Written with deep gratitude to Joy Lieberthal-Rho, Kat Nielsen, and Martha Crawford.
As a budding psychotherapist who has shared adoption in common with clients, I approach this work with a nuanced lens. Yet still I am challenged to manage strong emotions evoked by my clients’ narratives of adoption trauma, loss, and grief. My first therapy session with a fostered youth was my first and most powerful experience with countertransference. In a brief moment of silence I became wholly and powerfully filled with anxiety and sadness—the space between us heavy and charged with emotion. These sensations filtered through my experiences as an adoptee and were assigned the label rejection. I felt panicked—quick to think that I could be of no help to her—before catching my racing thoughts. Rejection. What did this mean to her? To me? I held it, tolerated it. Slowly, I wondered if this feeling that crept over my shoulders and filled my chest so tightly was her disavowal that became my privilege to hold or if these familiar ghosts—abandonment and rejection—were ominous visitors from my own childhood.
Navigating countertransference evoked by adoption grief, loss, and trauma is a road well trodden for clinicians who share adoption in common with their clients, one I need not walk alone. To complete an assigned paper before the conclusion of my master’s degree, I set out through autoethnographical process to glean the wisdom of adoptee Joy Lieberthal Rho, first mother Kat Nielsen, and adoptive mother Martha Crawford (biographies included at the end). In this piece, I share with you a glimpse of my findings and the powerful words of these experienced clinicians.
Adoption Grief, Loss, and Trauma
The American Academy of Pediatrics (2013) advises to “assume that all children who have been adopted or fostered have experienced trauma” (p.7). In one study of foster children, 70.4% were exposed to complex trauma (Briggs, Kisiel, Layne, Ko, & Fairbank, 2011). Relational trauma resulting in negative behaviors places foster children at risk for placement instability (Leve, Harold, Chamberlain, Landsverk, Fisher, & Vostanis, 2012) and places children at risk for adoption dissolution (Child Welfare Information Gateway, 2012). Foster care trauma includes exposure to lengthy court battles, hostile relationships between first and foster parents, and delayed permanency (Lewis, 2011). The trauma from early institutionalization of adopted children, such as in orphanages, has long-lasting effects to executive functioning in some adopted children (Groza, Ryan, & Thomas, 2008).
Infants also experience trauma when separated from the familiar environment of their first mothers’ bodies that nurtured them through pregnancy (Verrier, 1993; Lifton, 2010). Adoptees are then often tasked with integrating their pre- and post-adoption lives, which includes experiencing the trauma of past memories intruding in the present (Fagan, 2011).
For first parents, a child’s placement in foster care is overwhelming and humiliating (Lewis, 2011); these parents may have extensive trauma histories of their own (Fostering Perspectives, 2011). First mothers may experience overwhelming disenfranchised grief after placing a child for adoption (Aloi, 2009). This grief intensifies in first mothers who were coerced or who feel shame associated with the adoptive placement (De Simone, 1996). First mother grief can be intense and ongoing due to the ambiguous nature of her loss (Blanton & Deschner, 1990). The ambiguity of adoption loss may contribute to notable secondary infertility rates among first mothers (Andrews, 2010).
Some adoptive parents have experienced the trauma of infertility which confronts them with altering their personally and socially expected life path from becoming biological parents (Kirk 1984, Lifton, 2010). Historically, adoption has been viewed as a solution to the trauma of infertility en lieu of encouraging couples to grieve (Renne, 1977). The mutual experience of traumas—loss, abuse, infertility, a lengthy adoption process—between adoptees and adoptive parents places each at risk of activating the other (Landerholm, 2001). A significant number of adoptive parents have pre-existing adoption connections, and approximately 6% of adoptive parents were adopted as children (Malm & Welti, 2010) indicating that these individuals may have experienced a multiplicity of multi-dimensional adoption-related loss and trauma.
Literature exploring countertransference specifically between clinicians and clients who share adoption-related trauma in common is virtually nonexistent. One pioneering article on countertransference in adoption work noted only two previous references on the topic (Kraft et. al., 1986). This article presented Racker’s (1968) three types of countertransference to identify countertransference issues in adoption, (Kraft et. al., 1986). More recent articles on the topic present clinical case material describing countertransferentially containing “ghosts” from an adopted child’s traumatic past (Gatti, 2011); representing the child’s lost birth mother (Salo, 2004); and experiencing the adopted child’s pain (Kendrick, 2005).
