Questo articolo è stato adattato dal materiale sviluppato dalla Dott.ssa Fahlberg sull’assistenza ai bambini con assenza di attaccamento e bambini “confusi” da multipli collocamenti, presentato anche nei suoi libri. I lettori possono trovare questo articolo ed altri in Internet all’indirizzo  http://www.perspectivespress.com/ourfactsheets.html

INTRODUZIONE

Una delle principali funzioni genitoriali consiste nel creare un ambiente che permetta al bambino di raggiungere la sua piena potenzialità in tutte le aree dello sviluppo: fisica, cognitiva e psicologica.  Anche se di solito i progressi in queste tre aree si intrecciano, frequentemente lo sviluppo fisico si dimostra precursore rispetto a quello cognitivo e psicologico. A  loro volta, i progressi raggiunti in queste ultime sfere incidono, comunque, sullo sviluppo fisico successivo.

In generale, se ci sono ritardi in una delle aree dello sviluppo, questi incidono su altre aree principali. Una volta che il bambino si è “bloccato” in termini di sviluppo in qualsiasi delle tre aree principali, è probabile che gli effetti sulla continuazione della crescita e dell’evoluzione si faranno sentire anche nelle altre sfere.

La crescita e l’evoluzione del bambino sono in funzione delle interazioni tra lui, i membri più stretti della famiglia, particolarmente le figure genitoriali, ed il suo ambiente. Problemi connessi anche ad uno solo di queste tre variabili possono provocare l’interruzione della normale progressione dello sviluppo.

La maggior parte dei bambini che entrano, per qualsiasi motivo, nel sistema di collocamento dei minori, incontrerà problemi relativi alla continuazione della crescita e dell’evoluzione, rispetto alla norma. Se lo sviluppo del bambino è stato normale in tutte le sfere e se il bambino ha avuto una vita familiare normale fino al momento del collocamento (in tal caso si potrebbe presupporre che sia stata una crisi familiare a motivare il collocamento), è probabile che la separazione dalla famiglia provocherà un’interruzione della normale progressione dell’evoluzione e nella crescita.

Più frequentemente sono già sorti gravi problemi prima dell’ingresso del bambino nel sistema di collocamento dei minori. L’origine di tali problemi potrebbe essere attribuibile a condizioni presenti nel bambino dalla nascita o a fattori di stress esistenti all’interno della famiglia. Quale che sia la situazione, non è stato offerto un ambiente che soddisfi i bisogni del bambino. Una volta sviluppato un problema nell’una o nell’altra area (bambino o famiglia), troviamo, ancora una volta, che questo, di per sé, andrà ad incidere sull’altra area. Le reazioni di un bambino incideranno sui comportamenti dei genitori; i comportamenti dei genitori avranno un effetto su come reagisce il bambino. Più che reazioni lineari, reazioni cicliche sono comuni nelle famiglie. I fattori ambientali tendono a modificare i comportamenti sia degli adulti, sia dei bambini.

Possiamo quindi comprendere come un bambino che entra nel sistema del collocamento dei minori sia particolarmente soggetto al “blocco” in una delle aree inerenti alla normale progressione delle funzioni evolutive. Come abbiamo notato prima, è probabile che ciò abbia in una certa misura un effetto sulle altre aree principali dello sviluppo. Chi di noi lavora con questi bambini, a qualunque titolo, è tenuto ad identificare i problemi e a tentare di assicurare che venga creato un ambiente ottimale per rispondere ai bisogni attuali del bambino in modo che possa “sbloccarsi” ed essere di nuovo pronto per la continuazione della crescita e dello sviluppo in tutte le aree.

La nostra esperienza ci dice che, avvenuto l’ingresso del bambino nel sistema di collocamento dei minori, è importante identificare come e dove si sia “bloccato”, nonché il perché. Sapere “il come”, “il perché” ed “il dove” ci farà capire cosa dobbiamo fare per aiutare il bambino a districarsi dal blocco e renderlo libero per una crescita futura sana ed ulteriori cambiamenti evolutivi.

Quattro modi in cui i bambini si “bloccano”


I modi in cui i bambini si possono “bloccare” sono stati suddivisi in quattro aree:

1. Il bambino può presentare ritardi dello sviluppo in una o in tutte le tre aree principali: fisica, cognitiva e psicologica.

2. Potrebbe aver sviluppato pattern anormali (o maladattivi) di comportamento.

3. Problematiche irrisolte relative alla separazione possono portare il bambino a “bloccarsi”.

4. Errate percezioni, su base organica o su base psicologica, possono essere di forte intralcio alla normale progressione della crescita e dei cambiamenti evolutivi.

In tutte queste situazioni le energie del bambino sembrano spese per tener testa ai problemi, lasciando poca energia disponibile per la continuazione della crescita e del cambiamento. Non è raro vedere bambini intrappolati negli stessi pattern per molti anni. Frequentemente vediamo bambini che a distanza di anni dalla separazione dai genitori di nascita, continuano ad essere “congelati” al livello di sviluppo psicologico che avrebbe dovuto essere presente al momento della separazione. Ad esempio, un bambino di otto o nove anni può essere ancora impegnato nella conquista dell’autonomia, la quale di solito è già conclusa tra i due e i tre anni, oppure un bambino di sette anni può continuare a dipendere dalla protezione e dalla sicurezza fornite dall’esterno, piuttosto che apprendere qualche grado di auto-controllo.

 In seguito a trasferimenti non è insolito osservare periodi di regressione nel funzionamento. Questa è la norma per tutte le persone, ma è più evidente sia nel bambino che ha sperimentato molti trasferimenti, sia nel bambino che già presenta segni di uno sviluppo ritardato o anormale.

Come aiutiamo il bambino a “sbloccarsi”?

Nel mio lavoro di trattamento residenziale ho appreso che il vero strumento terapeutico consiste nella quotidianità della situazione abitativa. Si può adattare questo ai sistemi di affidamento e di adozione attraverso il riconoscimento che esistono similarità tra queste due situazioni ed  il trattamento residenziale. In entrambi i casi il bambino è stato prelevato da un ambiente che ha favorito lo sviluppo di problemi, o almeno non ne ha posto fine, ed è stato collocato in quello che si spera sia un ambiente correttivo.

Se noi ci rendiamo conto di questo, i terapeuti possono riconoscere che il loro ruolo nel percorso di assistenza sia quello di diventare esperti nell’individuazione del come e del dove il bambino si è “bloccato”, e poi lavorare con la nuova famiglia per creare strategie che servano ad offrire stimoli ottimali per la continuazione della crescita e dell’evoluzione del bambino all’interno della struttura familiare, aiutando in questo modo il bambino a “sbloccarsi”. È lo stesso ruolo del consulente che opera in una struttura di trattamento residenziale. Si esige che il consulente proceda con la presa in carico, raccogliendo l’input costituito dall’anamnesi,  da test formalizzati e dalle osservazioni giornaliere degli operatori socio-sanitari, per individuare poi ciò che il bambino ci sta facendo capire riguardo ai suoi bisogni. Si esige inoltre che il consulente aiuti gli operatori socio-sanitari a sviluppare un piano per l’attuazione di apprendimenti nuovi per il bambino nel contesto della quotidianità della situazione abitativa.

Il ruolo rimane uguale quando i terapeuti lavorano con famiglie adottive o affidatarie. I terapeuti devono individuare quali siano i bisogni del bambino relativi allo sviluppo, quali le esperienze di apprendimento nuove o correttive di cui ha bisogno, quali le errate percezioni del bambino, e poi aiutare la famiglia a sviluppare un piano di rimediazione familiare quotidiana. Il piano deve coincidere con il funzionamento generale della famiglia e con i bisogni della famiglia. Di conseguenza deve necessariamente variare da famiglia a famiglia, poiché ciascuna famiglia costituisce un sistema unico. 

LE QUATTRO AREE PROBLEMATICHE

Ritardi dello sviluppo: Il nostro compito è individuare i livelli evolutivi di funzionamento del bambino e in seguito aiutare la famiglia a creare un ambiente congruo rispetto a quei livelli piuttosto che all’età cronologica. Per fare ciò serve una conoscenza della normale progressione dello sviluppo.

Per i bambini che si trovano nel sistema di collocamento, livelli di sviluppo chiaramente disomogenei sono consueti. Questi bambini di solito presentano alcune aree di ritardo, mentre altre aree si avvicinano di più a livelli normali dello sviluppo. Il nostro obiettivo è individuare le prime e utilizzare le aree di forza per effettuare il processo di rimediazione.

I ritardi dello sviluppo del linguaggio sono molto comuni tra i bambini in età pre-scolare nel sistema di collocamento. Riguardo lo sviluppo delle abilità grosso-motorie, i ritardi sono meno comuni e frequentemente sono meno severi, ma non è insolito incontrare bambini in età pre-scolare con ritardi che variano dai 6 ai 12 mesi. Anche i ritardi nella motricità fine e quelli relativi all’integrazione percettivo-motoria sono fenomeni comuni. I rapporti interpersonali di alcuni bambini sotto tutela affidataria sono caratterizzati da livelli molto più elementari rispetto alla loro età. Un bambino di sette o otto anni può essere capace di giocare stando solo accanto ai coetanei piuttosto che condividere il gioco e giocare a turni – un’abilità di solito già raggiunta entro i quattro anni di età.

Le paure e le preoccupazioni che sono normali nei primi anni di vita, frequentemente persistono molto oltre questa fascia d’età nel bambino sotto tutela affidataria. Tali paure possono inoltre essere di un’intensità singolare, fattore che interferirà con il funzionamento quotidiano del bambino.

Se il nostro compito è quello di aiutare il bambino a crescere in termini di sviluppo e a seguire i consueti percorsi evolutivi, dobbiamo aiutare coloro che vivono con il bambino a creare un ambiente che quotidianamente non solo risponde ai bisogni evolutivi tipici di un’età più giovane di quella del bambino, ma offre anche stimoli adeguati per la continuazione della crescita.

Pattern maladattivi: Quando sono presenti pattern maladattivi di comportamento, dobbiamo riconoscere i pattern, nonché renderci conto di come essi abbiano origine per poterci focalizzare sulla costruzione di un ambiente che offra al bambino un’esperienza di rimarginazione. A questi bambini servono opportunità per riapprendere pattern più normali dei legami tra adulti e bambini. Dobbiamo tenere sempre a mente che riapprendere qualcosa è più difficile e richiede più tempo che impararlo nel modo giusto la prima volta. Nella maggior parte di questi casi il bambino non ha avuto l’opportunità di vivere in una famiglia in cui i rapporti adulti-figlio sono basati sul beneficio del bambino e successivamente questo fattore diventerà cruciale nel nuovo ambiente.

Si osservano due pattern maladattivi molto comuni nei bambini che hanno subito abusi. Questi bambini hanno imparato a presumere che ciò sia un normale rapporto genitore- figlio. Possono difendersi psicologicamente ritirandosi in se stessi o evitando interazioni con adulti, oppure imponendosi affinché siano loro a controllare il rapporto e quello che succede loro.

Non è insolito per questi bambini tentare di ricreare lo stesso rapporto adulto-bambino quando entrano a far parte di nuove situazioni di convivenza. Nel caso dei bambini che impongono la propria autonomia in maniera inappropriata, è importante per noi capire che questo non significa assolutamente che al bambino piaccia il dolore fisico, ma piuttosto che vuole verificare le proprie percezioni dei rapporti adulti-bambino. Questi bambini arrivano all’interno di nuove situazioni e si comportano in modi che possono persino sembrare inviti ad ulteriori abusi. Sembra che “se la siano voluta” e possono anche sembrare “sollevati” se riescono a portare un adulto ad adoperare nuovamente un’eccessiva disciplina fisica nei loro confronti.

Il desiderio del bambino di ricreare tali situazioni mira a confermare la sua abilità a percepire il suo ambiente con precisione, piuttosto che a voler semplicemente essere colpito fisicamente. Gli adulti che vivono con questi bambini devono rendersi conto che tutte le volte che sono provocati e portati ad esercitare una disciplina eccessiva, stanno rafforzando il pattern maladattivo. L’esperienza di apprendimento correttiva richiede che il rapporto adulto-bambino sia non-abusante.

Questo particolare pattern  maladattivo  è comunemente reso più complesso a causa di un’errata percezione di come tutti i genitori dimostrano l’amore. Alcuni bambini che hanno subito abusi, ma che sono anche stati amati dalle loro famiglie di origine, confondono le due cose in un unico intreccio, e pensano che “se un genitore mi  ama per davvero, mi picchierà”. È importante che noi sappiamo se un bambino ha questa errata percezione in particolare, cosicché si possano sviluppare strategie speciali per separare le due cose. Noi vorremmo che il bambino imparasse a sentirsi amato senza l’abuso.

Un secondo e frequente pattern maladattivo è osservabile in bambini che hanno subito abusi sessuali. Nel tipo di abuso sessuale più comune, cioè l’incesto tra padre e figlia, la bambina impara che “questo è il modo in cui i padri e le figlie interagiscono”. Quando una bambina con queste esperienze entra all’interno di una situazione abitativa alternativa, potrebbe continuare a comportarsi come le è stato insegnata prima. Lei cerca di mantenere la sua parte del rapporto. Le figure genitoriali sostitutive potrebbero commentare, “non c’è da stupirsi che questa bambina sia stata abusata sessualmente: è seducente e se la cerca”.

Dobbiamo capire, ancora una volta, che la bambina vuole una riconferma delle sue percezioni del mondo e che, come tutte le persone normali, desidera l’intimità fisica. Occorre distinguere questi bisogni dal comportamento che manifesta e insegnare alla bambina che nella maggior parte delle famiglie i rapporti padre-figlia sono diversi. Ha bisogno di imparare che può avere un’intimità fisica con il genitore maschio in maniera non sessuale. Di nuovo, i caregiver presenti quotidianamente devono essere consapevoli di come sia stato appreso il pattern precedente e loro stessi hanno bisogno di aiuto per elaborare una strategia di rieducazione. Incoraggiando la bambina ad evitare il genitore del sesso opposto chiaramente non può offrire la possibilità di un sano riapprendimento. Si deve, ancora una volta, focalizzare l’attenzione sull’insegnamento di cosa siano rapporti genitore-figlio più normali. Generalmente il genitore dello stesso sesso del bambino abusato sessualmente si trova in una posizione migliore per assumere il ruolo attivo nell’insegnamento di ciò che è appropriato nelle interazioni con il genitore del sesso opposto.

Se un bambino con pattern maladattivi riesce a far sì che gli adulti si comportino nei suoi confronti così come avveniva nell’ambiente precedente, abbiamo fallito nel nostro compito di rieducazione terapeutica.

Problemi relativi alla separazione: Alcuni bambini sembrano investire tutte le loro energie in rapporti che non fanno più parte della loro vita quotidiana. Ciò significa che resta poca energia disponibile per percepire cosa stia succedendo ora, per elaborarlo e per utilizzare i rapporti attuali per la continuazione della crescita e dei cambiamenti evolutivi. Con il passare del tempo, le energie si deviano verso un rapporto fantasticato: un “se solo fossi con… le cose andrebbero così.” Questo, necessariamente, è fantasia in quanto nessuno è in grado di assicurare ciò che accadrebbe se i rapporti precedenti fossero ancora in corso. Con l’aumentare del periodo di tempo tra il momento della separazione e il presente, diminuisce ancora di più la probabilità che questa fantasia possa somigliare alla realtà.

Da questo punto di vista, le separazioni più difficili sono quelle in cui sono stati altri a separare il bambino e le figure genitoriali, siano essi genitori di nascita o genitori adottivi, contro la volontà delle parti. Il bambino, in casi come questi, raramente ha ottenuto il permesso di andare via e di far strada nella vita. Di conseguenza, il bambino tenderà a pensare che se si avvicina ai nuovi caretaker, impara ad amarli e fa strada, deluderà le persone che in passato erano così importanti per lui.

Se i genitori, verbalmente o attraverso i loro comportamenti, rivelano chiaramente che loro: 1) non vogliono il bambino con loro, o 2) non sono in grado di soddisfare i bisogni del bambino, allora siamo nella condizione di aiutarlo a comprendere la separazione e di elaborarla. Possiamo aiutarlo ad affrontare il fatto che non può fare niente se il genitore non vuole il suo ritorno a casa, o se il genitore rifiuta di cambiare il proprio comportamento e dunque soddisfare meglio i bisogni del bambino. Per il bambino questo non è un compito facile da svolgere, ma si basa sulla realtà e quindi è più facile da confermare e risolvere rispetto a percezioni basate sulla fantasia.

In generale, è più facile aiutare il bambino a risolvere la questione se facciamo in modo che siano i genitori a comunicare il messaggio direttamente al bambino. Quando assumiamo la funzione di interpreti/intermediari, nel tentativo di proteggere il bambino dal suo dolore, è facile che il bambino focalizzi su di noi i suoi sentimenti relativi alla separazione. A volte poi, siamo di conseguenza messi sulla difensiva e non siamo più in grado di essere di aiuto nel percorso di risoluzione perché il bambino vede noi come i responsabili del suo stato. Se egli ci ritiene responsabili della separazione, potrebbe darsi che, così facendo, il bambino sia messo nella condizione di “dimostrarci che abbiamo torto” intralciando i suoi collocamenti successivi. In questo modo ci dà la prova che averlo spostato non è stata la scelta giusta.

