Guest post by Adam Pertman and David Brodzinsky, Ph.D.
At a recent adoption conference, about 80 attendees – a diverse group of adoptive parents, adult adoptees, birthparents and adoption professionals – were asked how many of them, their family members, or their clients had sought the help of a mental health professional during the last few years regarding an adoption-related concern. Roughly 60 percent raised their hands. In response to follow-up questions, easily two-thirds of those with raised hands said their therapists had lacked a solid understanding about adoption or its impact, and roughly half agreed they had received advice or counseling that “did more harm than good.”
This isn’t meant in any way to denigrate psychologists, psychiatrists, social workers or others who, with their experience and expertise, help people every day. It does underscore the point, however, that mental health professionals do not routinely receive training on adoption issues during their undergraduate or graduate educations – and because those issues can be specialized and complex, the resulting lack of knowledge can have serious consequences.
The good news is that there are a growing number of programs across the U.S. designed to change this unfortunate reality; the major ones are highlighted in a new report by the Donaldson Adoption Institute, titled “A Need to Know: Enhancing Adoption Competence among Mental Health Professionals.”
The Institute’s intent in this publication is to raise the level of awareness among mental health professionals about the nature and importance of adoption clinical competence, to heighten their desire to receive such training, and to identify various means by which the relevant knowledge and skills can be obtained. The report identifies and describes existing post-graduate adoption training programs, discusses the many issues involved – from grief and loss to openness and identity, to complexities in interracial adoption – and makes recommendations for improving clinical services to adopted persons, birthfirst parents, adoptive parents, and other members of the extended family of adoption.
One of the most frequent complaints among adoptive kinship members is their inability to find health care and ancillary service professionals who are adoption competent – who understand the unique issues associated with their histories and current lives and how adoption can color their views of themselves and their relationships. In a 2002 survey by the North American Council on Adoptable Children, for example, many of the 41 adoptive parent participants made positive comments about their involvement with mental health professionals, but they also reported experiences that were unhelpful and, at times, even hurtful.
A more recent and extensive survey conducted for the Center for Adoption Support and Education (to be published in Adoption Quarterly) involved data from 485 individuals (87% adoptive parents; 9% adoptees) across the U.S., as well as from eight other countries. Over 81% of respondents (84% of adoptive parents and nearly 77% of adopted persons) reported working with one or more mental health professionals. Of those who did, slightly under 25% believed the professionals were adoption competent; another 50% indicated that some of the professionals were adoption competent but others were not; and 26% noted that none of the mental health providers they saw knew much about adoption.
Insensitivity and a lack of knowledge about adoption are linked, in part, to the failure of graduate training programs to offer relevant adoption coursework to their students. In a survey of 224 directors of clinical training programs in marriage and family therapy, social work, or counseling, Weir, Fife, Whiting, and Blazewick (2008) reported that very few programs offered their students specific coursework in adoption and foster care, although these topics were sometimes included as a subcomponent of another course.
To effectively meet the developmental, familial, and mental health needs of adoptive kinship clients, it is essential for clinicians not only to have a foundation of clinical knowledge, assessment, and intervention skills and experience, but also an in-depth and sensitive understanding of how adoption impacts these individuals. Key areas of adoption training, identified in the definition of adoption competence by the Center for Adoption Support and Education’s national initiative on adoption competency, and included in most post-graduate adoption training programs, are described in an appendix of the Adoption Institute report.
Becoming a competent mental health practitioner requires more than taking graduate and post-graduate courses in one's respective field. It also depends on putting knowledge and skills into practice under the supervision of a more experienced professional. This is a core assumption in all health and mental health care professions, including adoption-related clinical work. Supervision supports the less-advanced practitioner in forming an identity as a clinical adoption specialist, and facilitates effective and sensitive application of newly-gained knowledge, values, skills, and techniques in the service of meeting the mental health needs of adoption kinship clients. The impact of competent clinical supervision is not only better trained practitioners, but also improved quality of care and protection for the public.
Being adoption competent also does not mean that a therapist is qualified to meet the mental health needs of all adoptive kinship members. Like others in the general population, adopted individuals, adoptive parents, and birthparents can, and do, present with a wide range of psychological problems. Some will be related to the adoption experience; others will not. Some will require clinical interventions that are within the scope of the therapist's competence; other problems will be beyond that scope. A fundamental ethical principle of all health and mental health professions is to provide services only within one's area and scope of expertise. This principle, of course, holds true for those who work with adoptive kinship members.
If the tendency of most mental health professionals is to ignore or minimize the role of adoption in their work with clients, the potential problem of adoption clinical professionals may be to overemphasize adoption in the individual and familial dynamics and symptom patterns of the people they work with — i.e., to view their clients primarily through the lens of adoption. Maintaining an objective, balanced perspective in working with adoptive kinship members is an essential goal of adoption clinical professionals. So, too, is knowing when a client's problems are beyond one's area of competence and a referral to another professional is needed.
For a variety of reasons, adopted children and their families are more likely to utilize mental health services than is the general population. Prenatal and early-life difficulties predispose some children to adjustment problems long after their adoptions have taken place. In addition, the experience of loss and questions related to identity can complicate normal developmental changes for these youth. Helping their children manage such life complexities can be a challenge for adoptive parents, often requiring the help of professionals, especially for those who have not adequately resolved their own issues related to infertility, who do not adequately understand the impact of trauma on their sons and daughters, and/or who are unduly anxious about their children's curiosity about or connections with their birth heritage. Furthermore, birthmothers and fathers also often need the services of mental health counselors as they struggle to cope with the loss of their children and, for a growing number of these individuals, find satisfying ways of managing relationships with their children's adoptive families.
Mental health and allied professionals must be prepared to meet the needs of these individuals and families. They must possess not only the foundations for competent clinical practice, but also a deep understanding of the unique issues confronting adoptive and birthfamily members. Unfortunately, current graduate education programs fail to routinely provide the necessary knowledge and experience required for becoming adoption clinically competent. As a result, too many members of the extended family of adoption experience dissatisfaction in their efforts to find professionals who can help them understand and deal with their life difficulties.
To better serve adoptive and birthfamilies, the Institute offers recommendations (which are discussed at length in its new publication), including:
- Develop certification for adoption clinical competence
- Expand adoption training programs across the country
- Strengthen the clinical components of existing training programs
- Integrate different approaches for training adoption clinical competence
- Develop distance supervision and consultation models to support adoption clinicians
- Encourage adoption clinicians to develop peer support groups
- Develop regional professional organizations for adoption clinical providers
- Develop stronger ties between local child welfare and adoption agencies, and mental health training programs and practitioners
- Develop outreach efforts to inform mental health providers about opportunities for enhancing adoption clinical competence
- Encourage research on training delivery, effectiveness, and outcomes
There is no single route to achieving adoption clinical competence, no one degree to ensure it, no specific graduate or post-graduate training program that can be expected to fulfill this goal itself, especially given that knowledge in this area is constantly evolving. Gaining and maintaining competence as an adoption clinician is best understood as an ongoing, multi-path process.
Graduate training programs in the mental health field and allied disciplines provide opportunities for developing a foundation of clinical knowledge and skills; as of yet, however, they do not provide much training directly related to adoption and foster care. Hopefully, in the future, this will change. Graduate-level practicum placements and internships also provide opportunities for developing specialized clinical experience related to adoption and foster care.
Although the most likely way to become adoption clinically competent today may be through enrollment in a comprehensive post-graduate training program, when this type of program is not readily available, professionals who regularly work with adoptive kinship members need to consider alternative ways of deepening their knowledge and improving their skills in this area.