Screening Questions When Seeking an Adoption-Competent Therapist

Adoption is beyond complex – the language, the losses, the expectations, the norms, the family dynamics, the feelings…the list is long, in-depth, and specific. When you’re searching for an adoption-competent mental health professional for your child, you may assume that adoption is well understood within the mental health field, and that any licensed professional is able to provide your child with effective services.

I had this assumption, before adopting my son. I figured, as an adoptee, most of what I know about adoption seems like common sense, and fits with what I know about mental health. So shouldn’t all professionals be competent enough to work with adoptees effectively? Nope. I’ll never forget the conversation I had with a fellow psychologist who is a dear friend and respected colleague, a few weeks after my Ethiopian-born son arrived to our home in the U.S. She asked whether I was going to attend an upcoming gathering with friends. I said that I didn’t think it would be a good idea, because my husband and I were still focusing on building a healthy attachment with our son, and therefore we weren’t leaving him with any other caregivers or taking him out to social gatherings for at least a few months. Her response: “Well, if you bring him with you, I don’t think it’ll affect his attachment for him to meet everyone.” The shock, irritation, and deflated feeling in my stomach were visceral. I was so in awe of her as a psychologist who specializes in trauma work – but she clearly did not understand attachment or adoption-related issues. A genuine understanding of adoption doesn’t transfer from knowledge of other mental health struggles.

A poor therapy experience can be an unhelpful waste of money at best, and fatally harmful to your child at worst, especially if it dismisses or incorrectly labels common adoption struggles.With that in mind, I believe it is important for adoptive parents to know how to screen effectively for an adoption-competent mental health professional for their child. I’ve gathered a list of questions, basic knowledge, and red flags as a guide.

The professional should have basic knowledge in:

• The 7 core issues/struggles in adoption (Silverstein)
• Trust-Based Relational Intervention (TBRI) (also often known by the book, “The Connected Child” by Dr. Karyn Purvis & Dr. David Cross)
• Trauma-specific therapy approaches (Examples: Eye Movement Desensitization Reprocessing (EMDR), Somatic Experiencing (SE), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and/or Play Therapy)
• Child development
• Attachment theories (founding theorists such as Bowlby, Ainsworth and techniques such as Theraplay or Circle of Security)
• Attachment-friendly discipline (experts such as Siegel, Hughes, Forbes, Post)
• Grief & loss
• Implicit/Pre-verbal/Sensory memories
• Racial Identity Models, if your family is transracially adoptive (experts such as Sue & Sue, Helms, Susan Harris O’Connor)

Questions to ask the professional:

• Does at least 50% of your caseload include adoptees/adoptive families? (The answer should be YES)
• How do you help families to build/reinforce attachment through treatment? (The answer should include some of the following: family sessions, play/filial/parent-child interaction therapy, Theraplay, TBRI, interactive exercises, parent education)
• How do you distinguish between typical developmental struggles and adoption- or race-related struggles? (The answer should include specific examples of the language or behavior the professional identifies – example: “I wish I had a different family!” vs. “I want to live with my real family!”)
• How do you incorporate birth families/culture into treatment? (This may be a difficult one to answer because it is likely to look different for each adoptee, but the professional should not look surprised by the question)
• If in an open adoption: Are you willing to include my child’s first family in treatment when appropriate? (The answer should be YES)
• How would you respond if my child said ___? (Choose examples of things your child has said about adoption or race that bother you, and decide if you like the professional’s approach, and if they seem calm and confident in their response)
• How do you talk about adoption/race with kids? (Make sure the language seems appropriate and very open and honest)

Red Flags:

• You state that your child was adopted and the professional does not ask any further questions about it
• Assumes that if your child was adopted at birth or early in life, they do not experience adoption struggles
• Believes you should raise your adoptive child exactly the same as your biological child
• Refuses to collaborate or engage with parents, wanting to only focus on the adoptee (Some treatment may include individual sessions with an adoptee who is a child/teen, but parents should regularly be kept in the loop on progress and feedback, and eventually integrated into sessions. *Note that this may look different if your child is old enough to consent to their own treatment and does not want parents involved, as it may take more time for parents to be integrated into sessions.)
• Speaks about adoption as all positive, views adoptive parents as saviors, views adoptees as lucky, believes adoptees should feel grateful, or speaks negatively about birth/first parents or birth countries
• Labels your child with multiple diagnoses (especially Reactive Attachment Disorder (RAD), Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, Conduct Disorder)
• Encourages isolation (i.e. time outs in separate room) or punishment (different than natural consequences or attachment-friendly discipline) to address behavioral concerns
• Doesn’t believe in pre-verbal trauma or implicit memories
• If you are a transracial/cultural family:
  • Promotes the idea of “colorblindness” as a way of raising a child of a different race
  • Encourages only that you assimilate your child to U.S. culture, ignoring birth culture integration
  • Doesn’t believe in systemic racism or “othering”

While this list is by no means exhaustive, it offers a brief guide to screening for an adoption-competent professional. Keep in mind that even if you find someone who meets all of the criteria above, the personality fit between your child and the professional is also extremely important – your child must feel safe, comfortable, and trust the professional if treatment is going to be beneficial. Best of luck to you and your family!