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Not All Therapists Are Created Equal - Guest Post

{I met Brooke at the 2018 Indiana Adoptee Network Conference where she spoke on Brainspotting, and throughout the years since my husband and I have went to her for marital counseling, as we both recognized that unhealed trauma and disconnection from self and others, on both parts, had built the track upon which our interactions rode, and to heal our connection, we would need someone skilled in the far-reaching effects of trauma, and adoption, even when we weren't speaking directly about either.

Having grown up going to a multitude of therapists and psychiatrists, by the time I was in my mid-twenties learning about working through trauma, I did not need to be convinced that some types of therapy are more effective than others. I was tired of talking about myself, my past, my issues that I had already turned over and over in my head and granted, had begun to understand more about. None of the talking seemed to help. Bessel van der Kolk, in his essential book The Body Keeps the Score, describes: "Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it.” A value of understanding and accepting the developmental trauma inherent in all adoption is that we can then apply discernment to the advice or counseling we are given, or seek. The untrained counselors I saw growing up believed me just as I believed myself when I said the issue wasn't my separation and loss. Many of us do not realize the chasm of difference between what we are consciously aware of and what our bodies are experiencing, but those trained in trauma and specifically adoption loss, will be equipped to help us build a bridge back into our bodies.}

Not All Therapists Are Created Equal

Brooke Randolph, LMHC One of the first things I noticed when I started going to foster care and adoption conferences that included parents, was how often I heard some version of “therapy didn’t help” or “we went to a therapist and it made it worse”.

I think there are three reasons for this:

1) Forcing a child into therapy that they don’t want is disconnecting

2) The fastest route to change in a household is support and education for the parents rather than the kids and

3) Therapists don’t know what they’re doing. Therapists don’t know what they’re doing because they weren’t taught.

Adoption is not a mandated component of curriculum in accredited schools of social work. Research into doctoral level psychologists reveals just how little priority is placed on adoption:

“65% of clinical psychologists surveyed were unable to recall any courses addressing adoption in graduate school which is better than the 86% that could not recall any courses addressing adoption in their undergraduate coursework either… When asked how much time they spend discussing adoption in doctoral-level clinical programs, professors reported an average of 7.95 minutes per semester on adoption, yet they reported spending 22.17 minutes on the rare dissociative identity disorder, and 76.82 minutes for schizophrenia (Sass, et al., 2000).” (Randolph, 2014)

We are not prepared in our academic programs, yet foster care and adoption was something I dealt with at least weekly during my Masters-level internship. Both colloquially and from research, we know that adoptees and adoptive parents are frustrated when therapists don’t get it and feel abandoned and hopeless when they are educating the professionals who are supposed to be helping them. While our Code of Ethics states that we should provide service in areas only in which we are competent, most therapists don’t know what they don’t know about adoption - or worse they believe they do know because they have “experience”. I mentioned how common it was during my internship; that is not a unique experience. Even working in the foster care system, though, is not a well-rounded education. In fact, some of the most disheartening (she said that???!?!) things my clients have reported have been said to them by therapists who would have said they are experienced in working with adoption. The saddest part is that people put off going to counseling, sometimes for years, because of the bad experiences they had as children. It is so important that therapists that work with the adoption constellation have expertise, not just experience. What is Adoption Competency?

Just like adoption itself, adoption therapy is complicated. Training is essential but not enough. While adoption competency courses do exist, those who are truly experts in the field recognize that competency is not a milestone we can complete, and instead refer to ourselves as adoption-informed or adoption literate. Expertise is about always growing, always learning, always listening. It requires training and seeking mentorship and reading and researching and a commitment to ongoing growth in this specific field. An expert never arrives, but is always on the journey.

Keeping up with research and best practices is necessary.

Listening to a variety of experiences is important.

Learning the history of adoption and how people of different generations may be impacted differently is foundational, yet not commonly explored.

How to Find an Adoption Informed Therapist

Once you find potential therapists, make sure to read their websites, blogs, and social media. Is adoption their specialty, or just one of many things that they do? A specialist is going to be working with that specialty at least a third of the time. My caseload is at least 90% adult adoptees or adoptive parents.

Do they list additional trainings on their website? If they don’t, ask them what trainings and adoption conferences they regularly attend. Look for modalities like Brainspotting, Internal Family Systems, Theraplay, TBRI, etc. Ask if the therapist is certified in these modalities, trained in them, or just familiar with them from reading a book. Who are they listening to and learning from? While you can get an idea from looking at who they follow on social media, also ask who they would consult with on cases like yours. What books are they reading or would they recommend? A Note on Insurance

The traditional medical model has trained most of us to check our insurance company to choose a new doctor or therapist. A true adoption specialist is rare, and they may not take your insurance for a variety of reasons. I won’t allow an insurance company to direct treatment; I would rather spend my time reading and attending trainings that will help my clients, than submitting claims and fighting denials. I also believe a diagnosis on your permanent medical record can create more damage and cost in the long run. Find a specialist and check your insurance plan for out of network benefits, or just use your HSA or FSA on the counseling that will actually help.

Effective Therapy for Kids What’s the motivation?

Counseling that doesn’t make things worse should be client-focused and not coercive. It isn’t helpful for your child, or your relationship with your child, to force them to go to therapy. If you believe it could be beneficial, but your child needs motivation, rewarding them with privileges or ice cream or small toys can be appropriate depending on how you explain it to your child, just like an allowance for chores is a way to keep kids motivated to establish important habits. Before meeting with a child, I always ask parents what is the child’s goal for counseling.

What’s the Goal?

Behavioral change is not the main goal for adoption therapy, unless it the child’s goal. Behavior is a symptom of dysregulation or disconnection. Regulation, felt safety, attachment, and processing traumas are the things we focus on so that they are able to make behavioral change. Who is the Client?

Parents can help shape behaviors in children because they shape their environment. Sometimes, the most effective therapy for a family doesn’t include the child at all. Parents need support, new ideas, an objective perspective, accountability, and the opportunity to process their own stress and sometimes secondary trauma. Children improve as much, or more when parents meet with a therapist, than if the children meet with a therapist.

In Conclusion

As complimentary as it is that people seem to think that a good therapist can solve all of your problems, going to therapy is never enough. You have to use therapy.

People get different results based on how they use their therapy time, and how much they allow it to change their life outside the therapy room.

It takes work, it isn't fun, but it is essential for adoptive parents, and it is worth it.

Therapists are not created equal; while there are many to choose from, there are not many who really understand the depth and complexity of adoption, and how it impacts individuals and families. My mission is to help more therapists learn about adoption, so some day there will be more good options for you and your family.

Brooke Randolph, LMHC, is a therapist, author, speaker, and trainer, specializing in Adoption and Brainspotting. She is a Certified Brainspotting Consultant & Speciality Trainer, Coordinator of Brainspotting Indy, and Member of the Midwest Brainspotting Institute. Brooke is also a Certified Imago Relationship Therapist. She is the founder and director of Counseling at The Green House, in Indianapolis, Indiana, where every therapist is adoption informed. A single, adoptive mother in an open international adoption, Brooke is an advocate for family preservation and openness in adoption. Brooke is the author of The Bully Book: A Workbook for Kids Coping with Bullies (2016), The Loss Book: A Workbook for Kids Coping with Loss (2017), The Choice Book: A Workbook for Kids Making Choices (2019), a contributing author to Adoption Therapy: Perspectives from Clients and Clinicians on Processing and Healing Post-Adoption Issues (2014), and the organizing editor of It’s Not About You: Understanding Adoptee Search, Reunion, & Open Adoption (2017). She has also authored adoption education materials for parents and therapists.

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