Recognizing Relinquishment as a Critical Variable in the Assessment and Treatment of Adoptees

1. Recognizing Relinquishment as a Critical Variable in the Assessment and Treatment of Adoptees Delores Teller, MSW, LCSW

2. Objectives for Lecture • Describe how the social construction of adoption in our society shapes the adoptees view of self. • List the unique developmental challenges of compromised bonding and limited attachment that adoptees face throughout the lifespan. • Describe the prenatal impact of separation and loss: how it relates to diagnostic assessment and treatment planning.

3. New Language • Adoptees are relinquished and then adopted. • Relinquishment and adoption are different; each needs its own focus in order for us to understand adoptive development. To properly appreciate each, they must be carefully separated in theory and language.

4. Defining Relinquishment • Relinquishment- is defined as the break in the primary bond between an infant or child and his or her parents of birth. It is the manner in which this rupture in first attachments occurs, informs and impacts psychological development.

5. Relinquishment and Transition • Relinquishment has to do with breaking a primal connection and adoption has to do with introducing an infant or young child to strangers who seek to become their new parents. • This is a much more difficult transition than imagined. It is a wound to the heart of the child.

6. Relinquishment and Transition • New (initially strange) parents talk differently, smell differently, behave differently. • The degree to which adoptees “make the shift” in attachment from birth parents to adoptive parents is the key variable in their future emotional and spiritual health. And that shift is not so much a moment in time; it is more wisely thought to be a process of grieving.

7. Unresolved Grief • Unresolved grieving can have profound affects on an adopted persons adult attempts at closeness in many ways. • Issues around the primal rejection of relinquishment can become the organizing principle by which the adoptee enters and manages and avoids intimate relationships.

8. Secrecy, Deceit, and Shame • Historically, in American culture relinquishment has been accompanied by secrecy, deceit, and shame. • It might be said that one of the major problems in the manner in which society has dealt with relinquishment is that relinquishment is related so directly with sexual shame.

9. Societal Attitudes • For many adoptees, societal attitudes towards their conceptions have set in motion dynamics that diminish or deny the reality and the importance of the loss of the first two people in their lives. • Of the 50 United States, only 14 allow adult adoptees a form of access to their original birth certificates and therefore, true information about their birthparents.

10. Adoption Defined • Adoption is a term referring to the event of initial bonding and ongoing attachment and detachment with adoptive parents in the formation and life of the adoptive family. • Adoption as a term should be used to make reference to the blessings and the problems that are part of the adoptee-adoptive parent relationship. • Adoption is a separate process of connection and disconnection to a person's adoptive family.

11. Attachment • “Intimate attachments to other human beings are the hub around which a person’s life revolves, not only when he is an infant or a toddler or a schoolchild but throughout his adolescence and his years of maturity as well, on into old age. From these attachments a person draws his strength and enjoyment of life and, through what he contributes, he gives strength and enjoyment to others.” - John BowlbyLoss, Sadness and Depression, 1980

12. Bonding and Attachment • The power of initial bonding and attachment to adoptive parents serves as the fuel needed to do the grieving that healthy relinquished children must do. • Insufficient attachment may mean that an adopted child shuts down inside and defensively avoids getting the job of mourning done because, without sufficient connection, it hurts too much to (consciously) know the injury of rejection.

13. Psychic Salvation • Adoption as this separate process is the psychic salvation of the relinquished child just as parental care is the critical foundation for mental and spiritual health for the rest of all of us. • “The healthy adoptee is a child who can feel her heart, be connected to the wide range of her emotions, able to experience both sorrow and joy, anger and peace, shame and relief, rather than being someone who simply manipulates life in order to survive.” • - Nydam, Adoptees Come of Age, 1999

14. Primal Wound • “When the natural evolution [of birth mother and fetus bonding] is interrupted by a postnatal separation, the resultant experience of abandonment and loss is indelibly imprinted upon the unconscious mind of these children, causing that which I call the ‘primal wound.’” -Verrier, The Primal Wound, 1993

15. Infancy • At birth and immediately afterwards comes the possibility of a significant injury in parental loss to the degree that a neonate is bonded to heartbeat, voice, and person. • The relinquished infant searches for the familiar and eventually adapts to the loss, to not having, to a compromised attachment.

16. Early Childhood • Around ages six or seven (for girls earlier than boys), relinquished and adopted children begin to figure out their birth stories, asking questions of interest, wanting to know more. • Their curiosity is sometimes accompanied by sadness. • With international adoptions, where “matching” with adoptive parents is obviously not a reality, curiosity and bewilderment may run higher.

17. Adolescence • In adolescence more grieving may occur; it often presents itself more as anger than sadness, but usually it has to do with further negotiations with self about loss. • In what sometimes looks like an angry protest, a fiery demand that life be different, relinquished and adopted teens may register their struggle with the alternate but so real reality of adoption.

18. Adulthood • With adulthood and its usual challenges, there may be yet another wave of mourning the loss of birth parents when certain experiences trigger grieving yet to be done. • Medical histories that are absent or incomplete may remind the adult adoptee once again of both the difficulties and the injustices of relinquishment.

