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P1: FTK Journal of Social Distress and the Homeless [jsdh]

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Style file version Nov. 19th, 1999

Journal of Social Distress and the Homeless, Vol. 9, No. 4, 2000

Adoption Issues: Preparation of Psychologists and an Evaluation of the Need for Continuing Education Daniel A. Sass1,2 and Douglas B. Henderson1

This study is an investigation of the level of preparation psychologists have in dealing with adoption issues and an assessment of the need for further education in treating triad members. A questionnaire was mailed to 497 psychologists randomly selected from the National Register of Health Service Providers in Psychology who received doctoral degrees between the years of 1990 and 1996. Two hundred and ten psychologists, all of whom were currently treating clients, participated in the study. Psychologists completed a Likert rating of their sense of preparation to treat triad members. The largest group (51%) rated themselves as “Somewhat prepared,” with the second largest group (23%) rating themselves as “Not very prepared.” Ninety percent reported they needed more education in adoption, and 81% reported interest in taking a continuing education course in adoption. Of the 210 participants, only 67 reported taking courses that dealt with adoption as part of their formal education. Of those psychologists who reported taking courses that involved adoption, they averaged only 1.3 courses during their undergraduate education, and 1.5 courses during graduate education, while the remaining 143 psychologists received no education in this area. When one considers the proportion of triad members seen clinically, this study suggests psychologists need more education and background information about the effects of the adoption process. KEY WORDS: adoption; therapy; education.

INTRODUCTION Every adoption affects approximately 33 people (Henderson, 1994). Those most directly influenced are members of the adoption triad: the adoptee; adoptive parents, and birth parents. However, the impact extends to siblings, grandparents, 1 University

of Wisconsin-Stevens Point. should be directed to Daniel A. Sass, 4889 N. Shoreland Ave., Whitefish Bay, WI 53217; e-mail: [email protected].

2 Correspondence

349 C 2000 Human Sciences Press, Inc. 1053-0789/00/1000-0349$18.00/0 °


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aunts and uncles, cousins, and other members of both the birth and adoptive families. Each year approximately 78,000 children are adopted: 20,000 through public agencies; 44,000 through private agencies, and 14,000 by overseas adoptions (Spake, 1998). Little is understood about the implications of this experience and what complications may occur later in life. The repercussions of the adoption process begin soon after conception when the birth mother realizes she may be unable to provide for the child. Issues for the adoptive parents often arise with the inability to conceive their own child, and the realization that adoption may be the last resort (Daly, 1988, 1990). For many adoptees, problems often occur as early as the second trimester because of the mother’s depressed mood or anxiety about giving up her child. Upon birth, the adoptee is often separated immediately from the birth mother to eliminate any attachment between the two (Silverman, Campbell, Patti, & Style, 1988). The adoptee may not begin to form a stable close attachment to the birth, foster, or adoptive parents until the legal system makes a permanent placement in the adoptive home. Additionally, the adoptive parents may not fully commit to their side of attachment until the adoption is finalized legally. Earlier studies have indicated adoptees are overrepresented in therapy. Dickson, Heffron, and Suellen (1991) reported adopted children represent 11.7% of the psychiatric inpatient population and appear at higher risk of returning to a psychiatric hospital after being discharged (13.6% for adoptees vs. 7.2% for nonadoptees; Dickson, Heffron, & Parker, 1990). These percentages may be understood in part by the increased number of difficulties adopted children encounter during their life cycle and the search for answers about their past. According to Brodzinsky (1987, 1990, 1993) few adjustment differences between adoptees and nonadoptees prior to 5 to 7 years of age can be found because at approximately 5 years old adoptees begin to develop an understanding of adoption and to realize they are different from other children. Following the development of the cognitive model suggested by Piaget, Lifton (1988) believes the reality of the adoption for adoptees becomes more intense during adolescence. At this stage, they develop abstract thoughts, consider multiple possibilities, and make complex logical arguments about their past. These advanced cognitive processes then allow adoptees to fully consider such issues as abandonment, loss, rejection, betrayal, self-worth, identity, separation, and trust of other people (Hall, 1997). For many adoptees, these issues often induce questions about their past and unresolved issues. Researchers have published limited information that deals with the effects of adoption on birth parents and adoptive parents. Nevertheless, adoption is a lifelong process, which continues to effect both sets of parents. For many adoptive parents, adoption is the last resort to having a family, however, they have still not exactly had a child (Deutsch, 1945). This implication can have effects on both the child and adoptive parents. Different phenotypes may constantly remind the adoptive