Se il bambino si è bloccato di fronte a questioni riguardanti la separazione, dovremo poi aiutarlo ad affrontare la realtà. Ciò potrebbe richiedere la necessità di stabilire un contatto con le figure genitoriali precedenti o con altri parenti tramite incontri diretti, lettere o telefono. A volte è necessario persino aiutare un bambino a scrivere una lettera a qualcuno che probabilmente non risponderà. Se una risposta alla lettera non arriva, siamo in una posizione che ci permette di aiutare il bambino ad affrontare i sentimenti suscitati di conseguenza. Se invece arriva una risposta, possiamo aiutare il bambino ad affrontare il messaggio ricevuto. Se non gli permettiamo di scrivere, in realtà stiamo sostenendo la sua fantasia del “se solo i miei genitori sapessero…”. Le forti emozioni associate alla separazione vengono poi spostate su di noi. Il bambino ci può incolpare per la sua rabbia o per la sua depressione: “È perché non mi avete lasciato contattarli”. Il nostro lavoro non è quello di proteggere il bambino dalla realtà, ma di aiutarlo a fronteggiarla.

Se il genitore e il figlio sono stati separati da tempo e il bambino sta investendo tutte le sue energie nel rapporto passato, forse dovremmo permettere a lui e al genitore di riunirsi, anche in presenza di dubbi che tale collocamento possa riuscire a lungo termine. Ciò è necessario per far rientrare la situazione in termini realistici, affinché possiamo aiutare il bambino con l’elaborazione della separazione in base ad una realtà piuttosto che ad una fantasia. Dovremmo assicurare, ovviamente, che non ci siano rischi per l’incolumità fisica del bambino e dovremmo supportare il bambino che sta affrontando la realtà della situazione e vi si stia adattando.

Alcune volte tornare ai luoghi del passato può aiutare il bambino a ricordarne quanto basta per rendere possibile la risoluzione. Se sono morti i caretaker precedenti, fotografie o visite al cimitero possono servire a facilitare il processo di risoluzione.

Nel percorso terapeutico, la questione più importante è spesso quella per la quale il paziente può fare poco o niente. Frequentemente la questione ha a che fare con la separazione. Per esempio, se il bambino è intrappolato in fantasie su un genitore di nascita che è deceduto e sta investendo le sue energie nel pensiero “se solo non fosse morto”, l’obiettivo è quello di aiutarlo ad affrontare il fatto che questa è una cosa sulla quale non ha nessun controllo. Non c’è niente che possa fare per cambiare la situazione. Ha comunque, in qualche misura, il controllo sull’influenza che la morte del genitore potrà avere sulla propria vita.

In molti casi, le persone dedicano molte più energie ad affliggersi per situazioni sulle quali non hanno alcun controllo e ad evitare quelle situazioni sulle quali invece hanno il pieno controllo. Il nostro lavoro, come terapeuti, è quello di aiutare le persone a distinguere i due tipi di situazione e di far sì che siano loro ad assumersi la responsabilità per la decisione su dove investire le proprie energie.

Le questioni relative alla separazione sono una causa principale di problemi a lungo termine e proprio per questo dobbiamo comprendere che il tempo impiegato nel tentativo di ridurre al minimo il trauma provocato da spostamenti è speso bene. La nostra prima linea di difesa consiste nel prevenire spostamenti inutili. Qualora però questi siano necessari, dobbiamo tenere a mente che quando un bambino si sente parte del processo decisionale, senza averne comunque tutta la responsabilità, ha meno probabilità di “bloccarsi” nel groviglio di problematiche irrisolte attinenti alla separazione. Se lavoriamo con cura durante la fase preparatoria, precedente il collocamento, e miriamo a trasferire coscienziosamente i progressi comportamentali e l’attaccamento, anche queste due azioni costituiranno misure preventive che potranno ridurre la probabilità di gravi difficoltà relative alla separazione.

Abbiamo poco controllo sulle circostanze che sono all’origine dei molti problemi presentati dai bambini che si trovano nel sistema di assistenza ai minori. Le questioni irrisolte inerenti alla separazione rappresentano un’eccezione. Abbiamo non solo un controllo sulle circostanze dei trasferimenti, ma anche modi riconosciuti per ridurre il trauma degli spostamenti, qualora questi ultimi debbano per forza avvenire.

Errate percezioni: Rispetto alla popolazione di bambini in generale, i bambini che si trovano nel sistema di assistenza ai minori hanno una probabilità più alta di avere disabilità di apprendimento e problemi percettivi di natura organica. I problemi percettivi possono essere di tipo visivo o uditivo. I bambini con questi problemi hanno anche più probabilità di essere più frustrabili e più impulsivi di altri bambini. Sono frequentemente caratterizzati da una breve durata dell’attenzione e sono emotivamente labili. In questi casi il nostro lavoro ha un duplice indirizzo: un aspetto riguarda l’assistenza fornita ai caregiver primari per creare un ambiente che aiuti il bambino ad imparare ad affrontare le frustrazioni, l’impulsività, ecc.; l’altro riguarda il lavoro da fare insieme ai caregiver per arrivare alla comprensione di come questo bambino percepisce il mondo, utilizzando  quindi gli adulti come mediatori per la focalizzazione dell’attenzione e per la correzione delle errate percezioni. Dobbiamo imparare a vedere e ad udire attraverso gli occhi e le orecchie del bambino se intendiamo aiutarlo a costruire un’immagine coerente del mondo.

Un secondo tipo di errata percezione, collegata al pensiero magico, spesso riguarda gli spostamenti. Nei suoi sforzi per capire il senso di questo mondo, il bambino cerca di trovare le cause di ciò che gli è successo. Tuttavia, spesso le cause sulle quali il bambino concentra l’attenzione non riguardano i veri motivi degli spostamenti. Se il bambino continua a funzionare come se il suo senso di causa ed effetto o il suo pensiero magico fossero veritieri, potrebbe sviluppare ulteriori problemi. Per esempio, quando un bambino è stato trasferito altrove, spesso ritiene se stesso responsabile per effetto del pensiero egocentrico. Può provare a trovare un senso alla situazione agganciando insieme come cause ed effetti fatti non correlati tra di loro. Si può fare ciò consciamente o inconsciamente. Il bambino tende a pensare: “se solo non avessi… tutto sarebbe andato bene”. Se il suo “se solo” non si basa sulla realtà, non giocherà a suo favore e potrebbe portare a problemi crescenti mano a mano che egli andrà alla ricerca di verifiche di questa sua errata percezione. Per esempio, un bambino trasferito poco dopo l’arrivo di un neonato in famiglia potrebbe presumere che l’arrivo di questo neonato sia la causa della propria partenza, mentre invece non lo è. Dall’altra parte, potrebbe sviluppare sentimenti di responsabilità per la separazione per effetto del pensiero magico del tipo “i desideri fanno avverare le cose”. Per esempio, un bambino piccolo che era arrabbiato con un adulto nei giorni appena precedenti al trasferimento potrebbe percepire la sua rabbia come la causa del trasferimento.

Un’attenta osservazione dei messaggi verbali e non verbali del bambino in prossimità del momento dei trasferimenti spesso fornisce indicazioni sulla particolare modalità del pensiero magico del bambino. Le percezioni nel presente possono attingere da vecchi ricordi a livello subconscio e portare a problemi comportamentali continuativi. Questo, ancora una volta, deve essere visto come degli sforzi sani del bambino di trovare un senso alle proprie percezioni.

Problemi possono anche sorgere se il bambino prende i vecchi messaggi dei genitori per verità assolute. Per esempio, se un genitore precedente ripeteva “sei cattivo” o “se non la smetti di piangere, ti lascio”, il bambino potrebbe interiorizzare questi messaggi e continuare a comportarsi come se fossero verità assolute, Le minacce di abbandono sono particolarmente dannose per i bambini piccoli poiché sono di solito proferite da genitori che ritengono il figlio responsabile per i problemi. Le minacce vengono fatte generalmente in modo che il figlio diventi responsabile per il comportamento dell’adulto. Per esempio, il genitore che minaccia un bambino che sta facendo capricci in mezzo ad un negozio dicendo “se non la smetti con questa scenata, ti lascio qui”, sta insinuando che tutta la responsabilità per il comportamento dell’adulto è nelle mani del bambino. Non c’è nessun riconoscimento della realtà che è l’adulto ad avere molte opzioni e che anche la responsabilità di sceglierne una è dell’adulto.

Il nostro lavoro è quello di aiutare a chiarire le errate percezioni e/o il pensiero magico del bambino, e di correggerli o durante il lavoro individuale col bambino, o attraverso le interazioni successive giorno per giorno. Normalmente un approccio che comprende entrambi è il più produttivo.

STRUMENTI PER INDIVIDUARE COME IL BAMBINO SI È BLOCCATO:

Il Lifebook [il Libro-Storia della vita del bambino] è uno strumento molto potente di aiuto per l’identificazione di come e dove il bambino si sia “bloccato”. Mano a mano che si completa o si rivede un Lifebook, ci sono occasioni per individuare forti emozioni suscitate da eventi passati, tra cui le separazioni, e per correggere errate percezioni.

Il Lifebook ci dà delle occasioni per concludere questioni relative alla separazione o per riconoscere quale tipo di contatto con persone o luoghi del passato potrebbe risultare utile a questo bambino particolare, allo scopo di risolvere vecchie questioni. Ci dà delle opportunità per vedere come i pattern maladattivi si sono sviluppati e per condividere queste informazioni con il bambino. Lavorare sul Lifebook è un modo per identificare errate percezioni e/o il pensiero magico affinché sappiamo ciò che occorre chiarire per poter aiutare il bambino.

Spesso per aiutare il bambino “bloccato” è necessario occuparsi con “pignoleria” di fatti e dettagli piccoli. Nel corso di questo processo si evidenziano sia le errate percezioni, sia i sentimenti sottostanti. Di solito è necessario separare i sentimenti dai comportamenti, accettando i primi e affrontando i secondi. Dobbiamo spalancare delle scelte al bambino ed aiutarlo a diventare responsabile delle sue azioni. Cosa potrà mai fare in futuro se continuerà ad avere gli stessi sentimenti di sempre? Dobbiamo insegnargli attivamente dei modi alternativi per esprimere i suoi sentimenti e per farlo bene, dobbiamo includere i suoi caregiver attuali nella terapia. Se non dovessimo includerli, correremmo il rischio di insegnare al bambino un modo di esprimere sentimenti non accettabile per loro e questo porterebbe al rafforzamento della mancanza di accettazione da parte dei caregiver.

Dobbiamo focalizzare il lavoro su come aiutare il bambino e la famiglia a trovare un senso, a comprendere come il bambino sia arrivato al punto in cui si trova ora. Questo, di per se, aumenta l’autostima e manda un messaggio che dice: “In fondo sei una persona saggia e percettiva”. Dopodiché possiamo impegnare il bambino a far uso di queste stesse qualità nell’immediato e farlo diventare attivamente partecipe nel decidere ciò che vuole nel presente e nel futuro, nonché come procederà per ottenerlo. Se riusciamo ad aiutare il bambino e la famiglia a trovare il senso dei comportamenti che non giocano a suo favore, sarà più facile per lui abbandonare tali comportamenti e per la famiglia intravedere la salute nel figlio.

Il compito consiste nell’aiutare tutti a capire che una volta questi comportamenti erano adattivi e avevano uno scopo utile, ma ora sono maladattivi e non hanno alcuno scopo utile. Se riusciamo ad inquadrare i comportamenti secondo un’ottica che spiega che erano utili una volta e avevano un senso, sarà più facile rinunciare ad essi, rispetto all’implicazione “questi comportamenti non sono mai serviti a nulla; tu sei sempre stato anormale”. Nell’ultimo caso il bambino avrebbe soltanto due alternative: essere d’accordo con noi e continuare ad essere anormale o non essere d’accordo e mantenere gli stessi comportamenti di sempre, cercando di renderli più utili in termini di guadagni secondari.

Il nostro compito è di aprire delle alternative per il futuro e mettere la responsabilità per le scelte che fanno e per le conseguenze delle proprie azioni sempre nelle mani delle persone con le quali stiamo lavorando, siano esse adulti o bambini. È questo il modo nel quale aiutiamo loro a togliersi dalla condizione di sentirsi impotenti rispetto alla propria vita. Nello stesso tempo, aumentiamo la loro autostima aiutandole a prendersi la responsabilità delle loro decisioni ed a cambiare affinché si sentano anche responsabili per i cambiamenti positivi.

Il nostro compito, in qualità di adulti che prestano assistenza, è quello di mirare sempre ad aiutare le persone a trovare un senso alla loro vita tramite la comprensione del proprio passato, correggendo le errate percezioni, spalancando alternative per il futuro e ritenendole responsabili delle loro azioni. Il nostro obiettivo non è quello di risparmiar loro il dolore della realtà, ma piuttosto quello di aiutarle a fronteggiarlo. Il nostro compito non è prendere decisioni unilaterali al posto loro, bensì aiutarle a prendere decisioni che abbiano senso e diano loro un senso di potere sulla propria vita, il quale accresce sia l’autocontrollo sia l’autostima.

Questo articolo, sviluppato per i workshop formativi condotti dalla Dott.ssa Fahlberg, rivolti a specialisti nel campo dell’assistenza ai minori, si collega ai materiali presentati nel suo libro intitolato A Child’s Journey through Placement.

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Questo articolo, sviluppato per i workshop formativi condotti dalla Dott.ssa Fahlberg, rivolti aspecialisti nel campo dell’assistenza ai minori, si collega ai materiali presentati nel suo libro intitolato A Child’s Journey through Placement. I lettori possono trovare quest’articolo ed altri in Internet all’indirizzo  http://www.perspectivespress.com/articlelist

Gli assistenti sociali spesso percepiscono il collocamento di un bambino all’interno della famiglia adottiva come il raggiungimento del termine del loro lavoro. Benché tale collocamento possa segnare la fine del soggiorno del bambino all’interno del sistema di assistenza ai minori, in realtà rappresenta l’inizio di un percorso che dura tutta la vita, il quale, si spera, porterà al superamento degli effetti dei traumi che lo hanno portato ad entrare nel sistema, nonché all’elaborazionedell’impatto negativo delle esperienze che potrebbe aver vissuto mentre era sotto la tutela del sistema.

I bambini che si uniscono alle famiglie adottive dopo aver subito abusi, sia fisici che sessuali, trascuratezza, separazione dai genitori e perdite, portano con se un retaggio di rapporti familiari falliti. La nuova famiglia offre nuove speranze e una nuova possibilità di sperimentare con più successo le complessità e i benefici della vita familiare.

Sebbene le precedenti esperienze di vita possono aver condotto a danni emotivi, i quali potrebbero trarre beneficio da interventi terapeutici formalizzati, la parte più rilevante della rimarginazione, se mai avverrà, avrà luogo nei contesti della quotidianità della vita familiare giorno dopo giorno. È il risultato dell’interfaccia tra le caratteristiche del bambino e quelle della famiglia che porta o al rimarginarsi delle ferite del bambino o alla revoca del collocamento preadottivo. Secondo Barth e Berry le caratteristiche del bambino, i suoi comportamenti, il temperamento, le abitudini e le capacità scolastiche hanno importanza solo in funzione delle caratteristiche e dei pattern familiari.

Sia i bambini, sia i genitori adottivi arrivano all’adozione con alcuni fattori di rischio aggiuntivi rispetto ai bambini che raggiungono la loro famiglia permanente al momento della nascita.I fattori di rischio per i bambini comprendono:

• comportamenti di sopravvivenza che hanno avuto origine quando vivevano in famiglie disfunzionali ed in un sistema disfunzionale
• vulnerabilità personali
• eventi traumatici pregressi
• separazioni o perdite irrisolte

I fattori di rischio per i genitori possono comprendere:

• assenza di un senso di empowerment [letteralmente: sentirsi investiti di pieni poteri; senso di controllo derivato dall’inclusione rispettosa nella pianificazione e nelle decisioni] e di entitlement [letteralmente: avere o acquisire il diritto; sentire di aver sviluppato un senso di appartenenza nei confronti del bambino adottato]
• “echi” dal proprio passato
• perdite non riconosciute o irrisolte
• aspettative non realistiche nei confronti del bambino o di se stessi

Elbow individua tre fattori concernenti l’adozione di bambini più grandi che contribuiscono alla difficoltà di riuscita nel padroneggiare i compiti evolutivi della famiglia.

1.  l’alterazione del ciclo di vita familiare: le famiglie adottive incominciano con la distanza e ci si aspetta che si muovano verso la vicinanza; le famiglie di nascita incominciano con la simbiosi e ci si aspetta che si muovano verso l’individuazione.
2. lo stress posto sui confini familiari a causa dell’invadenza dell’ente, dell’assenza dell’empowerment della famiglia da parte della società e dell’ente, e delle diverse lealtà in conflitto tra loro nel bambino.
3. le problematiche personali del bambino e gli echi dal passato per i genitori.

Data la natura dell’adozione con special needs, il coinvolgimento con i servizi post-collocamento e con le risorse di salute mentale dovrebbe essere considerato parte normativa dell’esperienza di queste famiglie adottive. I bambini adottati e le loro famiglie sono serviti nel modo migliore quando esiste una collaborazione tra la famiglia, gli enti di servizi sociali e le risorse di salute mentale. Ciascuno riconosce non solo il proprio potenziale contributo, ma anche quello altrui.

La famiglia

• offre le fondamenta dalle quali dipende lo sviluppo continuativo del bambino
• offre l’ambiente atto al cambiamento
• offre continuità e impegno
• il fatto che la famiglia abbia bisogno di aiuto nel soddisfare i bisogni del bambino, non significa che la famiglia non ci tenga o che non sia capace di partecipare al processo decisionale.
• qualora la famiglia  percepisca di essere stata relegata ad una condizione di impotenza, il trattamento generale ne subirà conseguenze negative
• i membri della famiglia possono essere partner più stabili se gli si riconosca che stanno facendo il meglio che possono in circostanze difficili e che hanno un ruolo importante in qualsiasi percorso di cambiamento.
• sfortunatamente, le famiglie potrebbero non cercare aiuto finché non si sentano sopraffatte e disperate, e in quel preciso istante si presenteranno nella loro veste peggiore. In quel momento è spesso difficile arrivare ad una solida valutazione delle capacità dei genitori a lungo termine.

