Understanding Adoption: Clinical Work With Adults, Children, and Parents (Book Review)

Author:  Hushion, Kathleen, Susan B. Sherman, and Diana Siskind
Publisher: Jason Aronson
Reviewed By: Katherine Marsh and Richard Ruth, Winter 2008 (Vol. XXVIII, No.1), pp. 37-39

We live in a world of mixed messages. When pop icons and movie stars make adoption as hip as the latest fashion trend, but an orphaned boy wizard even more popular in the collective imagination—Harry Potter—is forced by his adoptive aunt and uncle to live in a cupboard under the stairs, we are left to wonder what it means to be part of the adoption triad. With over 60 percent of the population of the United States reporting that their lives have been affected in some manner by adoption and over 100,000 children adopted each year in the U.S. alone (Evan B. Donaldson Adoption Institute, 2008), it is likely that most clinical psychologists have had at least one patient whose life has been touched by adoption. Despite a multitude of books dedicated to preparing and educating adoptive parents and adopted children, there is a dearth of material for the clinician working within the adoption community. Understanding Adoption fills a large chunk of the void.

Psychoanalysis has long had an interest in adoption, and psychoanalysts have made foundational contributions to the literature conceptualizing what elements of the adoption experience are like, for children and their birth and adoptive parents. Psychoanalytic thinking and approaches have also had great influence on social work and mental health practice in adoption. However, this thinking and work have tended to take place in a warded-off corner of psychoanalytic thinking and practice, echoing, somewhat disturbingly, the way adoption itself is often thought (and not thought) about in the larger culture and in the minds of even many people who themselves live through the adoption experience. And psychoanalytic thinking about adoption has been in need of some re-thinking, in light of new theoretical developments in our field and also in light of the changing nature of adoption itself, such as increases in adoptions of children from other countries, increases in adoptions by families with other-than-Leave-It-to-Beaver structures, increases in adoptions of children from trauma backgrounds and of older children, and increases in blended-family, kinship, open, and other less traditional types of adoption.

A compilation of 14 chapters designed to investigate psychodynamically oriented clinicians’ work with adoptees and their parents, written by contributors with a range of clinical experiences in adoption work—all apparently social workers and psychologists, interestingly; psychiatric voices seem on the edge of extinction—Understanding Adoption is a long-overdue look into how adoption affects everyone involved, from the clinician/patient and parent/child dyads, to the social workers, teachers, foster parents, medical professionals, and adoption agency personnel involved in the adoption process. It is a groundbreaking and very welcome contribution to the literature and deserves to be widely read and discussed,

For many of us, our first experience with adoption is a personal and profound event. We may first be introduced to the idea of adoption as a result of the loss and grief that accompany infertility, the joy of realizing the dream of parenting when biologically creating a child is not possible (for example, when unpartnered individuals or gay male couples decide to adopt), or the challenge of working clinically with an adopted child trying to solidify a sense of self. For one of us (KM), the first experience with adoption came as a result of working as a guest caregiver at a Soviet orphanage. After working with two hundred orphans for the summer, I came to the conclusion that adoption was one of the most logical (and therefore appealing) ideas around. What could be more simple: a child who needs parents, and an adult who wants to mother or father a child? After seven additional years as a caseworker in both domestic and international adoption, it became clear that adoption is anything but simple. For another of us (RR), introduction to adoption came through a commitment to working with traumatized children, and coming to understand, in the course of psychotherapeutic work with them and with their families, that adoption was not an irrelevant detail, but a central pole of their fantasy lives and lived experiences.

Understanding Adoption includes over 18 diverse case examples, chosen to identify common themes in mental health work—both formal psychotherapy and psychoanalysis, and other kinds of consultative work—with adoptees and their parents and, in the case of adult adoptees, their relatives, friends, and partners. The idea of unconscious communication of loss runs throughout several chapters, and emphasizes the need for adoptive parents to be aware of their own feelings of grief and of potential sensitivity to narcissistic injury, and of the need to remain aware consistently of their child’s, or grown child’s, experience as an adoptee. The diversity of the adoption experience is evident through the cases presented. Cases include a range of scenarios: from infant through teen adoption; domestic, foster-care, kinship and international origins; single, married, and same-sex adoptive-parented families; adult adoptees; and transracial families.

Chapters use a range of theoretical approaches, including most frequently interpersonal, self-psychology, Kleinian, relational, developmental, feminist, and family-systems orientations. More classical, especially Anna Freudian, thinking is also represented, and integrated, but seems less frequently seen by the clinicians writing as the theoretical organizer, or at least sole organizer, of their own contemporary thinking and experience.

