Adoptive Families and Professionals:
When the Experts Make Things Worse

By Steven L. Nickman, MD, and Robert G. Lewis, MEd, MSW

From the Journal of the American Academy of Child & Adolescent Psychiatry, June 1994.
Reprinted by permission of Robert C. Lewis

Adoptive parents often experience contact with professionals as more damaging than helpful. This is seen in most dramatic form when families are in turmoil during the adolescence of a later-adopted child. However, some adopters of infants also report problems in their relations with professionals.

Difficulties can be described under four main headings:

1. Failure To Be Aware of the Basic Categories of Child Placement and the Distinctions between Them. Some professionals do not understand the important distinctions between foster care and adoption, or among the several varieties of adoption (e.g., early and later placement, closed and open arrangements, subsidized and nonsubsidized adoptions). Without thoughtful consideration of the timing and quality of attachment, clinicians’ interventions are not well framed, and parents feel misunderstood.

2. Failure To Recognize and Support Existing Bonds at Times of Family Stress. Adopted adolescents demonstrate their confusion about identity and family membership by dramatic behavior that brings the family to professional attention. At such times feelings run high, and a degree of alienation may be seen between child and parent that confuses and troubles the professionals involved. When faced with parents and an adopted teenager who are intensely conflicted, clinicians may have trouble maintaining a nonjudgmental stance; they may overlook the possibly transient nature of the crisis. Stressed by the painful affects and deep ambivalence of family members, they may wish to intervene actively to "rescue" someone and end the distress they are witnessing. An unattuned psychiatrist, state social worker, or judge may thus simplify the task as saving the "good" parents from the "bad" adolescent, or vice versa. In either case, intervention may contribute to family disruption since the end result is often a weakening of the adoptive placement itself, notwithstanding that the child is a legal member of the family and that this membership may be the best hope of a troubled child.

Creative ways of "parenting at a distance" that are often useful temporary solutions to conflict - boarding school, residential treatment, or temporary placement with a relative or friend - are less likely to be recommended to adoptive families; instead there may be state intrusion and entry (reentry) into the foster care system. Parents who recognize a need for residential treatment may be told that foster placement is more appropriate or that they must abandon the child to state custody to obtain funding for residential care. Parents thus become effectively excluded from planning for their child.

Juvenile court judges may react impulsively to an adolescent’s acting-out behavior. One judge told a boy’s parents, "You shouldn’t have adopted this boy," and quietly added a profane remark disparaging the adoptive father’s judgment. Another judge was angered by an adolescent’s cocky, provocative talk. Ignoring evidence that this was a direct effect of a loyalty conflict (H. Leichtman, personal communication), he abruptly rescinded the adoption, which had been in force for 16 years, evidently trying to relieve parental distress. In both cases the parents were confused and angry that the judge, failing recognize their family unit, had instead undermined it. Similar lapses occur frequently in adolescent inpatient units. Adoptive families in crisis are vulnerable when unsupported by professionals and institutions whose protection they have a right to expect (Lewis et al., 1975). Professionals’ intolerance of less-that-optimal bonds suggests that adoptive families - particularly those with special needs - are stigmatized or deemed inferior.

3. Inappropriate Intrusions into Family Life. Adoptive families encounter a variety of intrusions, ranging from stigmatizing questions asked by schools to the unjustified removal of a child from a family. Parents may be asked routinely on enrollment forms whether their child was adopted; classroom teachers may fail to make provision for adoptees in their handling of the common but often insensitive "family tree" assignment.

More harmful intrusion is seen in the following not uncommon situation: A family adopted a young school-age boy after abuse and several foster placements. After a "honeymoon" period, the child predictably began testing limits severely. The parents managed to contain him by firm handling, including occasional mild physical punishment. The boy gradually settled into the family and attained school and peer success. After an incident of punishment, remembering his past and confusing his present parents’ motives with the questionable motives of his biological parents, the child alerted the authorities to the "fact" that he had been abused. The parents explained that their methods had led to improvement and that the boy’s history predisposed him to distort events. The protective agency, defining abuse rigidly, continued to monitor the parents, who now question whether they can continue without the support of community authorities. Although legally adopted, this child’s placement is now in jeopardy.

Abuse can occur in adoptive families, but recognizing genuine abuse in previously traumatized children requires skill and specific training.

4. Failure To Provide Appropriate Psychotherapy. A common complaint of parents adopting children with complex histories is that therapists do not understand the nature of the relationship between themselves and the child and do not appreciate the dilemma of the child who is trying to establish new loyalties. The problem of multiple emotional attachments (H. Leichtman, personal communication; Fishman, 1992) is particularly dramatic when the child remembers the biological parents or when an open adoption arrangement specifies ongoing contact. Problems tend to fall into two types. The therapist may work almost entirely the child and keep the parents on the periphery. The adoptive parents, aware of the child’s traumatically based tendency to lie or misrepresent, believe the therapist cannot succeed without a clear picture of what actually happens at home, or school, and with peers. Or the therapist may do only conjoint family therapy and scrutinize only the ongoing interactions of the family, not recognizing that much of the force behind the child’s symptoms and complaints derives from events that occurred in a prior situation. Parents may thus feel scapegoated by the child and therapist together.