Gli assistenti sociali

• hanno una conoscenza di come funziona il sistema
• è probabile che loro, più di altri, sappiano come accedere ad informazioni sulla specifica storia pregressa del bambino; esse possono essere cruciali per poter offrire un trattamento adeguato
• possono aiutare le famiglie a trovare e ad accedere ai servizi specifici di cui hanno bisogno (vale a dire servizi di supporto, respite [servizi di breve durata che offrono un “riposo” o una pausa durante una crisi, a domicilio o fuori casa], terapeuti ben informati sull’adozione
• possono fornire ai terapeuti informazioni sui comportamenti comunemente osservati nei bambini nei vari “sistemi”
• prevedono i momenti difficili per il bambino e per la famiglia (basandosi sulle informazioni riguardanti lo sviluppo del bambino e sulla loro conoscenza riguardante reazioni a ricorrenze varie, ecc.)

Gli specialisti

• di salute mentale
• possono fornire valutazioni delle famiglie e dei bambini, sia prima che dopo il collocamento
• possono riuscire ad intervenire precocemente in modo da aiutare a prevenire il consolidarsi dei problemi
• possono aiutare le famiglie a mettersi in comunicazione con gruppi di supporto
• lavorano direttamente con i bambini e le famiglie quando i problemi sono duraturi
• forniscono informazioni alle famiglie su quando potrebbero sorgere eventuali problemifuturi
• possono prendere parte agli interventi nei momenti di crisi
• possono aiutare a stabilire se il trattamento fuori casa sia necessario e quale sia il livello di trattamento più adeguato.

I servizi post-adottivi devono essere forniti da persone che:

• capiscono le tematiche attinenti all’adozione
• capiscono i sistemi di servizi sociali e legali, e l’impatto degli stessi sul bambino prima del collocamento
• supportano il ruolo e l’importanza della famiglia adottiva nella vita del bambino
• includono i genitori nella valutazione, nella pianificazione e nel trattamento
• lavoreranno insieme ai genitori per sviluppare strategie di intervento comportamentale
• collaboreranno insieme alle altre figure coinvolte con questo bambino e con questa famiglia (cioè scuole, ecc.)

I servizi post-adottivi possono assumere varie forme:

• servizi di supporto (gruppi per genitori, per bambini, respite care, formazione e servizi educazionali) possono soddisfare i bisogni di molte famiglie adottive.
• servizi mirati ad aiutare il bambino e la famiglia acongiungersi in breve tempo in seguito al collocamento
• terapia preventiva intermittente, la quale viene istituita in concomitanza con il raggiungimento di certi livelli evolutivi ad alta probabilità di far riemergere problematiche del passato (cioè di abuso sessuale, perdita, identità, ecc.)
• terapia intermittente a breve termine focalizzata sui problemi, mirata all’interruzione dei  comportamenti problema
• interventi di crisi con famiglie minacciate

Servizi di supporto: Le famiglie che sono state preparate all’adozione tramite un percorso di gruppo, spesso utilizzano gli altri membri del gruppo come una rete informale di supporto. Gli enti possono offrire gruppi di supporto per genitori o possono aiutare le singole famiglie a mettersi in contatto con altre famiglie che hanno avuto un problema simile; possono anche offrire presentazioni educazionali per genitori. Anche famiglie che hanno bisogno di servizi più intensivi considerano i servizi di supporto di aiuto.  Il respite care può costituire un servizio molto utile, ma sfortunatamente le famiglie sono spesso lasciate ad arrangiarsi con i propri mezzi quando si tratta di fornire respite care con regolarità costante.

Il progetto PARTNERS dell’Iowa ha istituito, presso un campeggio locale, respite care per un weekend al mese rivolto ai bambini con bisogni speciali. A questo servizio è stato aggiunto anche un campo estivo della durata di una settimana.Anche famiglie che necessitino di servizi più intensivi tendono lo stesso a vedere i servizi di supporto come un aiuto.

I servizi post-collocamento iniziali mirano ad aiutare il bambino e la famiglia ad unirsi come nucleo familiare. L’enfasi viene posta sul risolvere le problematiche attuali relative alla separazione e alle perdite, affrontare i problemi comportamentali attuali e facilitare il processo di attaccamento.

L’attenzione è focalizzata principalmente sul presente. Secondo Linda Katz, il cliente non è né il bambino né i genitori, ma piuttosto il rapporto. Durante questo periodo il provider dovrebbe preparare le famiglie e i bambini ad individuare i tempi in cui intraprendere un lavoro di prevenzione e quelli in cui è probabile vedere un riemergere di problemi pregressi.Il lavoro di prevenzione: nuove abilità cognitive, in combinazione con le attuali esperienze di vita, porteranno a ripetute opportunità per la reintegrazione degli effetti delle precedenti esperienze di vita. La comprensione dei compiti evolutivi che si presentano in età diverse aiuta sia gli specialisti, sia i membri della famiglia a capire l’impatto degli eventi preadozione ed ad avvalersi delle opportunità offerte per superare tali effetti. Se le problematiche dell’adozione non vengono affrontate al momento di queste tappe evolutive, sarà difficile per la famiglia adottiva e per il giovane padroneggiare i compiti evolutivi che si presentano.

L’intervento di crisi con famiglie minacciate: Kay Donley e Maris Blechner hanno definito famiglie minacciate come famiglie che di solito hanno uno stabile rapporto adottivo di lunga data, con presenza di ripetuti comportamenti autodistruttivi o violenti da parte del bambino. Questi episodi di comportamenti problema si stanno intensificano; i genitori possono aver compiuto vari tentativi per ottenere aiuto ma senza riuscirci e sentono che la situazione è fuori controllo.

La terapia intermittente a breve termine focalizzata sui problemi: quando le famiglie si trovano ad affrontare la convivenza con bambini che hanno comportamenti preoccupanti, cercano una terapia con obiettivi e una tempistica convenuti tra loro e il terapeuta. I genitori tendono ad abbandonare la terapia quando non sono inclusi in essa e quando non affronta le preoccupazioni riguardanti i comportamenti, motivo alla base della loro iniziale richiesta di un intervento.

Secondo Pam Grabe, non è questo il momento di mettere in dubbio l’impegno della famiglia, le dimensioni del nucleo familiare, in termini di numero dei componenti, o i motivi della decisione di adottare un bambino. È invece il momento di offrire un sollievo iniziale che possa aiutare la famiglia a perseverare restando unita, finché non si possano raggiungere dei miglioramenti concreti nei rapporti. Questo comprenderà una valutazione più completa e una flessibilità nell’erogazione di servizi capaci di aiutare questo nucleo familiare.

Donley e Blechner sottolineano quanto sia importante che chi è chiamato ad intervenire in casi simili non scambi queste famiglie per famiglie con disturbi cronici e senza alcuna esperienza derivante da un periodo di adattamento relativamente calmo alle spalle. Molte volte si tratta di genitori molto competenti, i quali possono avere qualche difficoltà nel convincere gli altri della gravità del problema. Possono essere più qualificati delle persone a cui si stanno rivolgendo per aiuto, le quali possono, a loro volta, essere intimidite da questi genitori.

In generale questi genitori o non si aspettavano che l’adolescente avrebbe avuto problemi comportamentali della gravità ora evidente o percepiscono in modo errato la prognosi a lungo termine. La famiglia a questo punto potrebbe essere sotto stress di varia natura. Potrebbe darsi che la patologia particolare del giovane si stia palesando maggiormente.

Servizi intensivi di preservazione dell’adozione sono necessari. Tali servizi comprendono tutti gli aspetti dei servizi di sostegno, tra cui anche il collocamento fuori casa a breve termine. L’obiettivo generale in questa fase è quello di coinvolgere le famiglie nel trattamento e di aiutarle a vedere i problemi in un contesto realistico. Nel corso dell’erogazione di questi servizi intensivi, potrebbe diventare evidente che il giovane abbia bisogno di cure fuori dalla famiglia. È importante offrire tale possibilità in modo sufficientemente tempestivo affinché la famiglia continui ad essere disponibile come risorsa a lungo termine per il giovane.

APPROCCI BASATI ESCLUSIVAMENTE SU TERAPIE TRADIZIONALI NON SI SONO DIMOSTRATI PARTICOLARMENTE EFFICACI CON QUESTA POPOLAZIONE

La terapia individuale non direttiva con il giovane:

• spesso non affronta problematiche relative all’abuso o alla trascuratezza se non è il giovane stesso ad introdurre questi argomenti
• di rado si focalizza sulle problematiche comportamentali che in ultimo andranno a determinare se il giovane rimarrà presso il collocamento attuale
• tende a disempower [destituire di pieni poteri, di partecipazione e di controllo] la famiglia ed ad allontanare tutti i membri della famiglia; non si focalizza sui rapporti familiari
• potrebbe non individuare mai le errate percezioni del giovane

La terapia familiare tradizionale

• vede i problemi comportamentali del giovane come una manifestazione della disfunzionalità complessiva della famiglia
• non tiene conto del concetto di patologia d’importazione (il bambino che porta una patologia all’interno della nuova famiglia)
• potrebbe considerare il genitore più come parte del problema piuttosto che parte della soluzione

Le famiglie adottive, le quali rappresentano la fonte di un cambiamento reale e della rimediazione, devono essere attivamente coinvolte nelle strategie di cura.

CONVINZIONI DELL’APPROCCIO BASATO SUI SISTEMI FAMILIARI CONCERNENTI IL TRATTAMENTO NELLE ADOZIONI CON BISOGNI SPECIALI

• Anche se la famiglia adottiva non costituisce la fonte dei problemi del bambino, è all’interno del contesto dei rapporti familiari che la rimarginazione primaria ha luogo
• È il risultato dell’interfaccia tra le caratteristiche del bambino e quelle della famiglia che porta o alla cura e alla ripresa del bambino o alla revoca del collocamento presso la famiglia.
• Molti bambini sentono l’impulso di ricostruire le loro precedenti esperienze di vita all’interno del nuovo ambiente familiare
• Una delle possibili conseguenze di questa ricostruzione è che i genitori adottivi possano, in effetti, apparire piuttosto disfunzionali quando arrivano al punto di cercare aiuto  
• È più importante che siano interrotti i pattern non utili di interazione familiare e che siano appresi nuovi comportamenti interazionali, piuttosto che venga identificato come “causa” del problema uno dei genitori o il bambino
• I terapeuti devono empower [investire di pieni poteri, di partecipazione e di controllo] i genitori adottivi includendoli negli interventi terapeutici
• Sotto stress, quando si sentono vulnerabili, le persone (sia genitori, sia bambini) stanno più sulla difensiva, diventando più resistenti e frequentemente più rigide
• Sebbene né il genitore adottivo né il terapeuta possano annullare i primissimi danni causati da trascuratezza o da abusi, entrambi possono minimizzare i segni di cicatrizzazione ed aiutare la persona adottata a compensare tramite l’apprendimento di nuove abilità
• Qualsiasi intervento che mette a repentaglio il rapporto genitore-figlio mina l’obiettivo di preservare la famiglia come risorsa per il bambino.
• Pur potendo preferire lo standard della priorità dei “migliori interessi del bambino”, in realtà ciò che dobbiamo frequentemente invocare è “l’alternativa meno nociva a disposizione”.
• Le decisioni devono essere prese tenendo conto non solo dei bisogni individuati del bambino, ma anche degli interessi della famiglia complessivamente, dato che le decisioni avranno un impatto anche sui genitori, sui fratelli e sugli altri membri della famiglia allargata.

QUANDO IL COLLOCAMENTO FUORI CASA SI RENDE NECESSARIO:

Il collocamento fuori casa può essere necessario in diverse forme ecircostanze, variando dal respite di breve durata al trattamento residenziale di lunga durata, e dalla valutazione al trattamento. Sono molti i motivi per cui i bambini adottati con bisogni speciali potrebbero richiedere gli interventi terapeutici più intensivi.

Il collocamento fuori casa non dovrebbe essere considerato un fallimento adottivo. Può essere, infatti, un forte indicatore di un’adozione riuscita qualora la famiglia riconosca che il loro giovane ha bisogno di un aiuto maggiore di quanto loro possano dare da soli e sia disponibile e capace di perorare la causa del figlio affinché lui possa ricevere questo aiuto.

I giovani che non godono di successo in nessuna delle principali arene della loro vita (ossia in famiglia, a scuola e nei rapporti con i coetani) sono frequentemente candidati per il collocamento fuori casa. La famiglia e gli specialisti dovrebbero altresì occuparsi di valutare il funzionamento del giovane all’interno dell’ambiente locale e del suo funzionamento più personale. L’esame dettagliato di queste aree è frequentemente un aiuto per la definizione del tipo di collocamento più favorevole.

Grotevant e McRoy nella loro ricerca sui bambini adottati e curati in strutture residenziali hanno constatato che, sebbene i giovani adottati e non, in cura presso strutture residenziali, avessero comportamenti e diagnosi simili, presentavano anche differenze significative. Rispetto alla popolazione di controllo, i genitori dei giovani adottati avevano meno patologie di salute mentale e matrimoni più stabili. Dei 50 giovani adottati e studiati in questa ricerca, in 33 casi si è osservato un ruolo principale dell’adozione nel disturbo emozionale; in 9 casi l’adozione aveva un ruolo minore e in 8 casi sembrava non aver alcun ruolo nel disturbo.L’intensità della vita familiare nel momento in cui il giovane sta reintegrando esperienze di vita precedenti e ripetendo i compiti relativi all’individuazione e alla formazione dell’identità, può interferire con il successo nel compimento di tali compiti. Alcuni giovani riescono a fare un uso migliore della propria famiglia quando non vivono con essae, a loro volta, i membri della famiglia, essendo meno provati, possono riuscire ad offrireun maggior supporto emotivo anche in questa situazione.

Sommario:l’obiettivo di tutti i servizi post-collocamento è quello di aiutare a mantenere l’impegno e l’accessibilità della famiglia a lungo termine come influenza positiva nella vita della persona adottata.

Bibliografia

Barth, R., Berry, M., Goodfield, R. e Carson, M.L. OLDER CHILD ADOPTION AND DISRUPTION. Washington D.C.: The Children’s Bureau, April, 1987. Dati e conclusioni derivanti dalla ricerca sulla revoca dell’affidamento preadottivo. Contiene, inoltre, una bibliografia ragionata e informazioni sull’approccio al lavoro, da parte di un centro di trattamento residenziale, con un modello di attaccamento.

Bourguignon, J.P. e Watson, K.W. AFTER ADOPTION: A MANUAL FOR PROFESSIONALS WORKING WITH ADOPTIVE FAMILIES. Springfield, Ill. Illinois Department of Children and Family Services, 1987. Disponibile dal National Resource Center for Special Needs Adoption; Crossroads Office Center; 16250 Northland Dr. Ste 120; Southfield MI 48075, USA. Identifica le differenze delle famiglie adottive rispetto ad altre famiglie, gli scopi dell’intervento terapeutico, sette aree in cui le famiglie adottive incontrano difficoltà con più frequenza, uno schema di base per la valutazione diagnostica post-adozione ed interventi che prendono in esame le barriere all’adattamento poste dal bambino, dai genitori e dall’ambiente.

Brodzinsky, Schechter e Henig. BEING ADOPTED: THE LIFELONG SEARCH FOR SELF. New York, Doubleday, 1992. Un approccio evolutivo all’impatto dell’adozione nel corso di tutta la vita. Le informazioni sono molto utili per lo sviluppo di servizi di supporto e di prevenzione rivolti alle persone adottate e per le loro famiglie.

Busch, L. (a cura di). THE MENTAL HEALTH CHALLENGE OF SPECIAL NEEDS ADOPTION: A Resource Book for Professionals Working with Adoptive Families. Per copie, contattare: Adoptions Unit; Children’s Services Division; 198 Commercial Street S.E.; Salem, OR 97310-0450, USA. Contiene alcuni articoli che compaiono anche nel libro a cura di Pam Grabe, ed altri, tra cui l’articolo di Donley sulla Post-Placement Services Analysis [Analisi dei Servizi Post-Collocamento], analisi da utilizzare prima di periodi di crisi e che esamina la capacità di attaccamento del bambino, la sua elaborazione delle problematiche della separazione e della perdita e i fattori di stress della famiglia che possono influire sull’adattamento, sono didimensioni comode per la riproduzione. Reputo “From Caregiving to Parenting: Family Formation with Adopted Older Children” di Margaret Elbow (pubblicato inizialmente in Social Work, Vol 31, n. 5, 1986, pp. 366-370) un ottimo lavoro per l’esame delle differenze delle problematiche familiari nelle famiglie adottive messe a confronto con le famiglie biologiche e per l’individuazione dei compiti evolutivi della famiglia adottiva considerata complessivamente. Un altro articolo utile in questo libro è quello di Patrick J. Koehne e intitolato “Adoption Process of Special Needs Children: A Family Therapy Perspective”.

Grabe, P.V. (a cura di). ADOPTION RESOURCES FOR MENTAL HEALTH PROFESSIONALS. New Brunswick: Transaction Publishers, 1990. Contiene vari articoli di diversi autori. Helping Threatened Families di Donley e Blechner e Post-Placement Services Analysis di Donley mi sono stati particolarmente utili durante la preparazione di questa presentazione.

