Adoption-Competent Therapy — What It Is, Why It Matters, and How to Find It

Adoption is a word that holds so much under the surface for adoptees, birth parents, and adoptive parents (the triad) including grief, attachment, trauma, and questions of culture and identity (Child Welfare Information Gateway [CWIG], 2018). While the mainstream narrative is that adoptees should feel lucky (Randolph, 2014; Boston Post Adoption Resources [BPAR], 2021), the reverberations of being relinquished and adopted last a lifetime (CWIG, 2018). Therapy, more specifically adoption-competent therapy, can help ease this journey through education, understanding, and proper support (BPAR, 2021; CWIG, 2018).

Adoption-competent therapists have the training, education, and experience to provide effective treatment to those impacted by adoption. They understand that adoption is complex and involves a nuanced approach for relational concerns, reunions, and much more (BPAR, 2021; CWIG, 2018). Adoption-competent therapists have a trauma lens and understand that our body has memory through our senses even before we had verbal language, meaning that even if relinquished as a newborn, an adoptee has experienced and remembers (on a body-level) the loss of their mother; this is called implicit memory (Randolph, 2014). Deb Olshever (2021), co-founder of Adoption Associates, says that for a professional to be adoption-competent, they must have knowledge of “loss, trauma, differences, attachment, and [cultural competency]” (para. 4).

Despite adoption being incredibly common in the therapy office, more time is spent on less common mental illnesses in counselors’ education (Randolph, 2014). Licensed mental health counselor, Brooke Randolph (2014) drops some scary statistics:

• 65% of doctoral-level therapists did not have any courses about adoption in their graduate school
• 86% of doctoral-level therapists did not have any courses about adoption in their undergraduate school
• 7.95 minutes per semester are spent discussing adoption in doctoral programs

(para. 6)

In my graduate program, I don’t remember adoption ever being brought up, unless I added it to the conversation. The majority of therapists do not have the foundational knowledge to effectively treat the triad (Olshever, 2021) and these therapists can cause more harm by trying to help (Randolph, 2014).

Why is adoption competency important?

Non-competent therapists can invalidate and brush off the significance of adoption (BPAR, 2021). They can tokenize a family member who may have been adopted and think they know all there is to know based on that person’s story (Randolph, 2014), when in fact, every adoption story is different; every story is a unique mosaic. Non-competent therapists may misdiagnose and overdiagnose mental illness since trauma symptoms mirror symptoms of mental illness; this can wind up overmedicating a person (Randolph, 2014). Randolph (2014) makes an important distinction between trauma symptoms and mental illness:

One essential component of diagnosis is that for anything to be considered a disorder the distress must be in excess of what would be expected from the stressor. When the stressor involves separation from one’s family and integration into a new family, a very high level of distress should be expected (para 30).

On the other hand, having an adoption-competent therapist “allows adoptees and their families to open up a path to healing” (BPAR, 2021, p. 46). Adoption-competent therapy offers opportunities for adoptees and families to be understood and to find the resources and tools necessary for honest conversations (Belanger, 2014). Adoption-competent group therapy builds relationships and provides validation and community; it normalizes the experience rather than further isolating it (BPAR, 2021).

Life events can trigger deep pain (CWIG, 2018). Karen Belanger (2014), an adoptee, writes about oscillating between fear and anger. She expresses that her strong emotions rooted in adoption were largely misunderstood, and she tried to cope using drugs and alcohol. Belanger (2014) expresses that fear “can consume us in our relations and responses to life circumstances and events” (para. 30). Haley Radke (2017), host of the Adoptees On podcast and an adoptee herself, encourages adoptees to seek adoption-competent therapy as a way “to move forward” (2:06). Belanger (2014) reports that after she sought adoption-competent therapy, “I no longer have to hide my authentic self away in a cocoon fearing further rejection from the world. . . .  I finally belong somewhere, but mostly now I belong to ‘me’” (paras. 48-49).

Of course, adoptees are not the only ones to benefit from adoption-competent therapy. Families, adoptive parents, birth parents, and other family members or significant others of adoptees can utilize adoption-competent therapy (BPAR, 2021; Randolph, 2014). In addition to the loss (whether it be loss of first parents, loss of child, or loss of being able to have biological children), “families with adoption often struggle with . . . diversity” (Olshever, 2021, para. 2). Transracial and international adoptions, as well as families that include LGBTQ members, add more complexity to adoption (Olshever, 2021). Even parents agree that they need their own adoption-competent therapy to discuss their concerns, fears, and thoughts without judgment (BPAR, 2021).

So, how do you know if your therapist has adoption-competency?

Therapists are trained in different modalities, and there are different licenses based on the education they received (CWIG, 2018). Unfortunately, so many non-adoption-competent therapists will keep a client on despite not having the proper experience and training for issues of adoption. Randolph (2014) says, “It is essential that clients act as their own (or their child’s) advocate in choosing a therapist, doing research, and asking tough questions” (para. 11).

