The Emotional Experience of Adoption

A Psychoanalytic Perspective

Debbie Hindle, Graham Shulman

• Publisher: Routledge
• Year: 2008
• ISBN:
  9781134192601
• Edition: 1
• Topic: Psychology
• Subtopic: Social Psychology
• Index: Psychology

Adoption is an extremely complex and emotionally demanding process for all those involved. This book explores the emotional experience of adoption from a psychoanalytic perspective, and demonstrates how psychoanalytic understanding and treatment can contribute to thinking about and working with adopted children and their families.

Drawing on psychoanalytic, attachment and child development theory, and detailed in-depth clinical case discussion, The Emotional Experience of Adoption explores issues such as:

• the emotional experience of children placed for adoption, and how this both shapes and is shaped by unconscious processes in the child's inner world
• how psychoanalytic child psychotherapy can help as a distinctive source of understanding and as a treatment for children who are either in the process of being adopted or already adopted
• how such understanding can inform planning and decision making amongst professionals and carers.

The Emotional Experience of Adoption explains and accounts for the emotional and psychological complexities involved for child, parents and professionals in adoption. It will be of interest and relevance to anyone involved at a personal level in the adoption process or professionals working in the fields of adoption, social work, child mental health, foster care and family support.

Part I
Setting the scene

Introduction

Graham Shulman

The three chapters in this first section set the scene in different ways and provide a context for those that follow. They lay out the broad conceptual foundations of the book and introduce readers to the characteristics and approach of a psychoanalytic perspective.

In the opening chapter, ‘Developing a curiosity about adoption: a psychoanalytic perspective’, John Simmonds describes the distinctive contribution that a psychoanalytic perspective can make to thinking about adoption. Simmonds argues that psychoanalysis has a ‘unique position in the human sciences’, and that a psychoanalytic approach goes to the emotional heart of human relationships with its focus on how feelings and unconscious fantasies shape relationships and interactions. He stresses the explanatory power of psychoanalytic understanding, with its emphasis on underlying meaning rather than merely on external behaviour or ‘symptoms’ and their management or treatment. This is in turn linked to the way in which a psychoanalytic therapeutic approach functions as a medium of change. Simmonds also gives a historical outline of the changing views about, and attitudes to, adoption within a social and professional context and suggests that a psychoanalytic perspective converges with current thinking in the field of adoption. Finally, through a reading of the fairy tale Thumbelina, Simmonds illustrates the emotional drama of curiosity about the past and the predicament of adopted children.

In the second chapter, ‘Why is early development important?’, Sally Wassell discusses some of the findings and theoretical developments in related fields which lend weight to the psychoanalytic focus on the significance and relevance of experience in infancy. The meaning and importance of experience in infancy has been a fundamental premise of psychoanalytic thinking from its beginning. Wassell’s discussion of attachment theory, research into the attachment patterns of adoptive parents, and neuroscience research on brain development explores the relevance of infancy to emotional, psychological and cognitive development and in turn to adoption. Wassell considers the implications for adoption practice of the findings in these fields. She argues that these findings highlight the critical importance of early intervention in relation to children who have experienced abuse, neglect or trauma. The chapter also stresses the importance of ‘the development of a wide range of therapeutic and support services for the adoptive child’.

The third chapter, ‘Understanding an adopted child: a child psychotherapist’s perspective’ by Lisa Miller, focuses on individual psychoanalytic psychotherapy as a therapeutic option for adopted children and adolescents experiencing serious emotional difficulties. Miller describes the nature of psychoanalytic psychotherapy, how it works, and the type of damage or disturbance at pre-verbal or non-verbal levels that it is well suited to address. She illustrates these points with detailed and vivid extracts from clinical material which bring to life those aspects of the inner world and of unconscious processes that can find expression and can be engaged within the therapeutic frame. The chapter reflects the way in which psychoanalytic psychotherapy serves not only as a therapeutic modality but also as a distinctive lens through which to see and understand those problems of emotional and mental life that have their roots in infancy and early development.