Groze, V., Young, J. e Corcran-Rumppe, K. PARTNERS: POST-ADOPTION RESOURCES FOR TRAINING, NETWORKING AND EVALUATION SERVICES. WORKING WITH SPECIAL NEEDS ADOPTIVE FAMILIES. Disponibile da Four Oaks, Inc.; 5400 Kirkwood Blvd, S.W.; Cedar Rapids, Iowa 52404, USA. Presenta un modello di trattamento in cinque fasi costituiteda screening, valutazione, pianificazione del trattamento,  trattamento stesso e fine del trattamento. Descrive diversi servizi di supporto, individua servizi di preservazione dell’adozione e servizi continuativi. In questo progetto un’Équipe multidisciplinare di Revisione dei Casi veniva utilizzato nella fase di pianificazione del trattamento. Spiega l’uso del Genogramma di Collocamenti, il quale integra informazioni, non solo sulla famiglia di nascita e sulla famiglia adottiva, ma anche sui collocamenti del bambino avvenuti nel tempo tra l’una e l‘altra. Questo strumento aiuta sia la famiglia sia i terapeuti a comprendere la singolarità della situazione di ciascun bambino. Inclusi nell’appendice ci sono un questionario di valutazione molto completo e tipologie di valutazione dei pattern di comunicazione familiare, della coesione della famiglia e della flessibilità/rigidità della famiglia.

Prew, C., Suter, S., e  Carrington, J. POST-ADOPTION FAMILY THERAPY. Anche questa pubblicazione è disponibile dall’Adoptions Unit di Salem, Oregon. Fornisce informazioni raccolte nell’ambito di un progetto che si è valso di un’équipe di trattamento formata da un terapeuta familiare e un assistente sociale in qualità di co-terapeuti. Le informazioni sull’individuazione dei comuni comportamenti problema e sullo sviluppo di strategie di intervento sono ottime e sufficientemente dettagliate. Nell’Appendice ci sono questionari utili, particolarmente un’Adoptive Family Risk Assessment Scale [Scala di Valutazione del Rischio della Famiglia Adottiva] e un Child Behavior Checklist [Lista di Controllo riguardante il Comportamento del Bambino].

Questo articolo, siluppato per i workshop formativ condotti dalla Dott.ssa Fahlberg, rivolti a specialisti nel campo dell’assistenza ai minori, si collega ai materiali presentati nel suo libro intitolato A Child’s Journey through Placement.

Volete condividere i vostri commenti? Inviateci un email a:  comments@perspectivespress.com  o scriveteci a:
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Chapter 1-2:

• Had you thought about the similarities and differences between adoption of an infant, toddler, and older child? What surprised you about the section “What’s So Special About Toddler Adoption?”
• How deliberate is your choice to adopt a toddler? How might that affect your adjustment to your child and your child’s adjustment to you?
• How are you preparing for the losses inherent in toddler adoption?
  What are you most looking forward to when your child arrives home?

Chapter 3:

• What is your plan for preparing to welcome your child into your family?

Chapter 4:

• What information will you attempt to gather about your child prior to placement?What is your transition and post-placement plan?

Chapter 5-7:

• What theoretical perspective on child development is most consistent with yours? Why?
• If you have received a referral, how might your child’s developmental age be affected by the adoption?
• How will you support your child’s development including the possibility that your child may need to regress for a period of time?
•  How will you support your child through the loss of previous caregivers?
• Based on what you know about your child’s history of care, discuss attachment challenges that you may face and strategies for fostering attachment.
• What support resources are available to you?

Chapter 8:

• What is your discipline style?
• How will you handle potential criticism of your parenting style by well-meaning but misguided family and friends? How will you help them understand your adopted toddler’s unique needs?
• Discuss ways to be a positive parent.

Chapter 9:

• What is your plan for taking care of yourself and your relationships?
• Who will be your ongoing support system?

Toddler Adoption is available both in paperback and Kindle ebook reader formats. Click on the book’s cover for purchasing information

For more information about the author of Toddler Adoption: The Weaver’s Craft, Dr. Mary Hopkins-Best, click here

© 2009 by Perspectives Press, Inc. for Mary Hopkins-Best

The following article has been excerpted from Chapter 6, Brothers and Sisters in Adoption: Helping Children Navigate Relationships when New Kids Join the Family.

It is so exciting to finally find a child to join your family by adoption! You and the children you already parent-the typically-developing children-can hardly wait to meet the new brother or sister, son or daughter. This pre-placement period is the time to lay the foundation upon which family members will forge strong bonds.

The information put forth, in this article, is designed to help parents, the prospective adoptee and the brothers and sisters-to-be begin to facilitate positive interactions. The suggestions that follow recognize that each family is unique. Family members may select those ideas-traveling together or not, and pre-trip and during the trip-which seem best suited to the particular needs of the family. The recommendations offer ways for each member of the family to participate in the process.

Considering Family Travel

Suggestions for moving a child via intercountry adoption need to take into account whether or not the family is traveling to the child’s homeland, and whether or not they will be traveling with the children already present in the family. In some instances, country policies may prohibit taking resident children. In cases where the siblings may go, parents must decide who will go on the trip based on their resources and their knowledge of their typically-developing children. Pros and cons that may be weighed in this decision-making process include these:

Pros for Parents and Siblings Traveling to the Homeland

• Experiencing the country gives a deeper understanding of what the adoptee’s life was like prior to the adoption. In particular, visiting the child’s orphanage makes clear the day-to-day living differences between such group life and family life. Parents, brothers and sisters can begin to see the type of work ahead in teaching the newcomer how to learn to be a family member.
• Experiencing the child’s culture contributes to raising the child in a culturally competent manner. As your family will be different from those around you, you can experience first-hand the type of cultural issues you and all of your children may experience once you become a transcultural family.
• If you are traveling as part of a group, you and your resident children have the opportunity to form relationships with other families. These relationships may become a source of support post-placement.
• You will have the opportunity to take photos and video that will prove invaluable to your prospective adoptee as he or she matures.
• You will be more involved in the adoption process.
• You may experience culture shock. You may begin to feel uncomfortable or out of place in a country where nothing is familiar. This is positive, as it will evolve into empathy for the new arrival. He will likely have similar feelings once you bring him home to his new country.
• Older siblings may benefit from the travel to a foreign country. Certainly, there is learning value in experiencing the rich diversities the world has to offer.
• Older siblings may prove helpful. They can carry luggage, get diapers, fix bottles and keep you company.
• Younger children, who lack a sense of time, may experience less separation anxiety if they accompany you on the trip.
• If your family already includes a child from overseas, depending on his age, the experience of returning to his homeland or visiting the country you have opted to adopt from this time around may be of great benefit. This is especially true if the child was too young at the time of the adoption to have memories of his own adoption process. Seeing another adoption take place fills in many of the pieces explaining how he joined the family. This may also raise many questions or lead to an expression of grief for the loss of his country of origin, his birth family or his orphanage mates. While comforting a grieving child is difficult for parents, active, healing grieving leads to healthy emotional well-being.

Cons for Parents and Siblings Traveling to the Homeland

• Completing an international adoption may be quite expensive. The family’s resources may prohibit taking the children already in the family.
• Travel advisories for your chosen country may prove unfavorable. The U.S. Department of State-www.state.gov-posts travel advisories.
• Parents and children alike may be affected by jet lag and time changes. If you are taking your birth and/or previously adopted children, especially those that are younger, you may want to arrive in the country a day or two early. This will provide some opportunity to adjust prior to initiating the steps necessary to bring your new child home.
• The flight is long and the trip may be long-longer if delays occur-and children may become affected by culture shock and by having access to limited activities.
• There are children who will have adverse reactions to an orphanage setting. The reality of children living without parents may be overwhelming to children with more sensitive temperaments. Parents need to think about the entirety of the trip. Depending on the adequacy and availability of child care, children who may suffer emotionally to seeing an orphanage may be best left at home with a caring relative or family friend.
• If the process is demanding or the prospective adoptee experiences difficulties, families must determine if adequate time can be made available for the children along on the trip.

Pre-Trip Suggestions

Considerations in this area need to include preparing siblings for the addition of a child-younger or older-to the family, preparing for the trip abroad or preparing for the separation from the parents. Here are some pre-trip activity ideas from which to choose.

Borrow a Child the Age of the Child you Plan to Adopt

Anyone who has parented an infant or toddler is aware of the amount of time required! Typically-developing children who have not had the experience of sharing their parents with a young child are often blind-sided by the parental time consumed by a little one. Parents can offer some preparation for the changes about to occur because of the addition of a baby or toddler.

If you know someone who is parenting a child a bit younger or the same age as the child you plan to adopt, offer to babysit. This will be helpful only if you do so on several occasions. As you care for this youngster, point out the tasks it involves. “Oh my, it’s time to the change the baby again.” Or, “The baby needs another bottle.” Each time the baby or toddler returns to his or her parents have discussions with the children you already parent. Of course, caring for a young child who has resided in a healthy family environment will be different from caring for the institutionalized infant. Yet, your resident children will at least gain an understanding that their new brother or sister will require sharing Mom and Dad’s time-perhaps much time!

A number of wonderful children’s books exist to help present the changes incurred when a family adds a younger sibling. Two excellent titles are A Pocket Full of Kisses by Audrey Penn and The Lapsnatcher by Coville. Both portray the negative and positive aspects of a young child joining the family from the perspective of an older sibling. Both convey that parents have enough love for all of the children they parent. Many children fear that, “Mom and Dad spend more time with my little brother because they love him more.” We want to convey, “We spend more time with your sister because we have to do things for her that you can do by yourself.” We want to give the children already in the family this message in as many ways as is possible.

Preparing for the New Brother or Sister

Once you have an idea of the age of the child or children who will be joining your family there will be tasks to do such as shopping and tending to setting up a bedroom. Include the children you already parent in these activities to the maximum degree possible. That is, do not carry out all of the preparations while they are at school. Brothers and sisters want to help, and involvement in the process makes them more invested in the arrival of their new sibling. While shopping, let your resident children pick out a few items for their sibling-to-be. Help them sort through packed away clothing and toys that they have outgrown and select items that will be useful for the new child. If old enough, let your children help assemble the crib or bed and other furniture.

If the addition of a new child to the family means that one of your typically-developing children will have to share his bedroom, help him make a space just for himself. This should be a space that is off limits to the new sibling. It could be a foot locker for items of special importance or it could mean cleaning out a corner of the den. Assure the child that he will be able to maintain some of the privacy he is accustomed to.

This above recommendation is especially important if the new arrival is a school-age or older child. The prospective adoptee who has resided in an orphanage setting long-term may have no ideas about boundaries. The concept of asking permission prior to using or taking things belonging to others is likely a concept with which the older institutionalized child is unfamiliar.

Chapter 3 of Brothers and Sisters in Adoption covers various “safety” related issues. International adoptees may have experienced sexual abuse while in residence in an orphanage. Believing that sexual activity is “normal”, the new arrival may display sexual behavior toward parents and siblings. Parents want to ensure that they have a plan in place to handle this behavior if it occurs. Parents also want to understand that most children who have been sexually abused do not go on to be life-long sexual perpetrators. The large majority of children who have experienced sexual abuse will never engage in or will learn to stop sexual interactions with other children. Once they move into a healthy family, they frequently conclude, or they are taught by healthy adults, that engaging in sexual activity with one’s siblings, other children or adults is improper.

Parents also need to understand that many adoptees do not possess skills in accord with their chronological age. The school-age sibling-to-be may not have the social skills to engage with toys and games designed for his actual age. Parents may want to keep purchases in this area to a minimum until the social and emotional age of the son or daughter-to-be can be determined.

Daily Reminders

Parents who will be away can leave the siblings left at home a daily gesture to ensure that these children do not feel that they are forgotten. These daily reminders can include cards, notes or small gifts. Provide a memento for each day you anticipate being gone. Leave a few extra in case of delays. Hallmark makes a lovely series of post-it note books. The titles all start with the phrase “Stuck on You.” There is Stuck on You Love Notes, Stuck on You Laugh Notes and Stuck on You-Warm, Witty, Wonderful You! Each book contains 100 notes. Kids just love these!

Another suggestion comes from the children’s book, Seeds of Love: For Brothers and Sisters of International Adoption by Mary Eberjer Petertyl and Jill Chambers. In this book, a mom and her daughter plant seeds. Mom tells her daughter that she and Dad will return home when the seeds begin to sprout. Their resident daughter places a daily sticker on the calendar to count down the days until her parents’ and new sister’s homecoming. This is a lovely story to read with children over and over.

Children also benefit when parents leave them in charge of an item with sentimental value. One mom gave her 12-year-old daughter a quilt to use for the duration of Mom’s trip abroad. The quilt had been handmade by the mother’s mother. It helped this young adolescent feel as if her mother was with her every day. Whatever you select-a locket with your photo or a key ring with the family photo that is attached to the child’s backpack, etc.-mementos and daily reminders lessen the impact of your absence.

Where Will I Stay?

Children of all ages want to know where they will be staying during the time you will be away. Preferably, the child can remain at home and Grandma and Grandpa, an aunt or a trusted family friend can come to your home for the duration of your trip away from your children. In this manner, they can continue school and their extra curricula activities with little to no interruption. Maintaining a routine lessens the impact of the life-altering transition for your resident children.

Of course this may not be possible and alternative arrangements will have to suffice. In these cases, go over what the children may expect in their temporary quarters. For example, “I talked to Janie’s mom and she is going to be able to get you to your soccer games while we are away. So, if there are any changes in your soccer schedule, you’ll be talking to Janie’s mom. I wrote her phone number down for you.” Lay out all areas that are covered and by whom they are to be covered. Larger families may need to separate their typically-developing children among more than one temporary caregiver. Make arrangements for them to communicate in your absence.

Older adolescents and young adult children might be able to stay at home with a trusted adult on call or looking in on them from time to time. Even they will miss you! Freeze some of their favorite meals and leave the cooking instructions. They will appreciate this thoughtfulness.

Leave a camera with the children at home. Encourage them to take photos of all the things they do while you are away. Reviewing these photos will make a great way to re-connect when you return home.

Plans to Prevent “I’m Bored” Syndrome

All parents have heard, “I’m bored” at one time or another. (Actually, parents have probably heard this more times than they want to think about!) If you are taking siblings-to-be with you, it will be particularly important to investigate your accommodations abroad. What amenities are available? What activities can your children take with them for on the plane and while in the country? It is also important to think about how much you can pack. Veteran parents who have traveled abroad with their children are a great resource when it comes to helping you decide what to take and what will be available in the adoptee’s homeland. Especially search out parents who have traveled in the six months prior to your own trip. These families will have the most up-to-date information for the area and facilities in which you will be staying.

Make Plans to Establish a Post-Placement Routine

Pre-placement is the time to realize that the institutionalized child-of any age-is used to operating on a routine. Likely, these children are also used to a smaller world. They aren’t leaving the orphanage on a frequent basis.

Prior to your trip abroad, consider the dynamics of establishing a routine for the newly-arrived child. In what ways can you eliminate some responsibilities for a few weeks or months post-placement? Who can you count on to take the children you already parent to their after school activities? Do not be afraid to ask for what you need from friends and family members. If you know that your friends or family are planning a shower, speak up. Let them know that gift cards to restaurants that deliver would be appreciated. A gift certificate for a cleaning service over the first months with your new adoptee would be of great benefit. Alleviating yourself of duties that others can carry out and making arrangements to take as lengthy an absence from work (or providing a stay-at-home parent) will allow you time to get acquainted with your new son or daughter. It will also give you time to stay connected with the children already in the family. In any event, one-on-one time with each of your children is more important than a few dust bunnies under the bed!

Suggestions for During the Trip

Recommendations in this area focus on gathering the child’s history, reducing the abruptness of the transition for the child who is moving and taking care of the siblings, whether they are with you or at home.

Photos, Videotape and Audiotape

Photos and video of the child’s actual living quarters, caregivers and friends are important! The child needs to know where he came from and who was there. Photos of Red Square and St. Basil Cathedral, The Great Wall and
Forbidden City, or a Mayan temple are nice, but they are not accurate representations of the child’s experience in his homeland. The child needs as many (or more) photos of the orphanage as he does the well-known places of his country of origin.

There are cases in which the family is unable to tour the orphanage. In these cases, take photos of what is available-the outside of the orphanage, the grounds, the room in which you spend time with the child, the other children, the staff, the director, your interpreter and so on. Take ample pictures! As children mature, they will want to know where they lived, who took care of them and who helped you adopt them. If you are close to the child’s birth home town, make the drive! The child’s birth parents are not going to recognize you. If you remain worried that they will identify the child, one parent can make the trip while the other cares for the child in the city where you are staying. Take photos of yourselves and your family at the orphanage. If you are not in the photos, young children often have difficulty connecting to the fact that you were actually at the orphanage. Children forget names over time. This often causes sad feelings. Gather the names of the children and adults you are photographing. This is especially important if the child had a special connection to a particular caregiver or an orphanage mate. Photograph the airports, the people who meet you at the airport, your hotel or apartment-take ample photos of each aspect of the trip!

Video is wonderful as well, and it records the sounds. Make it a priority to keep the video and photos safe during the trip and after arriving home. Video serves another purpose. Video footage can help your adoption medical professionals assess the child’s motor skills, obvious medical/congenital problems, severe malnutrition and other risk factors.

Audio taping is another consideration. One family recorded an orphanage caregiver singing a lullaby to their son while they were at the orphanage. This, combined with about thirty minutes of the normal sounds of the orphanage, allowed this child to fall asleep more easily in his new home.

Once home, photograph the “new” family. The visual depiction of the change that has occurred in the family helps everyone begin to adjust.

