability and willingness to be reached during a crisis
5. Compatibility with you and your child
6. Tangible relief

Tips on Selecting an Adoption Therapist
Used with permission from NAIC, the National Adoption Information Clearinghouse
Adoption is an event that has a life-long effect on everyone involved. Adoption brings unique rewards as well as challenges to families, and sometimes families will need or want professional help as concerns or problems arise. Timely intervention by a professional skilled in adoption issues often can prevent issues common to adoption from becoming more
serious problems that might be more difficult to resolve.
The type (e.g., individual, family, group) and duration of therapy will vary depending on many variables, including the
kinds of problems being addressed. Some families build a relationship with a therapist over years, "checking in" for help
as needed. Other families might find they need a therapist's help only once or twice. Sometimes a difficulty a child is experiencing is very obviously connected to adoption, but sometimes the connection is not readily apparent. On the other
hand, issues that seem to be related to adoption, after investigation, turn out not to be related to adoption at all. Clinicians with adoption knowledge and experience are best suited to help families identify connections between problems and adoption and to plan effective treatment strategies.
Finding the right therapist can seem like a daunting task, especially when parents may be feeling overwhelmed or burdened by the difficulties for which they are seeking help. Parents should take the time to shop around for a mental health provider who has the experience and expertise required to effectively address their family's needs. At minimum, a therapist must:
Be knowledgeable about adoption and the psychological impact of adoption on children and families
Be experienced in working with adopted children and their families.
Know the types of help available. (See below)

Check on Insurance The search for a therapist can be complicated by restrictions imposed by insurance companies or health management organizations (HMOs); however, it may still be possible to choose from a list of approved therapists.
Check with your insurance company to find out:
1. The extent of your coverage for mental health treatment
2. Specialty areas of approved providers
3. Company policies regarding referrals to, and payment for, treatment provided by therapists outside the plan.
You may be able to justify using a therapist outside of the network for specialized services if the insurance company
does not have providers with the required expertise. Although you might meet some resistance, persevere to secure the
needed services-you are your child's strongest advocate.
Some therapists accept Medicaid reimbursement. The challenge is to locate a therapist who accepts reimbursement and who has experience in foster care and adoption. Your local public foster care agency may be able to give you referrals to
therapists they use for children's treatment.

Know the Types of Help Available:
Many different professionals provide mental health services but not all may be available in your area. It helps to know
the training and credentials of various professionals attain.
Pediatrician or Family Practice Physician -
Medical doctor (M.D.) who specializes in childhood or adolescent care and who typically treats routine medical conditions; a primary care physician who refers a child for additional lab studies or diagnostic procedures and who coordinates referrals to other specialists.
Psychiatrist -
Medical doctor (M.D.) who specializes in the evaluation of major mental or emotional disorders which may require
medication. Psychiatrists complete medical school and follow with post-graduate training in psychiatric disorders and
perhaps subspecialties in child and adolescent psychiatry. Psychiatry's primary focus is on medication consultation
and management, and only a few psychiatrists have formal training in psychotherapy, counseling, or interventions
that address child and adolescent behavioral or emotional disorders. Rather, most work with or refer to specialists in
child and family evaluation and therapy.
Clinical Psychologist-
A clinical psychologist has completed a doctoral degree (Ph.D. or Psy.D.) in psychology and usually has completed
advanced courses in general development, psychological testing and evaluation, as well as psychotherapy techniques
and counseling. Many clinical psychologists develop a subspecialty in child and adolescent development,
psychological testing, and family therapy.
Clinical Neuropsychologist -
Clinical neuropsychologists hold a Ph.D. They complete undergraduate and graduate training in biological and medical
theories pertaining to human behavior and doctoral studies in clinical neuropsychology, followed by postgraduate
specialty training in the assessment and treatment of neurodevelopmental disorders, neurological and
medical conditions, traumatic brain injury, learning and memory disorders and the differential diagnosis of organic
versus psychiatric or psychological disorders.
Clinical Social Worker -
A clinical social worker (LISW or MSW) has completed a master's degree in social work with emphasis on family
structure and children's interactional strengths and weaknesses. Social workers typically focus on social, educational and family adjustment issues, but usually do not have professional training in psychological testing. Many complete advanced training and licensure in order to be qualified under state licensure requirements to offer counseling to individuals and families.
Marriage and Family Therapist -
Marriage and family therapists (MSW) have a master's degree in counseling techniques that mainly focus on family
relationships and couples. Family therapists focus on communication building and on family structure and boundaries within the family.
Licensed Professional Counselor -
A licensed professional counselor often has graduate training in a specialty such as education, psychology, pastoral
counseling, or marriage and family therapy. Licensed professional counselors focus on brief problem-solving therapies with a focus on reorganizing the family, building communication skills, and strengthening family relationships.
Pastoral Counselor -
A pastoral counselor has a minimum of a master's degree (many have completed doctoral training) and focuses on
supportive interventions for individuals or families, using spirituality as an additional source of support for those in

