A Discussion about Trauma Therapies

by Ariayana Harrell, Intern and UNC Psychology Major

If you have not watched our podcast about trauma that was released earlier this week, I would highly recommend watching it before reading this post! This post will discuss some of the major kinds of therapies that are used for treating trauma. This is not an exhaustive list, but these are some of the more popular therapies!

Narrative Therapies

Narrative exposure therapies are commonly used for treating trauma disorders such as PTSD (Narrative Exposure Therapy (NET, 2017)). This type of therapy is often completed in groups; however, it is not uncommon for someone to undergo this kind of treatment without a group (individually). How does this work? A therapist will ask the patient to describe the traumatic event while also asking to incorporate positive events to create a more cohesive narrative around the event.

This is so the patient can recognize that there is more context to the traumatic event, so they will be able to give less power to the traumatic event and start seeing a “bigger picture.” Hopefully, by discussing the traumatic event, the patient will be more comfortable discussing the event and discussing how they felt because of the event. From here, treatment will be more centered around the event and the patient (Narrative Exposure Therapy (NET, 2017)).

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is an eight-phase treatment and is primarily used on adults because of the methods that are used in this treatment. A client would “tap into” their emotionally disturbing event while also focusing on an external stimulus such as following the therapist’s finger from side to side. Therapist directed lateral eye movements are the most common external stimulus but there is a wide range of external stimuli that could be used (What Is EMDR? – EMDR Institute – EYE MOVEMENT DESENSITIZATION and REPROCESSING THERAPY, 2015).

  • Phase 1: history taking sessions.
  • Phase 2: Therapist educates the client about the various ways of dealing with emotional distress.
  • Phases 3-6: Target is identified and processed using the vivid visual image related to the memory, negative beliefs about self, and related emotions and body sensations.
  • Phase 7: Closure
  • Phase 8: Examining the process made

Eye movements are used during one part of the session, and after the clinician determines which memory to focus on first, then they will ask the client to hold different thoughts or aspects of that event and use their eyes to track the therapist’s hands. Some scientists believe that biological mechanisms in rapid eye movement (REM) sleep are connected to the effectiveness of the client being able to recall the traumatic event while also following the clinician’s hand movement.

A successful EMDR therapy would transform the meaning of painful events on an emotional level. For example, a person who was abused mentally, sexually, physically, and/or verbally would no longer feel disgusted with themselves, but rather, they would be able to walk out of the treatment being able to say, “I am strong. I can fight this. I have survived.” (What Is EMDR? – EMDR Institute – EYE MOVEMENT DESENSITIZATION and REPROCESSING THERAPY, 2015).

Trauma-Focused Cognitive Behavior Therapy (TF-CBT) 

TFCBT is a short-term treatment model that helps children and adolescents recover after trauma. Usually, treatment lasts for 8-25 sessions with the child/adolescent and caregiver (About Trauma-Focused Cognitive Behavior Therapy (TF-CBT) – Trauma Focus Cognitive Behavioral Therapy Certification Program, 2021). This is exactly what it sounds like! These are therapy sessions that focus on the traumas that the child is going through. Caregivers will also be present to be a piece of the session.

These therapies set out to identify the traumas the child has experienced, how to think about the trauma, and how to effectively cope with the experienced trauma. Additionally, it helps the family better understand how to care for their child and how to provide the proper resources for their child. For more information, here is a peer-reviewed article that goes into more detail about TF-CBT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476061/

Child-Parent Psychotherapy (CPP)

CPP is therapy primarily used for children from birth through age five who have experienced trauma and their caregivers. This is very similar to TF-CBT; however, CPP is based on attachment theory but also integrates psychodynamic, developmental, trauma, social learning, and cognitive behavior theories. The primary goal is to support and strengthen the connection between child and parent as a vehicle for restoring various aspects of the child’s well-being (Wu, 2017).