Stay in Touch with Those at Home

Using email wherever you can find capabilities, send as many photos and videos home as you can. The brothers and sisters are eagerly waiting to see their new sibling!

Likely, those at home will want to talk to their mom and dad as well! Call as often as possible. Investigate the cost of international phone calls in advance. Budget this expense into your journey to your child’s homeland. The children at home want and need to talk to you as frequently as possible.

Keep a Journal

Children love to hear the story of how you got them; they love to hear it over and over! Keep a journal of the sights, sounds, people, food, your reaction to being in a different country, what it was like meeting your child the first time-simply everything you can think to include. A journal in any medium-written, audio or video-will do. This will be a gift to the adoptee of immeasurable value. In the event you experience culture shock, this will be a good exercise for you to process the thoughts and feelings of this experience.

Accommodate the Sensory Needs of the Child Who Is Moving

Infants and young children are very sensitive to sensory experiences, so when their possessions and their world change dramatically they can be harmed emotionally. The family has options to offset the impact of moving young children. Make special efforts to carry out this suggestion. It is so important to the transition of the child into your family.

The family could ask ahead of time if the orphanage is amenable to an exchange of sheets and/or clothing. If so, the family would provide new sheets and outfits for those currently being utilized by the child who is moving to your family. They may not smell good to you, but they will certainly comfort your newcomer. Resist washing them for several days. Wait until the child has had a chance to become accustomed to your scent and then you can go ahead and begin to remove these orphanage items. Keep them! Kids love having these belongings.

If it is not possible to keep some clothing and linens from your child’s orphanage or foster home, investigate sending ahead, or at least bring with you some type of transitional object-a blanket, a stuffed animal, a small toy. See if you can leave it in the child’s crib. Be aware that sometimes such gifts disappear; however, it is important to make the effort. Let the child keep this object throughout the trip and at home.

Keep in mind that older children will also be experiencing sensory changes. Many school-age adoptees report that the first car ride they remember was with the adoptive family. The toilet flushing, a hair dryer, the flash of a camera, the smell of new foods, the taste of juice, soda pop and water-all of these will be stimulating to a child who has had limited experiences outside of the orphanage.

If feasible, families may want to consider staying in a family setting rather than in a hotel. This provides a realistic glance at what any child, but particularly an older child, will experience upon changing countries. In a family setting, you would have to attempt to communicate, determine what you are eating, learn the family customs and routine, and try to understand social cues and emotional expression. Parents, brothers and sisters would gain a depth of understanding of what the sibling-to-be will feel like upon moving to their home.

Closure with Significant Adults and Orphanage Mates

The feelings of the institutional staff regarding children being adopted varies along a continuum. I have seen video of orphanage staff providing a good-bye party for children leaving with their new families. I have seen video of the staff being indifferent to the child departing. In other snippets, the staff is tearful and hugging the children. The same seems to hold true for orphanage mates. Parents who have the opportunity to visit the orphanage may size up their child’s connections to peers and adults. If a closing ceremony seems to be necessary, see what arrangements can be made. If there are any willing adults, have them share stories of their experiences with the child. Record these memories. Children love to hear stories about themselves.

Additionally, if the adults are approving of the move, write down these positive sentiments. It is of great benefit to children to know they were cared about and that their move to the adoptive family was supported. Share photos of the event with the orphanage friends and the adults. The child can be provided with parting gifts to give to friends and caregivers. Allow time for final hugs and good-byes. Hopefully, your interpreter can attend the event in case anyone-peers or adults-have questions about what is happening. It would be great for you to know what is being said to the child in the process of leaving the orphanage. You are now the child’s historian.

Plan Time with the Child Who Came Along

The day-to-day activities may make for a busy trip, although some families report that there was much down time. In any event, ensure that you devote time each day to the child or children making the trip with you. Even if you are busy, a few minutes goes a long way towards validating the typically-developing child’s feelings about being in a foreign country and sharing his or her parents with a new sibling.

Expect Regression

The children you already parent may regress while traveling with you or post-placement. This is completely normal, especially if they are young. A parent’s first instinct is to respond by stating, “Honey, act your age!” Regression is a way for children to express the stress of a change in life. So, allow the regression. Usually this passes on its own. However, it is always a good idea to increase parental time with the child who has regressed.

Implementing as many of the above suggestions as possible will ensure that the process of bringing the new child home gets off to a positive start. A vast array of post-trip ideas and ways to facilitate attachment, among all family members, over the long-term are included throughout Brothers and Sisters in Adoption: Helping Children Navigate Relationships when New Kids join the Family.

Once upon a time there lived a princess so beautiful both inside and out that every man in her parents’ realm longed to marry her. After many months of grueling challenges, a noble, kind, and handsome prince won her hand, and they were married. As they left the palace of her parents to make their own way in the world, the young people were given the blessings of the monarchs, who presented them with a carefully drawn map. On it were plotted the roads and the rivers, the mountains and the mansions, the forests and the fields, the towns and the trading posts of their known world. It was a beautiful map, complete in every way…for as far as it went, that is. All around the edge of the map, beyond the blue of the wide sea and the purple of the impenetrable mountains, were printed warnings in bold red ink, “DANGER! Here there be dragons!”

Most of us spent many childhood days curled in warm laps listening as a parent read even more sexist versions of stories much like this one. Surrounding us was the firm shape of a parent who kept us safe and secure. The fairy tales gave way to more realistic stories, but the themes remained substantially the same: for those who are good, noble and true, for those who try their best, the dangerous unknown is only a fairy tale. Those who try hard will succeed.

And so, like the fairy tale princes and princesses of our childhoods, our expectations about love and family building were idealistic and simplistic. Two people fall in love. They commit to one another. They establish a firm foundation on which to build a secure home. They have children.

In biology class, in family living, in health and sex education there were drawings and diagrams, and warnings about the dangers of premarital sex. These classes offered several messages for Gen Xers and Millennials who are reading this, my third infertility/adoption decision-making book. The first message was about the demons of sexually transmitted diseases, and in particular AIDS. The second was the one familiar to earlier generations: our bodies are time bombs set to go off. If we engage in sex, we will get pregnant! Beware of that dragon, for sure!

Social studies sent a third message to those of us who did not find a partner with whom to parent as well as to those of us who were not heterosexual. It was that growing tolerance in society would soon open family building opportunities for us as well.

Ah, and then there was the comforting final message: People of the second and third birth control generations, you have as long as you want to become parents! Go ahead and delay marriage and parenthood. Get all of your financial, educational and career ducks in a row; take time finding just the right partner before parenting. There’s always time.

You listened, and here you are—young-marrieds or married-agains, without a partner or with a same gender partner—facing a dragon guarding the entrance to parenthood.

When this dragon rears its head, many tend first to play ostrich, burying their heads in the sand and pretending not to see. For months and even years we may deny the possibility of a problem. We just haven’t met the right person, we tell ourselves. Or, when we have and we are trying to conceive it’s, well, We’re under so much stress at work. Our timing is off. The travel schedule has gotten in the way. Looking back now and remembering your own denial, you may wonder why it took so long for you to realize that you needed help, why you wasted so much time with the wrong partner, the wrong doctor, why you refused to acknowledge that there was a problem brewing here.

The answer is not so difficult. You were afraid. Somewhere in the back of your mind you sensed that a dragon was lurking there. You hoped to avoid the crisis of facing the dragon by ignoring it.

The Chinese, an ancient and philosophically sophisticated culture, write not with a sound-based alphabet, but with complex word pictures. Interestingly, in Chinese, the written expression of the concept of crisis is said to be drawn by putting together the characters for two other words: danger and opportunity.

Because we sense danger in the face of any crisis, we often put off facing its reality. And so it was with singles, with gay couples, with fertility impaired heterosexual couples. To acknowledge a barrier to becoming a parent was to face imminent danger. Though at first we might not have been able to clearly identify precisely what it was that we feared, our subconscious sensed the possibility of loss or disappointment ahead and insulated us from pain through denial.

Do you remember that childhood friend who moved away when you were four? The special toy lost irretrievably on the plane to Grandma’s? The cat that ran away? The math test you failed? The first love who dumped you unceremoniously? The college which turned you down? Getting laid off from that great job? Every day we experience losses and disappointments. Some of them are painful, etching themselves on our memories, changing who we consider ourselves to be. Others pass by nearly unnoticed because we have become so accustomed to dealing with them–keys misplaced for a couple of frustrating hours, another lottery ticket with the wrong numbers, forgetting an appointment, missing your train. But every loss–the large and the small–is one of the lessons which contribute to the development of a unique and very personal pattern for how each of us copes with disappointment and loss, a pattern which becomes so familiar, so automatic, that one rarely even recognizes that it has begun and is going on again.

Do you recall, for instance, having found yourself in a situation like the following…

After having spent a day shopping, you arrive at home with your house key in your pocket and your arms loaded with packages only to hear the insistent ringing of your telephone on the other side of the door.

Almost since the invention of the telephone at the dawn of the 20th century, people who have one have had a terrible time allowing a phone to go unanswered, so as a typical person, you struggle with the packages you are juggling in order to fish out a key and then rush inside to answer the phone.

As you put the receiver to your ear, you hear yourself saying, “Hello? Hello?”… to a dial tone (denial). You’re surprised to hear that dial tone, and yet, after ten rings, you knew of course that enough time had passed between the last ring and your picking up the phone?

You begin a litany of “if onlys” (bargaining). …”If only I’d had my key out and ready”… “If only they’d let it ring one more time.”

Feeling frustrated and disappointed about the lost call, you begin to vent a little anger at somebody… “Doggone it! Why are people so impatient? They should have let it ring!” Or, perhaps, “Darn it, won’t I ever learn to keep my keys in my hand!”

You look at the packages strewn in your foyer and, subconsciously you begin a familiar process—your personal process—for coping with (accepting/resolving) a loss.

Remember, all of us have been experiencing losses since infancy. There was the babysitter who talked on the telephone despite your cries for a diaper change or a bottle. The goldfish from the fair died and Daddy helped bury it in the backyard. Your best friend moved clear across the country when his mom was transferred. That really cute girl said no when you asked her to the eighth grade dance. You failed an all important math test. Your favorite uncle died. A lover left.

There are many ways of coping with loss, and after years of experiencing losses large and small, each of us develops a personal pattern for doing so. Some people are more comfortable than others in accepting loss as normal and natural, as a part of their fate. They may shrug this lost phone call off with an “Oh well, if it is important, they’ll call back” and go about the business of putting away the groceries. Others feel more comfortable with a substitution. Such a person may pick up the phone and call a friend. “Hi, did you just call? No? Yeah, well, I missed a call just as I got in from shopping and I thought it might have been you? So what’re ya doin?”…

Still others cope with loss more aggressively by seeking to avoid future losses of a similar kind and assuming as much control as possible over every situation. If this is what you most commonly do, your reaction to an accumulation of lost phone calls may inspire you to explore the option of adding voice mail or caller ID to your phone service or send you out shopping for an answering machine.

Those whose family building is challenged by infertility or their marital status or their sexual orientation experience multiple losses, each with its own degree of significance. Taking the time right now to determine how it is that you (and your partner, if you have one) cope with loss is an important step toward deciding what family building alternative is right for you. But first you must acknowledge the series of losses built into your experience. Over many years of thinking about it, reading about it, talking with hundreds of couples about it, I have come to see six distinct areas of significant loss , many of which encompass several other related losses. The following sections address each of those areas.

Losses Accompanying Challenged Family Building

• Control over many aspects of life
• Individual genetic continuity, linking past and future
• The joint conception of a child with a beloved life partner
• The physical satisfactions of pregnancy and birth
• The emotional gratifications of pregnancy and birth
• The opportunity to parent

The Loss of Control

Perhaps most clearly and immediately felt by those who experience family building challenges is the loss of control over numerous aspects of their lives.

Today?s adults, who came to sexual maturity and selected partners after the birth control revolution precipitated by the wide availability of the birth control pill in the mid sixties, have always had the distinct expectation that they would be able to control their family planning. Unfortunately, because infertility was not discussed as they grew up, this expectation included not just the expectation that they would be able to avoid pregnancy when they so desired, but that they would be able to achieve pregnancy when they so desired. Losing control of a part of life which one’s peers take so completely for granted is devastating and, for many people, precipitates a humiliating blow to self esteem.

Treating infertility demands that couples give up even more control. Control of their sexual privacy and spontaneity, for example, is forfeited to a medical team which asks them to chart their intercourse, supply semen samples, appear within hours after intercourse for a post-coital test, etc. Control of their calendars is given over to treatment.

Couples often comment that with infertility they feel that they have lost control of every aspect of their lives. What type or size car to buy depends on whether or not it will be carrying children. Accepting a new job or a promotion can become dependent on how travel impacts the treatment program, whether or not the new company has excellent health care benefits which cover infertility treatments, as well as whether or not the new employee’s coverage for infertility treatment would be excluded because it was defined by the insurance company as a pre-existing condition. Continuing education may be put on hold when a woman expects that any day she will become pregnant, so that finishing a term might be difficult or impossible. Whether to buy a house in the suburbs with sidewalks for Big Wheels and excellent schools, or a condo in the city close to work and cultural events is controlled by infertility. Social calendars may be driven by the menstrual cycle. Even the most private of decisions–how much time to spend in a hot tub, how much coffee to drink, how many miles to run each week, whether to buy briefs or boxer shorts–can be controlled by the infertility experience.

Singles and gay couples, most already feeling the sting of discrimination, have often compensated for much of the rest of their feelings of being “out of control” by taking careful control of as many aspects of their lives as they can. They may have planned and lived out successful careers, own beautifully designed homes in carefully chosen communities, yet they know that the dragon which guards the door to family building is outside their control.

To many individuals for whom being in control is an important part of theirability to feel confident and competent, challenged family building represents a devastating loss, but this is not its only loss.

The Loss of Genetic Continuity

Potentially, challenged fertility means the loss of our individual genetic continuity–our expectation that we will continue the genes of our families in an unbroken blood line from some distant past into a promising future. For those raised in blood-is-thicker-than-water cultures, this loss is significant enough to be avoided at all costs. While some extended families are entirely comfortable with the idea of adopting in order to carry a family into the future, others believe strongly that the family blood line cannot be grafted onto. Why we feel this way is not as important as is the fact that we acknowledge that we do. When the potential for this loss is felt powerfully– sometimes re-enforced by repeated conceptions which end in miscarriage–alternatives such as donor insemination which allow a woman to use her own eggs and to be pregnant, or traditional surrogacy which provides a man with the opportunity to carry on his genetic material, or gestational surrogacy which allow both partners to use their own genetic material can sometimes be more attractive than traditional adoption. However, as we’ll discuss later, for individuals for whom loss of genetic continuity is central and powerful, pursuing family building alternatives which allow the other partner to retain genetic continuity at the loss of one’s own can be devastating to the relationship.

The Loss of a Jointly Conceived Child

Our earliest dreams about parenting included the expectation of our parenting a jointly conceived child. Gay and lesbian partners perhaps face this loss earlier than heterosexuals do. In choosing a life partner all of us do at least a little fantasizing about what our children might be like. Will he have her intellect and his sense of humor? Grandpa’s red hair and Aunt Wilma’s athletic prowess? Gosh, think of the medical expenses if she inherits both her mother’s crossed eye and her father’s terrible overbite! This child who represents the blending of both the best and the worst of our most intimate selves also represents for many a kind of ultimate bonding of partner to partner. In giving our genes to one another for blending, we offer our most vulnerable, intimate and valuable sense of ourselves—a gift that is perhaps the most precious we can offer. How more vulnerable can we be to another, how much more trusting, than to agree to give 23 of our unique chromosomes in exchange for 23 of our partner’s to make a new 46 chromosome human being? Losing that dream and so feeling forced to consider alternatives such as donor insemination, hiring a surrogate mother, adopting, etc. can be painful indeed for those for whom this expectation was particularly important.

Pregnancy and Birth: Lost Physical and Emotional Expectations

Another challenging loss to deal with is that of the physical satisfaction of successful pregnancy and birth experiences. Though many people see the loss of a pregnancy as belonging entirely to women, this is not so. True enough, the physical changes and challenges of pregnancy and birth are experienced by women alone, but producing a child, as any counselor of pregnant teens will verify, is the ultimate rite of passage for both men and women—the final mark of having reached adulthood. You’re grown up now, and your parents aren’t in charge anymore. Beyond that, the physical ability to impregnate a woman or to carry and birth a child represents the ultimate expression of maleness or femaleness—our bodies at work doing what they were built to do. For many people, losing such capacities challenges their feelings about their maturity or their sexuality or both about their competence as adult men and women. It is their own discomfort with, and fear of, this loss which generates from outsiders the tasteless humor which relates infertility to sexuality in comments such as, “Do you need a little help there? Happy to offer my services!” or “Let me show you how it’s done.” or “Hey, all Steve has to do is look at me and I’m pregnant–must be in the water!’

Some do succeed in becoming pregnant–sometimes over and over again–but these pregnancies result in repeated miscarriages and neo-natal deaths. Trying to block out the unhelpful platitudes from well-meaning others (“Perhaps it was God’s will.”…”Don’t worry, there will be another.”…”At least you know that you can get pregnant!”) can be a struggle like no other.

And there’s more. Over the last several decades, a substantial element of our society, fearful of the impact of massive changes in family structure (and there certainly have been some), has mystified the experience of birth to an exaggerated extent. In search of the perfect “bonding” experience, couples carefully choose specific kinds of childbirth preparation—they attend classes together, read books, practice breathing, and so on. They expect to experience a magical closeness in spousal relationships, an irreplaceable wonder in sharing the birth experience, an expected instant eye-to-eye bonding between parents and child (a kind of magical superglue without which many fear that families will disintegrate). Hospitals marketing to the expectations of these couples, compete with one another to provide birthing rooms with the perfect equipment (birthing beds, chairs, tanks), the perfect atmosphere (music, guests allowed, champagne afterwards), and the perfect preparation (Lamaze classes, classes for siblings-to-be).