DISCUSSION

The propensity of adopted adolescents to tax their parents’ resources has long been recognized (Brodzinsky, 1990a,b; Reitz and Watson, 1992). This phenomenon is seen commonly in teenagers who were placed in infancy and whose acting-out behavior arises mainly from what have been called "covert" and "status" looses (Nickman, 1985). "Covert loss" refers to prolonged inner reflection about one’s personal history of relinquishment and transfer, and of having learned about it long after the event; there is consequent damage to self-esteem and confusion about identity. "Status loss" refers to the experience of being perceived as different from others, or stigmatized, by virtue of some fact about one’s birth or status, or some publicly visible anomaly, such as appearing different from one’s parents. In addition to having suffered covert and status losses, the older children placed more commonly since the 1970s have undergone substantial overt losses (Nickman, 1985): neglect, abuse, separation from original caretakers, multiple placements.

The results of these overt, tangible experiences of privation and discontinuity go beyond the usual problems of covert and status losses to include trouble connecting emotionally with adoptive parents and identifying with the adoptive family (Delaney and Kunstal, 1993; Fishman, 1992); difficulty in being optimistic about themselves and their lives (Delaney and Kunstal, 1993); and impaired concentration because of emotionally and organically rooted problems with attention and learning. An additional factor may be substantial dissimilarity between the child and parents which may lead to a greater alienation from parents than one would expect from an early placement and a relatively a traumatic early history.

In many adoptive families, professionals may observe significant pathology not only in the adolescent but in the family system as well (Delaney and Kunstal, 1993; Reitz and Watson, 1992). Clinically, the most relevant issue is not whether the pathology began in the family or was "imported" into it, but that the family as a legally constituted unit needs help to return to a better functioning state.

Clinical Principles

1. When an adoptive family is stressed, professionals can make an invaluable contribution by emphasizing positive aspects, rather than questioning the placement. The complex mutual adjustments that have transpired over the years should be recognized and supported at a time when family members may lose sight of the hopeful aspects of the relationship.

2. Families with adopted children with special needs may not meet workers’ stereotypes of a typical middle class family. Deeply held religious or ethical convictions may bear on the making of such a commitment. If professionals question these decisions directly or by implication, they may overreach their authority and be perceived as unsympathetic.

3. Initially, traumatized children may not see parental love as a reward, but rather as coercive and frightening. Many now believe that even disturbed children deserve the chance to profit from family life; innovative management techniques may be required. What may be seen as an under involved or overly strict management style may in fact be a creative coping strategy, similar to methods of management in well-run group homes or residential treatment centers. Protective service workers assigned to asses adoptive families should be alert to the risk of using a uniform standard of close, warm involvement; this is a Procrustean bed unsuited to many adoptive families.

4. Therapists need to recognize that many adoptees have sustained psychopathology before entering their present families. Treatment plans should reflect the possibility that adoptive parents may contribute to problems, but also the likelihood that they have developed a degree of expert awareness about their child’s previously acquired difficulties.

5. Those in control of public funds should recognize the ongoing clinical needs of some adoptive families after legalization.

Conclusion

Professionals should be trained in the needs of adoptive families; such training should include instruction about common biases and stigmatizing beliefs. Psychotherapists, social workers, judges, pediatricians, and other experts serving children need to take the adoptive attachment seriously; otherwise they will unwittingly contribute to the dissolution of adoptive families. The anticipated benefits of adoption in general, and special needs adoption in particular, will be lost if these families fail to receive helpful services at times of crisis.

REFERENCES

Brodzinsky, D.M. (1990), A stress and coping model of adoption adjustment. In: The Psychology of Adoption, Brodzinsky, DM, Schechter MD, eds. New York: Oxford

Brodzinsky, D.M. (1990), Adoption from the inside out: a psychoanalytic perspective. In: The Psychology of Adoption, Brodzinsky DM, Schechter MD, eds. New York: Oxford

Delaney, R.J., Kunstal, F.R. (1993), Troubled Transplants, National Child Welfare Resource Center for Management and Administration, Edmund S. Muskie Institute for Public Affairs, University of Southern Maine

Fishman, K.D. (1992), Problem adoptions. The Atlantic 270(3):37-69

Lewis, D.O., Balla, D., Lewis, M., Gore, R. (1975), The treatment of adopted versus neglected children in the court. Am J Psychiatry 132:142-145

Nickman, S.L. (1985), Losses in adoption: the need for dialogue. Psychoanal Study Child 40:365-398

Reitz, M., Watson, K.W. (1992), Adoption and the Family System: Strategies for Treatment, New York: Guilford

ABOUT THE AUTHORS

At the time of publication Dr. Nickman was Clinical Professor of Psychiatry, Havard Medical School (Massachusetts General Hospital) and Mr. Lewis was Executive Director of Project IMPACT, Boston, Mass. The authors wish to thank H. David Kirk, PhD., Lauren Frey, M.S.W., and Joyce Forsythe, M.S.W., for assistance in the preparation of this paper. Visit Mr. Lewis' website at http://www.highpopples.com/

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