Common Clinical Issues Among Adoptees Who Have Received Psychological Treatment

1. Disrupted attachment of feelings of disconnectedness (especially in delayed adoptions). With infant adoptions there is a sense of ambiguous attachment, a tenuous sense of attachment. Even if loved, an adoptee may feel like they don't fit in or belong in the family.

2. Splitting of good/bad self and good/bad objects. Around 8-11 years of age, adoptees have trouble integrating nurturing and punitive parts of self and parents. They may switch the fantasy back and forth. Birthparents are rejecting parents as nurturing and vice versa. Black and white thinking can become prolonged. Ambivalence towards parents.

3. Damaged self-image, low self-esteem. Thinking, feeling, acting rejected, sees self as "damaged goods." "I must have done something horrible to have been sent away from my (birth)- mother."

4. Feelings of rejection. Understanding concept of relinquishment.

5. Feelings of shame and guilt. Shame that they were so "bad" they had to be given away. Anger towards birth/adoptive parents, guilt about anger. Feeling overly grateful/protective towards parents.

6. Problems in identity development. Physical/psychological similarities and dissimilarities. Who am I like? Where do I belong? Fit in?

7. Difficulty in differentiating from family of origin/birthfamily culture.

8. Perceived lack of control. Increased oppositional behavior, stubborn, pouting, temper tantrums. Things have been "done" to them. They had no choice/control in ending up in their family. Ambivalence - no choice of parents /wish to be with birthfamily . Anger that the parents made them feel the loss of their birthfamily. Not knowing their background they struggle to find some sense of control in their lives. The issue of control is crucial. Many adoptees feel over-controlled by simple home/school rules other kids easily accept. Help regain some control for them by answering questions, making adoption rituals, giving choices / decisions to child . Get them involved in rule making too.

9. Loss and unresolved grief. With the loss associated with divorce and death, people get comfort, support and recognition for their grief through accepted universally known rituals. With adoption, the child experiences a loss (like a divorce or death) of an unknown person, and doesn't know why. There is no social context in which the loss is recognized. There are no adoption rituals to help you cope and grieve. It seems there is no one who understands your loss. Consequently, adoption loss rituals are encouraged for your family to create.

10. Active fantasy life. With no knowledge of one's past, there is an emptiness, a void, which the adoptee "fills" with an active fantasy life. With the loss being an on-going issue and never fully resolved, reunion fantasies increase.

11. Learning disabilities. Learning disabilities are more common in adopted children due to genetics, prenatal care, teenage birthmothers, birth trauma (drugs, forcep birth, induced labor, prematurity, low birth weight, etc. ) . Boy babies are weaker at birth and more vulnerable to birth trauma (as well as the genetic factor of Lid.) Learning disabled children feel different, depressed, angry, confused about the learning disabilities. They need help dealing with this as well as their adoption issues (which may be put "on hold" until they can cognitively understand it). You may need to present adoption information at a later date or in a different form (puppets, play therapy, etc. ) .

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