This set of expectations about the emotional gratifications of a shared pregnancy, prepared childbirth, and breast-feeding experience, though far too often unrealistic, is widely held. To risk losing such an experience is much more significant to today’s would-be parents than it would have been to their parents and grandparents–whose mothers gave birth anesthetized in sterile operating rooms while fathers paced in waiting rooms outside, who often didn’t see and hold their children until hours after their births, who bottle fed formula to their infants, and who bonded with their kids!

The Loss of the Parenting Experience

Finally, to be permanently family-challenged threatens the opportunity to parent, which is a major developmental goal for most adults. The psychologist Eric Erickson identified a series of developmental milestones humans work toward throughout their life span. In adulthood, Erickson wrote, the major goals are regenerativity and parenting. To be infertile, single and partnerless, or homosexual on the surface threatens our ability to achieve that goal, so that for many, challenged family-building represents a devastating blow.

Erickson and others have clearly demonstrated that it is possible for individuals achieve this developmental goal and to satisfy the need for nurturing without becoming parents. Many adults find other ways of redirecting or rechanneling their need to nurture–through interaction with nieces and nephews and family friends; by choosing work which brings them in frequent contact with children; by volunteering as religious class teachers, scout leaders, or for a group such as Big Brothers/Big Sisters; by substituting pets for children; by becoming active in non-child centered volunteer work; by nurturing the earth through nature hobbies such as gardening, etc. This is not to imply that lists of possible redirections like these are seen as equivalent substitutions, or as realistic direct replacements for the lifelong experience of parenting a child jointly conceived and birthed with a much loved partner. While some adults can and do actively choose to meet their developmental needs to nurture without becoming parents, for those who have made the choice to become parents and have then been thwarted by family building challenges, the choice to redirect that energy is difficult.

For readers of this book – people who are considering adopting – reactions about this particular loss (parenting) are the most important of all. Adoption provides the opportunity to avoid this loss and this one alone. Singles and couples who adopt will become parents, but in doing so they will give up even more control to the process of adoption: they will forfeit their genetic continuity, they will lose the jointly conceived child of their dreams, and they will be deprived of the emotional and physical expectations of pregnancy.

It is these potential and realized losses which tore at your gut during those days or weeks or months when you tried to deny the challenges you faced. These losses were the danger lurking in the crisis, and they were difficult to face. Now you are asking yourself to examine adoption—one of the potential opportunities which is a part of the crisis. Facing your feelings about infertility’s losses can help you to decide if adoption is right for you.

So unless the loss of the opportunity to parent strikes you as the one loss you would most like to prevent–the one you would find most devastating–adoption may not be for you. The truth is that adoption is not a good choice for everybody!

Addressing the Crisis of Challenged Family Building

When I was a child we had a toy—a child-sized plastic figure with a clownish face filled with air and weighted on the bottom with beans or sand. Its purpose was to be punched, and to rise from the blow grinning, waiting to be punched again.

It has often seemed to me that as my husband and I experienced infertility we were like a pair of those punching bag toys placed on a conveyor belt moving through a system punctuated by swing arm gates. As we moved along that conveyor belt from doctor to lab to bed, to doctor to hospital to bed, to doctor to pharmacy to bed, to doctor to counselor to agency to attorney, and on and on, we found that the belt began to speed out of control (rather like the conveyor belt in the candy factory where Lucy and Ethel scrambled to fill boxes that rushed by).

Grinning madly (stiff upper lip, and all that) we were knocked askew by alternating swing arm gates—the doctor, the lab, the hospital, etc. and sent separately reeling to cope with new information, new alternatives. Occasionally in swinging upright again from a blow we would bump against each other and provide one another with a momentary steadiness. But each time we were hit again, we went our own separate ways—alone.

There are several ways that people commonly deal with crisis, but victimhood is the least helpful. Spending significant amounts of time allowing yourself to become the victim of the crisis, floundering in a sea of despair as you are overwhelmed by waves of decisions that must be made is often undergirded by a sense of damaged self esteem. Infertile heterosexual couples, gay or lesbian couples, partnerless adults may all harbor the fear that family building challenges are a punishment of some sort or a message that they wouldn’t be good parents anyway. Some fertility-impaired people react by believing that they are somehow less competent than they were before infertility was discovered. If their reproductive systems aren’t working, they somehow illogically reason, then maybe they shouldn’t trust their judgment, either. (Maybe Uncle Charlie was right; we’re just trying too hard. Perhaps Mom’s manicurist’s cousin’s doctor in Podunk is better than the reproductive endocrinologist at the medical center. Maybe my neighbor who thinks adoption is a sad substitute for real parenting because nobody could ever really love somebody else’s reject isn’t so far off base!)

Feeling neither confident nor competent, victims become unwilling and unable to make decisions. They begin to abdicate more and more control to others, losing their power. The partnerless may date desperately or not date at all, putting aside any thoughts that time is passing quickly. Infertile people may move robotically from treatment to treatment, never looking at alternatives such as adoption or collaborative reproduction. Caught up in the panic of the situation, such people tend to make decisions only when they must be made, struggling forward from crisis to crisis. Those who allow themselves to become victims drift into a childless future they do not want because they haven?t been able to make the decisions that might have helped them consider choices available to them. Victims will fall into a dropped-into-their-laps adoption because someone they saw as competent told them it was the next logical step, and, unprepared for the challenging differences in adoptive parenting, will struggle for years with a feeling that things aren’t quite right, that this didn’t work either.

I worry about victims, because when one operates by crisis management there is little opportunity for reflection. Victims stumble forward on that conveyor belt carried by a panicky momentum much like that we felt as out-of-control young runners about to skin our knees again. I worry because family-challenged people operating in such a mode tend to act out of desperation. With self-conscious laughter, they tell you that they would do anything to have a baby?even drink poison! Sadly, many really would. They sense that the surrogacy service or the adoption lawyer made it just a little too easy (and yet too expensive) for them to skip ahead of more “traditional” clients. They beg for one more cycle of a drug their doctor has decided isn’t working. They borrow money for yet another in a long string of unsuccessful IVF attempts. They risk it all on a not-quite-legal adoption. They juggle two or more potential adoptions or an adoption and a high risk pregnancy at the same time. Obsessively driven toward the goal of bringing a baby home to a waiting nursery, they have thought very little beyond arrival day.

I worry about these would-be parents, because by allowing themselves to become victims of the challenge to their family building dreams, by allowing themselves to avoid thinking about the ramifications of their crisis management style, they almost guarantee that they won’t effectively deal with their losses. And, that years later those losses will reappear as reopened wounds when new and different losses set a grief reaction in motion – for example, losses of jobs, divorce, death of a parent or close friend or spouse, their adopted child’s recognition of loss as a part of his adoption experience.

I worry because the self-absorption of people operating as victims won’t allow them to feel compassion for others–for birthparents, for people dealing with secondary infertility, for the confused and panicked parents of quads or quints conceived on fertility drugs or in IVF cycles, for couples dealing with an untimely pregnancy, for pregnant infertiles who can’t find a place to ‘fit in’ anymore. For one who has experienced reproductive loss or challenged family building to have lost compassion for those experiencing other types of family-related challenges is particularly ironic.

I worry because for victims there is no joy in living.

There comes a time to stop—to recognize that one has not been in charge and to step off the conveyor belt, regain balance, and look around for a better way. My hope is that the process for decision making offered in the next chapters of this book can become a tool to help couples and singles make that pause for reexamination happen, offering them practical ways to regain control of their lives again, helping them to look far enough beyond the danger represented by the dragon to see the opportunity lying just ahead.

Many significant beginnings and endings in our lives are marked by rituals that publicly mark the transition and invite the support–either in celebration or in mourning–of others. Weddings, funerals, christenings, baby showers, bar mitzvahs, graduations, going-away parties are examples of transitional rituals. Psychologists and sociologists are increasingly noting that transitions which are not accompanied by ritual–divorce, loss of a job, miscarriage, private changes of direction–are often harder to make, since they lack support.

Many family-challenged people are finding it important to create and participate in private or public rituals which acknowledge the progress of their lives. Infertility support groups across the county have put together periodically repeated mourning ceremonies for miscarried or unconceived children. Such ceremonies offer the opportunity for couples and their supportive family and friends to experience a release similar to that in a traditional funeral service.

Several years ago Bonnie and Lawrence Baron of San Diego wrote about their personally composed ceremony in which they formally ended treatment and moved on. Their ceremony was firmly rooted in their Judaic tradition and included elements of several ceremonies and prayers, as well as some nonreligious readings and music.

Mike and Jean Carter of North Carolina, authors of Sweet Grapes: How to Stop Being Infertile and Start Living Again (Perspectives Press, Inc., 1989, rev. 1998), note in their book and in their presentations the formal way in which they marked their choice to live a childfree lifestyle.

Wendy and Rob Williams of Ontario, Canada, created a poignant and very personal ceremony for saying goodbye to the child whose adoption was not completed because his birthmother changed her mind several weeks after placement.

In many ways the structure of the decision making format which will follow encourages the opportunity for using or developing rituals, whether formal or informal. You may wish to explore with your partner the idea of participating in appropriate transitional rituals yourselves as you mark your journey.

In “The Picnic,” one of the wonderful short stories in her collection The Miracle Seekers: An Anthology of Infertility/ Mary Martin Mason tells the story of Jill and Dan, frozen in time and unable to move beyond the miscarriage of Gerald, the baby they had waited for so long. In an awkward attempt to help, Dan takes Jill on a picnic along the raw Rhode Island shore. With her sketch pads and charcoal in hand, Jill makes her way to an ancient cemetery to do some rubbings. Dan finds her later, weeping over a one hundred year old tombstone that bears the names of a couple and their five sons–each of whom was named Josephus, each of whom died in infancy.

Here, Jill comes to see that what is preventing her from moving on is the fact that no one–not her mother-in-law, not her friends, not her husband–has allowed her to experience her grief openly, to mourn the loss of her son, to say goodbye in a formal way to the baby who was not to be. And so, together, Dan and Jill say goodbye to Gerald by burying a baby rattle which Jill has brought with them in the earth above the babies Josephus.

All significant endings and beginnings are indeed crises, fraught with the fear that is a part of facing the unknown. The Chinese concept of crisis consisting of both danger and opportunity is an important one for us to keep in mind as we do the hard work of making good decisions. Many years ago I clipped from a church bulletin a wonderful quote that speaks to this. It was attributed to Merle Shain.

“There are only two ways to approach life–as a victim or as a gallant fighter–and you must decide if you want to act or react… a lot of people forget that.”

But not you, the reader of this book! You’ll remember and decide!

The following article has been excerpted from Chapter 9: “The Role of The Child Welfare/Social Worker” in Deborah Gray’s 2007 book Nurturing Adoptions: Creating Resilience after Neglect and Trauma. Those reading it as a printout will find it on the internet at http://www.perspectivespress.com/parentassess.html. Adoption agencies have the author’s permission to print out and use this tool in their staff training on adoption assessment.

Homestudies should not be expected to identify only “perfect families.” All families have areas of weakness. The homestudy should act as an educational tool that will help families be successful. It is also a screening process that acts to remove families who are markedly unsuitable for parenting children who will need extra help from sensitive parents. The two percent of prospective families who should not adopt children are also the ones who take inordinate amounts of time away from the child welfare system. Identifying unsuitable families before, not after placement, allows for significantly more time for post-placement training and support for families, completing adoptions, and recruiting more families.

The interview template which follows should only be used in the form of a face-to-face interview, not in the form of questions soliciting written responses. The template incorporates some of the research and theory behind the Adult Attachment Inventory. This format presents homestudy questions from an attachment point of view. It adapts concepts from attachment research and literature to the homestudy process.

Homestudy Interview Questions

1. Describe the relationship you had with your mother as a child. To your father? List five adjectives that describe your mother, and five for your father.

The social worker should write down these descriptive adjectives, and then ask for examples of situations or events that demonstrate those qualities. Social workers should be looking for a description of parent-child intimacy. They should also be judging the general quality of the description. The narrative should be smooth, coherent and have a firm basis in reality. Words and facial expressions should be consistent. If people cannot remember any examples to support the qualities that they mention, then start tracking the quality of sensitivity in their relationships.

2. Can you detail some times in which you really needed to depend on your parents? How did they respond? How did this affect you at the time? What do you think of it now? Would you parent in the same way or differently?

The examples should fit the answers to the questions. Any contradictions indicate the presence of something that should be explored further. One big red flag to watch for is the interviewee trying to turn instances where the parents were not there for them into an advantage.

3. Can you describe times where you felt lonely or rejected by your family? Were they aware of your feelings? How did you interpret their actions as a child? And now? Would you parent in the same way or differently?

Ideally, people should be able to describe painful experiences in a way that demonstrates an understanding of their parents’ points of view. They should have an idea of why something happened, and also be able to acknowledge the effects of painful experiences on their own development. The person being interviewed should be able to do this without becoming overwhelmed with bitterness or any other emotion.

4. What is your current relationship like with your parents? How often do you see them or talk on the phone? If they are not living, what was it like when they were alive and how did their loss affect you?

Answers to this question should contain information about

• the degree of reciprocity/ attunement that they had as children,
• descriptions of how painful family situations were acknowledged and repaired versus being ignored,
• smoothness and coherency in the descriptions,
• insight into how those first relationships shaped their present lives.

5. Were you ever frightened of or hurt by your parents? How was this dealt with in your family? How do you think that this affected your childhood and who you are today?

Parents-to-be who describe bitter memories of abusive, insensitive, or abandoning parents, and who also show little resolution will need to work these issues out before placement. They will need a referral for therapy. Watch for positive indicators as well. People who experienced childhood abuse may have been buffered by positive attachment figures, like grandparents, who were sensitive and responsive. Descriptions of their alternate caregiver’s sensitivity, with a sense of resolution about why their parents were not there for them are good signs. The more people are able to describe the reasons behind parents’ actions, with appropriate, regulated emotion and insight, the better. An appropriate answer to this question looks like this.

My mother would not listen to me when I was upset by my family’s sudden move. She ignored my tears and said, ‘Pack.’ Now I know that she had just had a Caesarean section a week before, was hormonal, in pain, and had to move our whole family, including a new baby. My dad had to choose between flying to the new city within 48 hours and losing his job. We had to follow him. As an adult, I have concluded that we must have been behind on rent. That’s one reason why we moved so quickly.

“My mother never apologized, though. I think that I would do things so differently. I would at least try to explain what was happening and let my daughter know that I cared about her feelings. That would have helped a lot. My grandma let me cry at her house and took me to my school and around our neighborhood so that I could say goodbye to my friends and my teacher.”

Notice that this sample contains an honest description of pain and a conclusion about her mother’s point of view. It also includes a description of a sensitive parent figure, the grandmother, who provided support during an overwhelming situation. She went on to describe how she would do things if she were the parent. The example is relatively brief and easy to follow. It is clear that this person has the ability to use her own life stories as a source of empathy for others.

6. Give me a ten-minute description of your life, including main events and the major decisions that you have made. Start either at the present and go backwards, or begin at birth and go forwards. What are your earliest memories?

This type of narrative should demonstrate a person’s sense of mastery over most of the events in life, or their ability to take responsibility for personal decisions and actions. Answers to this question will also highlight the contrasting attitude of blaming others. It will show thinking that is shame-based, and also reveal whether people view themselves as helpless victims or in a grandiose way. Listen for the inclusion of instances of seeking out support and acknowledging helpers, as these abilities act as important attributes for adoptive parents.

Look for a coherent life narrative. The narrative should be relatively smooth and should not have gaps. Emotions, as conveyed both through facial expressions and with words, should match the person’s story. Pay special attention to life narratives that do not make sense! Why is the person lacking integration? If you, as an adult, find the person emotionally confusing, a child will certainly have difficulties using this parent as an emotional guide.

7. Tell me about your best friends. How did you meet them? How long have you known them? What do you do together? How often do you get together? How do you work out problems in relationships?

Get a sense of how connected the person is to their community and also the quality of their relationships. Check to see how long-term their relationships are. Loners who cannot work with others are not good choices as adoptive parents. They cannot instruct a child who needs help learning how to resolve problems and become more trusting. When angry, does this person cut people off permanently? Certainly this trait comes back to haunt social workers, in the form of disrupted placements.

Scrutinize people who have the following characteristics, as they are potential child abusers.

• They are charming.
• They are willing to accept an especially needy child.
• They have intense but short-term relationships, and no one knows them well over an extended period of time.
• The person seems too good to be true.

If you observe these traits, look for a hidden price tag. Sexual predators and antisocial personality types gravitate towards the most vulnerable members in our society. They tend to be especially charming throughout the homestudy process. Check these peoples’ histories thoroughly. Make certain that they have a clean, well-researched record. Take seriously minor charges, such as fraud, assault, drug or alcohol abuse, and domestic violence, and examine especially carefully all charges that are accompanied by great rationalizations.

Pay attention to red flags in the history that indicate instability: sudden firings, financial irresponsibility, frequent moves, lies, multiple marriages, affairs, and a lack of continuity in relationships. These form the symptom clusters predictive of personality disorders. It is important to remember that a caseworker cannot simply befriend every family. The homestudy process must effectively screen out predatory adults.

