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Anticipating Core Issues In Adoption/FosterCare

Eyes Anticipating Core Issues

7 Core Issues Parents Need To Be Aware + Mindful of Always

Awhile back, I found myself wondering aloud to my family about how to resolve a personal conflict and nurture someone back into my life who had distanced themselves. As my one-sided dialogue meandered, I stopped when my 20-year-old adopted daughter said with an edge to her tone, “Mother….Why do you care so much?”  My first impulse was to just state what I thought was obvious so I could go on with my own thoughts. This strategy would have sounded something like: “Honey, you know how important it is to resolve conflicts with people that we love—what’s with the attitude?” 

Yet something about the intensity of her tone and the sorrow and anger all mixed up underneath her words that caused me to stop dead in my tracks and really listen. Not only with my ears, but also with my eyes, my mind, my heart and soul, taking her whole message in. I knew in that moment that my daughter’s statement was directly related to her adoption—her feelings of loss, rejection, and abandonment—having been given up at birth. My daughter in her own way really meant, “When will you realize that you have to let go of people who don’t have it in them to stick around for the hard stuff, no matter who they are?” or more simply, “You need to push them away because they have already pushed you away.” And so I paused before responding so that I could reflect on the fact that she was giving me an opportunity to see inside her emotional process, and that our conversation needed to relate to the emotional pain of loss and rejection she has endured as an adoptee.

Upon receiving my daughter at two months old from an orphanage in Bogotá , Colombia, and returning home with her a month later, it was striking what an easy going infant she was. She went along with everything that life threw her way, which was a ton in that three=month span: birth; separation from the only person she intimately knew—her mother; transfer from the hospital to the orphanage; cries of other babies around her while adjusting to the smells, sounds, and sights of her first home; building bonds with her Spanish-speaking caretakers only to then suffer separation from the orphanage/first caretakers; placement with us (an English-speaking family comprised of two doting parents and a 2 ½ year old extremely active, verbal brother); sounds, sights, and smells of Bogotá, including the high adventure of taxi rides in the city, hotel stays, and appointments; and then airports and immigration, three plane rides to get home, an airport homecoming party in Buffalo, NY with very excited new family members and friends who were eager to hold, talk, to and touch her. My daughter experienced all this before finally arriving to her new home with her forever family that also included meeting three new pets—a dog and two cats.

My daughter grew from an infant to a toddler to a preschooler, all while maintaining the same easy going, happy temperament. Looking back, I had the thought then that she would always be an easy going, happy child. It wasn’t until she became school-aged, around age 6 that her distress started alarmedly sounding. There was a direct correlation between her gradual awareness from just hearing the words/language of adoption to the meaning/significance of her life story. She began awakening in the middle of the night crying inconsolably, eventually being able to identify and articulate that she was missing her family in Colombia that she had no cognitive memory of, yet sensed with her whole being.

For most parents, discerning the cries of their child comes naturally. There’s the hungry cry, the wet diaper cry, the tired cry, the attention seeking cry, the boredom cry, the witching hour cry, the frightened cry, etc. However, for adoptive/foster parents there’s an additional cry to decipher that may not come so naturally. It’s the loss and trauma related to adoption/foster care cry. As an adoptive/foster parent it’s important to develop the skills to recognize this cry, but to understand that this distress signal doesn’t stop at any given age; although it may come and go, it is lifelong.

In order to recognize and anticipate an adopted/foster child’s distress, one must have knowledge of and inherently understand the 7 Core Issues of Adoption and Foster Care. (Silverstein, Kaplan 1982). They are: Loss, Rejection, Guilt/Shame, Grief, Identity, Intimacy, and Control. The 7 Core Issues impact all parties involved in the adoption constellation. They start with loss, because adoption and foster care are created through loss. Without loss-the crisis or trauma that precipitated the circumstance, there would be no need for adoption or foster care. Adoptee/foster child loss may result in a fear of abandonment, attachment issues, difficulties with change, and a dysfunctional pattern of holding onto or letting go of relationships, places, and objects.

The second core issue, rejection, relates to a real, imagined, or implied perceived loss of social acceptance, group inclusion, or a sense of belonging. We get our most basic needs met through human connectedness. Being rejected by a person, family, or community can leave a person feeling a deep sense of abandonment and isolation perpetuating feelings of unworthiness and fear of future rejection. Adoptees and foster children may internalize their placements as a rejection by their birth parents/family and in turn suffer from feelings of low self-worth, fear future rejection, and expect rejection throughout life.

Perceptions of being rejected lead to feelings of guilt and/or shame. Shame is a sense of being bad at one’s core, while guilt refers to remorse for real or imagined behaviors of wrongdoing. Foster children and adoptees may end up feeling shame around their differences or circumstances of their placement, and experience feelings that they deserve bad things and/or are unworthy of anything good in life.