1
Developing a curiosity about adoption

A psychoanalytic perspective

John Simmonds

Psychoanalytic understanding has a distinctive contribution to make to our understanding about individual, group and social processes. Over the course of its development, its intense focus on the depth and richness of the human psyche has given it a unique position in the human sciences. In part this results from many of its ideas coming principally from clinical work with patients and in part from the fact that it has never avoided confronting some of the darker, more disturbing and even sinister aspects of human emotion and behaviour. But maybe above all, it has almost exclusively relied in its approach to providing therapy on the essence of what it is to be human – people communicating with each other through ongoing relationships that have meaning, are structured, provide consistency and are relatively long lasting. In particular, it has developed a powerful perspective on the impact that people have on each other, often unknowingly, through the concept of transference and countertransference. Its focus on the importance of understanding through reflective consideration of the emotional content of what is inside the therapist and what is inside the child or adolescent in interaction makes it distinct. This explanatory and relational perspective is central to bringing about change and drives the power of its therapeutic endeavour. However, many of these principles, indeed the psychoanalytic approach to therapeutic interventions, do not sit easily in the modern world’s demand for quick – if not instant – solutions to human problems. With the demand for evidence-based, low-cost and low-skill interventions, psychoanalytic psychotherapy sits uneasily in the modern world of child and adolescent mental health. However, whatever challenges it faces, it has never been static and recent explorations of some of the links between its fundamental concepts of the structure of emotional processes, attachment theory and neuroscience (Fonagy, 2001; Fonagy et al., 2002; Siegel, 1999) have been re-affirming and continue to deepen its knowledge base.

One issue that has driven psychoanalytic approaches to therapy is its radical intent. While the relief of symptoms may be a part of its intended outcome, the psychoanalytic therapist is also concerned with a deeper understanding about the meaning of symptoms – emotional and behavioural – and their place in the greater architecture of the individual psyche. The focus of therapy is not therefore just to relieve the person’s symptoms but to understand and explore their meaning with the object of re-integrating them within the psyche. The symptom is not therefore regarded as a foreign object inside the person, to be ejected in the process of therapy, but a source of learning about something that is important about the individual. It is important not to misunderstand this, because for the most part the removal of symptoms is probably what drives the individual – or in the case of children and adolescents, their parents – to seek therapy in the first place. Therapists cannot ignore this, as symptoms do have very real consequences and cause great misery and pain. However, the significance of the psychoanalytic approach is that it has taken a perspective that symptoms are a route into an individual’s history and story – they tell us something about people that needs to be paid attention to and understood. This is not some romanticisation of the ‘symptom’ but a recognition of the part that uncomfortable and painful thoughts, feelings and behaviour play in the relational and social basis of human beings and the individual drive to create and have a sense of both meaning and belonging. Symptoms may threaten this sense of meaning and belonging but exploring and understanding them may be the pathway through which people can relate to both themselves and others. In this sense, the curiosity of psychoanalysis is one of the great humanising influences in mental health.

Adoption as an intervention: ordinary or extraordinary parenting?

Adoption is also one of the most radical interventions that can be made in the life of a child. Adoption changes everything. Whatever the child brings into their adoptive home – their genetic inheritance, their personality, their pre-birth and pre-placement experiences, their class, ethnicity, language, culture and family history – it will be changed by the people, circumstances and opportunities that make up their new world. And the adoptive home – the people, circumstances and opportunities – will also be changed by the child and what they bring to the placement. It is a therapeutic intervention of the most monumental kind and like all interventions, it is intended to change things for the better. What is striking about it as a therapeutic intervention of course is that the primary therapeutic agent is the loving and caring of ordinary but really quite exceptional adults as adoptive parents.

