Approaches to Adoption Therapy

by Child Welfare Information Gateway

(Page 2 of 4)

Different mental health professionals use different types of treatment. The type of treatment or the combination of treatments chosen may depend on the type and severity of the presenting issue, the age and developmental level of the child, and even the experience and preferences of the professional and family. Parents should be sure to ask prospective therapists about the different types of treatment that they might use. Some of these different types are described below.

Play Therapy. Therapists customarily use this form of therapy with very young children, who may not be able to express their feelings and fears verbally. The therapist will engage the child in games using dolls and other toys, since play is a way for children to communicate. Through gentle probing, the therapist will try to draw the child out. In this way, the child may be able to act out feelings and reveal deep-seated emotional trauma.

Individual psychotherapy. This therapy may take many forms. Often the therapist will work to help the client first express problems verbally and then find ways to manage them. This type of therapy tends to stress that people should assume responsibility for their own actions and ultimately for their emotional well-being. The therapist will offer challenges, interpretations, support, and feedback to the client.

Group therapy. This therapy allows a small group of clients with similar problems to discuss them together in an organized way. Group therapy makes efficient use of a skilled therapist's time and offers the extra advantage of feedback from peers. Occasionally, family members may be asked to join the group. Group therapy frequently is used with adolescents and usually is the treatment of choice for individuals and families affected by substance abuse.

Family therapy. Increasingly popular, family therapy is based on the premise that all psychological problems reflect a dysfunction in the "family system." The term "dysfunction" means that members of a group or system are working together in a way that is harmful to some or all of its members. The therapist requests the active participation of as many family members as possible and focuses on gaining an understanding of the roles and relationships within the family. Family therapy seeks to achieve a balance between the needs of the individual and those of the larger family system.

Behavior modification. A commonly used form of therapy, behavior modification has many practical applications. The basic approach in behavior modification is to use immediate rewards and punishments to replace unacceptable behavior with desirable behavior. The therapist will identify specific changes desired and will establish a system of rewards and punishments. The reasons behind the objectionable behavior are seen as irrelevant; the focus is on change. This therapy is especially useful with children who may not be inclined or able to examine and understand their inner feelings.

Cognitive therapy. Cognitive therapy is based on the belief that the way we perceive situations influences how we feel emotionally. It is typically time-limited, problem-solving, and focused on the present. Much of what the patient does is solve current problems through learning specific skills, including identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.

A Word About Attachment

Many adopted children experience problems that may be the result of breaks in attachment that occurred during the first 3 years of life. These problems impair, sometimes severely, the child's ability to trust and bond - to attach - to other human beings. Children who have experienced maltreatment or traumatic separations may be hesitant to trust others enough to attach quickly or easily.

Attachment can be viewed as a continuum, with healthy attachment at one end and attachment disorder at the other. While a small percentage of children with attachment problems can be correctly diagnosed as having Reactive Attachment Disorder (RAD), many more adopted children display signs of some attachment difficulty, a midpoint along the continuum. Signs of attachment problems can include lack of conscience, lack of cause-and-effect thinking, superficial charm, obvious lying, stealing, indiscriminate affection with strangers, and cruelty to animals and people.

Attachment therapy. Attachment therapy includes a number of different approaches to therapy with children, but all approaches are based on common principles and theories of attachment and healthy development. Attachment therapy (sometimes incorrectly equated with holding therapy) includes an ever-expanding continuum of interventions based on treatment theories from an array of therapeutic approaches, including behavioral and cognitive therapies.

The focus of any attachment therapy should be to build a secure emotional attachment between the child and the parents. Because the primary focus is on the attachment relationship, not on the child's symptoms, one or both parents must be active participants in the therapy. The basis of attachment therapy is that the development of a trusting attachment relationship will provide the security essential to healing the psychological, emotional, and behavioral issues that may have developed as a result of earlier disruptions and trauma. These issues may include posttraumatic stress disorder, grief and loss, depression, and anxiety.

While some families find attachment therapy to be a useful approach, there is less evidence to support its effectiveness. As a relatively newer form of therapy, few studies of attachment therapy have been evaluated for outcomes.

Treatments such as "holding therapy," "rebirthing therapy," or other types of treatment that involve restraint of the child or unwelcome or disrespectful intrusion into the child's physical space have raised serious concerns among parents and professionals. Some States have written statutes or policies that restrict or prohibit the use of these therapies with children in the care or custody of the public agency or adopted from it.

Other therapies. There are a number of other types of therapies, as well as variations of therapies, that may prove useful. These may include art therapy, music therapy, and couples therapy. Parents should ask the professional to explain the treatment and goals before deciding on a particular therapy.

About the Author

www.childwelfare.gov
Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.