Profound loss issues in adoption and foster care compounded by feelings of rejection, guilt, and shame, if left unaddressed, may result in complex grief. No matter the age at the time of placement, grief may occur in response to separation from the child’s birth mother and family, and all that is familiar: their language, culture, customs.

The next core issue impacting the adoption/foster care constellation is identity. Placement is a life-altering event that affects the identity of adoptees and foster children that is lifelong. It is common for there to be a lack of history information in the system leading to difficulties in identity formation and integration.

Intimacy requires a person to know who they are and what they need in relationships, and also believe they have value. If the earlier core issues of loss, rejection, guilt/shame, grief and identity up to this point have not been addressed, it will be difficult for the adoptee/foster child to understand themselves well enough to know what they really need or could offer someone in an emotionally intimate relationship. This may play out by the individual being fearful of getting close and risk re-experiencing loss issues, subsequently sabotaging relationships to avoid intimacy.

Lastly, Mastery and Control is the 7th Core Issue in adoption/foster care. All members of the adoption/foster care constellation experience loss of mastery over some point of their life circumstance, with the adopted/fostered child losing the most as they had no input whatsoever over the decision for their life. Regaining a sense of power and control over their lives will be important and is the ultimate goal to achieve in order to find balance.

Some helpful resources on this topic:

https://www.americanadoptioncongress.org/grief_silverstein_article.php

https://affcny.org/adoption/become-an-adoptive-parent/adoptionissuestoconsider/7-core-issues/

https://www.rainbowkids.com/adoption-stories/grief-and-loss-issues-for-adopted-children-331

https://www.mentalhelp.net/parenting/long-term-issues-for-the-adopted-child/

https://www.friendsinadoption.org/adoption-information-and-resources/resilience-in-adoption/http://www.brooke-randolph.com/Blog/7_Core_Emotional_Issues_in_Adoption


Adopted/foster children are constantly giving us clues to their inner world of emotional distress, we just need to stop long enough and pay attention to discern them. The clues come through their cry (or lack of cry), their words, questions, tone, play, reactions, behaviors, and their interactions in relationships.

Anticipating the 7 Core Issues with knowledge of their impact, and in conjunction with developing an awareness of the child’s trauma-related distress signals, will not only lead to more opportunities to help set the stage for the adopted/foster child to heal through timely, open, and validating communication, but will also build close, meaningful familial relationships and promote resilience in the child and adoptive/foster family.

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Enhance Provider Relationship To Promote Healing

Enhancing provider relationship

Healthcare providers, we can enhance relationship + experience.

Understanding the mentality and feelings of individuals who have experienced adoption or foster care without having a direct connection to either community or the proper insight into the lifelong impacts of adoption/foster care is complicated. The complex nature of these systems can leave healthcare providers feeling as if they are up against a wall not knowing how to best acknowledge and discuss these important issues with their patients or their colleagues. Learning about the degrees of trauma associated with adoption and foster care, using proper terminology, and taking the time to acknowledge and validate the individual’s point of view will enhance the relationship between provider and patient resulting in better quality visits and more effective outcomes.

As an adoptee and a trauma therapist, I have experienced firsthand the inequities that adopted individuals and those who have been in foster care face when it comes to healthcare. I can recollect countless examples throughout my life of entering providers’ offices where my adoption was not acknowledged or discussed or where I was asked invasive questions that seemed to stem more from the provider’s own curiosity rather than for the benefit of my treatment. In other cases, despite providers’ having an awareness of my history, I recall being questioned about my medical history or other family history information that I did not and still do not have access to.

As a mental health provider, I regularly witness providers who are at a complete loss when it comes to treating children and families touched by adoption or foster care. I have sat in countless supervisions and trainings with colleagues who demonstrate major discrepancies related to the quality of care being provided to these individuals; from unknowingly using insensitive adoption/foster care vocabulary, to completely ignoring separation trauma apart from noting it on a demographic form, to perpetuating the societal narrative of adoption and foster care as something for which to be grateful. To say these experiences with providers have caused me a fair share of headaches would be an understatement.

Oftentimes, as a patient, I would sit through an appointment feeling completely anxious or unheard. I would leave a provider’s office feeling uncomfortable, judged, and misunderstood. As a professional myself, I have participated in meetings with coworkers where the discussion focused on how challenging adoption/foster care cases are and how they have no idea where to begin— when to me, it was glaringly obvious. Admittedly, I became frustrated with them for not recognizing what felt natural to me. And while I realize this lack of understanding is not intentional, it quickly became evident to me that things need to change—we need to do better as professionals.

I believe it is important to shed light on these issues and assist providers to better understand that certain forms of questioning (or the lack thereof) or refusing to validate the adoption/foster care experience reduces feelings of safety in patients and can be negatively internalized by individuals who have been adopted or are in foster care. This makes it nearly impossible to form quality provider/patient relationships. Adoption and foster care related trauma is something that impacts clients/patients to their very core and affects every facet of an individual physically, mentally, and emotionally. It is the responsibility of providers to increase adoption/foster care competency as a way to promote and enhance provider relationship and achieve what we all strive for—healing.

