Children’s Bureau/ACYF/ACF/HHS

800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

Adoption has a lifelong impact on those who 

experience it. After an adoption is finalized, 

therapy can be a useful support to help adoptive 

families with challenges that may arise at different 

phases of life. It is just one component of a range of 

services for adoptive families that can effectively 

address issues related to grief, attachment, or 

trauma. This factsheet provides suggestions for 

finding an adoption-competent therapist and offers 

information about the types of therapy that can 

help adopted children and their families. Foster 

parents considering adoption could face similar 

issues and therefore also may find definitions and 

descriptions in this factsheet useful. 

WHAT’S INSIDE

Approaches to therapy

Finding the right 

therapist 

Working with a therapist

Conclusion 

National resource 

organizations

Finding and Working With 

Adoption-Competent 

Therapists 

FACTSHEET 

FOR FAMILIES

November 2018
2

Therapy as Part of Adoption Support and Preservation Services

Adoptive families and adoption professionals recognize that children and families need different kinds of 

support and that those needs change over time. Like all families, adoptive families may seek therapy more 

than once as children go through different developmental stages and their needs change. Before adoption, 

during different developmental stages, and throughout life events—such as graduating from school, starting 

at a new school, getting married, and experiencing a death in the family—therapists can help children who 

have been adopted make sense of their feelings and emotional responses to these challenges. These life 

changes affect the parent and other family members as well, so they may also benefit from working with a 

therapist. 

Beyond therapy, other types of adoption support and preservation services (sometimes called postadoption 

services) are available. Postadoption supports can help you explain adoption to your preschooler, address the 

needs of a child who has experienced early childhood abuse and trauma, support your adopted teen’s search 

for identity, or provide guidance if your child decides to search for and reunite with his or her birth parents. 

Support may include educational seminars, webinars, and support groups for parents and children. Parents 

are encouraged to use postadoption support as much as needed to help manage the issues common to 

adoption as well as the more complex challenges associated with children who may have experienced abuse 

or neglect. 

Accessing a range of supports and services will help nurture healthy child and family development. For more 

information about support and how to find it, see any of the following Child Welfare Information Gateway 

resources: 

 Accessing Adoption Support and Preservation Services (factsheet for families): https://www.childwelfare.

gov/pubs/f-postadoption/ 

 Finding Services for an Adopted Child (webpage): https://www.childwelfare.gov/topics/adoption/

adopt-parenting/services

Experienced therapists who have a working 

understanding of loss, attachment, trauma, and brain 

development, as well as knowledge of issues associated 

with adoption, are best suited to help address the 

concerns of adoptive parents and effectively treat their 

children. Adoption-competent therapists understand 

that the origin of a child’s problems may be embedded 

in the abuse or neglect experienced before the child was 

adopted. They believe that children can heal within the 

context of new family relationships and with parents 

who have the skills to support children who come 

from traumatic beginnings. The therapist you choose 

must recognize the importance of including parents 

(and possibly other family members) in the treatment 

process. If you seek treatment from a therapist who 

attempts to exclude you as a parent, you may want to 

reconsider whether that professional is appropriate for 

you and your family. 

Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

This publication is available online at https://www.childwelfare.gov/pubs/f-therapist/.
Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

3

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

This publication is available online at https://www.childwelfare.gov/pubs/f-therapist/.

Approaches to Therapy 

Working with a therapist is not a sign of poor parenting 

but an opportunity to receive help that may be needed at 

different stages in a child’s life and family development. 

Reaching out for help at the earliest sign of difficulty 

shows strength and gives your family the best chance of 

working through difficult issues effectively and together.

Before starting therapy, a complete assessment helps 

identify the challenges to be addressed. Assessments 

may be designed as questionnaires or involve 

conversation or observation. A thorough assessment 

includes a series of different tests that may require an 

overall health assessment conducted by a physician, a 

psychiatric evaluation conducted by a child psychiatrist, 

or a vocational assessment completed by professionals 

trained in identifying the strengths and needs of children 

in a variety of environments. 

