ABSTRACT

The purpose of this qualitative study was to examine how eight adoptees viewed the impact of adoption on attachment and identity formation, which in turn would emphasize the need for competency standards for mental health professionals. The majority of adoption studies have focused on either comparisons of adoptees and non-adoptees or on post-adoption needs of adoptive parents. Prior research shows a higher representation of adoptees seeking mental health services for various reasons, but also that mental health professionals are not adequately trained to work with specific issues related to adoption. Eight individuals who were adopted at (or near) birth were interviewed for their lived experiences, and seven themes emerged: loyalty, feelings of ‘otherness’, identity, being a people-pleaser, relational/attachment issues, secrecy and lies, and experience with mental health professionals. The relevance of research findings and implications for mental health professional competency are discussed, and suggestions for future research are included.

CHAPTER I:  INTRODUCTION

Now a man of the tribe of Levi married a Levite woman, and she became

pregnant and gave birth to a son. When she saw that he was a fine child,

she hid him for three months. But when she could hide him no longer, she

got a papyrus basket and coated it with tar and pitch. She placed the child

in the basket and put it among the reeds along the bank of the Nile. His

sister stood at a distance to see what would happen to him. Pharaoh’s

daughter went down to the Nile to bathe. She saw the basket among the

reeds, opened it and saw the baby. He was crying, and she felt sorry for

him. “This is one of the Hebrew babies,” she said. Then his sister asked

Pharaoh’s daughter, “Shall I go and get one of the Hebrew women to

nurse the baby for you?” “Yes, go,” she answered. So the girl went and

got the baby’s mother. Pharaoh’s daughter said to her, “Take this baby and

nurse him for me, and I will pay you.” So the woman took the baby and

nursed him. When the child grew older, she took him to Pharaoh’s

daughter and he became her son.  – Exodus 2:1-10

Moses was adopted, and throughout his life he struggled with elements of his identity and the incongruence between who he was expected to be and who he thought he was. Born Jewish, adopted by the Pharaoh’s daughter, and raised as an Egyptian, Moses was in line to become Pharaoh of Egypt. Yet, he could not abide the abuse that the Egyptians meted out against the Jewish slaves. Moses dealt with the identity issues his adoption caused by ultimately renouncing the throne, and went on to lead the Jewish people out of Egypt and oppression (Cohen, 2003).

Biology, as it relates to heritage and genetics, is important to identity and identity development (Strauss, 1994; Wegar, 1997). Though there are a myriad of reasons that biology is important, for an adoptee the psychological need to know about heritage is a necessary part of identity formation. Yet, information about heritage has most often not been attainable for adoptees (Sachdev, 1989). Grotevant, Dunbar, Kohler, and Esau (2000) state, “Adoptive identity cannot be understood without placing it in the context of societal attitudes toward kinship” (p. 381).  “Kinship” is defined in American cultural terms as directly related to blood and biological ties to our family, and the kinship that is provided by an adoptive family (regardless of how close the adoptee is to the adoptive family) is fictional (Modell, 1997, p. 45).

Currently, there is a good deal of societal emphasis on genealogy and genetics, but there is little access for an adoptee to be a part of this trend (Carangelo, 2011). In situations where there is a limitation of information in the adoption process, adoption is referred to as being “closed” (Muller & Perry, 2001; Samuels, 2001; Sorosky, Baran, & Pannor, 2008). Closed birth records and secrecy erect a barrier for adoptees that can make genealogy and genetics another obstacle in identity development. Advances in medicine have allowed the general public to be made aware of possible genetic risks they may carry, while adoptees do not have the luxury of this information (Muller & Perry, 2001). Yet, there have always been barriers for adoptees who seek information about their biological origin (Strauss, 1994). Secrecy has surrounded adoption by limiting information that might identify either the adoptee or the birth parents. Lifton (1994) defines closed adoption as one in which all identifying information is withheld from an individual by an agency and/or the state in which the adoption was completed. Conversely, open adoption follows a spectrum that includes the sharing of information ranging from names and the exchange of occasional photos to full disclosure and ongoing contact with the individual (Grotevant & McRoy, 1998; Modell, 2002).  Such secrecy and lack of information in closed adoptions result in researchers’ inabilities to estimate a ratio of “closed” to “open adoptions” (those in which varying degrees of identifying information are made available to all parties, depending upon the wishes of both the birth parents and the adoptive parents) (Grotevant & McRoy, 1998).

For those who have been openly adopted, the recent popularity of social media sources can facilitate relationships and reunions by providing access to information once largely unattainable (Haralambie, 2013). Social media allows most people to essentially choose with whom they want to be in contact. Non-adopted persons can find out where they came from and see how their identities have been influenced over time (Modell, 2002). At the same time that social media enhances relationships for non-adoptees and those involved in open adoption, the access provided through the use of social media is limited for those involved in closed adoptions.

The conflict over open versus closed adoption is intensified by reality television that sensationalizes and exploits members of the “adoption triad” (i.e., adoptee, the adoptive family, and all members of the birth family) through staged reunions that often end disastrously (Sorosky, Baran, & Pannor, 2008). While in some ways bringing the issue of adoption and identity development to the attention of the public, the trend by social media and television clearly contradicts the traditional stance of the American adoption system, which has prized confidentiality (Sorosky et al., 2008).

The importance of identity has been a focus in the social sciences for decades (Grotevant et al., 2000).  Erikson’s theory of development emphasizes the importance of attachment, as well as psychosocial crises, in identity formation (Erikson, 1968). Because there are often struggles for the adoptee in forming healthy attachments, there are also struggles in forming a healthy identity.  Feeney, Passamore, and Peterson (2007) identified that adoptees are underrepresented with respect to secure (healthy) attachments. A study by Borders, Penny, and Portnoy (2000) identifies that adoptees are more fearful and feel less support from family or friends. Feeney et al. (2007) report that even though the relationship with adoptive parents is important, birth relatives also play a part in healthy identity development and secure attachment. Further, adoption may be a risk factor for relational difficulties through insecure attachment.