In recent years, there has been increasing concern about the nature of this ‘ordinariness’ in adoptive parents and the extent to which the ‘exceptional’ is really a requirement – whatever the exact definition of the ‘exceptional’ might actually be. What once had been considered to be the primary therapeutic agent – the placement itself – has given way to a debate about whether, as a necessary condition, it requires a skill and knowledge base to provide what can be called therapeutic parenting. There are however, some difficulties with this. The adoption of young children is a highly emotive subject. The image of an abandoned, unwanted or unloved child is both a disturbing and also an appealing image, to which most people will respond immediately and instinctively. The Tsunami disaster in 2005 brought thousands of requests from people wanting to know how to adopt orphaned children. National Adoption Week 2006 in the UK produced 3500 telephone calls after children needing adoptive homes were shown on GMTV and several thousand information packs were requested by people interested in applying to adopt. Adoption draws on the powerful desire in adults to provide something that children need – lifelong, loving parents and a home they can call their own and which lasts through childhood and beyond. It also draws on the need that adults have to be parents. This powerful combination is the basis of successful adopter recruitment campaigns.

However, as instinctive as this response might be, it is often negated by the fear of individuals or couples that they will not meet the strict standards that agencies set to become an adopter, or that the process will take too long (Performance and Innovation Unit, 2000). Addressing misconceptions about the process to create a more open, welcoming and realistic picture of the adopter approval process, as well as creating greater consistency and transparency, has been an important policy and practice objective for some time (Secretary of State for Health, 2000; Dept. of Health, 2001). However, this has also created a dilemma – for while campaigns that encourage people to come forward to meet the demand for adoptive homes are important, the children who need adoptive homes often have complex special needs. These may result from abuse and neglect but other factors like genetic vulnerability, mother’s drug use/diet/health in pregnancy, premature birth and perinatal complications may be significant. The placement of sibling groups, children with a black or a mixed race heritage and the need to consider contact with birth parents and other relatives will complicate the process. Experiences in care, the length of time in care or the number of placements in care will add to this.

While the number of children adopted from care increased steadily to 2005¹ (Dept. for Education and Skills, 2006), there is still a significant mismatch between children needing homes and those approved to take them. This has resulted in a sizable proportion of children who have had a ‘best interest decision’ made that they should be placed for adoption, never in fact being placed. In one study (Selwyn et al., 2006) of 130 children who had a best interest decision that they should be placed for adoption, 104 were matched, although 15 of these disrupted during introductions. Ninety-six children (74 per cent) were actually placed in families and at follow up after, on average, 7 years, 80 (61 per cent) were still there. It is also important to note that in this sample, while many of the children had severe and persistent problems at placement, only 7 per cent received therapeutic help from Child and Adolescent Mental Health Services. However, this increased to 55 per cent on follow up, although only 16 per cent received more than an initial consultation.

If the appeal to ordinary people to come forward to adopt is to be helpful, it should be modified by simultaneously making it clear that adopters have the capacity to manage the complex needs of children who are to be adopted – that which makes up the extra-ordinary. Children who have been abused or neglected and who have experienced disrupted early-caring relationships and uncertain plans have exceptional needs, because their developmental pathways have been so distorted. Changing the material, emotional, and social circumstances and opportunities for the better may be necessary for children who have had such a poor start in life. Not to do so is very likely to result in the continuation of that trajectory, with many of the poor child development outcomes that are known to be the result – and for some this may include death. However, the most significant questions that needs to be addressed are: Is such a profound change in the child’s circumstances and opportunities through adoption actually sufficient in itself to turn this trajectory around? Is what starts out as a major piece of environmental therapy enough?

The answer to these questions for many adoptive children is ‘No’. In the course of their developmental pathway something, although it is probably no one thing, seems to have become locked inside them that prevents them from fully making use of their new relationships, circumstances and opportunities. Why is it that ordinary, but what in many circumstances is really quite exceptional, loving and caring does not seem to be enough to unlock this? One likely exp...

Table of contents

• Contents
• Notes on editors and contributors
• Foreword
• Preamble
• Acknowledgements
• Introduction
• Part I Setting the scene
• Part II Unconscious dynamics in systems and networks
• Part III Primitive states of mind and their impact on relationships
• Part IV Belonging and becoming
• Part V Being part of a family
• Part VI Adoption and adolescence
• Further reflections
• Index