19. Assessment • Loss, betrayal, trust, abandonment, rejection, worth, separation, and identity may be predominate themes during intake assessment. • The adoptee may resemble antisocial personality with impulsivity, low frustration tolerance, little empathy, superficial charm but little intimacy. • Complex and varied emotional patterns may be mistaken for a mood disorder.

20. Good Adoptee/Bad Adoptee • The adoptee may present to you on a wide emotional and psychological continuum. You may have the compliant, non-rebellious, afraid to express feelings adoptee dedicated to preserving his adoptive parent relationship at all costs. • At the other extreme are the adoptees who have murdered their adoptive parents and have extreme psychopathology and dissociated rage.

21. Baseline Therapeutic Goals • Building trust through a continuous, positive alliance. • Addressing adoption issues upfront and consistently: loss of parents, identity, self. • Encouraging search and reunion as much as possible and providing support for. • Clarifying thoroughly before confirming a diagnosis. • Handle termination sensitively while encouraging autonomy and progress.

22. Best Clinical Practices • Interpret signs and symptoms that an adoptee might present, in the light of the necessary mourning of early losses in life. • The process of grieving includes not only the tears of sadness but also anger, fear, and denial, all part of coming to terms with loss and facing an uncertain future.

23. Best Clinical Practices • Include “Are you adopted?” (or “ Are you a birthparent?”) on all intake forms.Consider this a diversity issue. • Inquire about an adoptee’s birth parents and birth narrative as well as past and present fantasies about both. • Asking questions about birth parents and birth narrative is not to be thought of as “leading the client.”

24. Best Clinical Practices • Consider struggles with bonding and attachment as normal responses to parental loss (as well as possible neglect and abuse). • Avoid pathologizing adoptees in terms of attachment and mood/personality disorders until a clearer picture of emotional relating takes shape. • Relinquishment itself must be seen to some degree as the behavior of (pathological) shame-based decisions in society.

25. Best Clinical Practices • Observe problematic patterns of intimate relating for adoptees in the light of central struggles with the ongoing impact of relinquishment on development. • To whatever degree relational difficulties in adult adoptee life emerge, they may be best understood by way of reference not so much to adoptive parent relations as they might to birth parent relations, seeking the lost objects.

26. Transference Concerns • Transference issues in working with adoptees will often be a result of their projecting onto the therapist both sets of parents. This may result in both a strong need for attachment by the adoptee, along with an intense fear of rejection. • Counter-transference can cause a therapist to minimizing the impact of adoption, or by making the adoptee a victim by trying to “save” them from adoption.

27. Challenges of Search & Reunion • Expect the effects to impact the entire family constellation, especially intimate partners and siblings. • Encourage support groups, taking time to get to acquainted, family therapy, and a regression of emotional states in the adoptee and the birthparent. • Be prepared for early signs of g\Genetic ( Sexual) Attraction known as GA or GSA.

28. Genetic (sexual)Attraction • Genetic sexual attraction,” is a reference to the eroticization of the newly experienced connection between birth parents and birth children or between birth siblings whereby strong feelings of sexual attraction emerge out of reunion.

29. Professional Ethics • Ethics pertains to the beliefs we hold about what constitutes correct or moral conduct. • Ethical conduct is behavior that results from a combination of knowledge and a clear set of guiding principles underlying a code of ethics. • In relinquishment and adoption, ethical conduct has been widely misconstrued and interpreted under the guise of a socially constructed view of adoption as “normal family” formation without consideration of the lifelong impact of relinquishment.

30. Principal Ethics • Focus on moral issues and resolves ethical dilemma's within a particular set of guidelines that frame behavior and thinking. • In relinquishment and adoption an example might be when a birthmother changes her mind after giving birth and decides not to place. The adoption agency would use a set of guidelines to support her decision. The adoptive family may need to use principle ethics to support this difficult change.

31. Virtue Ethics • Focus more on the personal character traits and non-obligatory ideas to which the person or professional aspires than on specific ethical dilemmas. • In relinquishment and adoption, examples include the adoptive parent understanding that allowing for more contact with the birthmother is best even if it is difficult, or a reunited birthmother not wanting to tell the name of the birthfather even if she knows the importance that she does.

32. Virtuous Professionals • Typically motivated to do what is right for the right reasons • Possess compassion for the whole adoption triad • Consider class, race, and culture issues • Allow enough time for adoption decision making • Have a regard for all parties to the relinquishment and adoption with sensitivity for their suffering • Possess self awareness with the capacity for self observation – knowing when they are biased!

33. Information/Resources American Adoption Congress www.americanadoptioncongress.org Evan B Donaldson Adoption Institute http://www.adoptioninstitute.org The Handbook of Adoption, Javier 2007 Journey of The Adopted Self , B. Lifton 1995 The Primal Wound, N. Verrier 1993 Adoptees Come of Age. R. Nydam 1999 Loss: Sadness, and Separation. J. Bowlby 1980 Delores Teller, LCSW : Teller@ohsu.edu 503-494-4161