Exploring Shared Experiences
Working therapeutically within the adoption community involves witnessing client narratives and discovering the deeply personal, shared adoption experiences. Both Ms. Rho and Ms. Crawford noted that a strength of their connection to adoption is that itinforms their ability to listen to their clients’ narratives and avoid making pathologizing generalizations that are commonly made by other clinicians. Ms. Crawford described deeply empathizing with client members of the adoption community through the shared experience of narrative burden—when kinship ties are questioned and not mirrored by surrounding society and popular media. She explained that this means,“Members of the adoption community all encounter each other with deep unmet needs for mirroring relationships.” She explained that working with the adoption community allows her to universalize their narrative burdens through her own and to understand from their insight what her own children—and their birth parents—might need from her.
Ms. Rho also identified feeling a narrative burden in society—one in which articulating the complexities of being adopted is discouraged by others and written off as “offensive.” She explained that being adopted provides her with “one of the main lenses through which I see best when working with members of the adoption community;” she clarified that this is only part of her expertise in addition to obtaining theoretical training, education, and credentials. “Personal experience gets one in the door, doing the hard work of getting disciplined in the art of therapy is what keeps one there,” she explained.
Ms. Nielsen intentionally chose work that involved counseling expectant mothers considering adoption; having not had counseling that led her personally to an informed adoption decision, Ms. Nielsen has spent over a decade researching adoption ethics to ensure that the women she counseled could make an informed decision. Time constraints and socioeconomic stressors make it impossible for mothers to research every adoption agency and policy relating to their decision; Ms. Nielsen’s personal desire to research this issue, coupled with her social work training, allowed her to skillfully fill this information gap for clients.
Exploring Client Emotions
Clinicians and clients who share adoption-related trauma in common may also share similar intense emotions pertaining to their respective adoption experiences, making it important for clinicians to monitor how the client makes them feel, and respond appropriately. Ms. Rho explains to clients that she is there to hold their thoughts, emotions, and confessions for them; however, it is harder to work with the client to hold things on their own and overcome the fear of coming undone when doing so. She described her work as offering clients interpretations of their emotions, insight on how others might be affected by them, and acknowledging the validity of how they feel. Ms. Rho expanded on the emotions relating to the narrative burden that Ms. Crawford described: how adoptees are often told how they must feel about their own adoption journey; work with adoptees includes processing “these projections, labels, and expectations” so that they can stand on their own in how they feel. After years of experience, Ms. Rho is able to do this work without holding every emotion for clients and becoming immersed.
Ms. Crawford explained that it is difficult to set lived experiences aside when working with the adoption community. “Containing our core conflicts—when they are activated in the room—adoption or not—can be quite draining, and this needs to occur in manageable doses.” For Ms. Crawford, because of her own adoption experience, it is most difficult for her to encounter the emotions of adoptive parent clients whose kinship ties have been invalidated by society. She described experiencing significant countertransferential frustration when her role as a therapist requires her to confront adoptive parents—her peers in the adoption community—experiencing denial or pathologizing their children. For some adoptive parent clinicians serving adoptive parent clients, their shared experience of adoption began in adulthood when they first inquired with an agency following infertility troubles—“it doesn’t recapitulate issues that date back to their childhood, or to their more primal identity consolidation.” She explained that experiencing a client’s emotions can be distressing and activating, adding another layer of complexity for her as a clinician with numerous life-long adoption experiences, as they activate childhood conflicts.
Ms. Nielsen explained that she took a great deal of time sitting with expectant mothers considering adoption, learning what it is like to be them and what their needs were. Doing this enabled her to embrace the nuance to each client’s own narrative and struggles and—by embracing the nuances of their human experience—avoid becoming immersed in their emotions. On two occasions she recalled this being difficult for her because the expectant mothers engaged with the agency and chose adoption just days before giving birth and relinquishing their babies. The emotions of these clients wrought from isolation from family and social support were intensely familiar to her.
Exploring Clinician Emotions
Clients evoke emotions within the clinicians that must be managed to avoid imposing these emotions on clients and contaminating the interaction. Ms. Nielsen described this as being a challenge of “self-checking”: to consciously decide if her emotional reaction to a client is coming from her identity as a birth mother or from her professional skill set as a clinician. She described a need to have research and unbiased sources on hand to be able to demonstrate that she was operating from professional frameworks when working with clients and not attempting to resolve her own emotional needs through her work.
