FactSheet 

For FamilieS 

August 2005 

Selecting and 

Working With an 

Adoption Therapist 

Adoption has a lifelong impact on those it touches, 

and members of adoptive families may want professional help as concerns arise. Timely intervention by a professional skilled in adoption issues 

often can prevent concerns from becoming more 

serious problems. 

Professionals with adoption knowledge and experience are best suited to help families identify connections between problems and adoption and to plan 

What’s inside: 

• Professionals who provide mental 

health services 

• Approaches to therapy 

• Treatment settings 

• Finding the right therapist 

• National resource organizations 

• Resources 

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau 

Child Welfare Information Gateway 

Children’s Bureau/ACYF 

1250 Maryland Avenue, SW 

Eighth Floor 

Washington, DC 20024 

703.385.7565 or 800.394.3366 

Email: info@childwelfare.gov 

www.childwelfare.gov 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Selecting and Working With an Adoption Therapist www.childwelfare.gov 

effective treatment strategies. Sometimes a 

difficulty that a child is experiencing can be 

directly linked to adoption, but sometimes the 

connection is not readily apparent. In other 

situations, issues that seem on the surface to 

be related to adoption turn out not to be at 

all. It is important that the therapist understand that although the adoptive family is 

often not the source of the child’s problems, it 

will be within the context of the new family 

relationships that the child will begin to heal. 

This factsheet offers information on the 

different types of therapy and providers 

available to help adoptive families, and it 

gives some suggestions on how to find an 

appropriate therapist. 

Many issues experienced by adoptive 

families will not require professional 

assistance. For many families, 

postadoption services like support 

groups or education workshops and 

seminars will provide all the help that 

is needed. For information about the 

different kinds of postadoption services 

available and how to find them, see 

the Information Gateway factsheet 

Postadoption Services: A Factsheet for 

Families at www.childwelfare.gov/pubs/ 

f_postadoption.cfm. 

Professionals Who 

Provide mental 

health Services 

Many different types of professionals provide 

mental health services. The person or team 

best suited to work with a particular family 

will depend on the family’s specific issues, 

as well as the professional’s training, credentials, and experience with adoptive families. 

Pediatrician or Family Practice 

Physician 

These medical doctors specialize in childhood or adolescent care and typically treat 

routine medical conditions. They serve as 

primary care physicians who refer children 

for additional diagnostic studies or procedures and who coordinate referrals to 

specialists. 

Psychiatrist 

These medical doctors (with M.D. degrees) 

specialize in the diagnosis and treatment 

of medical and emotional disorders and 

substance abuse. After completing medical 

school, psychiatrists receive postgraduate 

training in psychiatric disorders, various 

forms of psychotherapy, and the use of 

medicines and other treatments. Some 

psychiatrists complete further training to 

specialize in such areas as child and adolescent psychiatry. Psychiatrists are able to 

prescribe medications. 

clinical Psychologist 

A clinical psychologist has completed a 

doctoral degree (Ph.D. or Psy.D.) in psycholThis material may be freely reproduced and distributed. However, when doing so, please credit  Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/f_therapist.cfm. 
 

 

 

 

Selecting and Working With an Adoption Therapist www.childwelfare.gov 

ogy 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, or family 

therapy. Clinical psychologists assess and 

treat mental, behavioral, and emotional disorders, including both short-term crises and 

longer term mental illnesses. 

clinical Neuropsychologist 

A clinical neuropsychologist holds a Ph.D. 

degree. These specialists have completed 

training in biological and medical theories 

related to human behavior. Their postgraduate training focuses on the assessment and 

treatment of brain diseases and injuries 

and neurological and medical conditions, 

including traumatic brain injury and learning and memory disorders. These professionals may be able to help in distinguishing 

organic (medical) problems from psychological problems. 

Social Worker 

A social worker has completed a bachelor’s 

(B.S.W.) or master’s (M.S.W.) degree in social 

work. Social workers are trained to focus on 

a child or family within the child or family’s 

social environment. Some social workers 

may refer to themselves as psychotherapists; 

however, they may or may not have professional training in psychological testing. 

