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Therapy And Therapists

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therapy and therapists

As increasing numbers of children with SPECIAL NEEDS are adopted, it is likely there will be a need for adopted children and their families to receive some ongoing assistance and, in some cases, therapy. In addition, some number of adopted persons who were adopted at birth or an early age will also need counseling, although the estimated percentages of adopted adults needing counseling is open to wide dispute.

Because therapists are susceptible to hearing and believing the same prejudices and myths as the layperson, it is crucial that adoptive parents and adopted persons identify a therapist who does not presume adoption is the sole reason or the pre-eminent reason for an adopted person to experience emotional difficulties. Nor should the therapist automatically presume the adoptive family is the primary cause of the child's problem.

It is also important that a therapist be knowledgeable and sensitive to the unique issues that adoption does have for the child and the parents. To say that adoption plays no role is often just as damaging as it is to say it is the sole reason for a child and parents to have difficulties.

According to Marian Sandmaier, author of When Love is Not Enough, therapists are particularly suspicious of adoptive parents who have adopted children with special needs, presuming that a healthy family would not wish to take on the "burden" of such a child. As a result, the therapist may instead presume that the adopting family is masochistic or has a desperate desire to be needed. Social workers strive mightily to screen out any individuals with such motives, and in fact most adoptive parents are motivated by a sincere love for children and a desire to share their love. Unless a therapist enters into a therapeutic relationship with a positive orientation toward the parents, time and energy will be wasted trying to find the hypothetical "causes" of the problems rather than focusing on the solutions.

It is also important to note that the family situation has greatly deteriorated by the time the family seeks out a counselor, and the family may be very discouraged. Often they have received little or no support from extended family members. Sandmaier says the family's urgent first need is support and validation that problems exist but there may well be a way to work them out.

In some cases, a therapist inexperienced with adoption may unfairly presume that the child's problems have been caused by the adoptive family when in fact, the child entered the family with problems that occurred before he or she ever met family members. The family may have extended heroic efforts to help the child and a blaming attitude will confuse them and will only exacerbate the problem. The parents need to be respected for being part of the solution, and not blamed for being the cause of the problem. It is also possible that the family is contributing to the child's problems, for example, overreacting to negative behavior that may be common to a child at a certain developmental stage.

How does a parent know if and when a child needs therapy? This is a difficult question to answer because much depends on the child's age, behavior and many other factors. There are, however, some basic guidelines to consider.

For example, if the child's overall academic performance has deteriorated, and teachers are expressing concern about the child, this is one indicator of a possible need for counseling. In addition, if the child's relationships with peers have changed, for example, the child no longer wishes to see friends or share activities with friends (or if the child has no friends), this is another indicator of a potential problem.

One of the best indicators of a child's healthy adjustment is to observe the spontaneity and frequency of a child's smile and laughter. If a child looks and acts depressed, a professional evaluation is recommended.

Finally, if the child has gained or lost a great deal of weight, the basis for weight change may be physical or psychological, and both possibilities should be explored.

As a result, the child should see a physician to rule out medical problems and subsequently see a qualified psychologist or social worker to determine any psychological problems. An ethical therapist will reassure parents if the child's behavior is essentially "normal."

If the school-age child is behaving in a secretive reclusive manner, in contrast to earlier behavior, or is hearing imaginary voices or hallucinating, the parents should seek professional help immediately. In addition, if the child is expressing suicidal thoughts, such ideas must be taken seriously.

Information on the birthparents' personality traits is a valuable source of information in understanding and accepting a child's development, and medical and psychological experts will request such information. (For example, was there a history of depression, emotional illness or other problems in the birthfamily.) Note: Just because a birthparent may have had such a problem does not necessarily mean the child has inherited a predisposition to mental illness.

An effective therapist can help family members work through the pain of separation and loss, for example, the loss of birthparents and foster parents faced by the child or the loss of fertility still felt by the adoptive family. The therapist might need to help the child overcome the anguish and confusion resulting from physical or sexual abuse or help the parents deal with their frustration at being unable to reach the goal of being perfect parents.

In addition, siblings who were already in the family will need to receive counseling as the jockeying for position occurs and the relative BIRTH ORDER among family members changes and evolves. Unfortunately, some counselors choose to exclude siblings and address only the adopted child or the adopted child and adoptive parents together, despite strong evidence that the bonds of siblings can be very intense.

Another important aspect of brief therapy sessions is to find exceptions to the problem-when negative behavior (such as bedwetting) does not occur, when a child is not hostile-to get away from the presumption that the behavior always happens and cannot be rectified. One problem that adoptive parents face in finding a good therapist for their child (should the child need therapy) is that some therapists will assume the underlying problem is an "adoption issue." Adoption may or may not be part of the problem the child faces.

(See also PSYCHIATRIC PROBLEMS OF ADOPTED PERSONS; SIBLINGS.)


Marian Sandmaier and Family Service of Burlington County, Mt. Holly, N.J. When Love Is Not Enough: How Mental Health Professionals Can Help Special-Needs Adoptive Families (Washington, D.C.: Child Welfare League of America, 1988).

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