Attachment theory emphasizes relationship formation, maintenance, and growth (Gray, 2002).  Attachment theory suggests that a key purpose of a family is to assist the development of its members and also the functioning of the family in its entirety (Hughes, 2007). Bowlby (1969, as cited in Erdman & Caffery, 2015) viewed attachment behavior as a part of a coherent system of behaviors that culminate in a close relationship between a child and caregiver.

The quality of parent/child attachment becomes a guide for all future relationships. Nurturing and responsive parents raise children who form secure, trusting relationships as adults, while children who do not have access to nurturing caregivers are less able to form healthy adult relationships (Gray, 2002). Bowlby (1969) believed that attachment patterns correspond with an infant’s experience with the attachment figure (parent or caregiver). The quality of attachment is directly related to the consistency of the infant/caregiver relationship, and anything that disrupts this bond leads to a higher probability of developing an insecure attachment (Bowlby, 1988). Though no one can say for certain when attachment to the biological mother begins, most mental health professionals would agree that it begins at birth (Brodzinsky, Schechter, & Henig, 1992; Gray, 2002). Bowlby (1969) described a four-stage model of attachment that begins at birth. Still, others believe that the bond between mother and child begins before birth and that the relationship is well defined by birth (Lifton, 1994; Verrier, 1993).

Identity formation is an ongoing process that Erikson (1980) says begins very early in childhood but continues throughout the lifespan. Adolescence is a time in which parental values and input are examined and the notion of “Who am I” becomes important to self-discovery (Erikson, 1980). For an adoptee in a closed adoption, identity formation takes on a chameleon-like quality because there is no congruence in information available to an adoptee about who he or she is (Brodzinsky et al., 1992). Adding to the incongruence, there is the amended birth certificate (yet the adoptee knows he or she was born to different parents), and the idea that the adoptive parents really wanted the child (yet the biological parents did not). Conflicting information coupled with the paucity of biological information available in most adoptions, present huge roadblocks in the formation of identity for an adoptee (Brodzinsky et al., 1992; Wegar, 1997). Difficulty in identity formation can result in an “identity crisis,” which may lead to a higher instance of psychological and interpersonal difficulty (Erikson, 1968, p. 17). Some adoptees are able to accept the inconsistencies as an intrinsic part of the adoption process while others struggle with the disparity. These individuals are further motivated to try and put the biological pieces together that will help build a more comprehensive identity (Brodzinsky et al., 1992; Feeney et al., 2007).

When unable to navigate the identity crisis without help, adoptees may seek the services of a mental health care professional. Therapy can be very helpful, provided the adoptee is able to find a mental health care provider who has been adequately trained to deal with the scope of issues facing an adoptee (Wegar, 1997).  Many families report seeking help from multiple therapists before finding one who understands adoption issues. That is, if they can find one at all (Riley, 2009). Few college textbooks contain much information about the issues of adoption (Janus, 1997; Sass & Henderson, 2000; Stolley & Hall, 1994; Weir, Fife, Whiting, & Blazewick, 2008). Textbooks are important sources of what is actually taught in college courses and are second only to the professor in terms of information dispersal to students (Geersten, 1977). In fact, if the topic of adoption is mentioned at all in a textbook, it is likely pathology-oriented (Brodzinsky, Smith, & Brodzinsky, 1998; Javier, Baden, Biafora, & Camacho-Gingerich, 2007), which means that the topic of adoption is often addressed as it relates to problem behaviors (Kirschner, 2006).

College level counseling instructors, the other relevant source of information in higher education, have not been trained to work with concerns of adoptees and are not teaching students about the issues of adoption and family (Glenn, 1997; Penny, Borders, & Portnoy, 2007). The dearth of information may send the message to students that this topic is not germane to the study of families (Fisher, 2003), though an estimated 100 million Americans are impacted in some way by adoption (Siegel, 2013).

According to the 2010 United States Census Bureau (2012), 2-4% of the American population is adopted. The actual number is likely much higher because the census questionnaire counted children within the home who were adopted but did not include adopted adults or stepchildren. Nor did it include informal adoptions, such as those that have no legal basis but are treated as adoption. Informal adoption generally includes grandparents or other relatives who become primary caregivers for children and act as parents for the child. Conversely, it is estimated that as many as 15% of individuals in residential treatment centers or inpatient psychiatric facilities are adopted (Brodzinsky, 2008; Kirschner, 2006).  There is conflicting information about the disproportionate representation of adoptees in inpatient and residential treatment facilities across the United States; however, estimations all indicate that adoptees are many times over the norm for the general population to be in a treatment facility (Feeney et al., 2007; Grotevant, 2008; Ingersoll, 1997; Janus, 1997; Lifton, 1994; Moyer & Juang, 2011). Current research indicates that adoptive families are two to five times more likely to seek mental health services and that there are higher instances of post-adoption mental health diagnoses than among non-adoptive families (Howard, Smith, & Ryan, 2004; Hussey, Falletta, & Eng, 2012).

Though adoption did not begin with the biblical story of Moses, it is impossible to know where it actually began. It has existed in some form across history and cultures. In the seventeenth and eighteenth centuries, adoption took the form of apprenticeship and slavery. The British introduced a type of adoption to the United States at this time; orphaned children were rounded up and sent by ship to the United States in order to provide slave labor for the colonies (Sorosky, Baran, & Pannor, 2008). In the nineteenth century, adoption gained tremendous popularity in the United States because it provided adopters with heirs (Terrell & Modell, 1994). The more modern version of adoption began with the Minnesota Act of 1917, when state laws were enacted to seal birth records. In theory, sealing records was done to protect the adoptee from any stigma related to his or her biological parents, rather than to protect the identities of the biological parents (Barth & Miller, 2000; Muller & Perry, 2007; Strauss, 1994). Additionally, legal documentation began to be required at about this time. In many states, loose records were kept, and the adoptee’s natal identity was not sealed, rather; this was a more gradual practice that spread throughout the nation (Grotevant & McRoy, 1998; Howe & Feast, 2003; Samuels, 2001).