Mental health professionals may have training in a variety 

of treatment approaches to meet the diverse needs of 

the clients they serve. Before selecting a therapist, ask 

about the types of treatment they specialize in and about 

their experience working with adoptive families. For more 

detailed information about selecting a therapist, see the 

Finding the Right Therapist section of this publication.

In addition to different treatment options, different 

types of professionals provide therapy. Knowing your 

options is important. More information on various types 

of mental health professionals, as well as a helpline 

to assist in finding services in your State, is available 

on the website for the National Alliance on Mental 

Illness at https://www.nami.org/learn-more/treatment/

types-of-mental-health-professionals. 

Below are descriptions of different treatment approaches, 

followed by links to websites with general descriptions 

and examples of these therapies.

Behavior Modification. This therapy focuses on the 

specific behaviors that are of concern to a family. 

 Behavior Modification: http://www.tccwv.org/OurApproach/Behavior-Modification.aspx

 Parent-Child Interaction Therapy: http://www.pcit.org/

Family Therapy. This therapy seeks to achieve a balance 

between the needs of the individual and those of the 

family. The therapist uses sessions to build attachment 

relationships and improve communication between 

parents and children.

 Family Therapy: https://www.mayoclinic.org/

tests-procedures/family-therapy/about/pac-20385237

Group Therapy. This therapy allows a small group of 

clients with similar issues to discuss them together in an 

organized way. 

 The Benefits of Group Therapy: http://www.insteppc.

com/the-benefits-of-group-therapy/

 Parenting With Love and Limits: http://www.nafi.com/

innovations/parenting-with-love-and-limits

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.

 Why Play Therapy?: http://www.a4pt.org/page/

WhyPlayTherapy

 Theraplay®: https://www.theraplay.org/index.php/

theraplay

Situations and Treatments to 

Avoid

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. You should also avoid 

treatments that exclude the parents’ involvement 

in the process. Some States have written statutes 

or policies that restrict or prohibit the use of these 

therapies with children in the care or custody of a 

public agency or adopted from it.
Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

4

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

This publication is available online at https://www.childwelfare.gov/pubs/f-therapist/.

Cognitive Therapy. This therapy begins with the idea 

that the way people perceive situations influences how 

they feel. It is typically time limited, problem solving, and 

focused on the present. 

 Alternatives for Families: A Cognitive Behavioral 

Therapy: https://www.nctsn.org/interventions/

alternatives-families-cognitive-behavioral-therapy

 What Is Cognitive Behavior Therapy (CBT)?: 

https://beckinstitute.org/get-informed/

what-is-cognitive-therapy/

 What Is Cognitive Therapy?: https://www.

cognitivetherapynyc.com/What-Is-Cognitive-Therapy.

aspx

Trauma-Informed Therapy. Trauma-informed therapy 

acknowledges the impact that trauma has on children 

and recognizes that even an infant who experienced 

trauma may display behaviors related to that trauma at an 

older age. In other words, a child who isn’t old enough to 

“remember” a traumatic event may still experience the 

effect. Trauma-informed therapy focuses on specific ways 

to help process traumatic memories and experiences so 

they become tolerable. 

 ADOPTS (Address the Distress of Posttraumatic Stress) 

Therapy: https://qic-ag.org/logs/adopts-therapy/

 Trauma-Focused Cognitive Behavioral 

Therapy: https://www.nctsn.org/interventions/

trauma-focused-cognitive-behavioral-therapy

 What Is Trauma-Focused Therapy?: http://cctasi.

northwestern.edu/family/trauma-focused-therapy/

More information can be found on the National Child 

Traumatic Stress Network website at https://www.nctsn.

org/.

Attachment-Focused Therapy. This therapy focuses 

on building a secure emotional attachment between the 

child and his or her parents that can serve as a model for 

future positive relationships in all aspects of the child’s 

life. 

 Child Parent Psychotherapy – CPP: https://

www.attachmenttraumanetwork.org/

child-parent-psychotherapy-cpp/

 Dyadic Developmental Psychotherapy 

(DDP): https://qic-ag.org/logs/

dyadic-developmental-psychotherapyddp/

A Word About Attachment

The effect of abuse and neglect on the 

developing brain has revealed a lot about why 

children from chaotic and threatening homes 

often struggle to adjust to safe environments and 

lead healthy, positive lives. Children’s experiences 

with child maltreatment can negatively affect 

brain development and, consequently, the 

emotional, social, and behavioral functioning of 

the child. This can disrupt their ability to form 

healthy attachments, which allow children to trust 

and to form meaningful relationships throughout 

their lives. Children may experience attachment 

problems that range from difficulties relating to 

others to severe social-functioning disorders. 