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family of their genetic differences, which can create two separate identities inside the family (Deutsch, 1945; Toussieng, 1962). Nevertheless, the adoptive parents still need to accept their adopted children for who they are and not to hold biology against them. Adoptive parents also should not interpret the child’s misbehavior as being innately deviant or become upset when their children enjoy different activities than the parents. Instead, adoptive parents must understand their children are creating their own identity, which may be more similar to that of their birth parents. This situation leads to another predicament for the adoptive parents, which is the birth parent-adoptee reunion. Many adoptive parents fear a reunion may destroy the closeness of the adoptive family or that the adoptee, finding people who are genetically similar, might prefer the birth parent to them (Daly, 1988). Weiss (1984) believes sensing a fear-motivated lack of closeness causes harm to the adoptee and may instigate searching. Weiss’s (1984) notion is supported by previous research that suggests adoptive parents often have psychological conflicts concerning their inability to sexually reproduce. Brown (1959) stated that this conflict is what, in fact, causes the intimacy issues and attachment difficulties toward the child. For some, the adoption serves as a constant reminder of their inability to have children, and others view adoption and the adopted child as a savior of their marriage. Still others believe the child was necessary to prove their femininity or masculinity (Schechter, 1960). There are a certain number of adoptive parents, both childless and otherwise, who chose to adopt for the sole benefit of sharing their home with a child who otherwise would not have the benefits of an intact family. This is certainly a noble motivation, and ideally would be the only reason for adoptions. However, the fact that in New Zealand recent changes in the law have removed the consideration of the adoptive parents’ need or desire for children suggests the inherent complexity of the adoption process. Adoption in New Zealand is now less about finding children for families, but instead finding families for children. Unfortunately, even in this ideal situation, adoptees are left in the position of having been done an immense favor by both their adoptive parents and by society, and their natural curiosity about their birth families may be seen as an ungrateful response to this favor. Many adoptees may also test the love and loyalty of the adoptive parents to determine whether they too will “abandon” them as did their biological parents (Brinich, 1980). If these tests become too extensive, it may actually provoke the outcome the adoptee fears will occur. For this reason, it is essential for these adoptees to recognize their self-destructive behavior and get assistance before too much love is lost. Consequently, it is important that therapists and counselors monitor and inform the adoptee and adoptive parents of this potential problem to prevent these destructive behavior patterns from developing. Adoption is also a last resort for many birth parents as well. Few women get pregnant with the intent of giving their child up for adoption. Women who


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give their children up for adoption often do so because of the lack of financial resources and emotional support from the birth father, family, and social service agencies (Silverman et al., 1988). At least in the past, adoption agencies frequently encouraged the birth parents to forget the adoption experience and return to living their prepregnancy life. These same agencies often convinced birth parents that the child would be better off in another home with parents better qualified to raise a child. Many birth mothers relate that adoption agencies often pushed for adoption even when they preferred to keep the child (Silverman et al., 1988). These authors also discovered birth parents whose counselors encouraged adoption were more likely to search later in life, than those who voluntarily surrendered their child. Silverman et al. also reported 79% of birth parents searched for their children, and 74% of birth parents were in some type of adoption reform group. It would appear birth parents do not overcome their feelings of loss, but instead it is counselors who appear misinformed about the effects of adoption on birth parents. For this reason, it is vital that birth parents have qualified counselors to educate them on the future issues that may arise after the adoption. Adoptees search for many reasons. They wish to obtain answers to why the birth parents left, and also to answer some important questions about themselves. Most adoptees are interested in understanding their genetic characteristics and where certain traits arise (Krueger & Hanna, 1997). By answering these questions, adoptees are better able to find their identity, which is a crucial building block for their self-esteem (Jones, 1997). Clothier (1943) realized the importance of a relationship with the biological parents, and stated that adoption professionals underestimate the repercussions for children who do not know their genetic history and have trouble finding their personal identity. The effects of adoption last a lifetime for all members of the adoption triad. Delays in placement and problems with the legal system are just the beginning of potential problems with the adoption process. The disruption of contact between birth mother and child after birth can produce an early attachment problem, which can be seen in these individuals later in life (Verrier, 1993). Adoptive parents also miss the beauty of the childbirth and lack the early attachment that often begins even before conception. There have been numerous reports by triad members that psychologists have told these individuals to “forget about the experience” and “move on with their lives” (Kirschner, 1990). Conversations over the past 15 years between the second author (DBH) and numerous triad members have uncovered many adoption-related issues that seem largely unknown to psychologists. Reports of those attending search and support group meetings have also indicated few therapists adequately understand the issues triad members encounter. For example, therapists have made such ill-advised statements as telling adoptees they should be grateful they were adopted. Birth parents have been told to think of their child as having died to deal with the loss, while adoptive parents have been told if they loved their adopted child as if the child was their own biological child, then all would be well. It now appears