The type of trauma and the child’s age would determine the structure of CPP sessions. These sessions are conducted by a therapist who is certified. These sessions are typically hour-long weekly sessions, but the length of treatment varies between clients.

In conclusion, there are many different types of therapies to help treat and cope with emotional distress and trauma. Some therapies work better for children, but that does not mean those treatments would not work for people of other ages. One should look for a therapist who are trained and certified in these areas if they are planning or actively seeking treatment for trauma.

Each method has its pros and cons, so when choosing which treatment, be sure to fully weigh your options and do not be afraid to switch treatments if you feel the one you have chosen is not working for you. However, make sure you are giving adequate time for the treatment to work. Nothing will be solved immediately. Be patient!


About Trauma-Focused Cognitive Behavior Therapy (TF-CBT) – Trauma Focus Cognitive Behavioral Therapy Certification Program. (2021, March 26). Trauma Focus Cognitive Behavioral Therapy Certification Program. https://tfcbt.org/about/

Narrative Exposure Therapy (NET. (2017). Narrative Exposure Therapy (NET). Https://Www.apa.org. https://www.apa.org/ptsd-guideline/treatments/narrative-exposure-therapy


Wu, J. (2017, August 28). Child-Parent Psychotherapy. The National Child Traumatic Stress Network. https://www.nctsn.org/interventions/child-parent-psychotherapy

Written by: 

Ariayana Harrell, UNC Class of 2023

Psychology B.S and Sociology B.A

Women and Gender Studies Minor

Ask a Therapist – Depression FAQs

Rates of depression among all ages and genders have increased. It is important that parents, as well as children, know the effects and causes of depression. As a psychology major, I took a class at UNC called PSYC 245 – Psychopathology. After taking this class, I became more aware of the nuances of symptoms between different mental disorders and illnesses, including depression.

However, most people do not have the luxury of taking a class at a university to gain more information about a topic, so I interviewed a licensed therapist to answer the most commonly asked questions about depression. This is so those who seek more information about this topic can have access to reliable information from a licensed therapist.

What is the difference between feeling sad and being depressed?

“Sadness is an emotion that we all experience but being depressed is kind of like having a dark rain cloud constantly over your head. This is similar to when we talk about anxiety or worry, sadness is an emotion that we were created with to help us become activated. Our sadness helps us to be more understanding of others, helps us support others, and leads us to respond in ways that are needed at times.

However, depression is more than just a feeling of sadness that eventually passes. People who have depression often feel exhausted and heavy, like they are moving slowly and just have very little interest in pleasurable activities. Additionally, they can feel worthless or guilty and have difficulty concentrating. One thing is for sure, depression affects the way you think, feel, and act.”

How long do depressive episodes usually last?

“It really just depends on the person’s experience. For diagnostic purposes, a depressive disorder would last at least two weeks. It is not uncommon for episodes to last for months though.”

How can depression affect someone?

“It can affect one’s total quality of life. It becomes hard to do the simple tasks for daily care, let alone bigger tasks like attending a birthday party. It affects personal relationships as well as career or schoolwork. Having depression can make it more difficult to live life and perform simple tasks that used to be easier in the past.”

Can people still function at their jobs and in their relationships?

“Yes, some people can function in their jobs and in relationships despite their depression symptoms. I am not saying that they may not have difficulties, but they are functioning.  They get their job done and they stay in relationships. This is often because they have tools to help them though.”

How can friends and family support their loved ones with depression?

“Friends and family can support their loved ones by learning more about depression and being kind and empathetic to the person suffering. Loved ones can offer support by allowing family members to receive the care they need.”

What are the different kinds of depression?

“There are many different types of depression such as Major Depressive Disorder, which is probably the most common; but there are plenty of Depressive Disorders. These include: Disruptive Mood Dysregulation Disorder, Dysthimia (Persistent Depressive Disorder), Premenstrual Dysphoric Disorder, Substance/Medication-Induced Depressive Disorder, Depressive Disorder Due to Another Medical Condition, and Other Specified Depressive Disorder.”

