Mental Health Matters
Forensic Edition
January 2011
Published by: Lepage Associates 




The term "adoption" has various legal, behavioral, social, and emotional definitions. A common behavioral definition includes taking an individual into one's family through legal means and raising the individual as one's own child. Adoption is also a social construction meant to bring permanence to a parent-child relationship. Finally, it is a means of providing some children with a greater likelihood for their emotional and physical needs to be met by legally transferring ongoing parental responsibilities from their birth parents to their adoptive parents. For the purpose of clarifying who is being referred to in this article, the terms "adopted child" and/or "adoptive parent" are used; however, it is the belief of this author that it is not preferable to differentiate children and parents based on the process by which they joined a family.


Although adoption is becoming an increasingly more common phenomenon, there are many fundamental differences that adoptive parents experience in comparison to biological parents in order to "become parents."  For example, biological parents automatically become parents, with no intermediary (excluding fertility treatments), whereas adoptive parent(s) must work with an adoption agency and/or an attorney to become parents. While most biological parents have an assumed nine months to prepare for the coming of their child, adoptive parent(s) do not have the security of such a timeline. They may wait for years to receive the phone call that a child is "available" for them and then have a limited amount of time to "retrieve" this child. While this time period is generally perceived as one of excitement, there is also a great deal of anxiety as potential adoptive parents must demonstrate that they are competent, fit, and appropriate people. Additionally, biological parents do not expect their parenting rights to be questioned at the time of the child's birth. They may only lose their parenting rights based on negligent or abusive behaviors. Conversely, adoptive parents do not necessarily know when and even if they will "receive" a child. While it is crucial for potential adoptive parents to be ready for a child to enter their life, research finds that based on these discrepancies adoptive parents often feel increased feelings of self-doubt and anxiety regarding their own worth and abilities as parents.


In an effort to help parents-to-be and new adoptive parents who may be experiencing these distressing feelings, psychologists have worked to find out what factors can effect an adoptive parent's sense of comfort throughout the adoption process. For example, well known adoption researchers, Benson Jaffee and David Fanshel, use the term  

entitlementto refer to the adoptive parents' feelings and beliefs that they have both the legal and emotional right to be parents to their adopted child. The use of the word, entitlement, in this case is not to be confused with the concept of being overindulged, precocious, or self-centered as these terms have a much more negative connotation. While the adoptive parents' legal right is affirmed in court, the emotional right develops from parents' increasing understanding of their roles as the mother and/or father to the adopted child. Research found the more an adoptive parent felt entitled to parent their adopted child, the more secure the attachment between the parent and child. Additionally, Jaffee and Fanshel use the word claiming to describe the mutual process by which the adoptive family and the adopted child grow to feel they belong together. This may be demonstrated by adoptive parents or their relatives discussing physical and/or character similarities between themselves and their adopted child (regardless of different race or ethnicity) or by giving the adopted child a family name or nickname. The more the adoptive parent claimed the adopted child, the greater the interpersonal connection between the parent and child. Interestingly, subsequent research demonstrated positive correlations between entitlement/claiming and the adopted child's sense of self-worth and status in their adoptive family.    


Adoption Evaluations


Most adoption programs, agencies, and countries require prospective adoptive parents to complete a psychological evaluation or test; this requirement is aimed to ensure the safety and well-being of the child is maintained throughout his or her life. When potential adoptive parents are referred to psychologists for an evaluation, this can be an unnerving process for the parent. It is our goal as psychologists at Lepage Associates to make the prospective parent(s) feel comfortable and welcome when completing an adoption evaluation. Knowing what to expect can help make this process less overwhelming. The psychologist will most likely conduct the evaluation by performing a clinical interview, psychological testing aimed at gaining a better understanding of the person's personality functioning (i.e. the Minnesota Multiphasic Personality Inventory-second edition), and, potentially, other mental health assessments.