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that adoption experiences will remain with triad members throughout their lives. However, a well-trained therapist might help triad members comprehend their problems with adoption and assist in the problems’ resolution. The first step for an effective therapist is to help triad members recognize the key issues and aid in their healing by being sympathetic and understanding. Only then can the issues of the triad member be worked out and resolved (Russell, 1996). These skills need to be taught prior to psychologists treating clients, because too often at present it seems the clients are educating the psychologists on the issues triad members encounter. For this reason, it is crucial that psychologists are properly trained, if not before receiving their doctoral degree in psychology, then as part of the continuing education process. In this paper, the author’s will report on a survey of licensed psychologists conducted in order to formally assess their level of knowledge of adoption issues. This formal assessment has suggested a lack of training on this subject. Our hypotheses are as follows: (1) psychologists lack sufficient education in adoption issues to treat clients effectively, and (2) many psychologists do not consider adoption to be a serious problem facing triad members. METHOD Participants Data were gathered using a questionnaire mailed to 497 psychologists randomly selected from the 15th edition of the 1997 National Register of Health Service Providers in Psychology. This sample represented approximately 50% of the National Register psychologists who received a doctoral degree between 1990 and 1996. Only data from psychologists currently treating clients were included in the study. Two hundred and twenty one psychologists responded (45.4% of the questionnaires distributed), of whom 11 were eliminated because they were not currently treating clients. Participants came from all geographic areas of the United States and one participant from Canada. Unfortunately, gender and age were inadvertently omitted from the questionnaire and are not available for the participants who constitute our sample. However, of the 497 psychologists sent questionnaires, 217 (44%) were male and 280 (56%) were female. The respondents are assumed to represent the gender distribution found in the National Register, and therefore likely represent the population of recently trained psychologists who are currently treating clients. Instrument The questionnaire consisted of seven structured questions and one open-ended question (see Appendix). Questions were employed that inquired about the amount of education about adoption issues psychologists acquired during the course of


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their doctoral studies, the number of both total clients and triad members seen per week, and whether the respondents were interested in obtaining more education in adoption. Procedure Data from the 210 respondents were analyzed using SYSTAT (1997) and MINITAB (1998). Researchers were unable to identify specific respondents, and further contact occurred with only three participants who gave their name and address in order to receive the study results. An open-ended question permitted participants to state any additional comments or information they felt was beneficial to the study. RESULTS Of the 210 psychologists in the study, 90% believed psychologists need more education when treating issues in adoption and 81% indicated an interest in taking a continuing education course in the future. A significant positive relationship existed between the number of triad members treated per week and whether psychologists indicated an interest in continuing education, rs (199) = .230, p < .001. There was also a strong correlation between psychologists who were interested in continuing education and those who felt other psychologists needed more education, rs (193) = .458, p < .001. The vast majority of the psychologists (86%) reported having no courses that dealt with adoption during their undergraduate degree and 65% reported having no courses while in graduate school (see Table I). Only 39 respondents (19%) took adoption-related courses in their undergraduate education and 111 respondents (53%) received adoption content in their graduate courses. The psychologists who reported having courses that dealt with adoption averaged only 1.3 courses during their undergraduate education and 1.5 courses during their graduate education. Thus, the amount of education psychologists received during their studies was extremely low, especially when one considers the percentage of triad members seen clinically. Psychologists self-assessment of their preparation to treat adoption issues provided a normal distribution with the largest group (51%) rating themselves as Table I. Percent of Courses with Adoption Content Number of courses Education level

