DIRECTIONS NOT INCLUDED: Beginning Therapy with an Adopted Child

Jean MacLeod
8 min readApr 3, 2016


By Jean MacLeod

Parenting is a tough job. Adoption Parenting is a tough job that comes without directions. Baby books, child-care books, parenting and behavioral books — they are all based off a biological family ‘norm’. Without previous AP experience or any kind of a map, how can you discern which of your child’s problematical behaviors are derived from age-related flare-ups, and which are evolved from early trauma and the life-long core issues in adoption?

Without some help, you probably can’t. Adoptive parents are not prepared by the adoption process (or by the model of child-rearing they themselves were raised with) to understand the extra layer of emotions that adopted children may live with. Moms and Dads have not been taught to recognize the masked anger, sadness, shame or fear that is a part of some adopted and foster children’s psyche, and parents have not been trained to help their sons and daughters deal with the emotions that spring from the pain and loss of their children’s early lives.

Adoption Parenting is different; children who were adopted domestically and internationally at birth or as an older adoptee may process core issues and experience life transitions on a different timetable and with a different twist than their biologically-parented peers.

The cause of troubling behavior in a child is a tough call to make when a parent is left in this kind of uncharted Adoption Parenting twilight zone. It is easy when a child is young to rationalize his or her difficult behaviors as being part of the terrible twos, threes or even fours.

It becomes more difficult to accept as the child gets older, and it becomes terribly frustrating for an adoptive parent trying unsuccessfully to use traditional disciplinary methods on a rebellious pre-teen or adolescent.


It’s important for a parent to realize that a child’s behavior is only a symptom. The real underlying problem may be an adoption-related issue…the difficulty is deciding if your child’s issues are disturbing enough to himself or to others to seek professional assistance. Children who harm other people, animals or themselves, or who act destructively, need immediate help. For other children, who move in and out of intense emotions or behaviors or who try to hide their trauma, it’s harder to discern if therapy is required.

Questions adoptive parents can ask themselves to help evaluate the need for a therapist consultation:

All children may exhibit some of these issues while growing up, but parents usually recognize a red-flag behavior by its intensity and persistence. Worrisome moods and behaviors can fall at either end of the ‘healthy’ spectrum; everything is a matter of degree, but if your parent instinct has concerns, you are wise to listen to it and to seek help — especially for the ‘deal-breakers’:


Finding a therapist skilled in the specific issues of adoption and attachment can be a challenge. Your social worker, homestudy or placement agency may have the names of highly regarded local contacts.

The Association for Treatment and Training in the Attachment of Children (ATTACh) is a national organization that lists qualified member therapists and clinics on their website. Other highly informative websites that provide names of parent-recommended adoption and attachment therapists can also be found by doing an online search.

Attachment therapists recognize that a child’s minor or major adoption issues can interfere with a secure, intimate attachment with his or her parents, and can negatively impact the family as a whole.

Attachment is about relationships, and a reputable adoption/ attachment therapist will treat not just the child, but include the immediate family. A competent therapist should empower the parents with the knowledge and skills to reinforce the emotional work at home.

Traditional talk therapy and behavior modification may not be as effective in correcting adoption-based problems as some of the methods used by attachment therapists. Examples:

When parents are finally at the point of seeking outside help for their child, they are usually stressed, worried, confused and scared. Many parents have had no previous experience with psychotherapy and are not sure what to expect during the process.


An initial parent-only consultation with a potential therapist to discuss his or her philosophy and methodology is important to finding the best ‘fit’ for your family. If you have adopted internationally, it is essential that the therapist you choose is aware of the realities of institutionalization and its effect on a child, both developmentally and emotionally. Is the therapist knowledgeable and experienced with:

  • Attachment Theory and Treatment?
  • Seven Core Issues in Adoption?
  • Post Traumatic Stress Disorder (PTSD) and Complex Trauma?
  • Sensory Integration Disorder?
  • Fetal Alcohol Syndrome?
  • Institutional (physical or sexual) abuse?
  • Transracial adoption issues?

Does he or she understand that post-institutional or internationally adopted children may also display sensory, neurological, neurobiological, or speech and language issues that need to be addressed by a ‘team’ of specialists, concurrently with attachment therapy, for best results?

Importantly, an informed therapist will understand that your child’s present behaviors are in part a consequence of his or her past, and will not blame the child’s resulting conduct on your “inadequate” parenting.

Domestic adoptions bring their own set of complexities. Is the therapist experienced with the intricacy of open adoption, birthparent search and reunion, or the data compilation and personal review of a child’s pre-adoption history?

Many children adopted domestically, particularly from the foster care system, have vivid and often painful memories of living with their birth families.


Parents should not be afraid to ask what a therapist charges per session and how they accept payment. How long is each session and is there some flexibility built into the session time (can you go overtime five or ten minutes for an appropriate closure)? Is the therapist available for consultation in between sessions by phone or email, and does she or he charge extra for these services? How can the therapist be reached in a crisis?

Parents should also ask what therapies will be used in the office and what your role as parent will be. Unlike most traditional therapy, you should expect to be participating fully and interacting with your child in each session.

For an adopted child, attachment and security with mom/dad is the primary point of therapy…with the ultimate goal of the child internalizing that relational strength and self-regulating their own behavior.

Every therapist works a little differently; styles vary with the different kinds of therapists, the work they do, and the needs of their clients. A child may really benefit from multiple approaches, including the services of other professionals from neuro-psychology, sensory integration, and speech and language.

Your therapist may continue to strategize as your child progresses through the stages of healing, building on treatment with variations. Successful adoption or attachment therapy takes a creative and united team of therapist and parents to support the child while trauma is resolved.

The time-frame for treatment is also varied, ranging from a few consciousness-raising sessions to a much lengthier process for more severe issues. As therapy advances a therapist will constantly reassess the client’s progress and treatment plan, and therapy can be either shorter or longer than originally anticipated.


Support for parents is an important component of successful adoption or attachment therapy. If a Mom or Dad is too overwhelmed, depressed or emotionally burned out to participate in the child’s treatment, then therapy will fail.

A therapist should ideally provide the parent with educational resources, a parent support group and if necessary, a referral to a personal therapist and anti-depressive medications. Recognizing that the parent continues the emotional work done in the office at home, seven days a week, is vital on the part of an empathic therapist.

Adoptive parents need to realize that their child’s behaviors may be simply a reflection of what their child experienced — or didn’t experience — before joining their present family, in order to understand how to repair the trust that’s been broken.

As parents, you look for ways to protect your children and to soften the kind of life-blows that some of our children have received, and that no child deserves. Therapy can be challenging work for any family, and it won’t allow you to soften or protect. It will open feelings and conversations over the truthful realities of your children’s beginnings and will give you the insight and the capability, the map and the directions, to build the bond that will bring your family very close together. ♥

© Jean MacLeod, 2001, All Rights Reserved


Jean MacLeod is the author of At Home in this World, a China adoption story and the co-editor of Adoption Parenting: Creating a Toolbox, Building Connections. She is a conference speaker, freelance writer and the founder of SMART/SIMPLE Media. Jean is mom to three daughters, two of whom were born in China. Join her at Adoption Toolbox.

A version of this article was originally published in Adoption TODAY Magazine; it was also published in Adoption Parenting: Creating a Toolbox, Building Connections (EMK Press 2006)