The various chapters describe issues that are common in therapy with adoptees and their families, including identify formation, dealing with shame, sensitivity to secondary loss, custody issues, secrecy, trauma, and the specific issues relevant to gay and lesbian parenting and kinship adoption. A “special issues” section contains three chapters dedicated to legal and ethical issues.

Although several chapters strongly warn against overemphasizing the importance of adoption in any presenting problem, there are a few generalized statements throughout the book, the basis for which seems less than securely grounded or supported. The generalizations are few and far between, and do not take away from the overriding message of the individuality and uniqueness of the adoption experience.

It was surprising, for example, to find language that is generally frowned upon within the adoption community. There are several references to “natural” parents, or adoptees’ “own” parents, rather than the commonly promoted terms “birth” or “biological” parents, and references to birth parents who “gave up” rather than “relinquished” the children to whom they gave birth. If we are to encourage others to be aware of how their words and actions affect adopted children and their parents, we may do well to remain more vigilant about the language we use when speaking of how a child enters a family. Perhaps the kind of language used reflects some of the writers’ ambivalence about whether they are external to or part of the “adoption world,” a developmental struggle that, in our experience, many psychoanalytically and psychodynamically oriented clinicians go through as their experience with and commitment to work with adoption widens and deepens.

Although the vast majority of adoptions occur as a result of an inability to parent a child biologically, it seemed curious that none of the writers addresses the thoughts and experience of the many families who make adoption their first choice in family building. A small group, perhaps—reliable statistics are hard to come by (Evan B. Donaldson Adoption Institute, 2008) —but certainly one deserving of recognition and examination.

The birth parent is of scant focus in the book. One chapter references “the best and the worst among parents” as those who bring up “someone else’s” child and those who cannot raise their own child. There remains in the U.S. a predominantly negative stereotype of birth parents. Failing to recognize the bravery and compassion behind the decision to place a child for adoption—related, perhaps, to a more general difficulty making space for notions of bravery and compassion, and what they mean, in psychoanalytic thinking—contributes to this negative stereotype, and subsequently contributes to the profound sense of shame common among not just parents who choose to place for adoption children they feel unable to raise, but also among adoptees. We would have hoped for at least one chapter dedicated to working psychodynamically with birth parents.

The writers in this book seem to be clinicians, or teachers of clinicians writing primarily from their own clinical experience. Absent were contributions from psychodynamically oriented researchers, whose perspectives would have been especially welcome, given that much adoption practice is guided by research claiming the authority of an empirical voice but absent any note of sensitivity to the dynamic experience of those involved with adoption. As a result, we were left wondering, at points, how common or generalizeable some of the writers’ perceptions and experiences might or might not be.

While cultural themes are taken up in several chapters, it also seemed curious that none of the writers seemed to be speaking from personal experience as a non-European American, or out gay or lesbian, psychodynamic clinician or psychoanalyst, and that current psychodynamic writing on such topics as bilingualism, the subjective experience of being outside the majority culture or other than heterosexual, or racism was not drawn upon in a amore conscious or systematic way. This is less a criticism – it is refreshing to read writers empowered to speak with their own voice and unapologetically from their own experience – than an omission. Guided by the contributions presented here, others in our field, we hope, will write about the further questions this volume opens up.

Regardless of a few perhaps misplaced generalizations, omissions, and debatable lexical choices, Understanding Adoption is an incredibly valuable tool. It has the unevennesses expectable of writing breaking new ground, and is all the more exciting to read— and at points argue with—because it captures impressively well the feel and contours of an emerging field of thought and practice. As we read the book, we thought of the colleagues and the hundreds of families we have worked with through the years who could have benefited greatly from its thinking and practical guidance. I (KM) thought of my former coworkers, who wished to serve their client adoptive families in the most helpful and sensitive ways possible, but who lacked training or adequate teaching material to do so. And I thought of my own experiences. I recalled that, during the first several years that I worked with adoptive families, I failed to comprehend the profound sense of loss that they carried from years of infertility and multiple miscarriages, and I was unaware of the tremendous impact that the unresolved grief could have on their future families. And I (RR) thought back to hours in clinical work, when patients spoke about potent adoption experiences with greater difficulty than they spoke about forbidden sexual fantasies, and I felt more like surprised witness than helpful therapist; and hours in supervision when I did not know how to put into words the experiences my patients involved with adoption were living through—distinctly different from the internal and external experiences of those not involved with adoption—of which I was only emergingly and conflictually aware, and which my supervisors, equally unaware, did not ask about.

Given the opportunity to turn back time, we would gift a copy of this book to each and every coworker and adoptive family in our care. Including Harry and Dumbledore.

References

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