Can something trigger a depressive episode?

“Depression episodes can be triggered by stressful and negative life circumstances for some individuals. Other times, things may be going very well, and some individuals still experience depressive episodes.”

What actions can someone do to come out of a depressive episode?

“I would encourage someone to seek mental health treatment. A lot of people who suffer from depression benefit from psychotherapy and medication management. Another tip for people who are experiencing depression is to just make yourself do the things. Make yourself get out of bed, regardless of how tired and down you feel and go into work, go to that niece’s birthday party, go pick up some delicious food. It is really hard, but idol time is really not helpful at all. I also encourage people to exercise, monitor their diet and keep a journal.”

How often can someone feel depressed?

“It just depends. Some people may feel depressed for weeks, others months, and some people report feeling depressed or dysthymic for years”

Can depression be a part of other mental illnesses? Could it be a “symptom” or an effect of another mental illness like bipolar disorder?

“Yes and no. When you are diagnosing someone with something like Major Depressive Disorder, you are ruling out other disorders such as Bipolar. However, depression can be a part of another disorder like mood disorders. Another thing to remember is that depressive disorders can also be comorbid with other disorders and they may present differently across ages and cultures.

The way one group of people typically expresses symptoms and difficulties of depression may look different.  Depression can be misdiagnosed, especially when youth present as defiant and angry instead of sad and hopeless based on those expressions of emotions.” 

In conclusion, everyone will have a different journey when dealing with depression. Depression can affect any gender at any age. Treatment, triggers, experiences, and coping mechanisms will vary from person to person. However, having depression will affect anyone’s quality of life. If you or someone you know is struggling with depression or another mental health issue and cannot find immediate services, please call 911 for emergencies or go to the Crisis Text Line https://www.crisistextline.org/.

Try to reach out for help or help someone you know receive the help they need. Ideally, this person will see a therapist and seek psychological help; however, not everyone has the financial means or resources to do so. Be empathic to those who are struggling. They are trying their best!

Written by: 

Ariayana Harrell, Rising Senior at UNC Class of 2023

Psychology B.S and Sociology B.A

Women and Gender Studies Minor.

Anxiety Q&A Podcast

In this first episode of the Summer Q&A Podcast series, Megan and Ariayana discuss Anxiety.


Ariayana has prepared some of the most common questions about anxiety that people want to know. And therapist Megan Jernigan answers the questions and gives insight to getting help. What causes anxiety? What are some symptoms? When should I seek professional help?


If you or someone you know is struggling, please watch this video for some of the most common questions people have regarding this topic. New episodes will upload weekly with new topics explored and questions answered. Be sure to like and subscribe so you don’t miss an episode. If you feel you need help with anxiety, please visit our contact page and send us a message.

About Hope in Healing

Hope In Healing Family Services, PLLC. Offers counseling services to individuals, children, and families. Through professional counseling services, we may be able to help if you are struggling to find your balance, dealing with a time of transition, or finding your way as a family. At Hope In Healing Family Services, PLLC, we utilize tele-therapy to serve a greater span of individuals and families in North Carolina, including those in rural areas without local services and/or with transportation difficulties.

Our Counselors

Megan Jernigan, MS, LCMHC, LPC, NCC has been working with individuals and families for twenty years. She has experience working in mental health agencies, school systems, residential facilities, and private practice counseling. Megan graduated with her Master’s of Science in Counselor Education from East Carolina University in 2013.

Sheresa Elliot, Licensed Clinical Social Worker and Licensed Clinical Addictions Specialist (A). She strives to understand how environments impact a person’s behaviors and help them to address the emotional challenges and mental barriers. Working with individuals to explore how trauma, life changes, relationships and stressors impact a person’s behavior. Her primary therapy models are Cognitive Behavioral Therapy (CBT), Brief Solutions Focused Therapy (SFT), Child Parent Psychotherapy (CPP) and Dialectical Behavior Therapy (DBT).

Happy New Year!