0

1

2

3

4

Total n

Undergraduate Graduate

86% 65%

11% 22%

2% 8%

.5% 4%

.5% 1%

202 206


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being “Somewhat prepared,” and the second largest group (23%) rating themselves as being “Not very prepared.” Only 22% described themselves as either “Very well prepared” or “Well prepared,” and 4% reported they had “No knowledge about adoption issues.” Of the 4% (or eight psychologists) who stated they were “Very well prepared,” six were either part of the adoption triad or specialized in adoption or foster care issues (see Table II). The remaining two psychologists did not provide an explanation for their high level of preparation. To examine the relationship between the level of preparation of psychologists in adoption and the number of triad members treated per week, a Spearman’s Rho correlation coefficient was computed, rs (206) = .224, p < .001. Preparation of psychologists also correlated negatively with psychologists’ inquiry about whether their client was part of the adoption triad, rs (206) = −.319, p < .001. The mean of total clients treated per week was 22.6, with a mean of 1.8 triad members per week (see Table III). Triad members represented 8% of the total clients reported in this study. However, not all psychologists inquired whether their clients were part of the adoption triad. This likely led to underreporting of the percentage of triad members seen by the noninquiring psychologists. A negative correlation was obtained, indicating a relationship between the number of triad members seen per week and whether psychologists inquired about the clients adoption status, which supported this notion, rs (204) = −.329, p < .001). In fact, one half of the respondents reported they did not routinely inquire whether their clients were part of the adoption triad. Of those psychologists who did not routinely Table II. Level of Preparation to Work with Adoption Issues Reported by Psychologists Response

n

Total percent

Very well prepared Well prepared Somewhat prepared Not very prepared No knowledge about adoption

9 48 106 38 9

4% 23% 51% 18% 4%

Table III. Descriptive Statistics for Each Question Question

n

Mdn

M

SD

Range

Number of undergraduate courses Number of graduate courses Clients per week Triad members per week Preparedness level Inquiring vs. noninquiring More education needed Interest in continuing education

202 206 210 206 209 207 198 203

0.0 0.0 21.0 1.0 3.0 1.0 1.0 1.0

0.2 0.5 22.6 1.8 3.0 1.5 1.1 1.2

0.5 0.9 11.2 2.1 0.9 0.5 0.3 0.4

4.0 4.0 98.0 12.0 4.0 1.0 1.0 1.0

Note. 1 represented “yes” responses and 2 represented “no” responses.


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inquire, only 5% of their clients were identified as part of the adoption triad. Of the half who did inquire, 10% of their clients were identified as triad members. A positive relationship existed among psychologists who inquired if their client was part of the adoption triad and those who were interested in continuing education, rs (200) = .219, p < .002. Evaluation of this statistic suggests as psychologists inquire whether the client is part of the adoption triad, they also realize the importance of adoption and are interested in the critical factors that might affect the individual. An analysis of variance indicated a significant difference between the number of adoption triad members seen per week and whether the psychologists inquire if their clients were part of the adoption triad, F(1, 203) = 10.742, p < .001. Chi-square analysis revealed a significant difference, x 2 (2, N = 206) = 26.334, p < .001, between psychologists who inquired whether their clients were part of the adoption triad and how well prepared they felt to deal with adoption issues. A positive correlation suggests a relationship between psychologists own preparation to deal with adoption issues and whether they felt other psychologists needed more education in adoption issues, rs (197) = .147, p < .039. The data supports the authors’ hypotheses that psychologists lack sufficient education in adoption dynamics to treat clients effectively, and that many psychologists do not consider adoption to be a serious problem facing triad members. DISCUSSION The results of this study support the authors’ hypothesis that psychologists need more education about the effects of adoption on triad members. Because of the high proportion of triad members seen in therapy, it is important that psychologists become more educated about adoption and its consequences. This study also suggests that psychologists feel they are undereducated on this issue and are interested in continuing education. Psychological problems, their evolution, and systematic procedures for recovery are studied extensively in psychology courses in both undergraduate and graduate programs. However, a lifelong experience such as adoption, that affects a much higher proportion of the population of the United States than many other psychological problems, is not given adequate consideration during the education of most psychologists. Perhaps a lack of proper education in dealing with the consequences of the adoption process causes the negative reactions that Kirschner (1990) found psychologists show to the difficulties that triad member’s experience. The need for continuing education is further supported by the small amount of adoption course work reported. Psychologists completed on average only 0.19 classes in undergraduate and 0.54 classes in graduate school. Psychologists themselves (90%) acknowledged that they lack sufficient education in adoption issues, and 81% stated they needed more education in this area. These points are further supported by the majority (51%) of the psychologists who reported they were only “Somewhat prepared” to deal with adoption issues. Analysis of these results


