|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
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
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.
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:
- The extent of your coverage for mental
- Specialty areas of approved providers
- 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
- 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
- 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
- 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 post-graduate 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
Clinical Social Worker -
- A clinical social worker (LCSW 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
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 treatment.
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 advocacy.
Check with the following resources for
- Agency social workers involved in the
- State or local mental health
associations - most offer referral services and list specialty areas for
- Public and private adoption agencies
- Local adoptive parent support groups
- Specialized agencies providing
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 interview.
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
- What is the therapist's experience with
- Adoption, in general?
- Special needs adoption?
- Open adoption?
- Transracial adoption?
- Identity issues in the context of
- Search and reunion?
- Adoptive families?
- Adopted children?
- Children who have histories of loss,
abuse and/or neglect?
- Children who may have learning or
- 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 approaches:
- behavioral therapy, which focuses on
treating overt behaviors
- cognitive therapy, which focuses
clinical intervention on thinking processes, motivation, and reasons for
- family systems therapy, which views
family members as a unit and focuses on their interpersonal and
- 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 information.
- What is the therapist's arrangement for
coverage when he or she is not available, especially in the event of an
- Are daytime, evening, or weekend
appointments available? What about after-school appointments?
- Does the therapist offer discounted or
sliding scale fees if he or she is not an approved provider for your
- Does the therapist accept adoption
subsidy medical payments or Medicaid reimbursement payments?
- 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:
- 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.)
- Mutually agreed-upon goals for treatment
approaches and desired outcomes.
- Progress on problems that first prompted
the request for treatment. Parents should realize that some behaviors need
extensive intervention before progress can be identified.
- A tentative diagnosis.
- The therapist's evaluation of the
chances that therapy can improve the situation(s) which prompted
- 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 process.)
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
their families navigate the challenges adoption presents as they grow and
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
The American Association of Marriage and
1133 15th Street, NW
Washington, D.C. 20005
The National Association of Social
750 First Street, NE
Washington, D.C. 20002
Source: National Adoption Information
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