Welcome to 2022. Many of you have been waiting to close out another crazy and unpredictable year, but you may also be apprehensive to what the new year will bring. With no way to know what to expect in 2022 and after being conditioned for conflict, pandemic, and many challenges in the past few years, it is beneficial to have a few “tools” In your coping skills bag. Mindfulness is a favorite of mine and it takes different shapes at different times for me. It could be noticing elements in nature on an afternoon walk that helps me to feel closer to and in awe of my creator or it could be the recitation of scriptures or prayers that bring me peace and comfort. I value self-care, especially practical self-care skills that allow me to better manage my time, goals and life’s demands. There are other go to “tools” that I like as well. This year, I suggest creating a coping skills plan to help you be better prepared for things that you may face. What are your go to coping skills? When do you use them and how do they work for you? Ask yourself, “what would I do when…” Just having a coping skills plan may alleviate some of the worry that comes from the unknown future. Best wishes to you on your journey during 2022 from Hope in Healing Family Services, PLLC. 🎊

Grief and Loss in Adoption

While sticking with the adoption focused blog posts, we will focus on the topic of grief and loss.  You can find a previous post on the subject of grief and loss, but this post will focus primarily on it in adoption.  For a clinician the topics of grief and loss are critical to assessment and treatment in work with adoptees and even other parties involved in the adoption network.

Loss is a core adoption issue, just like mentioned the the blog post focusing on core adoption issues, and it is a part of everyone’s adoption story.  The beauty of the process and event of adoption itself very sadly started with such profound loss.  However, loss has to be recognized and not avoided in order for grieving to take place, which is normal.  When grieving doesn’t happen or when loss is not recognized or allowed, the unresolved grief can wreak havoc in the person’s daily life and functioning.  It can even lead to greater psychological distress, such as depression and other clinical diagnoses.  What we often see in younger children and teenagers who were adopted is the expression of the loss and unresolved grief, which manifest through behaviors, such as anger and aggression.  Sometimes younger children will express fear and sadness as a result of the loss but not fully understand it.

Kubler Ross is pretty well known for the theory of stages of grief, and I often share these with clients who are grieving.  However, these stages look very different for different people. The stages (denial, anger, bargaining, depression and acceptance) are not usually moved through in a linear fashion, nor do they have a specific amount of time that is allotted  for each stage.  It is also okay to maintain bonds with a lost one versus completely letting them go, and it is essential to make meaning of the loss. For adopted children it is hard to move through these processes and make meaning because usually there are missing parts of information in their story.  Sometimes they may want and benefit from some continued connections with members of their birth family.

Grief and loss are complicated with adoptees, because our society doesn’t often recognize the negative aspects of adoption.  I mean, doesn’t focusing on the positive usually feel better for everyone.  However, that isn’t what your adoptee needs.  Another complicating factor is that parents often don’t realize that what they are seeing is just how children express grief and loss at various ages, and it can take professional help through psycho-education for some parents to be able to break away from preconceived notions about behavior and better understand the complexities of their child’s grief and loss.  Additionally, adopted parents often fear that acknowledging the child’s grief and loss will only further complicate their emotions and behaviors.  But, actually we know that it doesn’t.  These things need to be normalized, so the adoptee isn’t boiling over like a pot with the lid on at high heat on a stove.  It is hard for any parent to see their child experiencing emotional pain, so avoiding it is much easier, but the benefits of doing the dirty work of processing the adoptees loss and grief has much greater benefit in the present and future for all parties involved.  Since this can be so difficult for parents, I encourage them to seek out a counselor to walk beside them on this difficult journey.