Licensed clinical social workers (LCSWs) 

have a graduate degree and have passed a 

clinical test to become licensed in their State 

to offer counseling to individuals and families. Licensure and titles differ from State 

to State. 

marriage and Family therapist 

Marriage and family therapists have graduate degrees in counseling or psychology and 

may have taken a licensing exam to receive 

their Marriage and Family Therapy (MFT) 

license. Almost all States have licensing laws 

for marriage and family therapists. These 

professionals evaluate and treat mental 

and emotional disorders and other health 

and behavioral problems, addressing a 

wide array of relationship issues within the 

context of the family system. Family therapists focus on communication building and 

on family structure and boundaries within 

the family. 

licensed counselor 

A licensed professional counselor has a graduate degree in a specialty such as education, 

psychology, pastoral counseling, or marriage 

and family therapy, as well as a State license 

to practice counseling. Licensed professional 

counselors diagnose and provide individual or group counseling with a variety 

of techniques. 

Pastoral counselor 

Pastoral counselors include pastors, rabbis, 

ministers, priests, and others who provide 

faith-based therapy and counseling. They 

usually have a graduate degree (many have 

completed doctoral training), and many 

also have a special certification in pastoral 

counseling. They focus on supportive interventions for individuals or families, using 

spirituality as an additional source of support 

for those in treatment. Not all individuals 

who provide faith-based counseling have 

been formally trained or are credentialed as 

pastoral counselors. 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

It is important for adoptive families to share 

openly with their mental health professional that their family includes one or 

more adopted persons and to inquire about 

the counselor’s training and experience 

related to working with adoptive families 

and adopted persons. A growing number 

of States offer a postgraduate certificate to 

mental health professionals to help them 

to understand the dynamics of adoption 

and to tailor treatment modalities to the 

needs of families and individuals impacted 

by adoption. 

approaches to therapy

Different mental health professionals use 

different types of treatment. The type of 

treatment or the combination of treatments chosen may depend on the type 

and severity of the presenting issue, the 

age and developmental level of the child, 

and even the experience and preferences 

of the professional and family. Parents 

should be sure to ask prospective therapists 

about the different types of treatment that 

they might use. Some of these different 

types are described below. (A resource that 

rates the effectiveness of different treatment interventions for specific populations 

of children and families is the National 

Registry of Evidence-Based Programs and 

Practices at http://modelprograms.samhsa. 

gov/template_cf.cfm?page=effective_list.) 

Play therapy 

Therapists customarily use this form of 

therapy with very young children, who may 

not be able to express their feelings and 

fears verbally. The therapist will engage the 

child in games using dolls and other toys, 

since play is a way for children to communicate. Through gentle probing, the therapist 

will try to draw the child out. In this way, 

the child may be able to act out feelings and 

reveal deep-seated emotional trauma. 

individual psychotherapy 

This therapy may take many forms. Often 

the therapist will work to help the client 

first express problems verbally and then find 

ways to manage them. This type of therapy 

tends to stress that people should assume 

responsibility for their own actions and ultimately for their emotional well-being. The 

therapist will offer challenges, interpretations, support, and feedback to the client. 

Group therapy 

This therapy allows a small group of 

clients with similar problems to discuss 

them together in an organized way. Group 

therapy makes efficient use of a skilled therapist’s time and offers the extra advantage 

of feedback from peers. Occasionally, family 

members may be asked to join the group. 

Group therapy frequently is used with 

adolescents and usually is the treatment of 

choice for individuals and families affected 

by substance abuse. 

Family therapy 

Increasingly popular, family therapy is based 

on the premise that all psychological problems reflect a dysfunction in the “family 

system.” The term “dysfunction” means 

that members of a group or system are 

working together in a way that is harmful 

to some or all of its members. The therapist 

requests the active participation of as many 

family members as possible and focuses 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

on gaining an understanding of the roles 

and relationships within the family. Family 

therapy seeks to achieve a balance between 

the needs of the individual and those of the 

larger family system. 