In the 1940s, laws that concealed the identity of the adoptee became commonplace, and this practice remained virtually unchanged until the 1980s (Carp, 1998).  After the Second World War, the number of families adopting children increased dramatically as middle-class Americans began starting families. The United States entered a period of prosperity after the war. Orphanages that had been overcrowded and disease-ridden emptied as families opened their homes and hearts to adoption. It seemed like a perfect solution at the time, and no one was really thinking about potential problems that might arise. Along with the increase in American families adopting children, there was also a gradual shift in attitudes toward adoption (Fessler, 2006).  Adoption had not been a common way to build a family, and now middle-class Americans were utilizing the services of adoption agencies to secure physically healthy babies of normal intelligence (Fessler, 2006). Hollywood stars were adopting children and were talking about it in the news, and healthy, White babies became a commodity (Herman, 2002).

The availability of birth control in the mid-twentieth century had lowered the number of desirable, healthy babies (babies free of physical or mental defect) in this country and opened the door to global adoption as an alternative (Carp, 1998; Fessler, 2006). The availability of babies for adoption was also impacted by the passage of Roe versus Wade in 1973, which made abortion legal. In recent years, it is more commonplace for older children to be adopted, and family diversity has become more widely accepted (Grotevant & McRoy, 1998; Samuels 2001; Verrier, 1993).

The concept of open adoption was beginning to gather steam during the last decades of the twentieth century, but a trend toward full disclosure of family information is becoming more widely acceptable at this time (Grotevant & McRoy, 1998; Samuels, 2001).  Birthparents now often retain active roles in the lives of the children they relinquish for adoption. However, for the millions of post-Second World War adoptees to whom familial and ancestral information is not available, the current trends toward openness make no difference. It is still difficult for those born between 1946-1964, a group commonly called “The Baby Boomers,” to access information about who they are and who/where they come from. For this group, adoption records often remain sealed, and the process of searching for information can be arduous (Auth & Zaret, 1986; Penny, Borders, & Portnoy, 2007).

In the early 1960s, the search for ethnic roots became somewhat popular, particularly among immigrants to the United States (Lifton, 1994; Powell & Afifi, 2005; Strauss, 1994). At the same time, adoptees were beginning to push back against a system that had necessitated a barrier between the adoptee and any biological information (Wegar, 1997).  During the 1970s, several events began to change how society viewed identity. In 1974, Alex Haley published his Pulitzer Prize-winning masterpiece, Roots, The Saga of an American Family. Roots went on to become an Emmy Award-winning television miniseries in 1977, and viewership surpassed popularity of any television program ever at the time it aired (Haley, 1974). While Roots seemed to generate public interest in the biological component of identity formation, the first wave of adoption activists began efforts to reform the laws that required birth records to be sealed. Magazines began publishing adoption stories for public interest. The “search narrative,” which is the personal story of an adoptee’s quest for information about her or his origins (Strauss, 1994) and birthparents’ experiences with adoption led to the formation of groups like The Adoptees’ Liberation Movement Association (ALMA), which formed in 1971. ALMA’s purpose is to tell the stories of adoption, assist individuals in their searches for biological identity, and provide support for all members of the adoption triad (Carp, 2002; Lifton, 1994; Modell, 2002).

In the 1980s and 1990s, television talk shows began to gain popularity for addressing real and often controversial topics. Adoption reunions, sometimes in the form of surprise reunions, were met with mixed feelings by a public who had not previously glimpsed the complex relationships formed through adoption (Fessler, 2006; Sorosky, Baran, & Pannor, 1984; Triseliotis, Feast, & Kyle, 2005). Though the intention was to entertain television audiences, much harm was done to both adoptees and birth parents because no real thought went into negotiating reunions. No one was prepared for the myriad of emotional debris these voyeuristic reunions created, and often the viewing public bore witness to disastrous reunions (Modell, 2002; Muller & Perry, 2001; Wegar, 1997). The fallout from poorly planned television reunions further fueled the argument for keeping identifying records sealed.  In spite of and because of this, the 1990s brought more national attention to adoption and related issues than ever before in the United States (Fessler, 2006; Grotevant & McRoy, 1998).

The years between 1990 and 2013 have brought many changes and challenges to the realm of adoption. Same-sex couples and single people are now easily able to adopt children; this was unheard of in years past (Brodzinsky & Perman, 2014; Modell, 2002; Moyer & Juang, 2011). Facebook and other social networking sites have made information more readily available, but have also presented new problems.  The classified advertisement has become a conduit to facilitating adoption as both prospective parents and birth parents advertise in publications and on the Internet (Modell, 2002). The popularity of websites like Ancestry.com and genealogical forums have sparked anew the global interest in biological identity. Ancestry.com boasts five billion records and is among the top five paid subscription sites online (http://ancestry.com/press/pressrelease). Genealogy has become a popular hobby among all age groups, largely due to the amount of information that is easily accessible via the Internet. Understanding one’s biological history is universally important, and this is true for adoptees, too. Yet, adoptees are often only able to form a partial identity – generally that of their adoptive family. How does this correspond to the high number of adoptees who end up in residential treatment facilities? Although the purpose of this study is not aimed at exploring this phenomenon, the incongruence does suggest that while identity formation is crucial to healthy emotional development, adoption adds layers of complexity to the process (Fall, Roaten, & Eberts, 2012; Grotevant, Dunbar, Kohler, & Esau, 2000; Muller & Perry, 2001).

Moses spent his entire life solidifying his identity. He returned to his people, the Jews, which is where he believed he belonged (Exodus 2:1-10,NIV Holy Bible, 2012) Identity is as critical for adoptees as it is for non-adoptees, and the ability to form healthy relationships is largely dependent upon identity formation (Brodzinsky et al., 1992; Gray, 2002). In order to better understand the complexities of identity formation for adoptees, the following questions are raised:  (1) What are the lived experiences of adoptees in forming their identity and healthy attachments? (2) How do adoptees think mental health professionals can help with issues of attachment and identity formation?