To complicate things even further, there are different types of grief.  Ambiguous loss is a type of loss or grief that comes with distress from confusion in the relationship.  If you think about adoptees, their grief is more complex due to it being ambiguous.  Finality of life isn’t usually what starts one’s adoption story, so without death there is confusion about the relationship with birth family or first family members.  For many adoptees, their first parents are alive but just unavailable to them.  For internationally adopted individuals, likely may not even know if their first family members are alive or not.  I know for my son, he will ask me from time to time if his first mom is alive.  I also remember a lot of confusion and challenging emotions (guilt and shame, sadness, longingness, etc.) that my daughter, whom we adopted domestically through foster care, experienced until she was about to turn eighteen and finally reunited with her first family.  Another reason for ambiguous loss is if someone is physically present but not emotionally available, as in cases of child neglect, and so your adoptee may have been experiencing this form of loss even prior to the event of adoption itself.  The clinical implications of ambiguous loss often overlap with those of trauma and attachment problems.  It is complicated and difficult, but the journey to processing and moving forward can be very beautiful in time.

I have heard people say that the child shouldn’t be experiencing loss or grief because they were adopted right at birth or a few days after birth, but I strongly disagree with this.  There has been plenty of research to support my stance as well, but it just makes sense to me that a baby growing inside of its mom for nine (or so) months has a connection, both physically and emotionally, to that host.  To abruptly be birthed and have all that familiarity stripped away must be shocking for a newborn.  Even if you disagree with that, I have worked with many adult adoptees who were adopted at birth or very early, and they do experience ambiguous loss and grief.  They usually begin to have a a big clue to what is happening within their inner experience in early adulthood as they are transitioning and all these emotions and confusions are stirred up for them.  I bring this up to encourage parents to be more aware and begin the process of dealing with  your adopted child’s loss and grief, which they surely have, sooner than later.

If you are not sure if your adopted child (or yourself as an adoptee) is experiencing ambiguous loss, here are a few symptoms: difficulty with changes and transitions, trouble making decisions, feelings of being overwhelmed, problems coping with routine childhood or adolescents losses (school, death of pet, moving, etc.), learned helplessness and hopelessness, depression and feelings of guilt. Other signs that your adopted child is experiencing loss and needs help include the following: frequently asking for help with things, cries a lot, performance declines, seem preoccupied or worried/anxious, develops fears that are unreasonable, cannot concentrate, play centers on family’s breakups and coming together (etc.), loss of interest in doing things children like to do, isolation, shutting down emotionally, exhibits low self-esteem, sleep problems, bedwetting, proactively sexual behavior, or difficulty attaching to others. This can be hard work for adoptees and all those involved in the adoption network, so please reach out to a professional that is trained to hold and support you and your family while using appropriate tools to process the loss and grief.

Information was taken from C.A.S.E. (Center for Adoption Support and Education) TAC (Training in Adoption Competency) Training Manual.  For more information about the loss and grief associated with adoption, please visit their website at https://adoptionsupport.org


Communicating about Adoption

For some families, communicating about adoption and all of its facets is just normal, and while it may be difficult conversation at times because it brings up all sorts of thoughts and emotions, it is seen as a normal and needed thing to happen.  For other families, communication about adoption is okay on a surface level only, as long as you don’t get into those yucky thoughts and feelings.  Then, for other families, communicating about adoption is a big problem that must be avoided.  The later always breaks my heart, especially after having worked with adoptees who really needed their families to be more open to communication about the hard stuff.  A few things that I have learned working with families over the years include the following things: The first thing is telling a child at age three or after that they were adopted is too late and will be much harder than if you had always talked about it with them.  The second thing is that telling your kids the adoption story when they were little and then stopping the communication about their adoption as they began to age may result in the child believing they were not told until later, and thus causing negative emotions in the child and confusion in the parents.  Thirdly, not telling the child at all that they were adopted will backfire on parents, because they will find out somehow and then experience betrayal and other very negative emotions.  So, my conclusion has been that communication with your child about their adoption story should start from day one and be a continuous, while age appropriate, conversation with no secrets. The Center for Adoption Support and Education (C.A.S.E.) recognizes three family communication styles: Blind, Balanced, and Blaming.  Let’s explore those a little more, and you can decide what communication style your family has.