8. Do you consider yourself to have been a physically or emotionally abused or neglected child or teen?

Ask about any abuse that may be a part of the person’s background. If there is abuse, when did it start? Did it involve the person’s nuclear family? How have they come to understand it; what are they doing to resolve their relationships and gain safety? Were there multiple traumas? Does the person have night terrors? Does the person have flashbacks? Are they bothered by loud noises? Would a screaming or aggressive child bring out reminders of the abuse?

Remember that there is a difference between Type I and Type II abuse. Type I abuse is short term and does not result in traumatic stress reactions. It stands out as an unusual and unique experience. Social workers often have optimistic views, taken from accounts of parents who have been successful in spite of abuse and in the absence of counseling. These views are usually based on people with Type I abuse, as they were impacted less.

As described in Part One, Type II abuse involves multiple events or long-standing abuse, with extreme stress. People with Type II abuse who have had no or poor treatment outcomes pose a risk for high-stress children. These parents can easily fall back into a behavior pattern of dissociation, flood with old trauma, and suffer from anxiety and depression. People with Type II abuse tend to incorporate numbing and dissociation, substance abuse, rage, mistrust, interpersonal relationship problems, suicidal ideation, and uncompleted grief into their personalities (Veitch, 1998). Even children with no histories of maltreatment find these personality states alarming. Children tend to form disorganized attachments with these adults. These individuals have often the complex trauma described in Chapter 2. These homes are not healthy enough for adoptive placements.

9. Have you had periods of depression, or do you think that your moods swing more than most people’s? Do you think you have anxiety problems?

Please ask these questions in person, not just on a form. It is easy to check “no” on a form. It is much more difficult to lie in person. Many people have experienced periods of anxiety and depression but have responded very well to counseling and medications. These people do quite well with children after placement. They certainly should not be screened out of adoption. Check into the mood issues in a person’s history. Are there periods of depression? How have they been handled? What is different now? Did they show resolution over losses from infertility? Are the losses related to infertility being confused with a long-term mood disorder?

Be wary of people with ongoing problems with depression, anger, or anxiety. Depressed parents will have attachment problems with any child, even a healthy newborn. They are simply not capable of doing the difficult emotional work that is required in the placement of a toddler or an older child. People with anger management problems make children feel as if they are still in a hostile environment. This signals them into fight, freeze, or flight mode instead of attachment. Anxious parents cannot help children calm down. They instead reinforce a wary, paranoid outlook on life. Encourage angry, depressed, and anxious applicants to get treatment for these issues first, and then proceed with the adoption process.

10. Are you comfortable letting others help you with this child? Do you mind working with professionals?

Parents need to embrace the team mentality. Children described in this book are best placed as special needs adoptions. Parents should expect that they will need to coordinate a helping team for such children. They will have to develop resources that help their children. Mistrustful, angry, highly anxious, or depressed individuals will not be able to meet these children¡¦s needs, as they will not understand their need for advocacy and the use of teamwork within a community.

11. Are you able to accept lots of acting out and controlling behaviors in children as a probable scenario for the beginning of placement? For children who have trauma histories, will you be willing to get therapy, a necessary part of children¡¦s medical care?

Many parents naively believe that the child they are adopting from foster care or from an orphanage overseas will be a withdrawn, sad child who will be gradually drawn out in their home. Of course this is frequently not the case. Parents need to be informed of the long-term consequences of sexual abuse, physical abuse, trauma, and exposure to domestic violence. In particular, physically and sexually abused children are among the most aggressive children seen in clinical samples. Professional adoption workers must include, as part of the homestudy process, a discussion of the essential trauma-specific therapy that will probably be a part of their child’s future. Research clearly shows that children who receive trauma therapy, especially when it includes a cognitive-behavioral approach, do enormously better as compared to children whose parents omit this therapy.

12. Will you be able to provide more structure and nurture for children who need this approach, rather than using the parenting style that most closely fits your own personality?

Successful parents of children who have experienced neglect, prenatal exposure to substances, or maltreatment almost always run highly structured and nurturing homes. While the structure may be gradually relaxed as children develop more internal structure and emotional maturity, success does require that parents use consequences rather than emotional outbursts or lectures.

13. What resources available in your community will help you support a child who has been neglected, abused and/or otherwise traumatized?

This question includes the opportunity for some educational work so that families understand the differences between children adopted later in childhood or after maltreatment as compared to children who have a healthy start. It gives families time to think and talk about these differences in an individualized manner. It also gives them time to ask and answer a variety of questions and do their own homework. For example, does their insurance have mental health coverage for families? If not, could they change their policy to one that does? When is the open enrollment period? Have they located a mental health provider who takes their insurance and could see them with their child? Does the child need occupational therapy to remediate the effects of neglect? What is the monetary and time commitment of these therapies? What will they give up in order to make time and money available? Parents need either to have a rich assortment of resources already in place, or to be well-connected to their communities so that they can acquire these extra resources. Cover the potential needs of a child similar to one they would like to adopt in a specific manner, detailing the necessary community resources. For example, help them locate respite care in a specific manner during the homestudy process.

Many people assume that their friends, relatives, neighbors, or religious community will help them. This often is not the case, and it is also one of the saddest disappointments for parents adopting children with special needs. Most people have busy lives and do not readily volunteer their time to these commitments–especially long term. Parents need to ask potential supportive people to commit to meeting the child’s prospective needs, in specific terms, in advance. I have given several trainings where close friends have come in with the prospective adoptive parents. The parents had asked for support in advance, and, as a result, their friends had time not only to clear their schedules in preparation for the child, but to receive training.

About 30% of adoptive parents are single parents (AFSCAR, 2006). Social workers should help single parents work on identifying their future support systems throughout the homestudy process.

14. What resources are available for children with learning issues through the school district?

In a study in the State of Washington, the average foster-adopted child was two full years behind grade level by the 8th grade. Will the school in the parent¡¦s district help their child immediately and effectively? Do the parents understand an IEP process?

This information is part of the educational effort of the homestudy. It should include providing or assisting in locating resource numbers and references for the education services in the parents’ school district. Even if the family is lucky enough not to need these services, they will be informed and can support other families who do need them.

15. How will you individualize and meet the needs of this child or children?

Parents need to have enough time and space for each child in the family. Educate parents about the differences and the special needs of children adopted after stressful beginnings. Sometimes one parent has deferred to the other in a decision to adopt such a child. They have a tacit understanding that they will still enjoy eighteen holes of golf weekly after the placement. These issues of entitlement should be recognized and addressed during the homestudy process. It is unrealistic to believe that one parent can plan and implement the entire childcare and community resource plan alone, without coming to resent the other parent.

Ask parents who are already too busy or too financially stretched to make a list of the activities they will drop. Give each parent a sheet of paper, and ask the partner to list what the other should drop. This leads to a healthy discussion about compromising as they barter with the partner’s lists. Ask them to begin the “dropping¨ process before the placement. Single parents do this exercise with a close friend or relative. Sometimes parents are taking on too much. This constitutes one common reason behind poor placement outcomes; families accumulate too many stressors and adopt too many children.

Families should be able to individualize the needs of all existing members, and reflect on how they are already meeting those needs, as well as how they will continue to meet everyone’needs after placement. This gives them a sense of the resources that they have. They should then talk about how they will meet a new member’s needs, in specific terms.

16. For what type of child do you think you would not be able to meet the needs? Can you tell me about this?

Parents need to explore what they could not see themselves handling. This exercise gives the social workers enough information to help parents avoid these and related situations. Be certain to listen to parents and help them plan for placements that realistically fit their strengths. For example, parents may say that they are planning to have children share rooms and they could not handle sexual acting out behaviors. This should lead to a discussion about placement issues so that the family’s wishes are met as closely as possible. It should also lead to a conversation about what to do if acting out did occur.

In conclusion, this section’s approach and information is a necessary addition to homestudies in the 21st century, helping families prepare realistically for the parenting ahead for those who adopt traumatized/neglected children being placed today. It should be considered a best practice technique for today’s adoptions.

Organizations are welcome to reproduce the 16 questions above for use in their work in face-to-face interviews.

Deborah Gray may be contacted at deborahdgray@yahoo.com

Care to comment? Send us an email at comments@perspectivespress.com or write to us at
Perspectives Press: The Infertility and Adoption Publisher
PO Box 90318
Indianapolis, IN 46290-0318

The following article has been excerpted from Chapter 4 of the May, 2005, book from Perspectives Press, Inc Having Your Baby through Egg Donation. Those reading it as a printout will find it on the internet at http://www.perspectivespress.com/donoreggdecisions.html.

Like all travelers, you should plan well for the journey through egg donation. We’d like to begin by reminding you of some of the elements of and influences on decision making that we addressed in Chapter 1 and then offer additional suggestions

Decisions Are Made Sequentially

If you have been struggling with infertility, you have probably already figured out that as your reality changes, so do your perceptions of your options. How many of you once thought, “I’ll never do IVF?” By now many of you are veterans of IVF cycles many times over. As you traveled down one path, you discovered that options which once seemed daunting or disturbing could actually have become attractive.

Never Say Never

You have probably figured this out as well. It is easy to say you will never do this, or never do that, but as we said before, as your reality changes, so do your decisions. Remember also, that not yet does not mean never. For instance, your partner may say “Not yet” to something that you think you want to do. Listen carefully to your partner, talk openly about your concerns, and repeat after us, “Not yet is not never.”

Husbands and Wives Move at Different Paces and This Is Not Necessarily a Bad Thing

Remember that we said, “Not yet is not never.” We remind you of this so soon because if you are like most couples facing decisions about using donated ova, one of you will be ready to consider this alternative path to parenthood before the other. When this happens, the person who wants to move forward is often upset and angry with the one who says, “I’m not ready” or “We need to try again.”
You are perhaps puzzled by our saying that this is not necessarily a bad thing. In fact we have found that couples have a way of balancing each other. One of you can sound—and feel—eager to explore options beyond conventional treatment in part because you know that your partner will slow you down and help insure that you make wise, informed decisions. Similarly, you who are trailing at the rear can afford to take it slowly because you know from past experience that your spouse is well prepared to take the lead.

Your History Will Inform Your Decision Making
Remember that you and your partner have different histories as well as a shared one. Inevitably, decisions about using donated ova, adoption and other options will be shaped by your past experiences. If your favorite cousins were adopted, you will have one set of associations about adoption. If the worst trouble maker in your elementary school was adopted, you will have different notions about people who joined their family through adoption. If you were a birthmother and placed a child in adoption, your feelings about adoption will be influenced by this experience, and if your cousin’s daughter was a program-recruited oocyte donor, you will have her as a reference point for egg donation. Be prepared for significant losses to help shape your perceptions of each of these options. This leads us to…

Loss and Grief Are Part of the Journey

Surely you will feel loss and grief along the way. After all, things are not working out the way you had hoped or expected. However, if you may still succeed in having a biological child (or another biological child), you may not face the full loss and grief encountered by those who learn or realize that they will never fulfill their dream. Nonetheless, you are experiencing loss—loss of the hoped for spontaneous conception, loss of feeling that you can plan your time (let alone your family!), loss of money, loss of a great deal of emotional and physical energy already invested, loss of the perception that hard work always pays off. Be prepared for a journey—or the continuation of a journey—that involves loss and grief and ever unfolding new realities. We hope that you, like others who have traveled before you, will discover the unanticipated rewards that come from being able to accept loss, to grieve, and then to celebrate your new realities.

Infertility researcher Dr. Stacy Ellender captures this in an essay she wrote about her own infertility experience and her daughter’s arrival from China in Experiencing Infertility (Josey Bass, 1998)
Ellender writes, “Someday, my daughter will learn that she was ‘forsaken on the street,’ abandoned under unknown circumstances, and waves of pain may send her reeling. But I like to think that I will steady her, that we will share our stories of loss and redefinition. I can hold her hand in mine and show her how to face pain with honesty, integrity and a deep wonder at its unexpected potential to shape our lives.”

Don’t Punish Yourselves

Remember that you have made the best decisions you could along the way. Regret is a painful, poisonous feeling, and infertile people are often the maestros of regret. It is so tempting to look back and second guess yourself. “I should have been less focused on my career and we should have tried earlier.” “I shouldn’t have had an abortion when I was 22. It might have been my only chance to have a baby.” “I should have pushed my husband when he said we had time to wait.” “I should have met him earlier.” “I should have tried to marry a younger woman.”

Although none of us make decisions expecting to regret them, sometimes the choices we make turn out to be the wrong ones. We wish we could tell you that you can be fully spared regret about future decisions, but you cannot be. It is almost inevitable that you will look back and contemplate how things could have been different if only you had made a different choice. All we can ask is that you try to be gentler with yourselves and each other and remind yourselves that in most instances, you did the best you could with the information you had at hand. As we know, hindsight is twenty/twenty, but in looking forward, all we can do is to try to see things as clearly as we can. Now is the time to look forward with hope rather than back with regret.

The People You Meet along the Way Will Shape Your Journey

Be prepared to meet some wonderful people, perhaps people who will change your lives. People struggling with infertility find one another in doctors’ waiting rooms, on line through sites like INCIID.org and fertilethoughts.com, through infertility support groups like RESOLVE and the American Fertility Association, the Infertility Network, and the Infertility Awareness Association of Canada. People considering using donated ova and adoption turn for guidance to others who have traveled these paths before them. How reassuring it is to attend an adoption agency meeting and see a couple smiling happily as they dote over their newly adopted baby. And you say to yourself, “They look just like regular parents!” How comforting it is to see a woman pregnant through egg donation, glowing and very much “with child.” You feel tickled as again you say to yourself, “She looks no different than any other pregnant woman.”

The people you meet along your journey will have a lot to do with the choices you make. This is, for the most part, a good thing. We expect that you will find mentors and friends. But take caution as well. You are vulnerable. You will be listening carefully and with emotion to everything you hear about the options that lie before you. If someone has had a bad story using an option that you are considering, that doesn’t mean that everyone’s experience is bad or that yours will be.

You will meet people along the way who will become friends for the journey. You may also meet people who will become friends for life

You Have the Right to Make Your Own Decisions and to Feel That You Are Doing So Free and Clear of the Influence of Others

As you travel this journey, you will surely find that others will offer advice. First of all, you will receive a tremendous amount of medical information and advice, requested and unrequested, from physicians, nurses and other caregivers. Medical and program staff’s information is given so that they can be sure that your decision is made autonomously and that your consents are fully informed. You should take all of this information in and consider it carefully before making your own unique decision. Advice about non-medical options in family building or the non-medical aspects of gamete-donation, on the other hand, is unauthorative when coming from medical personnel, and should be thought of as such. You will receive additional advice from what we call “the self-appointed experts”—the family members, friends and complete strangers who want to give you such sage advice as “Relax and you will get pregnant” or “Parenthood is not so great anyhow” or “Why don’t you just adopt?” You will need to remain strong and sure-footed as this advice comes your way, often when you feel least equipped to cope with it.

Speak from a Position of Strength

Do not tempt advice givers! If you let people know only the basic facts about your situation—that you want to have a baby and that you are doing your best to make that happen—you are less likely to invite unsolicited advice. And this is really all that anyone needs to know. They don’t need to know that you are contemplating using a donor’s egg or adoption or another IVF cycle. When you do have some news that you want to share, speak from a position of strength. If you say, “We’re thinking about using a donor ovum” or “We are looking into adoption,” you may get upsetting responses such as, “Oh we’re so sorry IVF didn’t work for you,” or “Are you sure you’ve seen a good doctor? We know someone who had 25 miscarriages and then saw Dr. So-and-So in North Rural, South Dakota and…or “Whatever you do, stay away from adopting from That Country. We know people who…”

What you need to say—if and when you say anything at all—is “We have great news. We’ve decided to …” or better yet, “We have great news, we’re expecting a child through…”

If you found this excerpt from Having Your Baby Through Egg Donation provocative or enlioghtening, you’ll love the book!

Care to comment? Send us an email at comments@perspectivespress.com

Not fair, you say? I understand. Been there. Felt that. But as my children by adoption have grown up, as our relationships with them and some of their birthparents have developed, I’ve changed my thinking a lot.

Here�s something you probably don�t understand if you are not yet a parent. Parenting itself changes everything. From the moment you become a parent forward, your child�s needs will always come before yours and before anyone else�s in your life. For those who conceive their children, that shift comes automatically as part of the pregnancy experience. Indeed, it�s that shift in thinking that makes it possible for birthparents to plan an adoption.

For those who adopt, however, making that shift is not automatic. Unless one makes a deliberate choice to shift thinking, to participate in an adoption expectancy period, the shift won�t likely happen until after the child arrives. And by then, many infertile couples can have made some pretty bad choices already�choices rooted in their frustration, in their reactions to many losses that infertility has brought to them, in the desperation they have begun to feel about ever being able to parent.

Over the past twenty years or so, changes in adoption have done little more than move the locus of power in adoptions. First power was moved from adoption professionals to adoptive parents, and now it has been transferred to birthparents. But changes in who holds the power have not often included the education necessary for all of these parties to understand and accept what children themselves need from adoption. And what is it that children need? They need well-prepared, unafraid, stable and loving families over their entire lifetimes!

Too many of those involved in adoption right now seem to experience it as a competition. Agencies compete with other agencies and with independent service providers to draw in limited numbers of birthparents whose healthy babies can be offered to an apparently unlimited supply of prospective adopters. Special needs agencies compete with one another for public and private grant money, and often trash one another and their differing approaches to counseling and preparation. Prospective adopters compete with other prospective adopters for the opportunity to adopt available babies. They look for too many shortcuts to �faster� placements by looking for providers who will not require education, extensive preparation, and screening, because it is too �invasive and unfair.� Adopters attempt to demonstrate to expectant parents that their adoptive family would offer a “better” life for the child about to be born than would the child�s family of origin or any other prospective adopters. When an expectant parent has a change of heart about adoption during the window of time a state or province grants for the change-of-mind process, many adopters and their professional advisors take the stance that possession-is-nine-points-of-the-law and go to court so that they might “keep” the baby, even though they are not yet the legal parents. Adopters, birthmothers and professionals often conspire to keep birthfathers and their families out of the picture entirely.