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suggests adoption needs to be discussed directly in college curricula. Adoption needs to be studied directly, rather than just in the form of adoption-based studies of genetic concomitance of psychological disorders, or of heredity-environment issues. Future research needs to address such topics as the impact of the loss of the primary attachment figure, the transition between birth and adoptive parents, the loss of a birth child, and the other postadoption issues experienced by triad members. The positive correlation between the number of triad members seen in therapy and the preparedness of psychologists to treat triad members suggests that experience in these issues increases psychologists’ skills. However, many triad members may undergo inadequate treatment before psychologists recognize adoption as a serious issue. Knowledge of adoption needs to be presented prior to receiving a doctoral degree and treating clients. It is also vital that psychologists become aware of these effects prior to treatment in order to prevent false conclusions about the importance of the adoption process and to learn the most effective method to treat these issues. In addition, psychologists appear to inquire about adoption more frequently as they become aware of the effects of adoption on clients they treat. Attempts to obtain the correct proportion of triad members seen clinically are problematic, because only one-half of the psychologists in our sample inquired about this information from their clients. This likely led to a reduction in the proportion of triad numbers reported. Additionally, psychologists presumably did not review all their client’s records prior to answering our survey to determine the precise number of triad members. Unfortunately, our data also suffers from our failure to obtain clearer identification of the specific numbers of adoptive parents, birth parents, and adoptees in the client loads of the respondents. However, this study likely provides a good approximation of the number of triad members seen clinically using only the inquiring group, which reported 10% of their clients to be part of the triad. Psychologists who do not consider adoption a serious issue may experience problems when treating triad members, because they are unable to fully understand the triad members’ life experiences. This creates a distance between the clients and psychologists and reduces the therapists ability to treat the core problem. For example, one psychologist who responded to the study wrote, “Adoption does not routinely cause disruption in life development” and another stated, “A good psychotherapist should be capable of handing this kind of issue without specific training.” Psychologists such as these possibly do not adequately understand the multiple effects of adoption, and thus may not be qualified to treat the triad member. An example of the manner in which better knowledge of adoption issues might contribute to our understanding of human development, consider the potential discovery of a disorder present in both adopted children and their birth parents, with the disorder absent in the adoptive parents. The typical interpretation of this pattern of results would be to assume that the disorder was genetic, passed on from the birth parents to the adoptees. However, an adoption-enlightened therapist or researcher might at least consider whether the presence of the disorder in both the


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birth parents and the adoptees might be caused by their common participation in an adoption, rather than their common genetics. Post (1999) surveyed instructors in various graduate programs in mental health fields and supports the need for increased adoption education in graduate curricula. Two of the present authors are also surveying triad members to determine how they evaluate their own therapy and what they wish their therapists had known (Sass, Webster, & Henderson, 2000). Further research needs to be conducted in order to obtain a more complete understanding of the adoption process and the effects that could possibly arise as issues in therapy.