Behavior modification 

A commonly used form of therapy, behavior modification has many practical applications. The basic approach in behavior 

modification is to use immediate rewards 

and punishments to replace unacceptable 

behavior with desirable behavior. The therapist will identify specific changes desired 

and will establish a system of rewards and 

punishments. The reasons behind the objectionable behavior are seen as irrelevant; the 

focus is on change. This therapy is especially useful with children who may not be 

inclined or able to examine and understand 

their inner feelings. 

cognitive therapy 

Cognitive therapy is based on the belief 

that the way we perceive situations influences how we feel emotionally. It is typically 

time-limited, problem-solving, and focused 

on the present. Much of what the patient 

does is solve current problems through 

learning specific skills, including identifying distorted thinking, modifying beliefs, 

relating to others in different ways, and 

changing behaviors. 

attachment therapy 

Attachment therapy includes a number 

of different approaches to therapy with 

children, but all approaches are based 

on common principles and theories of 

attachment and healthy development. 

Attachment therapy (sometimes incorrectly 

equated with holding therapy) includes an 

ever-expanding continuum of interventions 

based on treatment theories from an array 

of therapeutic approaches, including behavioral and cognitive therapies. 

A Word About AttAChment 

Many adopted children experience 

problems that may be the result of 

breaks in attachment that occurred 

during the first  years of life. These 

problems impair, sometimes severely, 

the child’s ability to trust and bond— 

to attach—to other human beings. 

Children who have experienced 

maltreatment or traumatic separations 

may be hesitant to trust others enough 

to attach quickly or easily. 

Attachment can be viewed as a 

continuum, with healthy attachment 

at one end and attachment disorder 

at the other. While a small percentage 

of children with attachment problems 

can be correctly diagnosed as having 

Reactive Attachment Disorder (RAD), 

many more adopted children display 

signs of some attachment difficulty, a 

midpoint along the continuum. Signs of 

attachment problems can include lack 

of conscience, lack of cause-and-effect 

thinking, superficial charm, obvious 

lying, stealing, indiscriminate affection 

with strangers, and cruelty to animals 

and people. 

The focus of any attachment therapy should 

be to build a secure emotional attachment 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

between the child and the parents. Because 

the primary focus is on the attachment relationship, not on the child’s symptoms, one 

or both parents must be active participants 

in the therapy. The basis of attachment 

therapy is that the development of a trusting attachment relationship will provide the 

security essential to healing the psychological, emotional, and behavioral issues that 

may have developed as a result of earlier 

disruptions and trauma. These issues may 

include posttraumatic stress disorder, grief 

and loss, depression, and anxiety. 

While some families find attachment 

therapy to be a useful approach, there is less 

evidence to support its effectiveness. As a 

relatively newer form of therapy, few studies 

of attachment therapy have been evaluated 

for outcomes. 

Treatments such as “holding therapy,” 

“rebirthing therapy,” or other types of 

treatment that involve restraint of the 

child or unwelcome or disrespectful intrusion into the child’s physical space have 

raised serious concerns among parents and 

professionals. Some States have written 

statutes or policies that restrict or prohibit 

the use of these therapies with children in 

the care or custody of the public agency or 

adopted from it. 

other therapies 

There are a number of other types of therapies, as well as variations of therapies, 

that may prove useful. These may include 

art therapy, music therapy, and couples 

therapy. Parents should ask the professional 

 Christian, S. (2002, November). Post-adoption services: Issues 

for legislators. NCSL State Legislative Report, 27(7). Denver, 

CO: National Conference of State Legislatures. 

to explain the treatment and goals before 

deciding on a particular therapy. 

treatment Settings 

Therapy may take place as in-home therapy, 

outpatient counseling, group or residential 

treatment, or inpatient hospitalization. 

Most therapy sessions take place in an outpatient setting. This means that the client 

is seen in the therapist’s office, typically 

in a 0-minute session once a week. Most 

emotional and psychiatric problems do not 

become serious enough to require treatment 

beyond this level. Many adoption-sensitive 

therapists believe that therapy for adoptive 

families benefits from a more flexible time 

schedule and is best done when the entire 

family is included. 

Sometimes a child can best be treated with 

the limits and structured environment that 

a residential treatment center provides. 

Residential treatment is often the treatment 

of choice for children and teens with emotional, behavioral, or substance abuse problems. Residential treatment centers, which 

provide -hour care, are generally private, 

nonprofit facilities set up for children with 

severe psychiatric or substance abuse needs. 

They may be organized in individual community homes, in a campus-type setting of 

cottages, or in a large institution (similar to 

a hospital setting). 