A clinical interview usually consists of collecting relevant background information including the individual's own mental health history. The goal is to gain a better understanding of the person's current mental health functioning and to rule out or gain clarity regarding any mental illnesses. Think of it as the mental equivalent to a general physical examination. The measures which assess personality functioning are not pass-fail tests and there are no right or wrong answers. The goal is to assess the individual's patterns of behaviors, thoughts, and feelings. Other mental health assessments may be supplemented if the individual endorses items on the personality test, or during the clinical interview, which the psychologist believes may require further clarification. For example, an individual with a history of substance abuse issues or self-harming behaviors may be asked to complete an additional test which assesses the severity, frequency, and intensity of these past or current behaviors.


At Lepage Associates, we also provide direct services such as adoption readiness evaluations and therapy for children at any stage of the adoption process. This includes foster parents adopting children in their care, adopting a child who has previously lived in foster care, kinship adoption placements, adopting a child with special needs, and adopting a preadolescent or adolescent age child. Similar to the process adoptive parents undergo, adoption readiness evaluations can be an anxiety provoking experience for the child regardless of the child's hopes and expectations about the placement. Our aim is to provide a safe and secure setting where a child feels comfortable throughout the process. When a child undergoes an adoption readiness evaluation, the psychologist will meet with the child to collect information about his or her current and past functioning. This may include having the child complete standardized and structured psychological tests assessing thoughts, feelings, and behaviors, a clinical interview with the child, an interview with his or her prospective parents, and/or structured parent-child observation sessions. The psychologist may also collect collateral information from sources such as teachers and past foster parents.


Post Adoption Services


After the adoption process is complete, many children are not sure of "what will happen next" or what they are "supposed to do." The act of adoption can be very novel and anxiety provoking. As such, therapy for an adopted child entails supporting the child as he or she adjusts to changes, processes any losses and grief, and creates new attachments in the family. Additionally, feelings of loss and fear may cycle throughout the child's development. For example, certain dates or events such as birthdays, holidays, pregnancy within the family, or the adoption of a sibling may trigger old memories of abandonment or rejection. Therapy is a dynamic process and a skilled clinician can work with the child and his or her parents to turn distressing events into learning and growth opportunies. This in turn helps increase the child's positive sense of self and sense of trust in his or her environment.     


When parents are presenting for help in therapy, common issues they describe experiencing include engaging in ongoing power struggles with their child, beliefs that their child may be developing symptoms related to anxiety or depression (i.e. worry, withdrawal, irritability), or wondering "is it normal" for their child to be feeling, thinking, or doing certain things. As such, the following are suggestions parents can draw upon when they report any of the above mentioned issues.  


  1. The more an adoptive parent experiences a sense of entitlement (based on Jaffee and Fanshel's definition of entitlement) to parent his or her adoptive child, the more secure the adopted child feels about his or her status within the adoptive family. Most adopted children are likely to incorporate their adoptive parents' stance on the concept of entitlement.
    1. Therefore, parents are encouraged to explore and process any doubts, fears, anxieties, and impairments they may be experiencing when parenting their child.
  2. Adoptive parents who continue to significantly question and doubt their right to raise and parent their adopted child are more likely to experience conflict with this child about boundaries and limits in comparison to adoptive parents who do not continue to significantly question their right to parent.
    1. In certain contexts, parents report feeling guilty or fearful of disciplining their child due to beliefs and knowledge of what their child may have experienced prior to being adopted. Psychologists can help parents create a balance of providing structure, routine, and discipline while also meeting the child's current needs for nurturance and support.  
  3. One of the best predictors of positive outcomes for children in adoptive families is perceived similarities. There is a positive correlation between the degree to which adopted children and their adoptive parents perceived themselves as similar to one another in personality, mannerisms, and even physical characteristics (regardless of being of different race or ethnic identities) and how satisfied both the adoptive parents and the adopted child were with the adoption.
    1. Parents are encouraged to find common interests with their child, discuss these similarities, and create new family traditions and rituals with their child.

If you are interested in reading more about this topic, please see the reading list posted on our website. We have psychologists that specialize in working with adoptive families transitioning through any phase of adoption process. Learn more about our services by clicking here. 


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