The purpose of this study was to explore the experiences, thoughts, and feelings of adoptees in forming identity and attachments, the importance of biological history in identity formation and lastly, to explore how adoptees think mental health professionals can more effectively work with the adoption triad.

Definition of Terms

“Adoption is the legal proceeding whereby an adult person takes another adult or minor person into the relation of child and thereby acquires the rights and incurs the responsibilities of parent with respect to said adult or minor” (Modell, 2002, p. 5).  More specifically, it is to take another person into your own family and raise that person as your own child, with all the legal rights and responsibilities given to all members of the family (Carp, 2002).

Birthparents are the biological parents of a child given up for adoption. At one time, birthparents were known as “natural” parents. This terminology changed in the 1970s, as it was thought to be offensive to the adoptive parents (Sorosky, Baran, & Pannor, 2008).

The adoption triad is defined as the adoptee, the birth parents, and the adoptive parent. It is also known as the “adoption triangle” (Lifton, 1994). The concept of a three-part relationship became a focus in the mid-1970s at about the time that the sealed-records debate intensified (Carp, 1998).

Identifying information consists of data that could enable adopted persons to contact their family of origin. This information usually consists of names and addresses of the biological parents at the time parental rights were terminated (Carp, 1998).

Non-identifying information is data that would not allow the adoptee to locate any biological family members. It usually includes a vague medical history of the biological parents, ethnicity, occupation, religious background, and a variety of other facts (this varies by state) that do not identify the biological parents, but do provide information (Carp, 1998).

An open adoption is an adoption in which varying levels of biological information are made available to the adoptee. Open adoption gained popularity in the 1980s and has greatly changed the adoption process by allowing access to adoptees, but it has not been an entirely good change. For instance, questions regarding the birthparents’ motivation can lead to confusion if the birthparents are present in the adoptee’s life (Brodzinsky et al., 1992).

A closed adoption is essentially the American traditional model of adoption in which all identifying information about the adoptee’s biological origin is legally sealed. An amended birth certificate is issued, showing the names of the adoptive parents and omitting anything pertaining to the birthparents (Brodzinsky et al., 1992).  The adoptee’s identity is supposed to begin with the amended birth certificate (Lifton, 1994). Original birth records can often only be accessed by court order (Carp, 1998).

Identity has many definitions, but it can be loosely thought of as everything that makes up the self. It is “something so large and so seemingly self-evident that to demand a definition would almost seem petty” (Erikson, 1968, p. 15).

Attachment is a deep and enduring bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969). Attachment is important in forming and maintaining healthy emotional relationships. It both impacts and is impacted by identity formation (Brodzinsky et al., 1992).

Mental health professionals can be described as anyone who offers services for the purpose of improving an individual’s mental health (Reitz & Watson, 1992).  This includes social workers, psychologists, family therapists, or psychiatrists.

A search narrative is the story of how an adoptee finds information leading to the identification of birthparents. It can also be how the birthparent locates a biological child (Lifton, 1994).

CHAPTER II: LITERATURE REVIEW

In all of us there is a hunger, marrow deep, to know our heritage. Without

this enriching knowledge, there is a hollow yearning no matter what

our attainments in life.  — Alex Haley

Ideally, research surrounding issues of adoption should continue to move toward a more comprehensive understanding of the impact the adoption process has on the adoptee in relationship to attachment and identity formation (Brodzinsky, 2013). A considerable amount of research on adoption has focused on troubleshooting potential issues faced by birth parents, adoptive parents, and the adoptee (Brodzinsky, Schechter, & Henig, 1992; Carp, 1998; Dennis, 2014; Grotevant & McElroy, 1998; Gray, 2002). Such studies are often focused on the existence of certain issues common in adoption, but few studies address avenues for adoptive parents and adoptees to find professional guidance and/or support when problems related to attachment and identity formation arise (Javier, Baden, Biafora, & Camacho-Gingerich, 2007; Kirschner, 2006). In addition, most mental health professionals are ill equipped to treat issues in adoption that may masquerade as other mental health problems (Javier et al., 2007; Kirschner, 2006).

Further, most studies dealing with adoption issues do not suggest or support the idea that we cannot say for certain whether attachment begins at birth for an infant or if it is already well in place by the time a baby is born (Bretherton, 1992; Verrier, 1993; 2003). Brandon, Pitts, Denton, Stringer, and Evans (2009) state that continued research into maternal-fetal attachment is warranted as there are many studies in human relationships that point toward the relevance of this theory.

Introduction to Adoption

Loosely defined, adoption is the act of taking a child of other parents legally as your own child (Merriam-Webster, 2014). The central tenet of the American adoption process is “as if begotten,” which means that an adopted child has all the same standings as a biological child (Modell, 2002, p. 5). Therefore, by law, all identity and kinship information about the adoptee is transformed to that of the adoptive parents, and birth certificates are altered to reflect this transformation.

“Adoption tells uncommon stories about how children, adults, and families navigate the common experiences of love and loss, identity and belonging” (Herman, 2008, p. 1).  The landscape of adoption is as complex as life in general and its daily impact on the lives of American families is much more relevant than statistical figures used to represent adoption would suggest (Herman, 2008; Pertman, 2001).  Many social factors have affected the practice of adoption since the first American laws regarding adoption were passed in Massachusetts in 1851, including Americans’ view on what constitutes family.

“Adoption is a crucial long-term institution in virtually all societies but, unlike some others, in Western societies it has also come to be closely associated with secrecy” (Triseliotis, Feast, & Kyle, 2005, p. 1).  As the 20^th century wound down, secrecy in adoption became more and more challenged – first by adoptees, and then by birthparents who were interested in the lives of the children they had relinquished (Modell, 2005).  Certainly, the advent of the Internet brought change to the concept of secrecy as records about virtually everything became accessible to anyone with a computer (Modell, 2002). Though the concept of adoption is generally viewed as a positive thing, adoption creates “invisible” relationships between individuals who are not biologically related (Carp, 1998).  This relationship has generally required biological information to be withheld, leaving many adoptees feeling uncertain about whom they really are.