Residential treatment programs focus on the 

development of positive coping skills and 

personal responsibility. Behavioral therapy 

often is practiced in residential treatment 

programs; that is, the child’s good behavior 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

will bring about appropriate rewards and 

privileges. Children in residential treatment usually have regular visits with their 

parents. Family connections are critical 

to help motivate children to change their 

behavior so that they can return home. 

Hospitalization in a psychiatric hospital is 

available for clients with serious emotional 

problems that cannot be modified through 

outpatient therapy. It may be necessary for 

children who become suicidal or dangerous 

to themselves or others to be hospitalized 

to avert a crisis. It is important that parents 

stay involved; in fact, most child and adolescent units of psychiatric hospitals insist 

that parents participate in family meetings 

or therapy. If they are not automatically 

included, parents should be proactive in 

emphasizing the involvement of the family 

in their child’s treatment. 

Finding the right 

therapist

Locating the right therapist requires that a 

parent identify some prospective therapists 

who have adoption experience and then 

conduct preliminary interviews to find the 

one who seems best able to help the child 

or family. 

identifying Prospective therapists 

It is important that parents take the time to 

find a mental health provider who has the 

experience and expertise required to address 

their needs effectively. Professionals with 

adoption knowledge and experience are 

best suited to help families identify connections between problems and adoption and 

to plan effective treatment strategies. At a 

minimum, a therapist must: 

• Be knowledgeable about adoption and 

the psychological impact of adoption on 

children and families 

• Be experienced in working with adopted 

children and their families 

•Know the types of help available for 

adoption-related issues and problems 

• Have received training in working with 

adoptive families 

Parents may contact community adoption 

support networks, use the Internet, and 

ask their placement agency for referrals to 

therapists. Many public and private adoption agencies and adoptive parent support 

groups have lists of therapists who have 

been trained in adoption issues or who have 

effectively worked with children in foster 

care and adoption. Some adoption agencies 

and specialized postadoption service agencies have mental health therapists trained in 

adoption on staff. 

Parents can check with the following 

resources for therapist recommendations: 

•Agency social workers involved in the 

child’s adoption 

• State or local mental health associations 

• Public and private adoption agencies 

• Local adoptive parent support groups 

• Specialized postadoption service agencies 

• State adoption offices 

• National and State professional organizations (see National Resource 

Organizations below) 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

interviewing Prospective therapists 

Using the recommendations that they 

gather, parents can call prospective therapists or schedule an initial interview to find 

out basic information. Some therapists will 

offer an initial brief consultation that is free 

of charge. Parents should start by giving the 

clinician a brief description of the concern 

or problem for which they need help. The 

following are some questions to discuss: 

. What is your experience with adoption 

and adoption issues? (Parents should 

be specific about the adoption issues 

that impact their problem, such as open 

adoption, transracial adoption, search for 

birth relatives, children who have experienced abuse or institutionalization, 

children with attachment difficulties.) 

. How long have you been in practice, and 

what degrees, licenses, or certifications 

do you have? 

. What continuing clinical training have 

you had on adoption issues? 

. Do you include parents and other family 

members in the therapeutic process? 

. Do you prefer to work with the entire 

family or only with the children? 

. Do you give parents regular reports on a 

child’s progress? 

. Can you estimate a timeframe for the 

course of therapy? 

. What approach to therapy do you use? 

(See “Approaches to Therapy” above.) 

. What changes in the daily life of the 

child and family might we expect to see 

as a result of the therapy? 

0. Do you work with teachers, juvenile 

justice personnel, daycare providers, 

and other adults in the child’s life, 

when appropriate? 

There are other practical considerations 

when choosing a therapist. Parents should 

be sure to ask about: 

• Coverage when the therapist is not available, especially in an emergency 

•Appointment times and availability 

• Fees and whether the therapist accepts 

specific insurance, adoption subsidy 

medical payments, or Medicaid reimbursement payments (if applicable) 

Working With a therapist 

If the child is the identified client in 

therapy, the family’s involvement and 

support for the therapy is critical to a positive outcome for the child. An adoptioncompetent therapist will value the participation of adoptive parents. Traditional family 

therapists not familiar with adoption issues 

may view the child’s problems as a manifestation of overall family dysfunction. They 

may not take into account the child’s earlier 

experiences in other care settings and may 

view adoptive parents more as a part of the 

problem than the solution. Adoption-competent therapists know that the adoptive 

parents will be empowered by including 

them in the therapeutic process and that 

no intervention should threaten the parentchild relationship. 