The first thing to do is interview your potential therapist (or current one) (CWIG, 2018; Olshever, 2021; Radke, 2017). Here are some example questions to ask:

General (but important) questions

• What is your training and experience and your licensing information? (Radke, 2017, 14:22)
• What styles of treatment do you specialize in? (Radke, 2017, 14:28). Some therapy approaches that can be in alignment with adoption-competent therapy include (but are not limited to) group therapy, family therapy, trauma-informed therapy, attachment-focused therapy (CWIG, 2018). It is important to note that your relationship with a therapist (i.e. do you feel safe, comfortable to share, etc.) matters more than the modality they use. Additionally, some therapeutic approaches may speak more to you than others. Fortunately, many therapeutic styles can lead to the same place.

Questions using specific language to test their knowledge

• Have you worked with adult adoptees before or any other member of the triad? (Radke, 2017, 15:43)
• Have you heard of the ‘Primal Wound’? (Radke, 2017, 16:13)
• Have you heard the phrase ‘out of the fog’? (Radke, 2017, 16:25)

Questions that can show their experience

• Are there any themes that you see common to adoptees, and how would you work with someone on those themes? (Radke, 2017, 16.56)
• Have you taken any courses/training in adoption competency? (Child Welfare, p. 5)

Questions that will tell you how they see adoption, whether they recognize it as a nuanced experience or see it like the rest of society

• Do you believe that adoption can be considered a traumatic event for the mother and child, and do you have any training helping someone with PTSD or other trauma? (Radke, 2017, 17:54)
• Do you believe a family created by adoption is the same as one where all members are biologically related? Can you explain why or why not? (Radke, 2017, 20:10)

Randolph (2014) encourages potential clients to keep an eye out for therapists that may not be adoption-competent. The following are some examples to be wary of:

• Lacks additional training (para. 12).
• Does not ask for details and simply accepts “I was adopted” (para. 16). Usually during the assessment period, an adoption-competent therapist will ask for more information on a client’s adoption story.
• Does not understand implicit memory (pre-verbal) (para. 17).
• Talks negatively about family of origin or country of origin (para. 21).
• Does not understand or allow for multiple attachments (para. 24). It is healthy for adoptees to form attachments with their adoptive parents and their birth parents and/or birth family members (if possible).
• Expects gratitude for adoption (para 30). If a therapist believes an adoptee (or a birth parent for that matter) should feel appreciative of an adoption, they are falling into the mainstream narrative that dismisses the loss involved.
• Addresses behavioral concerns with punitive measures (para. 31).

If the therapist has exhibited some adoption-competency without red flags, Olshever (2021) encourages clients to try the therapist out for a short period of time. In the end, it needs to feel like a good match (Olshever, 2021; Radke, 2017).

What if your current therapist is not adoption-competent? 

• BPAR offers consultations for therapists who need guidance in understanding adoption issues.
• Ask your therapist if they are willing to seek supervision from an adoption-competent therapist (Randolph, 2014).
• Ask your therapist to attend adoption trainings and conferences (Randolf, 2014).
• Ask your therapist for referrals (Randolf, 2014).
• Consult a directory of adoptee - therapists in the United States: https://www.growbeyondwords.com/adoptee-therapist-directory/.
• Consult a directory of mental health clinicians who have trained with Center for Adoption Support and Education (C.A.S.E.): https://adoptionsupport.org/member-types/directory-of-tac-trained-mental-health-professionals/.

If you are a professional clinician and would like more information on adoption-competency, please reach out to BPAR for a consultation. Other professional resources include:

• Seek supervision from an adoption-competent therapist.
• The Training For Adoption Competency from the Center for Adoption Support and Education (C.A.S.E.).
• BPAR’s resources for professionals: https://bpar.org/post-adoption-resources-for-professionals/.
• BPAR’s adoption-related blogs:                https://bpar.org/category/professional-resources/.
• BPAR’s resources on transracial adoption: https://bpar.org/transracial-adoption-resources-on-anti-racism-social-justice/.
• Local adoption agencies offering education.

Written by Brittany Purrington
Boston Post Adoption Resources

References

Belanger, K. (2014). "Untherapied" adoption wounds. In L. Dennis (Ed.), Adoption therapy: Perspectives from clients and clinicians on processing and healing post-adoption issues. Essay, Entourage Publishing.

Boston Post Adoption Resources (2021). Voices in Transracial Adoption: Insights from Adoptees, Parents & Professionals. BPAR. https://bpar.org/voices-in-transracial-adoption-book/

Child Welfare Information Gateway. (2018, November). Finding and working with adoption-competent therapists - child welfare. Factsheet for Families. Retrieved March 10, 2022, from https://www.childwelfare.gov/pubpdfs/f_therapist.pdf

Olshever, D. (2021, May 4). Adoption Competent Therapy [web log]. Retrieved March 10, 2022, from https://bpar.org/professionals-in-adoption-competent-therapy/.

Radke, H. (Host). (2017, June 16). [Healing series] How to choose a therapist (No. 32) [Audio podcast episode]. In Adoptees On. Spotify.

Randolph, B. (2014). Red flags that a potential therapist could do more harm than good. In L. Dennis (Ed.), Adoption therapy: Perspectives from clients and clinicians on processing and healing post-adoption issues. essay, Entourage Publishing.