Blind communication style is exactly what it sounds like, going along blind to the adoption story.  In this communication style, there are no differences between the adoptive parents and the adopted child.  Often talking about adoption is brushed aside, and it can even be met with resistance or anger. For anyone who has been following my blogs, you will know that one of my favorite therapy lines is “speak the unspeakable”, and it applies to adoption stories as well.  When parents shy away from topics that the children are curious about it sends a message that there is something bad about that concern or something wrong with you for feeling that way.  There are many reasons why families have a blind communication style, which can include the parents shame around adoption or infertility or something else that is connected to the adoption, fears about how the child will feel about themselves if they know certain information, and anger that gets stirred up from other experiences that have not been dealt with.  This is one good reason why families of adoption should have an adoption competent therapist on their side, and especially if this is their communication style.  A therapist can help families become more educated about how children actually process the information and how that impacts their sense of self, as well as, helping families to deal with the reasons they become avoidant when communication about the adoption story.  I will say that my experience has been that less of my families have had this communication style, but I have worked with a handful of families who absolutely refused to talk about the adoption to their children.  What a shame.

Balanced communication style also implies what it sounds like, a balanced approach to communication with your child about their adoption story.  In this communication style, parents openly acknowledge the adoption of their child and the issues related to it.  Families with a balanced communication style do recognize that some things related to the adoption will be hard to talk about, and they are willing to communication the hard stuff anyway.  One other unique aspect of a balanced communication style is that they have an openness about birth family and, when appropriate, birth family searching.  I realize that later aspect of a balanced communication style can be really scary for a family who has already experienced forms of rejection and losses in life.  However, it can be done and done well in a way that not only supports the child but that actually brings them closer to you as the adoptive parent.  Again, I understand how scary it can be to talk about birth families, especially when the story is anything but happy, but leaving the child with unanswered questions will only create fractures in their own identity and worth.  I have seen how talking about the birth families openly can actually help adoptees have a more positive self-esteem when it is done in a way that demonstrates Godly love and respect for the birth family.  If you feel that a balanced communication style is just too difficult for your family, I urge you to seek support from a therapist who can help you with this process. If you have not had a balanced communication style, it is not too late, and your adopted child will both thank you and grow closer with you in the process of changing communication styles.

Blaming is another negative communication style but can be seen in some adoptive families.  In this communication style the parents often have a narrow view and perceptions.  Something the parents often express is an exaggeration of the importance of the adoption on the child’s status.  Also, shortcomings may be blamed on the adoption itself.  Conversely, when the adopted child meets the approval of the parents, this isn’t the case, and the communication then approves of the child as a claim to the family.  You can imagine the negative impact this communication style has on an adoptee, and it isn’t hard to see how growing up (or developing) in an environment with this communication style can cause a ton of damage to the identity of the adoptee.  Like all other communication styles mentioned, there are reasons that families employ blaming.  Sometimes the family has so much hurt or guilt or disappointment from unmet expectations that they are totally unaware that this is their communication style.  I would encourage you, as a family, to really think about your communication style and be honest about how you may use blaming.  If you feel that a blaming communication style is utilized by your family, please seek out professional help to repair and heal as a family.  You and your adopted child, and probably everyone else in your family or small circle too, will be very grateful if you work on changing this.

Communication styles are something that I work with many individuals on, and it is no different with adoptive families.  Communication styles help everyone in the family have a clear understanding, know where they stand as an individual, and most importantly, give the adoptee the gifts of truth, respect, and compassion.  When families have a balanced communication style, they help the adoptee to know that the parents are willing to sit with them in the hard stuff because they care that much about the child.  However, having a balanced communication style can be challenging for many families, but with the right support, it can happen.  If you know that your family doesn’t have a balanced communication style and you feel that you need professional support to move towards a more balanced communication style, don’t hesitate to reach out to me or even to C.A.S.E to find an adoption competent therapist in your home state. Information in this blog was taken by C.A.S.E. TAC Manual.