Ideally, changing adoption so that it really meets the needs of children would begin with fundamental changes in thinking and in the law. Different thinking would end the adversarial aura that surrounds adoption. If adoptions really kept the child’s interests center-stage, everybody involved in any untimely pregnancy would be seeking the best possible solution for the child to be born. This solution would find him with his permanent family (birth or adoptive) as soon as possible after his birth.

Getting off to this kind of a “clean” start in an adoption, however, demands a tremendous amount of understanding and emotional work on the part of both sets of parents, as well as careful judgment on the part of well trained and well informed professionals. Those working to launch a child-centered adoption must be helped to understand how each of the decisions made and each of the procedures followed will help the child at the adoption’s core.

For a baby’s launch to be optimal, everyone involved must be committed to being honest with everyone else in the adoption. Birthparents must be honest with one another, with helping professionals, and with prospective adopters. Adopters must be scrupulously honest with professionals and expectant parents. Intermediaries must be scrupulously honest with expectant parents and prospective adoptive parents. There must be no assumptions that �leaving that little something out� �letting that little something go,� causes no harm. Scrupulous adherence to ethical standards that keep the child at the center while respecting the needs and interests of both adoptive parents and birthparents is absolutely crucial in making all decisions concerning an adoption.

As an adoptive parent, wife, and sister-in-law, daughter-in-law, cousin-in-law to adoptees, sister-in-open-adoption to my child�s birthmother, and adoption educator, I hold those who elect to join to adopt to very high standards. That�s because this is what children deserve from their parents.

Patricia Irwin Johnston is a long-time advocate, infertility and adoption educator and author of several books, including Adopting after Infertility, Launching a Baby�s Adoption, and Adoption Is a Family Affair, written with the participation of the community members of the INCIID forums which Pat moderates: Exploring and Expecting through Adoption. and Parenting after Adoption. This article first appeared in the eletter of INCIID, for which Pat is an advisor board member.

Care to comment? Send us an email at comments@perspectivespress.com or write to us at
Perspectives Press: The Infertility and Adoption Publisher
PO Box 90318
Indianapolis, IN 46290-0318

Some Background

Children grow best in families, with one parent or two to nurture, encourage and cherish them. We all know this. Even if an orphanage is as bright and cheery as your neighborhood day-care center, with appropriate nutrition, health care, and activities, children who live in group care have far fewer opportunities to learn healthy emotional connections and living skills, and thus have less encouragement to reach their developmental milestones and to develop positive attachments.

As adoptive parents, one of our tasks is to help our children make sense of their world and to integrate the many strands of past and present into a cohesive sense of self. This may be more difficult for adoptive parents because we have to first accept that our children come to us with the rich tapestry of their past, one that may have included not only good things, but difficulties, even sad and hurtful times. And for many children, even infants, leaving what is familiar for a new family may be a sad and scary time.

Children who have lived in orphanages and are then adopted leave behind a world very different from that of their new family, but one which usually has had strong connections for this child. Even very young children bring along a wealth of memories, some accessible, some not, when they move into their adoptive families. These memories may include good times, a sense of sameness and stability, and trust in people they cared about who have cared for them. There may have been relationships with special caretakers and with other children with whom they developed ties as close as siblings. These kinds of relationships helped children begin to learn about the importance of human connections and attachment.

For other children there may be fewer good memories, perhaps because of abuse, neglect, abandonment or deprivation in their past. An overcrowded orphanage with overworked staff and few resources may be unable to provide more than the barest of essentials for children in their care; it may have been too cold in the winter, too hot in the summer, with too many children to feed adequately or to give attention to. In such an environment, children may feel all alone in the middle of the crowd, where they are seldom singled out for attention and affection. They may have learned that the world is not a safe place and that grownups are not dependable creatures. Yet if this is all that a child has known, this familiar environment is usually perceived as what is normal, the only place to call home.

There seems to be a strong and universal human trait to reach out to a child in need. For parents, it seems almost an ingrained reflex to want to try to protect our children from pain and to ease our child�s hurts. We want our children to be happy, to have happy memories and feelings to build into a positive sense of self-esteem. But all children, whether born into or adopted into their families, inevitably have a variety of experiences in life, with a wide range of accompanying emotions. It is how these experiences and emotions are dealt with-�not ignored or forgotten, but considered and incorporated into a sense of competence that one has succeeded in moving through difficulties�-that in part determines how a child grows stronger and more self-assured.

This tendency to want to protect children in need is perhaps part of the reason some people think about adoption as the �rescue� of a child, not just the growth of a family. But what adults see as a change for the better, some children experience as a kidnapping to an alien culture. Children and grownups may have very different perceptions and emotions about the same situations.

With adoption, all of the familiar and dependable people, places, schedules, food, words, clothing, and smells are gone. In their place are new and unfamiliar things an orphanage that seems like a less than positive, even deprived or negative place in an adult�s eyes may have been considered as a safe and familiar home to a child, even with all of its obvious flaws. A grownup who seems pretty ordinary to us may have had significance to our child either as a beloved lifeline or as a feared disciplinarian. A loving adoptive parent and a stable home filled with toys, pets, and security may appear like a wonderful choice for a child to the grownups involved in adoption, yet feel to a child like being ripped away from everything she has ever known. While adults rejoice with an adoption, children may have a range of confusing emotions.

Even names, what people call you and how you intimately identify yourself, may be changed. Children as young as seven and eight months can recognize their own names and the endearing nicknames caregivers croon to them that help infants place themselves in the universe. How confusing it must be in this strange new place where people don�t recognize who you are!

This can become even further complicated because some children are naturally easy-going and cope with changes with tentative smiles and curiosity, while other children, more sensitive, may view new things with more reserve, perhaps even with resentment or fear. Children who react with hesitation or even rejection when meeting these new people called parents are not necessarily indicating problems with attachment. The situation may actually be the reverse: you may be meeting a child who understands attachments to some degree and is reluctant to leave people and places where connections have been made. This child may know at some level deep inside that attachments are not instantaneous but take time and trust and energy to grow. A child who seems open and welcoming of new parents when meeting them at the orphanage may be temperamentally more relaxed in new situations, but she is far from being attached to these new parents, nor does her uncomplaining acceptance of her new home signal that she has already attached. This period is just the beginning of getting to know parents and slowly building trust. And it is trust, proven over and over again through countless interactions of both basic care and fun, that nurtures the bonding process towards attachment over weeks and months.

Although Borya and the Burps! is one of the very first books on international adoption from Eastern Europe to be widely available to families, families who have adopted from other regions of the world may find this story valuable as well. Simple comments from parents while reading about what were the same and what was different for their child can personalize this story. Adoption of children from orphanage care does share some common themes and situations in all parts of the world, and thus parents can share this story with their children no matter where their child�s orphanage was or will be located.

Practical Strategies for Parents

When you read Borya and the Burps! with your child you are not only reading a funny and feeling story about a little boy, you are also opening the door with your child to sharing the funny, sad, joyful, and emotionally complex issues and stories about adoption and your child�s and family�s adoption journey. Many young children like to read stories more than once, which can provide more than one chance to talk, question, and share. Reading the story again may spark new questions and concerns for your child, or new directions for discussion.

I happen to think the best way to read a book with your young child, especially a story about important family and life issues, is to snuggle close. Sit your child on your lap or sit close together with your arms around each other and the stories you explore become a way for you to connect in intimate ways important for growing attachments. Reading Borya and the Burps! together can be a warm positive way for each of you to talk about this one little boy�s adoption story and open up avenues to communicate feelings and information about your own adoption stories in simple ways.

Preschool children often like to relate the stories they read to themselves and their own world. After all, very young children who are loved know that they are the center of the universe (if only to those most important people in the world, their parents)! As you read to your preschooler, you may want to add short, simple comments about how this story is like or different from their own life situations. For example, while reading the pages that describe Borya and his friends in the orphanage, you might say something like

Older children may already know some of this information and may have enjoyed shared stories in the family of their time in the orphanage, meeting new parents, traveling home, getting used to a new family and home. Their questions and concerns may be more complex, sophisticated, and difficult for parents to answer. Consider what issues might be brought up while reading about Borya–or brought up again now that your child is cognitively more advanced. Think about some of the common themes and questions school-aged children have related to adoption and how you might address these with your child. Some typical questions and issues are

If your child does not have questions or comments about Borya�s adventures and feelings or about his or her own story, feel free to introduce a few of these. If your child is uncomfortable about answering questions or offering opinions, you might want to offer your own comments, but do state that your child might have different ideas and that�s okay too. Discomfort in talking about adoption issues with you may indicate that your child is either in the process of trying to work through understanding these or is having a problem intellectually or emotionally with some aspect of these. You may need to return to these issues another time and gently bring them up with your child.

One suggestion: Your child may find that reading about Borya and his wonderful burps leads your child to practice his or her own burps. Some families find burps and burping contests funny (at least for a short time) while others consider this to be inappropriate for children older than infants. You may want to think about how you will address this behavior in your family should your child be so inclined.

Using Borya with Parents-to-Be

Borya and the Burps! can be used as a tool and a resource in helping parents with adoption preparation or supports. It can be a simple, enjoyable way to introduce and explore important international adoption concepts, such as realistic parent expectations, orphanage conditions, attachment, and the views, perceptions, and reactions of children. Wherever in the world their children are adopted from orphanage settings, being familiar with these concepts can be extremely helpful for parents in understanding both the complexity of the process and the perspectives of children.

Why read a children�s book about international adoption before you even have your child placed with you? Children�s books can provide waiting families, grownups and children, with valuable insights and information, and possibly some ideas about how you will plan, act, and react in international adoption. Some important reasons for grownups to read children�s adoption books such as Borya and the Burps! include

For adoption preparation groups and adoption support groups, reading Borya and the Burps! aloud together can facilitate discussion about important concepts, about the differences between adult and child responses, and about talking with children about adoption and their own international adoption stories, for example

If parents are preparing for international adoption individually or with the help of an adoption homestudy worker, using Borya and the Burps! as part of recommended reading, perhaps with a list of questions to ask and important points to consider, can be a very helpful to gain insights into our child�s past and the process of moving from a familiar orphanage to the unknowns of a loving adoptive family in a strange new country. Here are some questions to think about:

Moving Forward

As you and your child lead your lives together in your adoption-expanded family, it is my hope that Borya will help you both find your way. Adoption is a complex and life-long journey for parents and children that starts with willingness to risk and to trust, and a commitment to being a family forever. Borya is finding this out in his story, as I hope that you all will.

If you liked author Joan McNamara’s guide to Borya and the Burps!, you’ll just love her book! Read its online review copy by clicking the title Borya and the Burps

Don’t forget to ask about discounts when buying Borya and the Burps! in bulk quantities!

We’d love to hear your comments about this and other PP books and articles. Write to us at info@perspectivespress.com

The problem lies in the misuse of the word adoption. Granted, the words adopt/adoption have more than one meaning. The primary definition describes the legal process of transferring parental rights from birthparents to adoptive parents; the second and third definitions “To take and follow by assent” and “To take up and use as one’s own,” describe non-family-related meanings, such as the processes by which schools adopt textbooks, campaigns adopt themes, etc. The adopt-a projects, with their gimmicky “adoption certificates” and “adoptive parent” labels, trade on the primary definition of adoption, which relates to family planning and family building, creating a striking mental image which packs a marketing wallop. Every marketing person we’ve ever spoken to about our concern about this admits that it is the immediately recognizable image of sheltering an otherwise unwanted “orphan” that makes such a theme attractive and successful.

Those of us who are parents by adoption and adoption activists believe that, in turning upon a kind of “save the rejects” image, such programs trivialize a serious topic. Though these programs may seem innocuous to abstract thinking adults, they confuse and alarm children and and further myths and misconceptions about this family planning method to yet another generation of children.

Those who are skeptical about the very existence of adopt-a confusion argue that it is up to adoptive parents to work with our kids to explain the realities of adoption. The reply is that yes, of course, as adoptive parents we work with our children (and with the children of friends and relatives) to help them sort through the differences between adoption of people and adoption of animals or adoption promotions. But because children are not abstract thinkers, this is not an easy task. Research by David Brodzinsky at Rutgers University has shown that children who were adopted are really no quicker to understand the complex social issues which underlie adoption than are their non-adopted peers, though children who were adopted do learn to parrot the terminology much earlier. Adoption is confusing enough an issue for young children without adding to the confusion through commercial projects. We wonder why we adoptive parents should have to spend all this time explaining, when, by just sensitizing good people responsible for developing marketing programs we could instead eliminate the confusion entirely!

Perhaps you have not experienced adopt-a confusion in your own family (or at least you may not be aware that such a confusion is at work,) but such misconceptions are widespread among 3 to 12 year olds, nearly all of whom are intellectually too undeveloped to reason logically. Three examples of adopt-a confusion among children under 10 typify those occurring regularly in cities across the country…

A five year old adoptee was “given” a giraffe by her grandparents through their much-loved zoo’s Adopt-An-Animal program. Over the course of several months the child was very upset to learn that not only could she not take “her” animal home or care for it directly, but she also could not consider it “hers” after the year had passed, when a different animal was substituted for “her” giraffe in the next year’s campaign. In another city, another child was distressed when he learned that an acquaintance had been assigned the same specific animal as had he! A third child was told by a non-adopted friend who had participated in such a program that if his parents wanted to, they could trade him for a “better” child next year, as his family had in “upgrading” their zoo adoption. Children waiting in foster care for permanency have been teased by peers with taunts such as, “We adopted a giraffe. Nobody wants you!”

A child who was eight at the time of the first round of Cabbage-Patch-mania, watched an evening news feature story on the black market developing in these ugly little creatures who spring from the dirt accompanied by adoption papers and turned to ask, “Mommy, is that the way adoption really works? Do they give babies to the people with the most money?” Similarly, school-aged children who look at the lists offered in programs such as that of most zoos’, which offer different “prices” for different varieties of “wild children” are often led to ask their parents how much they themselves cost and whether a brother or sister was more or less expensive and why! No amount of explanation about how adoption fees work and how they are disbursed can be absorbed by a non-reasoning small child.

We’ve heard from several families who have “adopted” an animal from Humane Societies. In contrast to other “adoption” projects, on the surface these seem “like” human adoption, in that there actually is an investigation and approval process, the animal is the family’s to take home and nurture, and thus participation in the program seems a good “lesson” for children in what adoption is about. Despite good intentions, these programs, too, can be confusing. In several cases problems have started when animals brought home turned out to be serious problems– biting, failing obedience training, etc.– and the family have come to the realization that they would have to find the animal another home or return him to the Society. Soon after, their children began to experience nightmares or other acting out behavior. Upon investigation it has been discovered that these kids were afraid that if they were “bad” they, too, would be “returned.”

Each of these children has become very confused and concerned about his own situation. In each case parents had had no idea before this experience that they were participating in a program which would lead to such stress for their kids or others’ children. That’s because the adults involved in the projects– program administrators, parents, etc.– could think abstractly and thus were able to see clearly the difference between adoption of people and sponsorships sold as adoption. These adults simply forgot that children are incapable of following a line of reasoning this complex to a clear conclusion and that they take everything very personally.

The way to prevent these confusions is really quite simple. Adoption is a process by which families are planned and formed. To trivialize it in a commercial way insults the birthparents, adoptive parents, and adoptees who have been personally touched by this process. We no longer find it acceptable to trivialize other minority groups in this society. The proliferation of adopt-a-promotions has become about as humorous to many of those personally touched by adoption as are shuffle-footed picaninny humor or Pollack jokes to the minority groups they deride. For the sake of children waiting for adoption and those who have already found their permanent families in adoption, we adults must insist that adoption be treated in a dignified manner.

Credit where credit is due… Change is in the wind! As of May, 1999, we are aware that the following have responded to concerns raised world-wide by members of the adoption community and have renamed their adopt-a fundraising programs out of respect for adoption-expanded families: Indianapolis Zoo, Carmel-Clay (Indiana) Public Library, Milwaukee Zoo, National Wildlife Federation’s Ranger Rick Magazine, LaPine National Forest in Oregon, Gleaners Food Bank of Central Indiana, Big Brothers/Big Sisters of Nassau Cty NY, Stoneybrook Farm (IL), Minnesota Zoo, The Toy library of Chester and Area Family Resource Centre, in Chester, Nova Scotia, Stoneyfield Yogurt of Londonderry NH., Prairie Park of Peoria IL. Also responding sensitively to the need to reconsider program names: New England Aquarium, Association of Booksellers for Children, Central Mass Regional Library System. Help us add to this list!

For a sample letter to use as a model when writing, and some alternative terms that have been successful substitutes in switching from adopt-a marketing, see the Adopt an Attitude page on the web site of Adoptive Parents Association of British Columbia! http://www.bcadoption.com/articles/aam/attitude.htm

This article has been adapted from Adopting: Sound Choices, Strong Families (copyright 2007) by Patricia Irwin Johnston.To peruse this book’s table of contents and sample its reviews, click here and navigate to the bottom of the left column. Those reading a print-out will find this article and others on the internet at http://www.perspectivespress.com/ourfactsheets.html

The article may be reprinted without further permission for distribution to newsletters or in your efforts to persuade adopt-a-marketers of the need for change. Thank you! The author may be reached at Perspectives Press, P.O. Box 90318, Indianapolis IN 46290. Telephone 317-872-3055.

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