Appropriate treatments can help parents build 

and foster secure attachments and cope with the 

behaviors that may result from earlier attachment 

disruptions.

 For information about attachment disorders, 

see https://www.attachmenttraumanetwork.

org/what-are-attachment-disorders/

 For information about attachment and signs of 

attachment problems, see http://www.attach.

org/faq/

 To find resources for parents, see http://www.

attach.org/for-parents/
Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

5

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

This publication is available online at https://www.childwelfare.gov/pubs/f-therapist/.

Finding the Right Therapist

Many different types of professionals provide mental 

health services. It is important to find an adoptioncompetent therapist who can address your family’s needs. 

Finding the right therapist means searching for one 

who has adoption-related experience and, if possible, 

has been trained in adoption competency. Take time to 

interview therapists by phone or in person to find the one 

with whom you feel most comfortable and who is the best 

qualified to help your child and family.

Interviewing Prospective Therapists. Call prospective 

therapists or schedule an initial interview to gather 

basic information. Interviews should start with a brief 

description of the concern or problem for which you need 

help. The following are some questions to discuss:

 Do you prefer to work with the entire family or only 

with children?

 What is your experience with adoption and adoption 

issues? How many adoptive families have you worked 

with? (Be specific about the adoption issues that 

affect your family, such as open adoption; transracial 

adoption; lesbian, gay, bisexual, transgender, 

and questioning adoption; searching for birth 

relatives; children who have experienced abuse 

or institutionalization; or children with attachment 

difficulties.)

 How long have you been in practice, and what 

degrees, licenses, or certifications do you have?

 Have you taken any courses/trainings in adoption 

competency?

 What approach to therapy do you use? (See 

“Approaches to Therapy” above.)

 What changes in the daily life of our child and family 

might we see as a result of the therapy?

 Do you give parents regular reports on a child’s 

progress?

 Can you estimate a time frame for the course of 

therapy?

 Do you work with teachers, juvenile justice personnel, 

daycare providers, and other adults in the child’s life, 

when appropriate?

The person or team best suited to work with your family 

will depend on your family’s specific issues, as well as the 

professional’s training, credentials, and experience with 

adoptive families. For more information about types of 

mental health professionals, visit the National Alliance 

on Mental Illness at https://www.nami.org/Learn-More/

Treatment/Types-of-Mental-Health-Professionals.

Identifying Prospective Therapists. Because adopted 

children can present the same problems common to all 

children, the therapist must be skilled in determining what 

problems are due to adoption and what problems are not. 

At a minimum, a therapist must be knowledgeable about 

the following issues:

 The psychological impact of adoption on children and 

families

 Loss as a core issue in adoption and how children 

process loss at different stages of development 

 The impact of trauma on children and families, as 

the most serious problems may result from traumatic 

experiences before adoption

 The role and impact of attachment on the mind and 

body of the developing child

The therapist must also have the following:

 Experience in working with adopted children and their 

families

 Knowledge of the types of help available for adoptionrelated issues and problems

 Training in working with adoptive families

To find a therapist, you may contact community adoption 

support networks, ask your placement agency for referrals 

to therapists, or search online. Many public and private 

adoption agencies and adoptive parent support groups 

provide lists of therapists who have been trained in 

adoption issues or who have effectively worked with 

children in foster care and adoption. Staff at some 

adoption agencies and postadoption services agencies 

are mental health therapists trained in adoption.
Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

6

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

This publication is available online at https://www.childwelfare.gov/pubs/f-therapist/.