Adoption in some form has been referenced in historical literature since the beginning of civilization (Brodzinsky & Palacios, 2005).  Recent statistics estimate that about 2.3% of the population of the United States is adopted (U.S. Census, 2010), and this includes adoption by stepparents. It is practically impossible to determine how many families are impacted by adoption in some way, and the statistics vary widely.  In general, adoption is viewed as a positive experience for all involved, but there are factors that can impact successful outcomes in adoption.  Minimizing secrecy is the healthiest approach for all members of the adoption triad, and this includes access to biological information for the adoptee (Triseliotis et al., 2005).

History of Adoption in the United States

Adoption is an institution that has been evolving rapidly in the United States over the last several decades (Brooks, Simmel, Wind, & Barth, 2005).  Early in the 20^th century, there was a serious problem in urban areas due to large numbers of homeless children (Palacios & Brodzinsky, 2010). Simultaneously, there was a bias against adoption in the early 20^th century that possibly contributed to a resistance toward adoption legislation (Triseliotis et al., 2005).  Public sentiment toward giving birth out of wedlock, as well as being born out of wedlock, was seen as a terrible stigma, and secrecy was the only way many could cope with perceived illegitimacy. There were many programs developed to help relocate the scores of “illegitimate” urban, homeless children, including orphanages and the transportation of children via train to the Midwest and western United States. These programs were not found to be in the best interest of the children, as no screening of families took place, and children were often adopted to become indentured servants. Orphanages or other institutional settings were hotbeds of disease, malnutrition, and mortality, which also made them less than ideal for homeless children (Carp, 2002).  As time passed, adoption began to evolve into a child welfare practice and social science began doing research on adoption (Herman, 2008). What began as interest in psychological or sociological studies related to the birth mother soon expanded to include research on characteristics of adoptive parents and ultimately, the benefit to the adoptee (Palacios & Brodzinsky, 2010). This early research was spotty and did little to establish a foundation from which future research could be based, but it did start the wheels turning, and by the 1960s, scholarly analysis of adoption began to emerge (Herman, 2008).

The 1990s brought more complex questions surrounding issues of adoption, and the ensuing research took a hard look at the psychological difficulties many adoptees experience with less focus on the gratitude that should be felt at having been given a home. This is a shift that has endured in adoption research, as more and more studies have shown that adoptees are over-represented in clinical settings (Palacios & Brodzinsky, 2008).  Schechter (1960) began looking at the prevalence of adopted children in treatment settings because he noticed that a high percentage of his own clients were adopted. This thread runs loosely through research done throughout the last several decades, and has resulted in numerous statistics and conclusions (Grotevant, Dunbar, Kohler, & Esau, 2000; Kirschner, 2007; Moyer & Juang, 2011; Triseliotis et al., 2005). Though the research has suggested that there is a great need for knowledge about adoption in the mental health care disciplines, there is still disparity in how practitioners are equipped to work with members of the adoption triad (Carp, 1998; Christoffersen, 2012; Feeney, Passmore, & Peterson, 2007; Fessler, 2006; Gray, 2002; Henderson, 2007; Herman, 2008; Modell, 2002; Nydam, 2007; Triseliotis et al., 2005; Verrier, 1993; Von Korff, Grotevant, & McRoy, 2006; Zuckerman & Buschbaum, 2007). “Not only is there little-to-no training for most counselors, social workers, and psychologists, but many have only anecdotal experience with adoption” (Dennis, 2014, p. 28). There is also little available to mental health professionals in the way of continuing education, and more damage may occur rather than the help being sought. In a quantitative study conducted by Sass and Henderson (2002), it was found that while adoptees are overrepresented in therapy, mental health professionals are not being adequately trained to work with adoption issues (Sass & Henderson, 2002). Figure 2.1 shows the findings of the study, which was in the form of self-report by 210 psychologists.

Figure 2.1 Percentage of Courses With Adoption Content

This study clearly supports the stance that more training is needed in order to provide effective mental health care services to all members of the adoption triad (Fisher, 2003; Kirschner, 2006).

Introduction to Attachment

Attachment between a parent and child forms the foundation for all future relationships, and whether those relationships will be healthy or troubled (Gray, 2002).  Bowlby (1979) dedicated his life to studying the importance of the relationship between mothers and infants, starting from his observation of the distress infants exhibit when separated from their mothers.  While most research about attachment focuses on the hours, days, and months after the birth of a child, there are theorists who believe that attachment begins before birth and that adoptees struggle with a loss that may not be easily understood or accepted. In her book, The Primal Wound, Nancy Verrier (1993) focused on the prenatal bond that develops between the mother and child. Her research has fueled her theory that the loss to the child because of adoption is directly tied to attachment difficulties throughout the lifespan. While attachment has been studied extensively in adoption, it is primarily geared toward the concept that losses occur after birth rather than before. This can make therapeutic intervention difficult because only a small piece of the puzzle is being looked at and addressed (Dennis, 2014; Herman, 2008). It also suggests that more research into prenatal attachment and adoption would be helpful.

In addition to being integral to forming healthy relationships, attachment is a necessary component to identity development (McGinn, 2007).  Secure attachment in the first years of life provides a solid foundation during adolescence and adulthood in which healthy identity formation can occur.

History of Attachment Theory

While there have been many theorists who have researched the role of attachment in human development (Herman, 2008), attachment theory has largely been attributed to John Bowlby (1979). Much of Bowlby’s work was influenced by Freud’s research about ambivalence, which for individuals connotes a conflict of ideas or attitudes (Bowlby, 2005), but Bowlby’s work encompassed ideas from many other existing theories (Ainsworth & Bowlby, 1991).  Attachment theory is rooted in object relations theory, which is a psychoanalytic theory that emphasizes the interpersonal relationships – particularly the relationship between mother and child (Ainsworth, 1969; Bowlby, 1980). The “object” in object relations theory is generally thought of as the person who meets the needs of an infant during the first year of life; this is a survival mechanism during the early phase of life when an infant is totally dependent upon others to live (Bowlby, 1980).  Bowlby also hypothesized that there is a biological bond between a child and the child’s caregiver that will ensure protection and survival of the child (Ainsworth & Bowlby, 1991; Bowlby, 2005; Mackey, 2013). This biological bond is pertinent to the development of a healthy self-image if the bond with the primary caregiver is a positive experience for the child. The converse is true for a child whose physical and/or emotional needs are not met (Bowlby, 2005).  Bowlby observed that early, close bonds formed between children and caregivers are likely to endure (Bowlby, 1979). “The infant and young child seek closeness to his mother when he experiences physical pain, or feels overwhelmed by his fantasies, as in nightmares” (Brisch, 2004, p. 15).