Parents’ commitment to the therapy may 

also contribute to the success of the therapeutic process. For instance, parents are 

obligated to keep scheduled appointments. 

They should refrain from using therapy 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

sessions as punishment for a child’s misbehavior. 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 and 

trusting communication. 

Parents may want to request an evaluation 

meeting with the therapist  to  weeks 

after treatment begins and regular updates 

thereafter. Evaluation meetings will help all 

parties evaluate the progress of treatment 

and offer the opportunity to discuss 

the following: 

• Satisfaction with the working relationship 

between the therapist and family 

members 

• Progress toward mutually agreed-upon 

goals for treatment approaches and 

desired outcomes 

• Progress on problems that first prompted 

the request for treatment 

• The therapist’s tentative diagnosis 

(usually necessary for insurance 

reimbursement) 

• The therapist’s evaluation of the chance 

that therapy can improve the situation 

that prompted treatment 

The cost of therapy varies and may be covered in part by health insurance or the child’s 

adoption assistance agreement. Some therapists, and most community mental health 

centers, provide services on a sliding fee scale based on income. Parents should ask about 

costs and when payment is expected (after each session, at the end of the month, or after 

reimbursement by insurance). 

Insurance companies have different requirements for coverage of mental health 

treatment. Parents may have to choose from a list of approved therapists, and there may 

be a limit on the number and types of sessions covered. Parents should find out from the 

insurance company: 

• The extent of coverage for mental health treatment 

• Specialty areas of approved providers 

• Company policies regarding payment for treatment provided by therapists outside the plan 

• Whether insurance will pay for an out-of-plan adoption-competent therapist if such a 

therapist is not available within the network 

If the child has an adoption assistance agreement, parents should see what the 

subsidy covers. 

InsurAnCe CoverAGe And other FundInG For therApy 

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Selecting and Working With an Adoption Therapist www.childwelfare.gov 

conclusion 

Members of adoptive families may encounter issues at different points in their lives 

that affect their behavior and emotional 

well-being and that require treatment from a 

professional therapist. Adoption-competent 

therapists, who understand adoption issues 

and adoptive family dynamics, are best suited 

to provide clinical interventions. With some 

research, parents can find the therapist best 

able to support their child and family. 

National resource 

organizations

The American Academy of Pediatrics 

..000 

www.aap.org 

The American Association of Marriage and 

Family Therapy 

0..0 

www.aamft.org 

The American Association of Pastoral 

Counselors 

0.. 

www.aapc.org/index.cfm 

The American Psychiatric Association 

0.0.00 

www.psych.org 

The American Psychological Association (APA) 

00.. 

www.apa.org 

The Association for Play Therapy 

.. 

www.apt.org 

The Association for Treatment and Training 

in the Attachment of Children (ATTACh) 

.. 

www.attach.org 

The National Association of Social Workers 

0.0.00 

www.naswdc.org 

For contact information on State adoption 

offices and local adoptive parent support 

groups, access Child Welfare Information 

Gateway’s National Foster Care & Adoption 

Directory at www.childwelfare.gov/nfcad. 

Acknowledgment: This factsheet was 

developed by Child Welfare Information 

Gateway, in partnership with Susan 

Freivalds. This document is made possible 

by the Children’s Bureau, Administration 

on Children, Youth and Families, 

Administration for Children and Families, 

U.S. Department of Health and Human 

Services. The conclusions discussed here are 

solely the responsibility of the authors and 

do not represent the official views or policies 

of the funding agency. 

Suggested Citation: Child Welfare 

Information Gateway. (00). Selecting 

and Working With an Adoption Therapist: A 

Factsheet for Families. Washington, DC: U.S. 

Department of Health and Human Services. 

This material may be freely reproduced and distributed. However, when doing so, please credit 0 Child Welfare Information Gateway. Available online at www.childwelfare.gov/pubs/f_therapist.cfm.