Psychoeducation for Pre-Adoptive Families

By Joyce Maguire Pavao, EdD., LFMT

With the media focusing more and more on adoption - and usually sensationalizing it – the public’s impression is often that of an adversarial relationship that must exist between the birth family and adoptive family. In many of the contested adoption cases, it looks like neither set of parents can do what is in the best interest of the child. Most certainly, the professionals (lawyers, judges, therapists) do not seem to understand the systemic problems for the families and the dysfunction these problems will cause the child who is placed in this adversarial arena.

Adoption can be a very positive way to create a family. It is estimated that adoption affects the lives of forty million Americans. Given these numbers and the fact that adoption is becoming more prevalent in the 1990’s, it will be increasingly important for clinicians to be skilled in working with the unique issues that face adoptive family systems. Marriage and Family Therapists can help these complex families. They can normalize and demystify the process of adoption so that those involved can be treated honorably so that those involved can be treated honorably and be prepared to handle the related issues. Mental health professionals should focus on family preservation when possible, a preventive approach to consultation, and the welfare of the children involved.

The Birth Family

When women and their partners deal with an untimely pregnancy, the decision about whether or not to surrender a child for adoption should be educated with all options. Family preservation and kinship arrangements should be explored prior to any discussion of adoption. Therapists should discuss with clients the kinds of adoption available and the post-traumatic effects that they will encounter over time. The pain of loss is great, but the reasons for adoption being considered indicate that parenting that child might also prove very difficult. Adoption is a serious one that indicates that being a parent might also be a very difficult choice for these people at this time. Birth parents need to speak with someone in the beginning of their decision making process. Once they’ve had adequate psychoeducation and counseling, then the possibility of a good and healthy adoption is secure.

Currently, birth parents often want to be involved in the selection of adoptive parents. What parent would not want to know something about where his or her child is going? Meeting the adoptive parents before a decision is made is not uncommon. Yet the trend appears not toward open adoption but toward semi-open adoption. In semi-open adoption, there is a one-time meeting between birth parents and pre-adoptive parents and first names are exchanged. An emotional connection is made between both parties as is an agreement to have the agency or adoption professional act as an intermediary in the yearly (or as otherwise decided by parties) exchange of letters and pictures and updated medical information. Semi-open adoption allows the birth parents to feel more connected to the child they cannot parent.

Closed adoption – the traditional form since the 1930’s – offers no identifying information, very little non-identifying information, and no agreement for future meeting. Open adoptions can vary a great deal, from regular meeting to occasional written contact. In all forms of adoption, girth parents terminate parental rights, and the adoptive parents take them on. The emotional and psychological connections are never terminated.

Pre-Adoptive Parents

Understanding what precedes the adoption, whatever type it may be, important. A majority of pre-adoptive couples have struggled with issues of infertility for years. The pain and loss that result from constantly hoping for a birth child and undergoing invasive medical, pharmacological and surgical procedures (that strain a couple’s relationship) make adoption seem like additional hoops to jump through to be parents. Like birth parents, adoptive parents feel like victims of the process. Pre-adoptive parents often suffer a lack of understanding by some family, friends, and society. This results in the subtle but lifelong experience of pain, guilt, shame and loss.

The panacea, in days of old, was adoption. We now know that adoption does not fix infertility. It fixes the desire to parent, and adoption is a wonderful way to do that. But the issues of never seeing a child of "one’s own" continue to exist. These issues exist for extended family members as well. (Parents of pre-adoptive couples benefit a great deal from being included in psychoeducation and counseling around adoption.)

In therapy, a 30-year-old woman adoptee clearly remembered and recounted a day soon after her eighth birthday. Louise was very close to her adoptive Mom. They were making her room into a "big girl’s room". They chose flowered wallpaper, colors for paint, and a lovely bedspread and curtains. The grandparents came to dinner soon after the project's completion. Mom and Louise each held one of Grandma’s hands and told her to close her eyes. They excitedly walked her to the door of the newly arranged room. They flung open the door and gleefully told her to open her eyes. Grandma opened her eyes and looked all around the room, "What a beautiful room for someone else’s child," she said.