Ask for Referrals Locating a therapist does not have to be difficult. You may want to contact community adoption
support networks, use the Internet, and/or ask your placement agency. Many adoption agencies have either consulting
mental health therapists trained in adoption on staff or referral resources in the community. Public agencies may have a
list of therapists who have effectively worked with children in foster care and adoption. In addition, there are independent
social service organizations throughout the United States that provide post-adoption services, which may include parent
support groups, individual and family counseling, children's support groups, educational seminars, consultations and
Check with the following resources for therapist recommendations:
1. Agency social workers involved in the original placement
2. State or local mental health associations - most offer referral services and list specialty areas for therapists
3. Public and private adoption agencies
4. Local adoptive parent support groups
5. Specialized agencies providing post-adoption services.
Using those recommendations, call therapists for a phone or face-to-face interview. Many therapists will offer a 15- or
20-minute initial consultation free of charge. In contacting a community mental health center, parents should ask for
names of the center's family and child specialists and then leave messages for those clinicians requesting a short phone
Phone Interview Questions Parents should start by giving the clinician a brief description of the concern or problem
for which they are requesting help. Listed below are some questions to discuss.
What is the therapist's experience with
1. Adoption, in general?
2. Infertility?
3. Special needs adoption?
4. Open adoption?
5. Transracial adoption?
6. Identity issues in the context of adoption?
7. Search and reunion?
8. Adoptive families?
9. Adopted children?
10. Children who have histories of loss, abuse and/or neglect?
11. Children who may have learning or developmental disabilities?
How long has the therapist been in practice, and what degrees, license or certification does he or she have?
What continuing clinical training does he or she have on adoption issues?
Does the therapist include parents in the therapeutic process?
Does the clinician prefer to work with the entire family or only with the child(ren)?
Will the therapist give parents regular reports on a child's progress?
Can the therapist estimate a time frame for the course of therapy?
What is the therapist's theoretical orientation regarding treatment? Many therapists treat from one or more of the following
1. behavioral therapy, which focuses on treating overt behaviors
2. cognitive therapy, which focuses clinical intervention on thinking processes, motivation, and reasons for
certain behaviors
3. family systems therapy, which views family members as a unit and focuses on their interpersonal and
communications patterns
4. psychoanalysis, which is based on psychosexual development theories, personality structure and psychotherapy techniques pioneered by Sigmund Freud.

Other Practical Considerations Most therapists or clinical practices have policies regarding late or missed appointments,
notice required for rescheduling appointments, and filing for insurance reimbursement. Parents should ask for this
1. What is the therapist's arrangement for coverage when he or she is not available, especially in the event of an
2. Are daytime, evening, or weekend appointments available? What about after-school appointments?
3. Does the therapist offer discounted or sliding scale fees if he or she is not an approved provider for your health
4. Does the therapist accept adoption subsidy medical payments or Medicaid reimbursement payments?
5. Does the therapist have experience working collaboratively with school personnel including attending any appropriate
school meetings.
Working with a Therapist
Parents may request an evaluation meeting with the therapist 6-8 weeks after treatment begins. This evaluation meeting will help all parties "take a pulse" on progress of the treatment and to discuss the following areas:
1. Satisfaction with the "chemistry" between the therapist and family members. (It is important for parents to understand
that a trusting relationship between clinician and the child may take several weeks or longer to establish. This is particularly true of children who have had histories of significant loss and separations.)
2. Mutually agreed-upon goals for treatment approaches and desired outcomes.
3. Progress on problems that first prompted the request for treatment. Parents should realize that some behaviors
need extensive intervention before progress can be identified.
4. A tentative diagnosis.
5. The therapist's evaluation of the chances that therapy can improve the situation(s) which prompted treatment.
6. Follow through by the family with the therapist's recommendations. Practiced any "homework" assignments?
(Parents should know that most of the "work" in therapy occurs between, not during, sessions and that it is a reciprocal
The family's involvement and support of the therapy is often critical to a positive outcome for the child. Families must
commit to keeping regularly scheduled appointments, and parents should not use therapy as a tool for discipline.
Family members must communicate regularly with the therapist and ensure that the therapist has regular feedback about conditions at home. The success of therapy depends heavily on open, honest and trusting communication.
Recognizing the need for outside support and early intervention when problems arise will help adopted children and theirfamilies navigate the challenges adoption presents as they grow and develop.
In Summary You can locate a therapist who has the experience and training best suited to your needs by checking with local, State, and regional referral sources. This may take more time but in the end, your research efforts should result in
finding the mental health service provider best able to work with you and your child.

There are national professional organizations that will provide you with information regarding therapists that specialize
in adoption issues. These organizations can direct you to therapists in your area.
The American Psychological Association (APA)
750 First Street, NE
Washington, D.C. 20002
The American Psychiatric Association
1400 K Street, NW
Washington, D.C. 20005
1-888-35-PSYCH (77924)
The American Association of Marriage and Family Therapy
1133 15th Street, NW
Suite 300
Washington, D.C. 20005
The National Association of Social Workers
750 First Street, NE
Suite 700
Washington, D.C. 20002
This material may be reproduced and distributed without permission; however, appropriate citation must be given to the National
Adoption Information Clearinghouse.