Core Adoption Issues

Last blog post, I discussed the increased rates of mental health services utilization and contributing factors for that within the adoptive population. This post, we will examine some of the core issues of adoption.  The Seven Core Issues Framework provides a a great value for clinicians working with adoptive families and was introduced in 1982 and expanded in 2019 to include foster care, kinship placement and third party reproduction (information taken from C.A.S.E. TAC training, Module Three, Slide Eighteen).  The Core Issues of Adoption framework is also valuable to adoptive families as well, as it provides an awareness and insight on how to address complex challenges that will arise.  Let’s face it, adoption has impacted everyone’s life and life relationships.  The framework of the Core Issues of Adoption allows all members to have a unifying lens in which they can communicate and better understand one another, which will help them to better address challenges and feelings they are experiencing.

The Seven Core Issues in Adoption and Permanency include the following:  loss, rejection, guilt and shame, grief, identity, intimacy, and mastery/control.  Loss is something that is present in all adoptions, and it must be grieved.  Multiple members of the adoption experience grief, and in a society where adoption is mostly seen as a positive solution, it is hard and not always accepted to express or process the grief experienced.  However, for successful and healthy development, it must be processed, and it will surface again and again at different developmental periods and transitions in various ways. Rejection is a force that multiple members of the adoptive party experiences as well, and many adoptees view their initial placement into the adoptive home as a rejection.  Adoptive families and their extended families may anticipate rejection, provoke rejection through projections and displacement, and even defend against possible future rejections.  Birth families also experience rejection in a host of different ways, and the social rejection and/or familial rejection that comes with choosing the path of adoption for your birth child can be unbearable for families.  Guilt and shame, which many are familiar with as belonging in the psychosocial stages of development, is an issue that many members of the adoptive party can also experience.  While guilt can sometimes be an emotion that produces positive change in individuals, in adoption it can often be a long going experience of the self and one’s being.  Not only does it impact self-esteem and worth, but it also impacts the way that one is able to connect with others in the present and in the future.  Identity is one of the seven core issues that I have seen be so powerful in the adoptive community; which sometimes I have seen this as positive, but mostly negative.  We all experience issues with identity, especially as we move through developmental periods, but it is an issue that is complicated further by adoption.  Having worked through previously mentioned issues will help with the adoptee’s identity, and sometimes further work needs to happen on a clinical level to address identity issues for those who have experienced being adopted. Intimacy, also another recognized element in the psychosocial stages of development, is an issue that can be further complicated by adoption as well. With a multiple losses, and adoptee can feel rejected and have the perception a fragmented self.  An adoptee may learn to protect themselves from future painful losses by not allowing themselves a healthy attachment with others, or they may simply believe they are undeserving of an intimate relationship because of their low self-esteem.  If these issues are not addressed, the future can be predicted with difficulty in relationships and when becoming a parent themselves, a pattern of unhealthy attachments to be passed on generationally.  Matery/Control is an issue that I hear the most about from working with the adoptive parents, and it is something that they and the adoptive child will struggle with until they realize the enormity and complicated facets that drive the issue. Regardless of the adoption, all members had to give up control in some fashion, and as humans that is something we all try maintain or rebalance.  This can set the tone for complications, but with the right opportunities to explore and integrate mastery/control, members of the adoption party can appropriately gain that sense of mastery/control.

If you are experiencing any of these adoption related issues and feel that you or your family would benefit from professional counseling services that are adoption competent, please reach out for more information.


Mental Health Needs of Adoptees and Their Families

While it is true that the vast majority of adopted individuals are well adjusted, there is an elevated need for psychosocial (as well as biological and experiential) supports ranging from factors that predate adoptive placement.  And, these needs must be addressed in the appropriate ways in order for that individual to have a healthy development process.  Some statistics taken from C.A.S.E.’s TAC training in 2021 include the following: “Adopted children are two to five times more likely to utilize outpatient mental health services than non-adopted children, four to seven times more likely to utilize inpatient mental health services or be placed in residential treatment centers (RTC’s) than non-adopted children, and in most recent survey, twenty-five percent to thirty percent of those in residential placement programs were adopted” (taken directly from slide twelve, module three, Training for Adoption Competency, Center for Adoption Support and Education, Cohort 4, April 2021).  And, to me, this is why it is important to be as proactive and prepared as possible for what could become a journey in mental health healing for yourself as an adoptee or for your family as an adopted parent.