MAKING POSITIVE CHANGE FROM WITHIN

Speak From Experience

One huge way in which I feel better care can be provided, is by increasing the number of therapists and other providers who have personal experience with adoption and/or foster care.

Since becoming a trauma therapist, I have worked with many individuals and families impacted by adoption and foster care. When working with these clients, I always disclose my connection to adoption and have found that it makes such a difference when working with these complex cases. When I disclose to my clients and their families that I am adopted and understand how complicated it is, I witness their bodies instantly loosen; the sigh of relief and physical response speaks volumes. Hearing me share that I am there to listen if they want to talk about adoption/foster care related issues or that I understand to a degree what their child is going through because of my own experience results in an immediate increase in safety and trust. The client sees me as someone who they don’t have to explain themselves to. I am not someone they have to educate about the conflicting feelings, the loss, or the other challenges, because even though our stories may not be exactly the same, we have a mutual understanding and respect. There is an inherent message of “I see you, I understand you, and I get it,” a message that I wish I had received from others when I was growing up.

Education

It is unrealistic to expect every therapist to have first-hand experience with foster care/adoption and this is where education comes in for providers. I have been in the position of having to educate my providers, as many of my adopted/foster care clients have had to. This is because too many professionals have no touchpoint or understanding of adoption/foster care, its complexities and its influence on health. This lack of experience unintentionally puts the client/patient in the position of knowing more that the professional, who is supposed to be the expert. This tip in the scale of power sends the underlying message to clients, “I don’t know what I’m doing, I don’t know how to help you, and I don’t even understand you.” This is not the message professionals mean to send or what clients need to hear. It does not facilitate feelings of safety and security that adoptees and individuals in foster care often crave the most—and that sense of safety is necessary to start the healing journey. It is imperative that education and training surrounding these topics are made a priority when first-hand experience does not exist to tip that scale into balance; otherwise, we only do a disservice to our clients/patients who have already faced so much.

The good news is, times have changed. I have noticed steady progress on the front of adoption/foster care education since my experiences as a child and even since I began working in the mental health field. There have been many research studies on the impacts of trauma associated with adoption and foster care, more adoptees/individuals with histories of foster care are in the field of healthcare, and there are evidence-based treatments that can address the deep-rooted feelings and promote healing. That said, there is still much to be done to make sure this often underserved population is receiving quality care.

Adoptive/foster parents and providers can be proactive in helping to make available the best quality care for those touched by adoption and/or foster care.

Enhancing provider relationship as an adoptive or foster parent:
  • Advocate for your child. Do not be afraid to voice concerns to providers or provide them with pertinent information about your child’s adoption or foster care placement. This information is always important. 
  • Search out adoption/foster care competency trainings to help you feel more confident in providing and advocating for your child’s needs.
  • Find pediatricians and other medical providers who are aware of the trauma associated with adoption or foster care and how it can cognitively, physically, and emotionally impact your child’s development. 
  • Seek out mental health providers who specialize in adoption, separation trauma, and attachment.
  • Locate therapists in your area who are trained or certified in trauma resolution therapy (e.g., Eye Movement Desensitization and Reprocessing or Progressive Counting).
  • Search for providers who are adoptees or have histories involving foster care such as Adoption Perspectives. Having that connection can go such a long way in helping solidify feelings of safety and therapeutic rapport.
Enhancing provider relationship as a provider:
  • Educate yourself about adoption and foster care related issues. This will only help you to feel more confident when working with these kids of clients/patients. Attend training(s), read adoption/foster care literature, meet with individuals willing to share their experiences. The more you know, the better you can serve those coming to you for help. More on Adoption Perspectives training seminars.
  • If you see the words “adoption” or “foster care” on intake paperwork or a demographic, don’t gloss over it! Don’t just have this be a one liner in a social history write up or a box you check off on a form. Work collaboratively with the adoptive/foster parents (biological parents if they are in the picture), foster care workers, and any other person who can shed light on the individual’s history to provide as complete a picture as possible.
  • Do not view early life adoptions or placements as irrelevant. Separation trauma, regardless of the age of the child, is serious and can have lifelong impacts. It is always a factor that should be considered throughout the course of treatment. 
  • Do not expect the client/patient to explain themselves to you. They have come to you for help and it is up to you to do your research on how best to help them. Avoid putting them in a position where they feel obligated to teach you about the adoption/foster care experience and associated issues.

My hope is that the future will be different for those touched by adoption and foster care when it comes to seeking healthcare services. I believe the best way to enhance the provider relationship is through education and open dialogues that include the voices of those personally impacted by adoption and/or foster care. By bringing these experts and their experiences to the table, we validate those who have dealt with the challenges personally and we empower professional healthcare providers to become more comfortable and effective with promoting healing for this population.

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