Much of Bowlby’s early research was driven by his own childhood, having been raised by distant parents who entrusted his care to a governess (Brisch, 2004). His early experiences influenced his interest in attachment, separation, and loss. Though other theorists studied attachment, Bowlby is generally credited for the focus on maternal/child bonds (Pistole, 2011).

Ainsworth expanded on Bowlby’s theory of attachment by describing how children deal with issues of attachment depending on how they interact with their parents, but she also emphasized the function of attachment styles in adult relationships (Karen, 1998; Hughes, 2009). In fact, attachment theory was interchangeably called the Bowlby-Ainsworth model (Ainsworth et al., 1978; Bowlby, 1973).  The theory sees attachment as an adaptive system of behaviors and cognitions, thought by many to be innate, but malleable as the infant learns that certain behaviors, such as crying or smiling, communicate the infant’s needs to a primary caregiver (Hughes, 2009). As an infant develops, responsiveness of caregivers provides a sense of safety in the world and the ability of an infant to explore new things (Hughes, 2009)

Ainsworth is best known in her field for developing the “Strange Situation,” in which she used interactions with strangers to investigate attachment of a child to his or her mother (Karen, 1998; Mackey, 2013). In a laboratory-playroom setting, Ainsworth observed 12- to 18-month old infants at play with their mothers. She followed the play with a brief separation from the mother and then a reunion. The infants in the study were categorized as being securely attached (70% were thought to be securely attached). The remaining 30% of infants had some difficulty and appeared to be harder to soothe than securely attached infants. In the laboratory setting, researchers noted two separate patterns in the children; one group displayed anxiety and became distressed at the brief separations from their mothers. When the mothers of this group of infants returned, they were unable to calm their children by holding them and were described as “insecurely attached; ambivalent” (p. 80). The second group of insecurely attached infants did not display anxiety over the laboratory setting and would readily explore and play with toys. Most of these children were not distressed when their mothers left the room and tended to ignore the mother when she returned to the room after the separation. This group was described as “insecurely attached; avoidant” (p. 80).

Later studies showed that avoidant infants had a physical response in the form of heart-rate increase, which would suggest that these infants did respond to their mothers’ departure in a similar way as did securely attached infants.  The difference between securely attached infants and avoidant infants is that the latter learns to internalize their desire for mother’s attention because they anticipate rejection. So, while avoidant infants outwardly seem calm, their increased heart rates indicate high anxiety at the expectation of rejection (Brisch, 2002).   Avoidant infants display anger sporadically and are often irritable (Mackey, 2013).

Mothers of securely attached infants tend to be sensitive and responsive to their infant. Her behavior is consistent and she is emotionally “available” to her child (p. 80). The infant knows his or her needs will be met and is free to explore the world using his or her mother as a safe (or secure) base. Mothers of ambivalent infants are sometimes unresponsive and may not always attend to the needs of the child, which produces anxiety and uncertainty.  Mothers of avoidant infants appear to reject emotional exchanges with their child. Additional research on attachment theory subsequently led to other categories of insecure attachment, but Ainsworth (1978) provides a good overview of the importance of the mother-child bond by describing the difference between secure and insecure attachment. There has been some criticism of Ainsworth’s conclusions by other researchers who suggest that temperament is responsible for how an infant reacts (Brodzinsky, Schechter, & Marantz, 1993). There were also psychologists who dismissed Ainsworth’s work as flawed because there was no replication and there was no way to ensure reliability of the observation methods she used (Karen, 1998).

Subsequent to the Bowlby/Ainsworth model, a fourth form of attachment has been identified (Main & Solomon, 1990). The infants in this category show behavior that is less predictable when faced with the separation-reunion experience. These children were labeled as disorganized when in a strange situation. Disorganized attachment arises from fear that may be experienced by the infant because both separation from the mother and seeking comfort from the mother can be stressful. In the situations where the child’s needs have not consistently been met (i.e., neglect or abuse), disorganized attachment is more common (Main & Hesse, 1990). The concept of disorganized attachment came about through intensive research into behaviors of infants who did not seem to fit into the categories established by Ainsworth and other known attachment theorists (Main & Hesse, 1990). The “disorganized” infants would often turn their heads away while approaching the parent or simply freeze in place. These behaviors were thought to be indicative of fear and a form of approach-flight, in which the infant wants the parent but also fears the parent (Hesse & Main, 2000; 2006). There is much evidence that disorganized attachment (rather than avoidant or ambivalent insecure attachment) indicates a greater likelihood of psychopathology in the form of dissociative disorder or borderline personality disorder later in life (Carlson, Egeland, & Sroufe, 2009).