Ms. Rho manages emotions evoked by clients using social work skills, as social workers are “encouraged to be with the client, walk with them, and guide them safely through their telling of their life.” If working effectively, Ms. Rho explained, it is impossible not to be moved by her clients’ stories and experiences—impossible not to cry with them and to also feel their pain. Ms. Rho also has counseling for herself where she can unpack her own triggers, work to understand her own trauma and abuse narrative. She is also always in supervision; there she processes her countertransference with her supervisor and a peer supervisory group of clinicians who are also adoptees.
Ms. Crawford translates her emotional responses to clients into empathy. For her, “points of identification and points of divergence” between her narrative and her client’s help to create this empathy. In other words, the similarities between the narratives allows her to approach the client from a unique place of understanding the client’s feelings; yet the difference in the narratives prevents her from becoming entirely activated or flooded with emotion—key to translating these emotions into empathy.
Some Lessons Learned
Through the interview process, I noticed four strong common themes emerged: narrative burden, community advocacy, depathologizing adoption, and conscious use of self.
Both clinicians and clients who share adoption-related trauma in common may experience narrative burden—an imposed obligation to prove the realness of kinship connections. Deeply personal experience with narrative burden strengthens a clinician’s understanding of the client’s experience, but also challenges the clinician to avoid seeking self-validation through a client’s narrative. Clinicians may experience a strong sense of advocacy specifically for clients with whom they share the same role in adoption, and countertransference from shared community roles and experiences, when identified and used appropriately, benefits clients.
Clinicians with personal adoption connections may also feel strongly about depathologizing adoption. This is consistent with the work of clinicians, such as adoptee Susan Harris O’Connor, who developed a transracial identity model (Tien, O’Connor, & Pillidge, 2012) in part to differentiate a transracial adoptee’s sense of feeling white with body dysmorphia (S. O’Connor, personal communication, April 28, 2013) and adoptive mother and adult adoptee colleagues, DiAnne Borders and Francie Portnoy, who developed an adoption re-construction model that normalizes a wide range of adoptee emotional responses to adoption (Penny, Borders, & Portnoy, 2007).
Lastly, these clinicians are tasked with identifying countertransference and differentiating between their own emotions and the client’s before responding to the client. A clinician’s personal experience with adoption may aid him or her in understanding how a client with a similar experience may feel; however, clinicians must not let their own emotions contaminate the interaction and must keep focus on the client’s needs.
I am among many professionals who professed to my young fostered client that we want her to teach us what it is like to be her. That the space between us is a holding space for things painful and scary. In the moment I described, I realized what I was asking of her as I gained just a glimpse, a reminder, of what it is like to feel engulfed by rejection. My process recording that day was full of questions, guesses, and remarks about my feelings but few answers or conclusions.
When faced with the strong countertransference that day with my young foster youth client, I felt frozen, as I often do when confronted with my adoption loss. I sat with her, quiet while she spoke. I asked myself questions that seemed impossible to answer. Are these her emotions? Are these my emotions? With the wisdom of mentors in the adoption community, I have answers, and am on the path to developing skills to manage and use countertransference. Although the use of countertransference will be an ongoing, skill-building process for me, wisdom from my peers and mentors has provided me with some guiding principles to lay a stronger foundation on which to build this skill.
Interviewed Clinician Biographies
Joy Lieberthal Rho, MSW, LCSW is an Asian-American woman who identifies as an adoptee. She was born in Korea and adopted at age six through closed international adoption to the U.S. by white parents. Ms. Rho is a private practitioner who serves adoptees and adoptive parents and specializes in young children to adults—most prominently in adolescents.
Kat Nielsen, MSW, PhD candidate, is a black woman who identifies as a birth parent. She placed her son through private U.S. domestic infant adoption with white parents in an open adoption—meaning she has a direct relationship with her son and his family. Until recently, she counseled pregnant women considering adoption, provided post-placement support, and created trainings for adoptive parents and social workers.
Martha Crawford, MSW, LCSW is a white woman who identifies as an adoptive parent, the granddaughter of an adoptee, and the sister of an adoptee. She and her husband adopted two Korean-born children through international adoption to the U.S. Ms. Crawford has been a private practitioner for 20 years with a portion of clientele comprised of adult adoptees, birth and adoptive parents, and youth in foster-care and foster-adopt placements. She also co-facilitates groups and workshops for adoptive parents in collaboration with adult adoptees.
~ Amanda H.L. Transue-Woolston, BSW
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