This was not a "wicked" grandmother, although both mother and daughter were devastated by her comment. This was an aging mother who suffered from the loss of never seeing her birth grandchildren. Psychoeducation, even 22 years after this unforgettable day, could help the entire family. And psychoeducation before adoption for parents and their extended family or community will lead to more support of the adoptive family, along with a greater understanding of participants’ own feelings. An MFT can help families discuss and make sense of these issues in the pre-adoptive process. Gay and lesbian couples and single parents who adopt will also benefit from pre-adoption psychoeducation about the added complexities that their families will face.


The normative model proposes that a systemic approach is needed to work with the adoptive family system. There is no identified patient in this model, but the whole system (from the wider context of adoption practices to the intricate relationships in the adoptive and birth families) is regarded as the client. Crisis can be normal and can even lead to transformation. Clinicians must be familiar with and empathetic toward each member of the adoption circle, including the birth family, whether known or not.

There are ongoing issues for the whole family: now to tell the child, what to tell the child, when to tell the child, how to deal with extended family members and neighbors, how to work with the schools and with professionals who have little or no experience with learning disabilities, attention deficit disorder and emotional difficulties in adopted children. Things that birth families take for granted, may pose serious dilemmas for adoptive families. One example is medical history – physicians state that dealing with an adoptee is like dealing with a coma victim in the sense that critical and current family history information is often missing and impossible to get.

In adolescence a variety of issues emerge for the adoptee and for the adoptive family. Adoptees, like all adolescents, begin to look at themselves more carefully. For the adoptee looking in the mirror may lead to the realization that he/she does not know another human being in the world who is related to him/her. The fact of adoption complicated issues of identity, sexuality, trust, self-esteem and individuation to name a few. As adolescence brings on a search for identity, adoptive parents are often faced with the confusing task of how to help the child integrate a complete sense of self when pieces of his/her heritage may be problematic, or even missing entirely. Simultaneous with the adolescent doing his/her search, the adoptive parents are often subconsciously or consciously dealing with the issues of loss, wondering what their birth child might have been like, and about the preparation for their adopted child’s move toward adulthood and intense feelings about the loss of this child who will soon be an adult.

There are also effects on the adoptee and the family if the search for birth parents is undertaken. The search brings up issues of conflicting loyalties for the adoptee between the adoptive and birth parents. It also brings up fears and fantasies that are often difficult to manage for all involved.

It is important to note that although the search brings up difficult and painful issues, I is an integral part of the healing process of identity and intimacy that is essential to making whole all of these broken connections. Clinicians must understand the importance and intricacies of the search and recognize that it is a healing journey no matter what is found.

Adoption is an ongoing issue throughout the life cycle and beyond, affecting not only the generations past, but the ones to come as well. We are now learning that for adoptees who chose not to search their children show similar patterns to an adoptee and often do a search on their own for the birth grandparents.

Brief Long-Term Therapy

What do families need? An inclusive, systemic approach that normalizes stages of development and includes diverse family members. While the first crisis may be about the decision to adopt or not to parent, other crisis often follow after adoption. In my therapeutic model called "brief long-term therapy", a family and various constellations (different family sub-systems) are seen during a crisis. The work that involves transforming that crisis into an empowering experience. If families come back for further therapy at a later stage of development, this is seen not as a failure. Rather it is a success in working through yet another stage of development. There is a completion of each stage of therapy but no "termination". (The word "terminate" is too loaded for those who have suffered the losses associated with adoption.) The therapist remains available for consultation and therapy. This avoids the emotional cut-off and loss that are primary issues in adoption.

MFT’s (1) are well equipped for this work. They already take a systemic view and seek empowerment over pathologizing problems. By working with all the family members involved, along with agencies, courts and schools as needed, MFT’s can spread understanding…and healing.

Joyce Maguire Pavao, EdD., LMFT is the founder and director of both the Adoption Resource Center (ARC), the Center for Family Connections in Cambridge, MA (with offices in New York and San Francisco), and the Pre/Post Adoption Consulting Team (Pact) in Somerville, MA. She is a clinical member and approved supervisor of the American Adoption Congress along with being on the board of the Kinship Alliance in Monterey, CA. Dr. Pavao believes her most valuable credential is that she has experienced life as an adopted person.

Reprinted from Child Welfare Report, February 1996
Keywords :
  preparing for adoption : adoption triad
  therapy and support : therapeutic models