Also check the following resources for therapist 

recommendations:

 Directory of Adoption-Competent Professionals: 

http://adoptionsupport.org/member-types/

adoption-competent-professionals

 National Foster Care and Adoption Directory Search 

(https://childwelfare.gov/nfcad) for: 

○ Public and private adoption agencies

○ Local adoptive parent support groups

○ Specialized postadoption services agencies

○ State adoption offices

 Family Preservation Services (webpage): https://www.

childwelfare.gov/topics/supporting/preservation

 Agency social workers involved in the child’s adoption

 State or local mental health associations

 National and State professional organizations (See 

“National Resource Organizations” below.)

Working With a Therapist

Your involvement in and support of your child’s therapy 

is critical to a positive outcome. For therapy to be 

successful, open communication between you, your 

child, and your therapist is a must. It’s important to 

keep scheduled appointments and commit to the full 

course length of treatment. Children whose lives have 

been affected by significant losses and traumas may 

require more extensive sessions or longer periods of 

treatment. While some children or teens may be resistant 

to engaging in therapy, you should refrain from using 

therapy sessions as punishment for their resistance 

or misbehavior. Family members must communicate 

regularly with the therapist about ongoing concerns 

as well as progress achieved. What is working is just as 

important as what is not working. 

You may want to request an evaluation meeting with 

the therapist 6 to 8 weeks after treatment begins and 

regular updates thereafter. Evaluation meetings will help 

all parties assess the progress of treatment and offer the 

opportunity to discuss the following:

 Satisfaction with the working relationship between the 

therapist, child, 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 diagnosis and ongoing treatment 

recommendations (usually necessary for insurance 

reimbursement)

 The therapist’s evaluation of whether therapy can 

improve the situation that prompted treatment

Even when the match with a therapist seems to be good 

initially, the relationship with the family or the results 

may change or become unsatisfactory over time. You 

should consider seeking a second opinion and possibly 

changing therapists if the therapy does not appear to 

be progressing appropriately. Discussing a change with 

the therapist may provide an opportunity to hear their 

perspective on your child’s progress and suggestions for 

alternatives. If you do change therapists, be sure to help 

your child understand the reasons for changing, especially 

if the child has developed a positive relationship with the 

first therapist. Remember the child’s history of loss and 

how to model healthy closure. Trust your thoughts and 

feelings; you are the expert on your children and you must 

decide what makes sense for them. 

Insurance Coverage and Other Funding for 

Therapy

The cost of therapy varies and may be covered in part 

by health insurance or the child’s adoption assistance 

agreement. Some States have extensive postadoption/

guardianship services that include comprehensive 

assessment, therapy, case management, support 

groups, and other services that are free to adoptive and 

subsidized guardianship children and families. Some 

therapists, and most community mental health centers, 

provide services on a sliding-scale fee based on income. 

Ask about costs and when payment is due (after each 

session or after reimbursement by insurance).

Insurance companies have varying requirements for 

coverage of mental health treatment. You may have to 

choose from a list of approved or in-network therapists, 

and there may be a specified time frame or a limit on the 
Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

7

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. 

This publication is available online at https://www.childwelfare.gov/pubs/f-therapist/.

number and types of sessions covered. You should ask the 

insurance company for the following information:

 The extent of coverage for mental health treatment 

(including whether it is covered and, if so, the time 

frames and limits on the sessions)

 Specialty areas of approved (in-network) providers

 Company policies regarding payment for treatment 

provided by therapists outside the plan or network

 Whether insurance will pay for an out-of-plan 

adoption-competent therapist if such a therapist is not 

available within the network

If your child has an adoption assistance agreement, you 

can check to see what the subsidy covers on the website 

of the North American Council on Adoptable Children 

at https://www.nacac.org/help/adoption-assistance/

adoption-assistance-us/state-programs. For State-specific 

information on adoption assistance, visit Information 

Gateway’s Adoption Assistance by State webpage 

at https://www.childwelfare.gov/topics/adoption/

adopt-assistance.

Conclusion

Many adoptive families have issues or concerns at 

different points in their lives that may affect their 

emotional well-being. Adoption-competent therapists, 

who understand adoption issues and adoptive families, 

are best suited to provide therapies based on the child’s 

and family’s needs. Finding the right therapist and 

managing the right therapy for your child takes effort 

and commitment. No one knows your child like you 

do. Successful therapy depends on your active role in 

engaging the right therapist, committing to the process, 

and being a part of the treatment.

