Selecting an Adoption Therapist

Selecting and Working With an Adoption Therapist
Author(s):   Child Welfare Information Gateway 
Adoption is an event that has a life-long effect on everyone involved. Adoption brings unique rewards as well as challenges to families, and sometimes families will need or want professional help as concerns or problems arise. Timely intervention by a professional skilled in adoption issues often can prevent issues common to adoption from becoming more serious problems that might be more difficult to resolve.
The type (e.g., individual, family, group) and duration of therapy will vary depending on many variables, including the kinds of problems being addressed. Some families build a relationship with a therapist over years, "checking in" for help as needed. Other families might find they need a therapist's help only once or twice. Sometimes a difficulty a child is experiencing is very obviously connected to adoption, but sometimes the connection is not readily apparent. On the other hand, issues that seem to be related to adoption, after investigation, turn out not to be related to adoption at all. Clinicians with adoption knowledge and experience are best suited to help families identify connections between problems and adoption and to plan effective treatment strategies.

Finding the right therapist can seem like a daunting task, especially when parents may be feeling overwhelmed or burdened by the difficulties for which they are seeking help. Parents should take the time to shop around for a mental health provider who has the experience and expertise required to effectively address their family's needs. At minimum, a therapist must:

1. Be knowledgeable about adoption and the psychological impact of adoption on children and families
2. Be experienced in working with adopted children and their families.
3. Know the types of help available.

Check on Insurance The search for a therapist can be complicated by restrictions imposed by insurance companies or health management organizations (HMOs); however, it may still be possible to choose from a list of approved therapists. Check with your insurance company to find out:

• The extent of your coverage for mental health treatment
• Specialty areas of approved providers
• Company policies regarding referrals to, and payment for, treatment provided by therapists outside the plan.

You may be able to justify using a therapist outside of the network for specialized services if the insurance company does not have providers with the required expertise. Although you might meet some resistance, persevere to secure the needed services-you are your child's strongest advocate.

Some therapists accept Medicaid reimbursement. The challenge is to locate a therapist who accepts reimbursement and who has experience in foster care and adoption. Your local public foster care agency may be able to give you referrals to therapists they use for children's treatment.

Know the Types of Help Available:

Many different professionals provide mental health services but not all may be available in your area. It helps to know the training and credentials of various professionals attain.

Pediatrician or Family Practice Physician

-Medical doctor (M.D.) who specializes in childhood or adolescent care and who typically treats routine medical conditions; a primary care physician who refers a child for additional lab studies or diagnostic procedures and who coordinates referrals to other specialists.

Psychiatrist

-Medical doctor (M.D.) who specializes in the evaluation of major mental or emotional disorders which may require medication. Psychiatrists complete medical school and follow with post-graduate training in psychiatric disorders and perhaps subspecialties in child and adolescent psychiatry. Psychiatry's primary focus is on medication consultation and management, and only a few psychiatrists have formal training in psychotherapy, counseling, or interventions that address child and adolescent behavioral or emotional disorders. Rather, most work with or refer to specialists in child and family evaluation and therapy.

Clinical Psychologist

-a clinical psychologist has completed a doctoral degree (Ph.D. or Psy.D.) in psychology and usually has completed advanced courses in general development, psychological testing and evaluation, as well as psychotherapy techniques and counseling. Many clinical psychologists develop a subspecialty in child and adolescent development, psychological testing, and family therapy.

Clinical Neuropsychologist

-Clinical neuropsychologists hold a Ph.D. They complete undergraduate and graduate training in biological and medical theories pertaining to human behavior and doctoral studies in clinical neuropsychology, followed by post-graduate specialty training in the assessment and treatment of neurodevelopmental disorders, neurological and medical conditions, traumatic brain injury, learning and memory disorders and the differential diagnosis of organic versus psychiatric or psychological disorders.

Clinical Social Worker

-A clinical social worker (LCSW or MSW) has completed a master's degree in social work with emphasis on family structure and children's interactional strengths and weaknesses. Social workers typically focus on social, educational and family adjustment issues, but usually do not have professional training in psychological testing. Many complete advanced training and licensure in order to be qualified under state licensure requirements to offer counseling to individuals and families.

Marriage and Family Therapist

-Marriage and family therapists (MSW) have a master's degree in counseling techniques that mainly focus on family relationships and couples. Family therapists focus on communication building and on family structure and boundaries within the family.

Licensed Professional Counselor

-A licensed professional counselor often has graduate training in a specialty such as education, psychology, pastoral counseling, or marriage and family therapy. Licensed professional counselors focus on brief problem-solving therapies with a focus on reorganizing the family, building communication skills, and strengthening family relationships.

Pastoral Counselor

-A pastoral counselor has a minimum of a master's degree (many have completed doctoral training) and focuses on supportive interventions for individuals or families, using spirituality as an additional source of support for those in treatment.

Ask for Referrals Locating a therapist does not have to be difficult. You may want to contact community adoption support networks, use the Internet, and/or ask your placement agency. Many adoption agencies have either consulting mental health therapists trained in adoption on staff or referral resources in the community. Public agencies may have a list of therapists who have effectively worked with children in foster care and adoption. In addition, there are independent social service organizations throughout the United States that provide post-adoption services, which may include parent support groups, individual and family counseling, children's support groups, educational seminars, consultations and advocacy.

Check with the following resources for therapist recommendations:

• Agency social workers involved in the original placement
• State or local mental health associations - most offer referral services and list specialty areas for therapists
• Public and private adoption agencies
• Local adoptive parent support groups
• Specialized agencies providing post-adoption services.

Using those recommendations, call therapists for a phone or face-to-face interview. Many therapists will offer a 15- or 20-minute initial consultation free of charge. In contacting a community mental health center, parents should ask for names of the center's family and child specialists and then leave messages for those clinicians requesting a short phone interview.

Phone Interview Questions Parents should start by giving the clinician a brief description of the concern or problem for which they are requesting help. Listed below are some questions to discuss.

1. What is the therapist's experience with
   
   
   
   • Adoption, in general?
   • Infertility?
   • Special needs adoption?
   • Open adoption?
   • Transracial adoption?
   • Identity issues in the context of adoption?
   • Search and reunion?
   • Adoptive families?
   • Adopted children?
   • Children who have histories of loss, abuse and/or neglect?
   • Children who may have learning or developmental disabilities?
2. How long has the therapist been in practice, and what degrees, license or certification does he or she have?
3. What continuing clinical training does he or she have on adoption issues?
4. Does the therapist include parents in the therapeutic process?
5. Does the clinician prefer to work with the entire family or only with the child(ren)?
6. Will the therapist give parents regular reports on a child's progress?
7. Can the therapist estimate a time frame for the course of therapy?
8. What is the therapist's theoretical orientation regarding treatment? Many therapists treat from one or more of the following approaches:
   
   
   
   • behavioral therapy, which focuses on treating overt behaviors
   • cognitive therapy, which focuses clinical intervention on thinking processes, motivation, and reasons for certain behaviors
   • family systems therapy, which views family members as a unit and focuses on their interpersonal and communications patterns
   • psychoanalysis, which is based on psychosexual development theories, personality structure and psychotherapy techniques pioneered by Sigmund Freud.

Other Practical Considerations Most therapists or clinical practices have policies regarding late or missed appointments, notice required for rescheduling appointments, and filing for insurance reimbursement. Parents should ask for this information.

• What is the therapist's arrangement for coverage when he or she is not available, especially in the event of an emergency?
• Are daytime, evening, or weekend appointments available? What about after-school appointments?
• Does the therapist offer discounted or sliding scale fees if he or she is not an approved provider for your health coverage?
• Does the therapist accept adoption subsidy medical payments or Medicaid reimbursement payments?
• Does the therapist have experience working collaboratively with school personnel including attending any appropriate school meetings.

Working with a Therapist Parents may request an evaluation meeting with the therapist 6-8 weeks after treatment begins. This evaluation meeting will help all parties "take a pulse" on progress of the treatment and to discuss the following areas:

• Satisfaction with the "chemistry" between the therapist and family members. (It is important for parents to understand that a trusting relationship between clinician and the child may take several weeks or longer to establish. This is particularly true of children who have had histories of significant loss and separations.)
• Mutually agreed-upon goals for treatment approaches and desired outcomes.
• Progress on problems that first prompted the request for treatment. Parents should realize that some behaviors need extensive intervention before progress can be identified.
• A tentative diagnosis.
• The therapist's evaluation of the chances that therapy can improve the situation(s) which prompted treatment.
• Follow through by the family with the therapist's recommendations. Practiced any "homework" assignments? (Parents should know that most of the "work" in therapy occurs between, not during, sessions and that it is a reciprocal process.)

The family's involvement and support of the therapy is often critical to a positive outcome for the child. Families must commit to keeping regularly scheduled appointments, and parents should not use therapy as a tool for discipline.

Family members must communicate regularly with the therapist and ensure that the therapist has regular feedback about conditions at home. The success of therapy depends heavily on open, honest and trusting communication.

Recognizing the need for outside support and early intervention when problems arise will help adopted children and their families navigate the challenges adoption presents as they grow and develop.

In Summary You can locate a therapist who has the experience and training best suited to your needs by checking with local, State, and regional referral sources. This may take more time but in the end, your research efforts should result in finding the mental health service provider best able to work with you and your child.

Resources

There are national professional organizations that will provide you with information regarding therapists that specialize in adoption issues. These organizations can direct you to therapists in your area.

The American Psychological Association (APA)
750 First Street, NE
Washington, D.C. 20002
202.336.5500
Website: http://www.apa.org/

The American Psychiatric Association
1400 K Street, NW
Washington, D.C. 20005
1.888.35.PSYCH (77924)
202.682.6000
Website: http://www.psych.org/

The American Association of Marriage and Family Therapy
1133 15th Street, NW
Suite 300
Washington, D.C. 20005
202.452.0109
Website: http://www.aamft.org/

The National Association of Social Workers
750 First Street, NE
Suite 700
Washington, D.C. 20002
202.408.8600
Website: http://www.naswdc.org/