While the statistics continue to differ at times between types of adoptions (domestic, international, from foster care, etc), it does appear that individuals who experienced foster care in their histories may be at a higher risk of emotional and behavioral health problems.  Some of the factors that contribute to this include the following: greater genetic risks (such as parents with addictions or mental illnesses), in utero exposure to harmful substances, histories of complex trauma, frequent changes in situations and living transitions, disrupted family relationships, inconsistent and inadequate access to mental health services, and over prescription of psychotropic medications. This is not to say that children adopted internationally, domestically as an infant or through private adoption, or kinship placements will not have experienced these factors, as many of them have as well.

Just to clarify, it isn’t exactly the act of the adoption itself that contributes to manifestation of mental and behavioral health problems, but it is likely a contribution of various factors that were occurring prior to the adoption.  However, adjustment problems can also arise after the adoption takes place, especially if the adopted parent isn’t aware of the normative adoption issues or they don’t know how to respond appropriately to the normative adoption issues that will surface for the child they have adopted.  Some examples of the ways adoptive parents may not be aware of or understand how to respond to those normative adoption issues include: not knowing how to communicate the child’s adoption information or not knowing how to share it in a developmentally appropriate way, not understanding the multiple facets of grief and how to support the child’s journey through the grief process, and not knowing how to support the child with or in finding more information about birth family and birth family connections.  To summarize, adoption as the act is not the cause of mental health and behavioral health problems, but rather it is the factors that come before the adoption and how normative adoption issues are shared, communicated, and dealt with in the adoptive family.  While an adoptive parent cannot control the factors that occurred prior to adoption (another issue that often leads to guilt and frustrations in which the adoptive parent may need to be supported by a therapist of their own) they can control how they deal with the normative adoption issues, even if this means seeking out professional help to have greater awareness and understanding or just support to deal with the hard stuff! We will look more at the core issues of adoption in the following blog post.




Adoption Competent Clinical Practice Principles

Last blog post, we discussed the importance of having a therapist who is an adoption competent therapist, but what are the adoption competent clinical practices? There are quite a few, so I am going to summarize them here: Adoption is a lifelong process, it is an experience different from giving birth to a child, adoptive family is permanent, child’s past and current relationships with birth family play a critical role in adjustment and development, kinship networks must be acknowledged, adoptive parents have a critical role in facilitating the child’s adjustment and identity formation, post-adoption services are important, services demonstrate respect and sensitivity to all differences in identity, approaches are family-based and strength-based as well as evidenced based, therapist employs an ecological perspective including biological and psychosocial considerations, therapist avoids pathologizing normal developmental process, services are attachment-focused, therapist promotes appreciation for child’s unique story, approaches acknowledge child’s historical relationship with parents and impacts of birth parents’ psychological and sometimes physical presence, and core issues of adoption are consistently assessed and addressed.  (The core issues of adoption include issues such as loss, rejection, guilt and shame, grief, identity, intimacy, and mastery/control). These were summaries of the original Adoption Competent Clinical Practices Principles taken from TAC Training through C.A.S.E. – For more great information from C.A.S.E, help finding an adoption competent counselor in your state, or about participation in TAC (Training in Adoption Competency), visit: https://adoptionsupport.org

Continue to follow this blog series as we discuss various issues in adoption.  The next blog will cover mental health needs of adopted individuals and their families.  And as always, please contact me if you would like to find out more information about specific services I provide or with help finding a therapist that may be a good fit for you and/or your family near you.  Thank you!