Attachment and Issues of Adoption

Infants may form attachments with other caregivers, but the bond with mother is usually the most powerful, particularly in the early years of life (Brodzinsky et al., 1993; Verrier, 2011). Much of the research on attachment suggests that the bond between mother and child begins at birth, but there are also theories that propose the idea of attachment being an integral part of the prenatal experience (Chamberlain, 1988; 2013; Verrier, 1993; 2003). Verrier (1993) addresses the relationship between mother and child as being more significant to a child during the first years of life, a concept that is supported by attachment theory. Additionally, Verrier does not discount the importance of the father during the early years of life, but points out that the role of mother is integral to the survival of the infant. Verrier (2003) is part of a group of researchers who believe that attachment begins prior to birth, and that the 40 weeks of pregnancy form a lifetime bond between mother and child.  Chamberlain (2013) views prenatal life as a responsive time – that the human fetus is a virtual “learning system” (p. 82).  The idea that a fetus learns and reacts to external stimulation while in the womb has been widely documented and is generally accepted as a fact within the scientific community (Brazelton & Cramer, 1990; Dirix, Nijhuis, Jongsma, & Hornstra, 2009; Martens, 2013). However, the concept that attachment might actually begin before birth is fairly abstract because there can only be speculation as to what a fetus experiences prenatally (Brandon, Pitts, Denton, Stringer, & Evans, 2009).  Conversely, it is widely accepted that pregnant women begin to exhibit attachment toward their fetuses early in pregnancy and see their unborn child as both a part of self and as “other” (Cannella, 2005).

The theory of prenatal attachment seems counterintuitive to Bowlby and Ainsworth’s stance that attachment begins at birth, but may be vital in future research that focuses on interventions for the fetus that may begin before birth (Brandon et al., 2009). Since the introduction of ultrasound, it has been possible to study the behavior of fetuses in utero. In fact, Dutch perinatologist Birgit Arabin conducted a study in 1996 in which she examined 25 sets of twins during various stages of gestation and was able to follow their complex interactions (Chamberlain, 2013). Arabin was able to track interactive behavior that included kissing and handholding between the twins and speculated that behavior between twins can easily be categorized as personality traits that parents report continued after birth.  Arabin’s study of twins supports that babies are able to relate intimately prior to birth, and are thus very likely able to bond with their mother prior to birth (p. 184). Chamberlain believes that bonding between fetus and parent should begin as early in the pregnancy as possible as an important component toward healthy attachment (p.183). Such a hypothesis can easily be applied to loss experienced through adoption when an infant may be permanently separated from the familiarity of his or her mother.  Though an infant can attach to another caregiver, it is wrong to assume that birth mother and adoptive mother can be interchanged without impact on the infant (Verrier, 2003).

In circumstances where an infant is adopted, the results of the strange situation are similar to those of biologically related mothers and children (Gray, 2002). The differences that have been noted are in infants who were adopted over the age of six months (p. 68). These infants have likely had disruptions in care during the early months of life and must adjust to new caregivers, often more than once during infancy. This is not to say that all adoptees will have difficulty because of events that led to disruption of care, but it is probable that attachment difficulties will be a factor in future relationships (Feeney et al., 2007; McGinn, 2007). Also, in many cases, the finalization of adoption may take six months or more. During this time, the adoptive parents of an infant may withhold affection because they fear the biological mother may change her mind and decide to keep her baby. This could impact an infant’s ability to securely attach to a primary caregiver (Gray, 2002), and exacerbate an existing sense of loss of the birth mother.

When an infant has already formed an attachment to the (birth) mother, he or she might enter the adoptive relationship grieving the primary bond (Brodzinsky, 1993).  Because the infant cannot verbally communicate his or her needs, he or she often exhibits behavior that can be alarming to the adoptive parents. There may be issues with sleeping and eating, and failure to thrive. The inability to form attachments is one of the primary reasons that adoption fails, and even when attachment does not appear outwardly to be problematic, adoptees are inarguably at greater risk for behavioral and psychological problems than are non-adoptees.

Attachment issues that begin in infancy continue to cause difficulty as a child grows (Ainsworth, 1969, 1978, 1989; Bowlby, 1973, 1980, 1988, 2005; Brisch, 2002). Some social psychologists have expanded upon the idea of the Bowlby-Ainsworth model and applied the secure base concept to include behaviors in adolescent and young adult populations (Brisch, 2002). Bowlby (1969, 1973, 1979, 1980) believed that the attachment style of an individual produces “internal working models” of the self and others. Bowlby maintained that these were mental representations that were formed in the context of the relationship between a child and the primary caregiver (McGinn, 2007; Pietromonaco & Barrett, 2000).  He thought that the attachment relationship with a child’s primary caregiver(s) would directly impact the way the child would develop and relate with the rest of the world. Bowlby suggested that the internal working models are constructed during infancy and early childhood and are preverbal. Because internal working models are formed so early and involve assimilation of information, they are thought to be unconscious and are likely very difficult (though not impossible) to alter (Pietromonaco & Barrett, 2000). This also means that what is learned through attachment in infancy is likely enduring, and this includes the quality of social relationships and self-understanding (Bowlby, 1969; Brisch, 2002; Hazan & Shaver, 1987).

As insecurely attached infants grow into adulthood, they may have difficulty in forming close relationships. In general, these individuals may find relationships to be unsafe and people to be untrustworthy (Karen, 1994; McGinn, 2007). Bowlby believed that children who have not had their basic needs met and are not securely attached will respond to others by either retreating from contact or doing battle (McGinn, 2007). Further, most developmental tasks are linked to a secure attachment, and these tasks are more difficult for children who are insecurely attached (p. 65). McGinn maintains that adoption and the consistency and quality of caregiving impacts secure attachment, and that the loss for a child of the birth mother may contribute to difficulties with development. There are some researchers who believe that adoptees follow a similar path in attaching as do non-adoptees, and still others who assert that it is only the relationship of a caregiver to an infant that establishes secure attachment – that blood ties have no bearing on attachment (Bayless, 1989).  Overwhelmingly, researchers who study adoption and attachment find that adoptees have much more difficulty with attachment-related issues than do non-adoptees (Brodzinsky, 1993; Feeney et al., 2007; Gray, 2002; Grotevant & McRoy, 1998; Herman, 2008; McGinn, 2007; Modell, 1994; Verrier, 1993).

