The Clinical Challenges of Adoption

As an adoptive parent and psychologist, I’ve long been drawn to all clinical aspects of the adoption process. I began this part of my journey with my wife, who, as an adoption social worker, referred home studies to me. A home study is basically a psychosocial evaluation of the prospective adoptive parents with recommendations about their “readiness” or “fitness” to adopt. Through those many intimate visits with clients, who, for a variety of reasons ranging from infertility to choice, I learned of the frustrations, despair, and hope that accompanied the decision to raise another person’s child.


The home studies laid the foundation of the post-adoption placements with those new parents who were fortunate enough to meet the often-stringent requirements for domestic adoption, and even more demanding requirements that accompanied adopting a child from another country. While those visits were often accompanied by the joys of new parenthood, they also came with a myriad of unanswered and unanswerable questions about what lay beyond the luster of that new status. From those visits, I learned of the many challenges that new parents faced, peppered in with the often-irrepressible joy they experienced.

From the child, especially when I was privileged to work with them in therapy, I witnessed firsthand the “primal wound” that Verrier described as a core dynamic in adoption. For as much as is gained by an adopted child, so too have they experienced loss, even when that loss was necessitated by birthparent neglect, abuse, and/or abandonment. I even had the opportunity to work with those birth parents before and after placement, where the experiences of grief and loss were clearly on display.

The Therapeutic Value of a Puppy

I remember 8-year-old Amber and her 4-year-old brother Asher, siblings who had spent most of their childhoods in various foster placements following removal from their biological parents due to severe neglect. My work with them began right around the time that their out-of-state adoption was being finalized, so I knew that my time with them would be short. Since they were, in every sense of the word, fellow travelers, I met with them together in play therapy, themes which revolved around family life.

I was able to loosely track the chronology of changes they had experienced in their short lives through their dollhouse and sandtray play. What stood out the most was the issue of loss, impermanence, and change, issues that were always at the forefront of their lived experiences. One of our sessions revolved around planting a small tree in front of the office. Metaphoric and literal conversations about growth, hope, and vitality were plentiful. Gardening and nature-based metaphors are among my favorites in therapy, made even more so when I have been able to literally get my hands dirty with clients.

And then the day of our last session came. Amber and Asher would be traveling the next day for what would hopefully be their permanent placement. I was very anxious. What could I possibly offer them in those last minutes of our short-lived relationship? What could I say that could even be mildly reassuring?

As I drove up to the office (and I promise that I am not making this up), there was a puppy sitting on the doorstep—very young, very lost, and thankfully, very affectionate. I knew at once what shape the final therapy session would take as I quickly scooped up this little lost creature and brought it inside.

The children came only moments after I got settled, so I thought it would be a good idea to include them in the welcoming of this puppy—water, a soft towel to lay on, and some of the resident cat’s kibble. We had to manage with what we had on hand, but no one, especially the puppy, complained. Asher and Amber fell instantly for the dog, taking turns gently holding it, assuring it that it was safe and loved, and that it would be cared for. We talked about fear, hope, loss, adoption, and forever homes that day, and we never used any of these words. This furry, four-legged metaphor was all we needed to help launch these children on the next leg of their own journey.

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Take whatever lessons you’d like or need from this story into your own clinical work, whether it be with children, adults, or any of your clients that have been lost and seek welcomed rest stops along their own journeys.

Questions for Thought and Discussion

What have you found to be some of the greatest challenges in working with adopted clients?

What are your impressions of the author’s approach to this case?

How have you used metaphors in therapy?


File under: Musings and Reflections, Child & Adolescent Therapy