Helping Children Understand Adoption
In Helping Children Understand Adoption, Dr. Marc A. Nemiroff shows how to help adopted children come to terms with the question of "Where did I come from?" and with any potential traumas they may have experienced before adoption. The child-centered approach illustrated in this video emphasizes empathizing with the child and helping parents to truly understand their adopted child's experience.
In this session, Dr. Nemiroff meets with a 9-year-old girl who, before being adopted, was believed to have been abused by her birth family as a toddler; in addition, she lived for some years in an orphanage. Dr. Nemiroff works separately with the girl's adoptive mother, assisting her in understanding her daughter's interpretation of her adoption and helping her to help her daughter cope with the trauma she has experienced.
Dr. Nemiroff's approach to working with adopted children utilizes a theoretical integration of Kohut's theories of the development of the Self, Winnicott's theories about containment and "the space between," and the work of the Object Relations theorists focusing on attachment and separation. The concepts of mirroring, containment, the existential experience of loss, and the possibilities of re-attachment to an "other" are emphasized.
Mirroring and containment are woven throughout treatment and are essential elements in the establishment and sustaining of the therapeutic alliance. Issues of loss, rejection, and the establishment of hope are best saved for later stages of treatment, although they are gently touched on in the course of the taped interview for teaching purposes.
Mirroring refers to helping a child understand that he or she has a Self (or can build a Self) by "seeing" him- or herself and his or her affect accurately mirrored by the therapist. Containment refers to the capacity of the therapist to contain (i.e., hold as if a vessel, the child's unwanted and unbearable feelings until the youngster has developed sufficient self to be able to "reclaim" the once-contained affects from the therapist-receptacle).
Loss is an inherent part of living, and the object relations theorists posit that separations and terminations are the primary reiterated life experience that must be understood and re-understood in the course of life. Adopted children have had a rupture in their attachments, by virtue of having been adopted, and this has happened prematurely (i.e., not at the child's developmental pace). This issue weaves itself in and out of the fabric of the treatment of an adopted child.
Adoption issues are not consistently present in the treatment of a child (and of course not all adopted children develop pathology requiring treatment; adoption itself is not a form of pathology), but recur at various stages. They become reexpressed throughout treatment at a level commensurate with the child's development.
Nonverbal communication and body language are often important in work with adopted children as they may be hypervigilant to their interpersonal environment. Treatment of adopted children, therefore, requires ongoing microanalysis of nonverbal communication occurring between both therapist and patient. Nonverbal communication is particularly notable in the taped interview in the stillness of the therapist, the timing of attempts at animation and humor, and the amount of emotional room the little girl is given.
Attachment disorders are often, but not always, associated with adopted youngsters who require treatment. However, in the course of this interview, Dr. Nemiroff tries to help this suffering little girl teach us about adoption itself and what it feels like to her.
The interview requires intense attention and microanalysis, and the youngster is very inhibited. It should be added that this is a brave and generous child who consented to be interviewed ("to make a movie") by a stranger so that it might help other doctors help adopted children.
Dr. Nemiroff uses this individual therapy approach with adopted children who are willing to be engaged in the therapeutic endeavor. Adoption concerns are usually interwoven with other psychotherapeutically required problems. The child's consent might be covert and considerably subtle and symbolic, but he or she will usually give some sign that he wants to be helped.
Dr. Nemiroff's approach uses an integration of several mainstream psychoanalytic concepts and techniques, and the patient must have sufficient ego (inner strength) to be able to work in this manner. That is, he or she needs to be willing to play and interact and understand that he or she is being scrutinized even while joined in play with the therapist.
Parental involvement in the child's treatment is critical and is something Dr. Nemiroff requires of all parents. He meets with the parents regularly (at least once monthly and sometimes more frequently) and requests that they call when there are noteworthy occurrences in the youngster's daily life. He will only work with a child in individual play therapy if both parents (in an intact family) consent to attend parent meetings regularly.
Dr. Nemiroff believes that this approach is contraindicated when a child's severe acting-out behaviors spill over into his or her treatment sessions such that they cannot be contained. In addition, sometimes this psychoanalytically-oriented type of play therapy is too agitating to a child (this is relatively rare) and leads to worsened behavior at home and an exacerbation of parent–child difficulties that is intolerable to the family and the child. In such cases, sometimes a form of benignly administered behavior therapy may be more appropriate, at least for a while.
Marc A. Nemiroff holds a PhD (1975) in clinical psychology from The Catholic University of America, Washington, DC. He is cochair of the Infant/Young Child Mental Health Training Program at the Washington School of Psychiatry, and an affiliate member of the Baltimore–Washington Society for Psychoanalysis.
Dr. Nemiroff has served as clinical faculty in George Washington University's Doctor of Psychology Program and has been the coordinator of Infant/Early Childhood Mental Health Services for Fairfax County, Virginia.
Dr. Nemiroff is also the coauthor of a number of psychotherapeutic books for young children, including A Child's First Book About Play Therapy; All About Adoption; and Help is on the Way: A Child's Book About ADD, among others. He has published in The Psychoanalytic Study of the Child, and has lectured and consulted in the areas of child development and child treatment.
During the Gulf War (1990), Dr. Nemiroff served at the request of the American Psychological Association as a media spokesperson regarding the effects of televised war on children. Dr. Nemiroff volunteers 1 month each year to work with street children in Mumbai, India, and has presented his work with adopted children to the directors of adoption agencies in Mumbai. Current plans include consultation with the staffs of those agencies.
Dr. Nemiroff maintains a private practice in Potomac, Maryland.
- Altstein, H, & Simon, R. (1991). Intercountry adoption: A multinational perspective. Westport, CT: Praeger Publishers.
- Buckley, P. (Ed.). (1986). Essential papers on object relations. New York: New York University Press.
- Coates, S. (2004). John Bowlby and Margaret S. Mahler: Their lives and theories. Journal of the American Psychoanalytic Association, 52, 571–601.
- Greenberg, M., Cicchetti, D., & Cummings, E. M. (Eds.). (1990). Attachment in the preschool years: Theory, research, and intervention. Chicago: University of Chicago Press.
- Goldberg, S., Muir, R., & Kerr, J. (Eds.). (1995). Attachment theory: Social, developmental, and clinical perspectives. Hillsdale, NJ: Analytic Press.
- Hicks, S., & McDermott, J. (Eds.). (1998). Lesbian and gay fostering and adoption: Extraordinary yet ordinary. London: Jessica Kingsley Publishers.
- Kohut, H. (1971). The analysis of the self. New York: International Universities Press.
- Levine, S. (2004). To have and to hold: On the experience of having an other. Psychoanalytic Quarterly, 73, 939–969.
- Nemiroff, M., & Annunziata, J. (2002). All about adoption: How families are made and how kids feel about it. Washington, DC: Magination Press.
- Simon, R., & Roorda, R. (1992). In their own voices: Transracial adoptees tell their stories. Westport, CT: Praeger Publishers.
- Solnit, A., Cohen, D., & Neubauer, P. (1993). The many meanings of play: A psychoanalytic perspective. New Haven, CT: Yale University Press.
- Stolorow, R., Atwood, G., & Brandchaft, B. (Eds.). (1994). The intersubjective perspective. Northvale, NJ: Jason Aronson.
- Summers, F. (1994). Object relations theories and psychopathology. Hillsdale, NJ: Analytic Press.
- Varon, L. (2000). Adopting on your own: The complete guide to adoptions for single parents. New York: Farrar, Straus & Giroux.
- Winnicott, D. W. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.
- Winnicott, D. W. (1971). Playing and reality. New York: Routledge.
- Cognitive–Behavior Therapy
Jacqueline B. Persons
- Cognitive Therapy
Judith S. Beck
- Culture-Centered Counseling
Paul B. Pedersen
- Functional Family Therapy
James F. Alexander
- Parenting Young Children
Edward R. Christophersen
- Play Therapy With a Six-Year-Old
- Psychotherapy of Children With Conduct Disorders Using Games and Stories
Richard A. Gardner
- Child Art in Context: A Cultural and Comparative Perspective
- Culturally Responsive Cognitive–Behavioral Therapy: Assessment, Practice, and Supervision
Edited by Pamela A. Hays and Gayle Y. Iwamasa
- Empirically Based Play Interventions for Children
Edited by Linda A. Reddy, Tara M. Files-Hall, and Charles E. Schaefer
- Empowered Families, Successful Children: Early Intervention Programs That Work
Susan Epps and Barbara J. Jackson
- Intervening in Children's Lives: An Ecological, Family-Centered Approach to Mental Health Care
Thomas J. Dishion and Elizabeth A. Stormshak
- Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice, Second Edition
Edited by Euthymia D. Hibbs and Peter S. Jensen
- Rewards for Kids! Ready-to-Use Charts and Activities for Positive Parenting
Virginia M. Shiller, with Meg F. Schneider; Illustrated by Bonnie Matthews
- Treatments That Work With Children: Empirically Supported Strategies for Managing Childhood Problems
Edward R. Christophersen and Susan L. Mortweet
- Violence Against Children in the Family and the Community
Edited by Penelope K. Trickett and Cynthia D. Schellenbach
Magination Press Books
- A Child's First Book About Play Therapy
Marc A. Nemiroff and Jane Annunziata; Illustrated by Margaret Scott
- All About Adoption: How Families Are Made and How Kids Feel About It
Marc Nemiroff and Jane Annunziata; Illustrated by Carol Koeller
- Finding the Right Spot: When Kids Can't Live With Their Parents
Janice Levy; Illustrated by Whitney Martin
- Jenny Is Scared! When Sad Things Happen in the World
Carol Shuman; Illustrated by Cary Pillo
- Solving Your Problems Together: Family Therapy for the Whole Family
Jane Annunziata and Phyllis Jacobson-Kram; Illustrated by Elizabeth Wolf