Introduction to Identity

While Bowlby (1969, 1973, 1980, 1982) primarily examined biological adaptation as a result of attachment style, Erik Erikson (1969, 1975, 1980) focused his work on developmental adaptation as related to culture and social norms. Erikson offered a stage model of development that was influenced by Freud’s model of psychosexual development and emphasizes individual growth and change (Pittman et al., 2011). Whereas Freud’s work was limited, both by the focus on body zones (Crain, 2011), and in how social experience impacts development across the lifespan (p. 36), Erikson’s work was a lifelong developmental model based on the gathering of developmentally appropriate, relevant information acquired in the context of important relationships (Erikson, 1968). Erikson believed that cognitive and biological development were the building blocks of psychosocial development. His stages of development were based on what he saw as “crises” (p. 19), which were dialectical pairs of opposites that represented psychological development during each stage. Erikson thought the order and developmental timing of each crisis was predetermined, but that the consequences were not and that individual’s experiences would impact the resolution at each stage. Figure 2.2 outlines the eight stages as proposed by Erikson (1959).

Figure 2.2 Erickson’s Stages of Psychosocial Development

Erikson theorized that across the lifespan of each person, there were eight dialectical stages that each individual would experience at the same approximate time in his or her life, and that each of these stages consists of a positive and a negative focus. Individuals work toward the positive while dealing with the influence of the negative, and the goal at each stage is to resolve the dialectic tension. In infancy, which is a crucial time for attachment, the dialectical struggle is between basic trust versus basic mistrust. This stage is commonly viewed as the most crucial for attachment, and the inability of an individual to learn to trust the primary caregiver leads to struggles in each subsequent stage (Brodzinsky, Schechter, & Henig, 1992; Erikson, 1968; Hoopes, 1990; Pittman et al., 2011). Erikson saw identity development as a task that could begin in adolescence because that is the time when social, cognitive, and physical maturity have also begun to develop (Pittman et al., 2011). It is at this point that the body and mind are at a crossroads between childhood and maturity (p. 37), and social roles begin to factor into development. Erikson (1968) perceived identity development as the outcome of multiple life experiences and stressed the importance of self-exploration combined with a secure sense of stability within the family (p. 161). The term used by Erikson (1959; 1968) to describe the inability of an individual to successfully form an identity is “identity crisis” (p. 16).

The Role of Attachment in Identity Formation

Research shows there is a direct connection between attachment and identity that often intensifies during adolescence, which is when insecure attachment begins to interfere with autonomy (Dunbar & Grotevant, 2004; McGinn, 2007).  During adolescence, patterns of behavior become more static, and even though change can happen at any point in life, it is much easier to intervene with insecurely attached children as early as possible (Karen, 1998).  The adolescent period is when “the child normally challenges and questions many of the assumptions that have guided his or her belief system and values” (Javier, Baden, Biafora, Camacho-Gingerich, & Henderson, 2007, p. 4). There is some question about what happens to the adopted adolescent during this period of identity development when there are attachment issues that are either pre- or postnatal, because there is a discrepancy between the biological information available to the adoptee and information related to the adoptive family. Separation-individuation is a process that is thought to begin at about age 3 and continues throughout the life cycle in various forms (McGinn, 2007). Mahler et al. (1975) proposed separation-individuation as phases in life in which an infant learns to distinguish itself from his or her mother, and as the infant grows, identity and will are discovered.  Fahlberg (2013) described adolescent separation-individuation in this way:

The primary psychological tasks of adolescents echo the tasks of years one to five. The young person must once again psychologically separate, this time from

the family, finding his place in society as a whole, rather than solely as a member of the family (p. 107). During adolescence, a combination of individuation and parental connectedness help facilitate transition into adulthood (Kenny, 1994). For an adoptee, separation from two sets of parents must occur, and there is a greater chance of confusion as the question “Who am I?” is not an easy one to answer (McGinn, 2007).

Research has also shown that major life transitions, such as leaving for college, are impacted by attachment, and that there is often a sense of abandonment rather than independence that can occur for the adoptee during these transitional periods (McGinn, 2007). There is also difficulty for the adoptive parents during the adolescent separation-individuation phase if they fear abandonment by their adopted child or fear that the adoptee will seek out the birth parents (p. 69).  Individuals who have developed a secure attachment to parents tend to be more comfortable exploring a wide variety of experiences because they have a safe base to support self-discovery and growth (Reich & Siegel, 2002).  Separation is much more difficult for the adoptee who deals with insecure attachment because of the loss inherent in adoption and the fear of further abandonment through separation from the adoptive family (McGinn, 2007).

Patterns of attachment are subject to change for various reasons throughout the lifespan (Weinfield, Whaley, & Egeland, 2004), but it is common to find stability in secure attachments over time (Waters, Merrick, Treboux, Crowell, & Albersheim, 2000). This stability in attachment suggests that when an infant has a secure base relationship with a primary caregiver or caregivers, he or she is more likely to form positive relationships with others throughout life (Pittman, Kiley, Kerpelman, & Vaughn, 2011).  According to Kenny and Sirin (2006), social adaptivity and psychological functioning are characteristics of secure attachment. In adolescents, secure attachment helps the individual navigate the developmental transitions and serves as a buffer for stress. Secure attachment also helps young adults move forward in healthy relationships and career choice. It is during this period of development that identity is established, and difficulty in this process can lead to multiple issues involving a person’s ability to work and love.

Identity Formation and Adoption

There are different ways an adolescent can cope with the identity crisis, though research indicates that unless an adoptee has a family that openly discusses adoption and encourages curiosity, the identity crisis will be harder to navigate (Brodzinsky, 1992). For adoptees who have no exposure to or information about their birth family, a fantasy may be constructed to fill in the gaps where information is lacking. Brodzinsky sees identity formation in adopted adolescents as similar to nonadopted adolescents, but they may struggle with the meaning of adoption and have a more difficult time moving through this stage of development. Identity development for adoptees has the added component of having to figure out oneself in the context of adoption in addition to stage-appropriate tasks faced by nonadopted persons. Brodzinsky, Schechter, and Henig (1992) developed a psychosocial model (see Figure 2.3) in response to Erikson’s eight stages of development that describes challenges faced by adoptees at some of the stages outlined by Erikson. Issues that are not resolved during a particular stage may reemerge during subsequent developmental stages, causing difficulty personally and relationally (p. 15).

Figure 2.3 A Psychosocial Model of Adoption Adjustment