Understanding Adoption Literate Mental Health care

Clinical Education

An Overview of Core Principles and Clinical Competency

Dr. Maria Cronyn, ND — Adoption Evolution

Introduction

Adoption involves powerful human themes: the creation of life, loss, belonging, and identity. While these are normative experiences, adopted individuals face additional adverse early life experiences (ACEs), requiring adoption-competent mental health services.

Why Traditional Therapy Often Fails

Most adoptees report not receiving appropriate care.

8 min of adoption-focused content taught per semester in many psychology programs¹

2/3 of mental health professionals have no formal adoption training²

8–10 therapists adoptive families often cycle through before finding effective care³

Clinical Realities & Statistics

Adoptive and guardianship families are:

3–5x more likely to seek outpatient mental health help⁴

7–10x more likely to seek residential treatment⁵

Poor outcomes are often linked to the failure to use adoption-focused frameworks.

16 Guiding Principles for Adoption-Competent Care

1

Adoption is lifelong

Issues emerge at different developmental stages.

2

Loss is central

Loss of parents, siblings, culture, identity must be validated. Repeatedly and with the Family participating. Grief and mourning the child's losses with them will help tremendously.

3

Children should not have to change to fit in

Adapt parenting and systems, not the child.

4

Attachment can be repaired

Secure attachment is possible with therapeutic work. Even if there is breakdown, it can be repaired with good quality effort and adoption competent support.

5

Identity is complex

Adoptees need help forming coherent personal narratives.

6

Diversity impacts adjustment

Honor race, culture, gender identity.

7

Acknowledge intergenerational impact

Separation affects generations.

8

Healing happens in family systems

Support parents as therapeutic agents.

9

Connections matter

Honor all meaningful attachments.

10

Family systems framework

Collaborate across school, therapy, family, and social systems.

11

Open communication

Reduces behavioral issues and increases self-worth.

12

Parental grief matters

Unresolved grief can derail attachment and care.

13

Normalize support-seeking

Therapy must reinforce that asking for help is strength.

14

Address professional bias

Clinicians must do personal work around diversity.

15

Acknowledge trauma history

Abuse, neglect, violence must be openly discussed.

16

Balance blame and truth

Do not vilify birth parents; teach nuance and compassion.

The Seven Core Issues of Adoption

(Kenny, 1966; Silverstein & Kaplan, 1982)

• 1 Loss

  Of birth family, culture, genealogical continuity. First we MUST see clearly the loss the child has endured is so severe, most can't comprehend the magnitude unless they are also adopted and experienced this loss also. And then, it isn't fully understood for decades. Coping with this kind of loss is lifelong. Skills for coping must be learned and repeated quite often.

• 2 Rejection

  Feeling unwanted or abandoned. This can be a lurking fear that can last for decades. Homeopathy can move this fear out and allow the nervous system to calm itself. Neuroplasticity is the brain's remarkable ability to change, adapt, and reorganize its structure and function by forming new neural connections and pathways throughout life in response to learning, experiences, and injury. This fundamental property allows the brain to recover from damage, learn new skills, and enhance cognitive fitness, demonstrating that the adult brain is not fixed but is constantly evolving.

• 3 Guilt/Shame

  Internalizing blame for circumstances. This core issue is so damaging to self esteem of a child or adult. Open honest dialog with proper tools taught by a skilled therapist are vital.

• 4 Grief

  Disenfranchised and ambiguous, often unsupported. Unvalidated unsupported unacknowledged grief causes, literally, PTSD.

• 5 Identity Issues

  Lack of narrative, fragmented sense of self. There are skills and exercises so vital to bonding with family and creating the safe trusting family everyone wants to create.

• 6 Intimacy Struggles

  Fear of closeness or abandonment. Fear of abandonment can resurface in the simplest rejection, and felt so deeply. This can resurface through life at different stages. After trauma of divorce, for example.

• 7 Mastery/Control

  Hyper-control or survival behaviors such as bullying as coping mechanisms. Later this leads to substance abuse and other pathological coping methods.

Special Concepts in Adoption Mental Health

Ambiguous Loss

Boss, 1999

Psychological presence but physical absence (or vice versa).

Disenfranchised Grief

Doka, 1989

Grief not socially validated.

Narrative Identity

McAdams, 1993

Adoptees need coherent life stories to form identity.

Survival Behaviors

van der Kolk, 2014

Often misunderstood as conduct issues.

Therapeutic Best Practices

• Use adoption-positive language
• Teach therapeutic parenting strategies
• Apply trauma- and attachment-informed therapy
• Validate all relationships, not just the adoptive one
• Help construct and reconstruct the life story
• Provide cultural and identity-affirming care
• Collaborate with schools, physicians, and caregivers

Adoption is not just a legal event; it is a lifelong psychological journey for all involved. Adoption-competent care is not optional. It is essential.

More to come stay tuned!! We will break down these issues more in future blogs.

Recommended Reading & References

1. McRoy, R., Grotevant, H., & Zurcher, L. A. (1988). Emotional Disturbance in Adopted Adolescents: Origins and Development.
2. Post, D. (2000). Adoption and the Family System. Journal of Family Therapy, 22(2).
3. Brodzinsky, D. M. (2011). Children's understanding of adoption: Developmental and clinical implications. Professional Psychology: Research and Practice, 42(2), 200–207.
4. Vandivere, S., Malm, K., & Radel, L. (2009). Adoption USA: A Chartbook Based on the 2007 National Survey of Adoptive Parents. U.S. Department of Health and Human Services.
5. Brzezinski, D. (2020). The Invisible Load of Adoption: A Mental Health Framework.
6. Boss, P. (1999). Ambiguous Loss: Learning to Live with Unresolved Grief.
7. Doka, K. J. (Ed.). (1989). Disenfranchised Grief: Recognizing Hidden Sorrow.
8. Silverstein, D. N., & Kaplan, S. (1982). Lifelong Issues in Adoption. Adoptalk.
9. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.