REFERENCES Brinich, P. (1980). Some potential effects of adoption on self and object representations. Psychoanalytic Study of the Child, 35, 107–133. Brown, F. G. (1959). Services to adoptive parents after legal adoption. Child Welfare, 38, 16–22. Brodzinsky, D. M. (1987). Adjustment to adoption: A psychosocial perspective. Clinical Psychology Review, 7, 25–47. Brodzinsky, D. M. (1990). A stress and coping model of adoption adjustment. In D. Brodzinsky & M. Schechter (Eds.), The psychology of adoption (pp. 3–24). New York: Oxford University Press. Brodzinsky, D. M. (1993). Long-term outcomes in adoption. The future of children, 3, 153–166. Clothier, F. (1943). The psychology of the adopted child. Mental Hygiene, 26, 257–264. Daly, K. (1988). Reshaped parenthood identity. Journal of Contemporary Ethnography, 17, 40–66. Daly, K. (1990). Infertility resolution and adoption readiness. Families in Society, 71, 483–492. Deutsch, H. (1945). The psychology of women (Vol. 2). New York: Grune & Stratton, 1945. Dickson, L. R., Heffron, W. M., & Parker, C. (1990). Children from disrupted and adoptive homes on an impatient unit. American Journal of Orthopsychiatry, 60, 594–602. Dickson, L. R., Heffron, W. M., Suellen, S., & Stephens, S. (1991). Discussing adoption in therapy. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 155. Hall, J. D. (1997). Issues relevant to therapy with adoptees. Psychotherapy, 34, 64–75. Henderson, D. B. (1994). Test your adoption knowledge. Unpublished manuscript, University of Wisconsin-Stevens Point. Jago Krueger, M. J., & Hanna, F. J. (1997). Why adoptees search: An existential treatment perspective. Journal of Counseling and Development, 75, 195–202. Jones, A. (1997). Issues relevant to therapy with adoptees. Psychotherapy, 34, 64–75. Kirschner, D. H. (1990). The adopted child syndrome: Considerations for psychotherapy. Psychotherapy in Private Practice, 8, 93–100. Lifton, B. J. (1988). Lost & Found: The Adoption Experience. New York: Harper & Row. Post, D. (May, 1999). Adoption in the college classroom. Paper presented at the American Adoption Congress Annual Convention, McLean, VA. Russell, M. (1996). Adoption wisdom. Santa Monica, California: Broken Branch Publications. Sass D, A., Webster, J., & Henderson, D. B. (2000, April). Triad members experiences in therapy. Paper presented at the meeting of the American Adoption Congress, Nashville, TN. Schechter, M. D. (1960). Observations on adopted children. Archives of General Psychiatry, 3, 21–32. Spake, A. (1998). Adoption gridlock. U.S. News and World Reports, 124 no24 30-2+ Je 22. Silverman, P. R., Campbell, L., Patti, P., & Style, C. B. (1988). Reunions between adoptees and birth parents: The birth parent’s experience. Social Work, 39, 523–528. Toussieng, P. W. (1962). Thoughts regarding the etiology of psychological difficulties in adopted children. Child Welfare, 41, 59–71. Verrier, N. N. (1993). The primal wound. Baltimore: Gateway Press, Inc. Weiss, A. (1984). Parent-child relationships of adopted adolescents in a psychiatric hospital. Adolescence, 73, 77–88.


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APPENDIX Survey of Licensed Psychologists on Adoption Issues 1. Please circle the number of undergraduate or graduate school courses in which you received information dealing with adoption issues, particularly any emotional or behavioral challenges that members of the adoption triad (adoptee, birth parents, and adoptive parents) might encounter. Undergraduate Graduate school

[None] [None]

[One] [One]

[Two] [Two]

[Three] [Three]

[Four or more] [Four or more]

2. Please indicate your average number of clients per week. 3. Please indicate the average number clients you treat per week who are part of the adoption triad. 4. Do you routinely ask your clients if they are part of the adoption triad? [Yes]

[No]

5. Do you feel that more psychologists need education dealing with the problems that members of the adoption triad face? [Yes]

[No]

6. How well prepared do you feel to deal with the problems members of the triad experience. [Very well prepared]

[Well prepared]

[Somewhat prepared]

[Not very prepared]

[No knowledge about adoption issues]

7. Would you be interested in receiving continuing education dealing with the problems of adoption and issues that psychologists need to be aware of while treating members of the triad? [Yes]

[No]

8. Any additional comments? (Use reverse if necessary.)

Thanks for your help. Please return as soon as possible in the enclosed envelope to: Douglas B. Henderson, Ph.D. Professor of Psychology University of Wisconsin-Stevens Point Stevens Point, WI 54481