National Resource Organizations

AdoptUSKids

Provides information and resources free of charge to 

adoptive families

888.200.4005, info@adoptuskids.org

https://www.adoptuskids.org

American Academy of Pediatrics

Supports the professional needs of pediatricians who 

work to improve the health and well-being of all children

847.433.9016, csc@aap.org

https://www.aap.org

Referrals: https://www.healthychildren.org/english/

tips-tools/find-pediatrician/Pages/Pediatrician-ReferralService.aspx

American Association for Marriage and Family 

Therapy 

Represents the professional interests of therapists 

concerned with the overall, long-term well-being of 

individuals and their families 

703.838.9808

https://www.aamft.org

Referrals: https://www.aamft.org/Directories/Find_a_

Therapist.aspx

American Psychiatric Association

Works to ensure humane care and effective treatment for 

all persons with mental illness 

202.559.3900, apa@psych.org

https://www.psychiatry.org

Referrals: http://finder.psychiatry.org

American Psychological Association 

Works to benefit society and improve people’s lives by 

creating, communicating, and applying psychological 

knowledge 

800.964.2000, practice@apa.org

http://www.apa.org

Referrals: http://locator.apa.org

Association for Play Therapy 

Promotes the value and therapeutic power of play to 

communicate with and treat children

559.298.3400, info@a4pt.org

http://www.a4pt.org

Referrals: http://www.a4pt.org/page/TherapistDirectory

Association for Training on Trauma and Attachment in 

Children 

Provides training to parents and professionals to promote 

healthy attachment and heal trauma

612.861.4222, questions@attach.org

http://www.attach.org
Finding and Working With Adoption-Competent Therapists https://www.childwelfare.gov

California Evidence-Based Clearinghouse for Child 

Welfare

Offers many resources and studies on cognitive and other 

therapies 

http://www.cebc4cw.org

Center for Adoption Support and Education 

Provides adoption-competent education, resources, and 

support services, including mental health services, for 

foster and adoptive families

301.476.8525, caseadopt@adoptionsupport.org

http://adoptionsupport.org

Referrals: http://adoptionsupport.org/member-types/

adoption-competent-professionals

ChildTrauma Academy

Works to improve the lives of high-risk children through 

direct service, research, and education

866.943.9779, cta@childtrauma.org

http://childtrauma.org

Child Welfare Information Gateway

Promotes the safety, permanency, and well-being of 

families and children by connecting them to information, 

resources, and tools covering topics on adoption and 

more

800.394.3366, info@childwelfare.gov

https://www.childwelfare.gov

 National Foster Care & Adoption Directory Search

http://www.childwelfare.gov/nfcad

 Choosing Therapy for Adopted Children and Youth

https://www.childwelfare.gov/topics/adoption/

adopt-parenting/services/therapy

 Lifelong Impact of Adoption

https://www.childwelfare.gov/topics/adoption/

adopt-people/impact

 Understanding the Emotional Impact of Adoption

https://www.childwelfare.gov/topics/adoption/birthfor/

emotional-impact

 Finding Mental Health and Substance Use Disorder

Treatment Services in Your State

https://www.childwelfare.gov/topics/systemwide/bhw/

resources/mh-sud

National Adoption Center

Supports the adoption community by providing free 

adoptive services

215.735.9988, nac@adopt.org

http://www.adopt.org

National Association of Social Workers

Works to enhance the professional growth and 

development of social workers, to create and maintain 

professional standards, and to advance sound social 

policies

202.408.8600

https://www.socialworkers.org

Referrals: http://www.helpstartshere.org/

helpstartshere/?page_id=3677

North American Council on Adoptable Children

Works to ensure that all children in foster care have 

permanent, loving families and that adoptive families have 

the support they need

651.644.3036, info@nacac.org

https://www.nacac.org

National Child Traumatic Stress Network 

Provides information on types of trauma, parenting, and 

treatments

919.682.1552, info@nctsn.org

https://www.nctsn.org/

Theraplay Institute

Provides Theraplay® training for mental health 

professionals, parents, and teachers

847.256.7334

http://www.theraplay.org

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau