What Do I Look for in an Adoption Therapist? 

How Can I Find a Therapist in Hong Kong?

By Staci England MSW and Erica Liu Wollin PsyD

While it is not possible to cover every aspect of finding a suitable therapist for all situations, this guide is a useful starting point for adoptive and foster parents and caregivers in finding appropriate help and therapeutic support for their family. This document focuses primarily on therapists for mental health issues and relationships, while acknowledging that therapists and professionals from many other fields are of importance to the adoptive family. These other professionals and support members on a care team will be introduced later in this article.

Note:

Adoptive Families of Hong Kong encourages all parents to seek professional therapy for their children that is trauma-sensitive and attachment-focused. The purpose of this article is to answer basic questions as a first step for families seeking help and support. AFHK does not endorse specific therapists or treatment modalities; this article is not a replacement for therapy or further training, and should not be considered as an endorsement for any of the resources included herein. All service-users should thoroughly research options and ask for references. 

“When should I begin looking for a therapist?”

Finding a therapist during early stages of fostering or adoption can help you understand confusing behaviors and initiate an ongoing professional support relationship. There are few adoption-competent professionals in Asia, and you may get put on a waitlist for a few months or more. However, you can even start to look for a therapist before you have been matched or have identified specific issues to work on (much as you might look for pediatrician options before you are matched). If you start early, you will hopefully get through the waitlist before any crisis hits, and seeing a professional becomes a normal experience for your family, making it easier to pursue therapy as needs or concerns arise. Scheduling visits periodically when a child first joins your family helps them see therapeutic support as a normal part of life, and it is less scary when issues arise. 

“What qualifications should I look for in a therapist?” 

Taking the time to find a therapist with the right qualifications is key for effective therapy. Basic level qualifications for a therapist should include an accredited Masters or Doctoral degree in psychology, counseling, clinical social work, or a related field. Additionally, it is ideal to find a therapist who has understanding of and experience with attachment, trauma, and brain development, as well as knowledge of core issues associated with adoption and foster care. 

There are a variety of mental health professionals that can support your family through adoption issues. There are also many types of therapy available, but not all are beneficial or efficient for working with trauma. For example, approaches focused on punishment and reward can trigger survival responses in children with trauma histories, or be completely ineffective for those with compromised executive functioning skills due to severe trauma or prenatal substance exposure. Later we will discuss various therapy models. 

While you can check quickly that a therapist is educated in relevant therapeutic approaches, it may take time to ensure you find one who “clicks with” you and your family. In addition to the qualifications and experience, you will want a therapist who is open-minded, remains calm, and listens well to your specific family dynamics so that therapy can be tailored to the needs of your family.

“How long will my child need therapy?”

There is no quick solution to the challenges faced in adoption. Bonding and attachment will take time, but if you are involved in the therapeutic process, you can help healing come more quickly by offering accurate information, being present for your child as they remember hard things, and continuing therapeutic interactions at home (Lozier, 2018).

It is important to stay hopeful even when things are hard. There is a lot of help available and with persistence you can find the right help for you and your child. Every child is different and every family situation is different, so even with an experienced therapist, it will take time to find the right approach for your family. Therapists cannot promise to remove all challenges from your child’s life. Some issues may stay with an adopted person throughout their lifetime, but with the right support and a lot of love, it is possible for you and your adopted child to grow as a family and adapt to individual needs.

This article from Creating A Family further explains why a parent should be involved in therapy. 

“What kind of help should I seek if my child had or is suspected to have had prenatal exposure to drugs or alcohol?”

Unfortunately, it is common in cases of adoption or foster care for a child to have been exposed to alcohol or drugs during pregnancy. Samples from the US and UK showed behavioural challenges linked to prenatal alcohol exposure in 28% and 25% respectively of children in foster and adoption systems (Chasnoff, Wells, King 2015); . The impact of substances on a developing child can vary in type and severity. Fetal Alcohol Spectrum Disorders (FASDs) are lifelong physical disabilities caused by the way alcohol impacts brain development. Both alcohol and other substance exposure can lead to behavioral challenges and delays in development. 

Getting a child assessed for an FASD or prenatal drug exposure effects is an arduous but important process, and there are only a small handful of professionals in Hong Kong who know about this area.  Despite these challenges, it is  important to seek psychological assessments for FASD or drug exposure. You may have noticed challenges in impulse control, aggression, reactions to medications, or sensory issues. A clinical psychologist who is knowledgeable in prenatal substance exposure and FASD can discuss with you the challenges your child is having, in addition to completing some assessments to identify the specific areas of your child’s brain that are affected, and help you find the supports your child needs.

After assessment, the psychologist or another therapist can help you find and implement accommodations and assistance tailored to your child’s challenges (Chasnoff, 2019). If warranted, a child psychiatrist (a trained medical doctor who prescribes medication for children) who is knowledgeable in FASD or prenatal drug exposure can help you find medication to assist your child (Noble, 2020). Several types of professionals may be needed to help your child through different challenges. You can learn about the treatment team later in this article. 

You can learn more about FASD here. 

“My child and I aren’t really bonding… How can I know a therapist will be able to help with attachment?” 

Since the traumas that adopted and foster children experience begin during prenatal and preverbal periods, normal attachment processes have typically been disrupted. An appropriate therapist will also be familiar with concepts of attachment and what types of approaches assist with strengthening attachment. Attachment styles developed early in life provide the template for relationships throughout life. Secure attachment provides a sense of security that is essential for psychological, emotional, and behavioral health (Purvis & Cross, 2018). Insecure attachment can be categorized as anxious, avoidant, or disorganized. For more information about attachment, look here.

Many children who come into foster care or adoption have begun to develop features of insecure attachment based on previous relationships or from having multiple caregivers. Insecure attachment styles tend to lead to fear-based behaviors that can be difficult for caregivers to understand and respond to. 

Attachment describes the bond between two people, thus it is not something that a therapist can resolve one-on-one with a child as an individual issue. Because the primary focus is on the attachment relationship, not on the child’s symptoms alone, one or both parents should be active participants in therapy. This is one reason that therapists who will not allow adoptive parents or caregivers to join in the treatment process should be avoided (Lozier, 2018).

While the adoptive or foster family may not be the original source of the struggle, it is the context in which the child will begin to heal. The relational aspects of attachment and bonding need to be explored and repaired, and the child must experience safety and connection (Attachment & Trauma Network, 2017). This also means you will need to be willing to reflect upon yourself and what you might need to change as well. 

A knowledgeable attachment-focused therapist is likely to want to understand your trauma history and attachment style as the caregiver (Qualls & Corkum, 2019). Studies from North America indicate that nearly half (42%) of mothers do not have a secure attachment style themselves, making it difficult to help a child develop a secure attachment (Bakermans-Kranenburg & IJzendoorn, 2009). Understanding your own attachment style and triggers, and the way you were raised, allows you (and your child as they get older) to understand what each of you brings into the relationship. This will help you support your child more effectively.

See the list of therapy models below for more information on what qualifications to look for. 

“My child has a really difficult background and has survived trauma. How can I know whether a therapist understands trauma?” 

Trauma is defined by its overwhelming effect on an individual's nervous system. A therapist who is trauma-informed should be familiar with leading experts in the field of developmental trauma such as Dr. Bessel van der Kolk, Dr. Bruce Perry, Dr. Dan Siegel, Dr. Karyn Purvis, Dr. Daniel Hughes, and Dr. Stephen Porges.

When considering early childhood trauma, a trauma-informed therapist will be able to understand the type, frequency, and timing of maltreatment that a child experienced during their development. As the effects of trauma are variable, so are the behaviors that result (Perry & Hambrick, 2008). Regardless of age, therapy will begin by exploring your child’s history, and then offer specific ways to help traumatic memories and experiences become more tolerable by working within your child's developmental stage. 

A trauma-informed therapist will be able to stay calm and curious during emotional outbursts or dissociative episodes and help you be a detective regarding your child’s behavior. This means looking for unmet needs, things that trigger a fear response, or identifying missing skills. They will help you understand that you do not need to battle against your child, but you and your child can work to overcome their trauma history together.

This work of discovering needs and triggers while maintaining a focus on attachment can appear counter to many parenting approaches that focus on behavioral compliance. A trauma-informed therapist is not likely to rely on behavioral parenting methods like rewards and consequences, sticker charts, or time-outs. Instead they will offer strategies to build attachment, to help explore the reasons underlying the behaviors, to increase collaborative interaction with the child, and to help the child’s body develop a felt sense of safety. This requires consistency and ongoing curiosity from caregivers to understand their child’s behaviors with the help of the therapist, in order to make deep changes and reinforce the child’s value beyond behavioural challenges. 

“What Kind of Therapeutic Approaches Are Used to Address Adoption and Fostering Issues?”

The types of treatment needed will depend on your specific situation and what fits well with your family. As a parent, you are encouraged to ask about the different types of treatment a potential therapist might use. All therapeutic approaches for children in foster or adoptive families should show an understanding of attachment and trauma (What Works and What Doesn’t, 2017). Some well-known therapeutic approaches are introduced below. 

Play Therapy

Play therapy is used with children (generally ages 3 to 12) who struggle to use words to process their feelings because of age, developmental delays, or trauma. Children naturally communicate through play so a therapist can engage a child through games and toys to allow feelings and memories to be expressed and processed. With some types of non-directive play therapy can lead to children avoiding issues that are necessary to address, but an experienced trauma- and adoption-informed play therapist should know how to gently guide a child towards addressing issues they might be prone to avoid.

Play therapists can also help parents develop stronger attachment and attunement to their child through play (Child Welfare Information Gateway, 2018). In one type of play therapy called Theraplay, the goal is to create playful and caring interactions between adults and children ages 0-12 with four essential qualities: structure, nurture, engagement, and challenge. The practitioner will guide parents to play with their child to establish safety and support development with fun, physical interactions within healthy parent-child relationships. Find out more here.

In another play therapy, Filial Play Therapy/Family Filial Therapy, the therapist focuses on educating and equipping parents to conduct short play sessions in the home with their child. These sessions are set aside as special play-times in which the parent takes a gentler approach to limit-setting and the child guides the play. Learn more here.

Family Therapy

Family therapists view the struggles of any individual as being both impacted by and affecting the family system. By taking into account the challenges of various members of the family, a family therapist can guide members to a better understanding of each other and more effective communication. Within adoption, this can be especially helpful in exploring questions an adopted child has about birth parents and deciding together how to speak to others who ask about adoption (Riley & Singer, 2020).  Learn more here. 

Child-Parent Psychotherapy (CPP)

CPP is designed to work with a child (age 0 to 6) and parent together in sessions to strengthen attachment and bring awareness to trauma responses that are contributing to challenges. This work also includes the parent and child working together to write the story of the traumatic experience to help the child make sense of their history and overcome developmental delays from trauma. Learn more here.

Circle of Security 

The Circle of Security approach can be used from birth through adolescence. It is based on attachment theory and focuses on the parent becoming a Secure Base from which children can explore and a Safe Haven a child can run to when they have a need. The parent’s role is to be “bigger, stronger, wiser, and kind”. Therapeutic work will focus on how to develop and strengthen these traits as parents and communicate these messages to your child in a way they can receive. Learn more here. 

Dyadic Developmental Psychotherapy (DDP)

DDP was designed for foster care and adoption and focuses on the importance of the parent-child relationship. To encourage a feeling of safety within a relationship, parents are expected to be active participants in sessions. DDP encourages parenting with Playfulness, Acceptance, Curiosity, and Empathy (PACE). A DDP therapist will also highlight the importance of the team and system surrounding the family to help each child. Find out more here.  

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

EMDR Therapy is one of the most well-recognized and researched approaches to trauma therapy. This approach requires less talking and can sometimes resolve trauma with fewer sessions. EMDR Therapy focuses on stimulating the brain’s natural healing process, helping to resolve traumatic memories, by shifting the interpretation of the event to more adaptive emotions, thoughts, and behaviors. Learn more here.

Somatic Therapies

Somatic Therapies put more emphasis on the body as a way to treat trauma and emotional difficulties. Sensory Motor Arousal Regulation Treatment (SMART) is a therapy based on concepts from Occupational Therapy, using therapeutic equipment and movement to provide sensory input for children and adolescents dealing with complex trauma. The therapist uses their calm presence and the equipment together to help a child’s body process trauma they may not be fully aware of nor able to process with words. Learn more here. 

Somatic Experiencing Therapy is another somatic therapy. As the body is designed to recognize threats and respond to survive, sometimes after trauma, the body (or parts of the body) get stuck in a stress response. Somatic Experiencing gently guides a person to release trauma energy by experiencing difficult sensations and emotions. Once these are experienced, the body is released from the trauma response. Learn more here. 

Adjunct Therapies

Safe and Sound Protocol (SSP)

The SSP is an auditory intervention that engages the nervous system with specially calibrated music to increase the body’s felt sense of safety and improve connection and communication (Porges, 2017). It is not a standalone treatment and should only be offered by an SSP-certified therapist alongside other therapies to strengthen connection and ability to tolerate difficult sensations or experiences. Learn more here.

Other Therapies

There are many types of therapies, variations on accepted therapies, and new approaches being developed constantly. These include expressive arts therapy, music therapy, neurofeedback, Brainspotting, and couples therapy. Any of these may prove useful. You should ask the professional to explain the treatment and goals to help you decide if this approach fits you, your child, and your family. 

“What about online or virtual therapy through video or phone calls?” 

There can be several obstacles to attending sessions in person, such as travel time, work and school schedules, illness, or significant stress for a child around transport or new places. Some families in regional Asia also may not have access to adoption-competent professionals in their region. For these reasons, many parents wonder if online sessions would be beneficial and effective for their child. 

Many therapists now have made online work available. The effectiveness of online therapy for children depends on many factors including the age and developmental stage of the child, resources in the home, reliability of internet connection and private spaces, and the ability of the caregiver to be present and engaged with the child throughout the session. Some children engage well online, while others may not. Some therapists may not be willing to consider online sessions until they have met the family in person to assess the child’s readiness and abilities, as well as equip the parent to be supportive and connected to their child through the session. Additionally, a therapist may determine that virtual sessions will not be suitable for certain situations - particularly if the child poses a risk of harm to themself or someone else. 

There is general agreement amongst therapists that in-person sessions will be more effective and efficient for treatment where space is shared and contained (i.e. a child cannot run out of the room, become distracted with other activities, or turn off the camera), movement can be coordinated, and non-verbal communication is enhanced. However, online parenting consultations to support parents in challenging situations can be helpful, and some online parenting courses or groups can be very useful in addressing specific situations.

“What questions can I ask to evaluate the suitability of the therapist?”

Here is a list of questions for a potential therapist that you can take to an appointment with you.

Questions to Evaluate a Potential Therapist:

1. Have you received specific training in adoption or fostering? Do you attend trainings or conferences related to adoption needs and concerns or do you research and read on the topic?

2. How are parents incorporated into therapy? (Carol Lozier has a great list of 10 reasons why a therapist should incorporate parents into a child’s session.)

3. What is your level of familiarity with relinquishment and adoption-related trauma?

4. Have you received specific training in prenatal alcohol or drug exposure? (if relevant)

5. Have you worked mainly with adopted children, or also with adult adoptees? What is your experience working with the adoption triad/constellation, and are you familiar with these terms?

6. Do you have experience working with transracial and/or intercountry adoptees? (if relevant)

7. What books or podcasts would you recommend to learn more about the issues inherent to adoption? Do you know of any support groups for adoptive parents, adoptees, or birth parents? (Do they have knowledge of resources regarding adoption?)

8. What is your experience with open adoption, roots tracing/search and reunion, DNA testing, or other specific adoption-related issues? (if relevant)

“What types of professionals might be added to the treatment team for my child?”

Many children with more significant issues will benefit from having a team approach. It is important that the team members communicate with each other and work well together. Other professionals may include:

Occupational Therapist. Occupational therapy focuses on assessing what is holding your child back in development and building skills needed for life and work. Specific areas include: eating, toileting, grooming, fine motor skills, gross motor skills, sensory processing skills, and attention and arousal level management. They are the primary interventionists when Sensory Integration issues are involved. Learn more here.

Speech Therapist. Speech and language problems are common for children. Speech therapists can assess a child’s current level and identify specific areas to improve. They can assist with issues from comprehending spoken words to making sounds and forming sentences to difficulty swallowing. Learn more here.

Medical Practitioner. Usually a family physician or pediatrician, the primary care doctor manages the general health of adults or families and can provide letters of referral to specialists in areas that need more attention. 

Psychiatrist. These are medical doctors with specialized training to be able to diagnose mental health disorders and prescribe medications to treat them. Some, but not all, will also offer “talk therapy” or other types of counseling.

Psychologist. A psychologist will have a Masters or Doctoral degree in a field of psychology representing their broad scope of knowledge about human development and neuroscience. Typically this would be in Clinical or Counseling Psychology. If it is in Developmental Psychology, it is important to verify that the psychologist has had direct training and experience in working with children and families, and not just academic or research experience. Some psychologists also provide assessments including psychoeducational assessment for learning and behavioral issues.

School counsellor. Many schools have a counselor available to support children in distress or support their mental health. The school counsellor can join you in being an advocate for your child within the education system. They also can be a supportive person for your child that is more available throughout the school day and can help you as parents understand the school setting of your child.

Social Worker. You have likely already met social workers in the field of adoption or foster care. Social workers are often found in a variety of charities and government offices that support families and children and can provide support and help you find resources available for your specific concerns.

For more information on how to find help in Hong Kong, look here. 

“What steps can I take to find a therapist?”

Therapists trained in adoption issues can work with children and with families to address adoption-related issues. However, finding a therapist who is competent and trained in adoption can be a challenge in Hong Kong. Here are some suggestions:

1. Ask other adoptive parents whom they have worked with, or ask any mental health professionals you know for a suggestion of someone familiar with adoption.

2. Contact Adoptive Families of Hong Kong, your adoption agency, or your home study provider you worked with to ask for recommendations.

3. Look at online directories for each type of therapy, including: 

   • Child Parent Psychotherapy

   • EMDRIA therapists

   • EMDRHK Therapists

   • Somatic Experiencing Trauma Institute Therapists

   • Registered Play Therapists Hong Kong

   • Theraplay Institute therapists - Asia

   • Safe and Sound Protocol Providers

4. Research on the internet for therapists in your area with trauma-informed therapy qualifications that have been shown to be effective with young clients who are adopted.
5. Watchdog Early Education Centre is a registered charitable organization in Hong Kong providing intensive and well-rounded early intervention and therapy programmes for children with special educational needs aged from newborn to six. Subsidised programs can be accessed via Social Welfare Department referral or privately via direct payment at prevailing market rates. Service Application details.

“Where can my family and I find support alongside therapy?”

Some issues experienced by adoptive families will not require professional assistance. Post-adoption support comes in many forms, including educational seminars, webinars, websites, and support groups, in addition to direct therapeutic intervention with a mental health professional. Here are some podcasts and support groups available for adoptive families: Learn more here

Support for adoption:

• Adoptive Families of Hong Kong - https://www.afhk.org.hk/

• The Adoption Connection - http://www.theadoptionconnection.com/

• Creating A Family - https://creatingafamily.org/category/radio-show/ 

• Honestly Adoption Company - http://www.honestlyadoption.com/ 

Support for trauma or attachment:

• Attachment and Trauma Network - https://www.attachmenttraumanetwork.org/ 

• Post Institute - https://postinstitute.com/

Support via national organizations for FASD 

• National Organization for Fetal Alcohol Spectrum Disorders 

• Canada FASD Research Network

• FASD United

• National Organization for FASD

Online support groups for FASD or other mental health issues:

• FASD Success - https://www.facebook.com/FASDSuccess/ 

• Flying With Broken Wings (for FASD) - https://www.facebook.com/groups/FASDaFlyingwithbrokenWings/

Conclusion

All this information can feel overwhelming, but it is also evidence that there are resources and there is hope! There are many other families out there who understand what it is like to feel stretched too thin, judged, frustrated, and let down - families who have walked the hard roads of adjusting expectations and accepting new normals. And there are many professionals who spend hours learning about behavior, development, trauma, and attachment to help these families - families like yours. Hurts can heal. You can adapt. Your family can thrive, even if it is not in the way you imagined when you began this journey.

如何選擇領養治療師? 如何在香港找到治療師?

翻譯者: 鄺靈思 - 聖方濟各大學高級講師,母親的抉擇前領養服務經理

雖然本指南不可能涵蓋所有尋找合適治療師時的情況及範疇，但它是一個為領養父母、寄養父母、以及照顧者為其家庭尋找適當幫助和治療時的有用起點。本文章主要著重於以心理健康問題和人際關係為主的治療師，而同事亦十分認同其他範疇的專業治療師對任何家亦很有幫助。而本文章末亦會介紹其他專業領域的治療師、專業人士和支持者成員，如何作為一個家庭的支援。

注意: 

Adoptive Families of Hong Kong 鼓勵所有父母為創傷敏感和依附感為重的子女尋求專業治療。本文的目的是回答基本問題，作為家庭尋求幫助和支持的第一步。 Adoptive Families of Hong Kong不代言特定的治療師或治療方式; 本文不能取代治療或進一步培訓，也不代言本文中所含的任何其他資源。所有使用者都應徹底研究各種選擇並參考所有資料。

我應該什麼時候開始尋找治療師? 

在寄養或領養的早期階段尋找一位治療師，可以幫助你理解令人一些令你困惑的行為，並建立持續的專業支援關係。在亞洲，能夠勝任領養工作的專業人士不多，你可能需要等待幾個月或更長的時間。不過，你其實可以在配對成功或確定有具體問題之前就開始尋找治療師(就好像你可以在配對成功之前尋找兒科醫生作咨詢一樣)。如果你及早開始，你就可以在危機來臨之前通過候診名單向治療師作出咨詢。而且當尋求專業治療師對你的家庭來說已經成為一種尋常的經歷，你會更容易及願意在出現需求或問題時尋求協助。 在孩子剛加入你的家庭時已安排定期探訪，有助於他們將治療支持視為生活的正常部分，當問題出現時也不會那麼可怕尋求治療。

我應該尋找具有哪些資格的治療師?

花時間尋找一位具備合適資格的治療師是有效治療的關鍵。治療師的基本資格應包括心理學、心理諮商、臨床社會工作或相關領域的認可碩士或博士學位。 此外，理想的情況是找到一位對依附關係、創傷和大腦發展有理解和經驗的治療師，並了解與領養和寄養相關的核心問題。

有各種心理健康的專業人士可以為家庭的領養問題提供支援，可用的治療方法也有很多種，但並非所有治療方法都對治療創傷有正面或有效影響。 例如，注重懲罰和獎勵的方法可能會引發有創傷史的兒童的生存反應，或對那些因嚴重創傷或產前接觸藥物而導致執行功能受損的兒童完全無效。稍後我們將討論各種治療模式。

雖然你可以快速核實治療師是否接受過相關治療方法的訓練，但可能需要一些時間才能確保你找到一位與你和你的家人「合拍」的治療師。 除了資格和經驗外，你還需要一位思想開放、保持冷靜並善於傾聽你家庭的特定組合的治療師，以便根據你家庭的需要去度身定制治療方式。

我的孩子需要治療多長時間? 

對於領養中面臨的挑戰，並沒有快速的解決方案。建立聯繫和依附關係是需要時間的，但如果你能參與治療過程，你可以透過提供準確的資訊、在孩子回憶困難的事情時在場、以及在家中繼續進行治療互動，這才能幫助孩子更快地康復 (Lozier，2018)。

即使遇到困難，保持希望也很重要。現在有很多幫助，只要堅持不懈 ，你便能找到適合你和孩子的協助。每個孩子都不同，每個家庭的情況也不一樣，因此，即使有豐富經驗的治療師也需要時間找到適合你家庭的治療方法。治療師不能承諾消除孩子生活中的所有挑戰。有些問題可能會伴隨被領養者的一生，但只要有正確的支持和大量的愛，你和你領養的孩子是可以在家庭中成長，並適應個人的需要 。

《創建一個家庭》的這篇文章能進一步解釋為什麼父母應該參與孩子的治療 。

如果我的領養孩子在產前接觸過或被懷疑產前接觸過毒品或酒精，我應該尋求什麼樣的幫助? 

不幸的是，在領養或寄養的情況中，孩子在其生母懷孕期間接觸過酒精或毒品的情況很常見。來自美國和英國的樣本顯示，分別有28% 和25% 的寄養和領養兒童的行為問題與產前酒精接觸有關 (Chasnoff, Wells, King 2015)。酒精對發育中兒童的影響類型和嚴重程度各不相同。胎兒酒精光譜障礙( FASD)是由於酒精影響大腦發育而導致的終身身體殘疾。接觸酒精和其他物質濫用都會導致兒童有行為障礙和發育遲緩。

為孩子進行FASD或產前藥物接觸影響評估是一個艱鉅但重要的過程 ，而香港了解這一領域的專業人士屈指可數。儘管存在這些挑戰，但為FASD 或藥物接觸尋求心理評估是非常重要的。你可能已經注意到孩子在控制衝動、攻擊性、對藥物的反應或感官上的問題。熟悉產前藥物接觸的臨床心理學家可以與你討論孩子所面對的挑戰，並完成一些評估，以確定孩子大腦中受影響的特定區域，協助你找到支援配合孩子的需要。

在評估之後，心理學家或其他治療師可以幫助你找到針對孩子所面臨挑戰的適應和幫助措施 (Chasnoff, 2019)。如果有必要，熟悉FASD 或產前藥物接觸的兒童精神科醫生 (受過訓練，可為兒童處方藥物的醫生) 可以協助你尋找合適藥物來幫助孩子 (Noble，2020 )。面對不同的挑戰，你可能需要多種類型的專業人員來幫助你的孩子 ，你可以在本文後面部分了解治療團隊。

您可以在這裡了解更多有關FASD的資訊。

我和我的孩子並未能建立親密關係。。。 我怎麼知道治療師能否幫助我解決依附問題?

由於領養和/或寄養兒童所經歷的創傷始於產前和語言前時期，因此正常的依附過程通常會受到干擾。合適的治療師也會熟悉依附的概念以及哪些類型的方法有助於加強依附關係。生命早期形成的依附風格為一生的人際關係提供了模板。 安全依附提供了對心理、情緒和行為健康至關重要的安全感（Purvis & Cross, 2018) ，不安全的依附可分為焦慮型、迴避型或混亂型。有關依附的更多信息，請點擊此處。

許多寄養或領養兒童由於以前的關係或有多個照顧者，已經開始形成不安全依附的特徵。缺乏安全感的依附方式往往會導致恐懼行為，而這些行為可能會讓照顧者難以理解和應對。

依附關係描述的是兩個人之間的紐帶，因此它不是治療師可以一對一與孩子單獨解決的問題。由於治療的主要重點是依附關係，而不是單純的兒童症狀，因此父母一方或雙方都應積極參與治療。這也是應避免使用那些不允許養父母或照顧者參與治療過程的治療師的原因之一 (Lozier，2018)。

雖然領養家庭或寄養家庭可能不是問題的最初來源，但卻是兒童開始癒合的環境。依附和親情的關係方面需要探索和修復，孩子必須體驗到安全與連結 (Attachment & Trauma Network，2017) 。這也意味著您需要願意反思自己，以及您可能有需要改變的地方。 一位知識淵博、注重依附關係的治療師很可能希望了解您的創傷史和作為照顧者的依附風格(Qualls & Corkum, 2019)。北美的研究表明，近一半(42%)的母親本身不具備安全依附風格，因此很難幫助孩子發展安全依附至關重要的安全感 (Bakermans‐Kranenburg & IJzendoorn, 2009)。了解自己依附風格和觸發因素，以及您的成長方式，可以讓您 (以及您的孩子隨著年齡的增長)了解您和您的孩子在這段關係中各自帶來了什麼。這將幫助您更有效地支持孩子。 

請參閱下面的治療模式列表，以了解有關應具備哪些資格的更多資訊。

我的孩子有一個非常艱難的故事，經歷過創傷，我怎麼知道治療師是否了解創傷?

創傷的定義是指其對個人神經系統的重大影響。一名了解創傷的治療師應是熟悉發育創傷領域的頂尖專家，如Bessel van der Kolk 博士、Bruce Perry 博士、Dan Siegel 博士、Karyn Purvis 博士、Daniel Hughes博士 和Stephen Porges 博士。

在考慮兒童早期創傷時，了解創傷治療師將能夠了解兒童正在成長過程中受創的類型、頻率和時間。由於創傷的影響是多變的，因此導致的行為也是多變的 (Perry & Hambrick, 2008)。 無論年齡大小，治療都將從探索孩子的歷史開始，然後提供具體方法，透過在孩子的成長階段開展工作，幫助他們更好地接受創傷記憶與經歷。

了解創傷治療師能夠在情緒失控或分離發作時保持冷靜和好奇心，並幫助您成為孩子行為的偵探。這意味著要尋找未被滿足的需求、引發恐懼反應的事物或辨識缺失的技能。他們會幫助您理解，您不需要與孩子對抗，您和孩子可以共同努力克服他們的創傷史。

這種在關注依附關係的同時發現需求和觸發因素的工作似乎與許多注重行為依從性的養育方法背道而馳。以創傷為基礎的治療師不太可能依賴行為養育法，如獎勵和後果、貼紙表、獨處反思等。相反，他們會提供建立依附關係的策略，幫助探索行為背後的原因，增加與孩子的合作互動，並幫助孩子的身體建立安全感。這需要照顧者在治療師的幫助下，堅持不懈地了解孩子的行為，並持續保持好奇心，以便進行深刻變革，強化孩子的價值，使其超越行為挑戰。

採用何種治療方法來解決領養和寄養問題?

所需的治療類型取決於您的特定情況以及適合您家庭的治療方式。作為家長，我們鼓勵您詢問潛在治療師可能採用的不同治療類型。所有針對寄養或領養家庭中兒童的治療方法都應體現出對依附和創傷的理解 (What Works and What Doesn’t, 2017)。下文介紹了一些著名的治療方法。

遊戲療法 遊戲療法適用於因年齡、發展遲緩或心理創傷而難以用語言表達情感的兒童(一般為3 至12 歲)。兒童天生就會透過遊戲進行交流， 因此治療師可以透過遊戲和玩具吸引兒童，讓他們表達和處理自己的感受和記憶。

遊戲治療師還可以幫助父母透過遊戲加強對孩子的依附和適應 (Child Welfare Information Gateway, 2018)。在一種名為 治療遊戲(Theraplay) 的遊戲療法中，其目標是在成人和0‐12歲兒童之間創造遊戲性和關愛性的互動，並具備四個基本特質: 結構、培養、參與、挑戰。治療師將指導父母與孩子一起遊戲，在健康的親子關係中，透過有趣的身體互動，建立安全感並支持孩子的發展。點擊此處了解更多信息。

在另一種遊戲療法‐‐ 親子遊戲療法 / 家庭遊戲療法 (Filial Play Therapy/Family Filial Therapy) 中，治療師主要是教育父母，讓他們有能力在家中與孩子一起進行簡短的遊戲。 在這些遊戲時間裡，父母會採取更溫和的方式來設定限制，而孩子則引導遊戲。點擊此處了解更多。

家庭治療 家庭治療師認為，任何個人的掙扎都會受到家庭系統的影響。考慮到家庭中不同成員所面臨的挑戰，家庭治療師可以引導家庭成員更好地相互理解並更有效地溝通。在領養過程中，這尤其有助於探討被領養兒童對親生父母的疑問，並共同決定如何與其他詢問領養事宜的人交流 (Riley & Singer, 2020)。點擊此處了解更多。

兒童‐家長心理治療(Child-Parent Psychotherapy -CPP) CPP 旨在與兒童(0 至6 歲)和父母一起在課程中加強依附關係，並讓他們意識到創傷反應所導致的挑戰。這項工作還包括父母和孩子一起寫創傷經歷的故事，幫助孩子了解自己的歷史，克服創傷造成的發育遲緩。點擊此處了解更多。

安全圈 安全圈方法適用於從出生到青春期的各個階段。它以依附理論為基線，重點在於讓父母成為孩子可以探索的安全基地和孩子有需要時可以求助的避風港。父母的角色是 「更大、更強、更聰明、更仁慈」 。 治療工作的重點在於如何發展和加強父母的這些特質，並以孩子能夠接受的方式將這些訊息傳達給他們。點擊此處了解更多。

依附關係重建治療(Dyadic Developmental Psychotherapy -DDP) DDP 是專為領養和寄養設計的，著重於親子關係的重要性。為了鼓勵親子關係中的安全感，家長應積極參與課程。 DDP 鼓勵父母以遊戲、接納、好奇與移情 (Playfulness, Acceptance, Curiosity, and Empathy (PACE)) 的方式養育子女。 DDP 治療師也會強調圍繞家庭的團隊和系統對幫助每個孩子的重要性。點擊此 處了解更多。

眼動減敏重整療法(Eye Movement Desensitization and Reprocessing -EMDR)療法 EMDR療法是最受認可、最受研究的創傷治療方法之一。這種方法需要的談話較少，有時只需較少的治療程就能解決創傷問題。 EMDR 療法著重於刺激大腦的自然癒合過程， 透過將對事件的解釋轉變為更具適應性的情緒、思想和行為，幫助消除創傷記憶。點擊此處了解更多。

體感療法 體感療法強調透過身體來治療創傷和情緒障礙。感官律動調節治療 Sensory Motor Arousal Regulation Treatment (SMART) 是一種基於職業療法概念的療法，它利用治療設備和運動為遭受複雜創傷的兒童和青少年提供感覺輸入。治療師利用他們平靜的存在和設備來幫助孩子的身體處理他們可能沒有完全意識到也無法用語言處理的創傷 。點擊此處了解更多。

身體經驗創傷療法 身體經驗創傷療法是另一種體感療法。由於身體的設計目的是識別威脅並做出反應以求生存，有時在創傷後，身體(或身體的一部分 )會陷入應激反應。 體感體驗透過體驗困難的感覺和情緒，溫和地引導人們釋放創傷能量。一旦體驗到這些，身體就會從創傷反應中釋放出來。點擊此處了解更多。

輔助治療

安適療愈整合治療(Safe and Sound Protocol - SSP) SSP 是一種治療性傾聽干預方法，它透過特別校準的音樂使神經系統參與其中，以增強身體的安全感並改善聯繫和溝通 (Porges，2017 ) 。它不是一種獨立的治療方法，只能由獲得SSP 認證的治療師與其他治療方法一起提供，以加強聯繫和承受困難感覺或體驗的能力。 點擊此處了解更多。

其他療法

治療方法有很多種，有公認療法的變體，也有不斷發展的新方法。這些療法包括藝術療法、音樂療法、神經反饋療法、腦點療法和夫妻療法。這些療法中的任何一種都可能被證明是有用的。您應該請專業者解釋治療方法和目標，以幫助您決定這種方法是否適合您、您的孩子和您的家庭。

透過視訊或電話進行線上或遙距心理治療怎麼樣?

親自參加會議可能會遇到一些障礙，如交通時間、工作和學習時間安排、疾病或兒童在交通或新地方方面的巨大壓力。亞洲地區的一些家庭也可能無法在本地區找到有領養領域的專業人員。基於這些原因，許多家長都想知道線上課程是否對孩子有益和有效。

最近，許多治療師出於對環境的需要，開始提供線上治療。兒童在線治療的效果取決於許多因素，包括兒童的年齡和發展階段、 家庭資源、網路連結和私人空間的可靠性，以及照顧者在整個治療過程中陪伴和參與兒童的能力。有些兒童能很好地參與網絡，而有些則不能。有些治療師可能不願意考慮線上療程，直到他們親自與家人見面以評估孩子的準備和能力，並讓家長在療程中支持孩子並與孩子保持聯繫。 此外，治療師可能會決定虛擬治療不適合某些情況尤其是當兒童對自己或他人構成傷害風險時。

治療師們普遍認為，在共享和控制的空間情況下 (即孩子不能跑出房間、分心於其他活動或關閉攝影機) 面對面的治療會更有效和有效率，身體上的互動和非語言溝通會增強。不過，線上育兒諮詢可以在具有挑戰性的情況下為家長提供幫助，一些線上育兒課程或小組在解決特定情況時也非常有用。

我可以問哪些問題來評估治療師是否適合?

以下是向潛在治療師提出的問題清單，您可以帶著這些問題去約見治療師。

評估潛在治療師的問題:

1. 您是否接受過領養或寄養領域的專門訓練? 您是否參加過與領養需求和關注問題相關的培訓或會議，或您是否研究和閱讀過相關主題?

2. 父母將如何參與治療? (卡羅爾‐洛澤爾(Carol Lozier)列舉了治療師應讓家長參與兒童治療的10個理由，非常實用)。

3. 您對棄養和領養相關創傷的熟悉程度如何?

4. 您是否接受過產前使用酒精或產前使用藥物的專門訓練? (如果相關)

5. 你的工作對象主要是被領養兒童，還是也包括成年被收養人? 您在領養三角中的要素 adoption triad/constellation 有哪些工作經驗，是否熟悉這些術語?

6. 您是否有與跨種族和/或跨國領養者工作的經驗? (如果相關)

7. 您會推薦哪些書籍或 podcast 來進一步了解領養的固有問題? 您知道有哪些針對養父母、被領養人或親生父母的支持團體嗎? (他們是否了解有關領養的資源? )

8. 您在開放式領養、尋根/尋親和團聚、DNA 檢測或其他與領養有關的具體問題有何經驗? (如果相關)

我孩子的治療團隊可能會增加哪些類型的專業人員?

許多有重大問題的兒童將受益於團隊治療方法。重要的是，團隊成員之間要相互溝通，合作無間。其他專業人員可能包括：

職業治療師 職業治療的重點在於評估阻礙孩子發展的因素，並培養孩子生活和工作所需的技能。具體領域包括: 進食、如廁、梳理、精細動作技能、粗大動作技能、感覺處理技能以及注意力和喚醒水平管理。在涉及感覺統合問題時，他們是主要的干預者。點擊此處了解更多資訊。

言語治療師 言語和語言問題對於兒童來說很常見。語言治療師可以評估兒童的現有水平，並確定需要改進的具體方面。他們可以幫助解決從理解口語、發聲、造句到吞嚥困難等各種問題。點擊此處了解更多。

醫生 初級保健醫生通常是家庭醫生或兒科醫生，負責管理成人或家庭的一般健康問題，並可就需要更多關注的領域向專科醫生提供轉診信。

精神科醫生 這些醫生接受過專業培訓，能夠診斷精神疾病並開藥治療。有些(但不是全部)也會提供談話治療或其他類型的諮詢 。

心理學家 心理學家擁有心理學領域的碩士或博士學位，代表了他們對人類發展和神經科學的廣泛了解。通常是臨床心理學或諮商心理學。如果是發展心理學，則必須核實心理學家是否接受過直接培訓練並擁有與兒童和家庭打交道的經驗，而不僅僅是學術或研究經驗 。有些心理學家也提供評估服務，包括針對學習和行為問題的心理教育評估。

學校輔導老師 很多學校都有心理輔導員為處於困境的孩子提供幫助助或支持他們的心理健康。學校輔導老師可以與您一起在教育系統中為您的孩子代言。他們也可以成為您孩子的支持者，在校期間隨時為您的孩子提供協助，並幫助您作為家長了解孩子的學校環境。

社會工作者 您很可能已經見過領養或寄養領域的社會工作者。社工通常出現在各種支持家庭和兒童的慈善機構和政府辦公室中，他們可以為您提供支持，並協助您找到可用於解決您特定問題的資源。

有關如何在香港尋求幫助的更多信息，請點擊此處。

我可以採取哪些措施來尋找治療師? 

受過領養問題訓練的治療師可以與兒童和家庭一起解決與領養有關的問題。然而，在香港要找到一位在領養方面有能力並受過訓練的治療師可能是一項挑戰。以下是一些建議:

1. 向其他養父母詢問他們曾與誰共事過，或向您認識的任何心理健康專業人士詢問熟悉收養的人的建議。

2. 聯絡 Adoptive Families of Hong Kong、您的領養機構或與您合作過的家庭調查提供者，請他們推薦您。

3. 查看每種療法的線上目錄，包括： 

• Child Parent Psychotherapy

• EMDRIA therapists

• EMDRHK Therapists

• Somatic Experiencing Trauma Institute Therapists

• Registered Play Therapists Hong Kong

• Theraplay Institute therapists - Asia

• Safe and Sound Protocol Providers

4. 在網路上搜尋您所在地區具有創傷知情療法資格的治療師， 這些治療師已被證明對被收養的年輕客戶有效。

除了治療，我和我的家人還能在哪裡找到支持? 

收養家庭會遇到的某些問題並不需要專業人士的幫助。領養後的支持有多種形式，除了心理健康專業人員的直接治療介入外，還包括教育研討會、網路研討會、網站和支持小組。以下是一些為收養家庭提供的播客和支持群組: 點擊此處了解更多

領養協助

• Adoptive Families of Hong Kong - https://www.afhk.org.hk/

• The Adoption Connection - http://www.theadoptionconnection.com/

• Creating A Family - https://creatingafamily.org/category/radio-show/ 

• Honestly Adoption Company - http://www.honestlyadoption.com/ 

創傷或依附協助

• Attachment and Trauma Network - https://www.attachmenttraumanetwork.org/ 

• Post Institute - https://postinstitute.com/

FASD 或其他心理健康問題的協助

• FASD Success - https://www.facebook.com/FASDSuccess/ 

• Flying With Broken Wings (for FASD) - https://www.facebook.com/groups/FASDaFlyingwithbrokenWings/

結論 

這些所有資訊可能會讓人感到不知所措，但這也證明了資源是存在的，希望是存在的! 還有很多其他的家庭，他們理解那種捉襟見肘、被評頭論足、沮喪和失望的感覺‐‐他們走過了調整期望值和接受新標準的艱難道路。還有很多專業人士花費大量時間學習行為、發展、創傷和依附方面的知識，以幫助這些家庭‐‐像你們這樣的家庭。傷害可以癒合。你可以適應。你的家庭可以茁壯成長，即使這不是你開始這段旅程時所想的方式。

References:

Attachment & Trauma Network (2017, January 22) What Works & What Doesn't. https://www.attachmenttraumanetwork.org/what-works-what-doesnt/

Bakermans-Kranenburg, M. J., & Van IJzendoorn, M. H. (2009). The first 10,000 adult attachment interviews: Distributions of adult attachment representations in clinical and non-clinical groups. Attachment & Human Development,11(3), 223-263. https://www.researchgate.net/publication/24440045_The_first_10000_Adult_Attachment_Interviews_Distributions_of_adult_attachment_representations_in_clinical_and_non-clinical_groups 

Chasnoff, I. J., Wells, A. M., & King, L. (2015). Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure. Pediatrics. https://doi.org/https://doi.org/10.1542/peds.2014-2171  

Chasnoff, I. (2019, November 20). The Mystery of Risk: Drugs, alcohol, pregnancy and the vulnerable child. Insight Conference 2019. Indianapolis, Indiana. https://ittakesanohana.org/wp-content/uploads/2015/08/Mystery-of-Risk-Dr-Chasnoff.pdf

Child Welfare Information Gateway. (2018). Finding and working with adoption-competent therapists. Washington, D.C.: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. https://www.childwelfare.gov/pubPDFs/f_therapist.pdf 

DDP Network. (2014, April 07). About DDP. https://ddpnetwork.org/about-ddp/

EMDR International Association. (2020, July 15). About EMDR Therapy. emdria.  https://www.emdria.org/about-emdr-therapy/ 

Heller, D. (2019, November 17). Attachment Styles. Dr. Diane Poole Heller Somatic Attachment & Trauma Expert.  https://dianepooleheller.com/attachment-styles/ 

Integrated Listening Systems. (2020, September 29). The safe and sound protocol. Unyte iLs. https://integratedlistening.com/porges/ 

Lozier, C. (2018, September 10). 10 Reasons for Adoptive Parents to Be in Child’s Therapy Session. Creating a family. https://creatingafamily.org/adoption-category/10-reasons-for-therapists-to-incorporate-parents-in-a-childs-session/

National Child Traumatic Stress Network & The Federation of Families for Children’s Mental Health. (2003). Effective Treatments for Youth Trauma. National Child Traumatic Stress Network. https://www.nctsn.org/sites/default/files/resources//effective_treatments_youth_trauma.pdf 

National Child Traumatic Stress Network. (2012). CPP: Child-parent psychotherapy. https://www.nctsn.org/sites/default/files/interventions/cpp_fact_sheet.pdf 

Noble, J. (Host) (2020, April 12). #016 FASD & Aggression with Dr. Mansfield Mela [Audio podcast episode] In The FASD Success Show. FASD success. https://www.fasdsuccess.com/blog/Fasdandagression 

Perry, B. & Hambrick E. (2008). The neurosequential model of therapeutics. Reclaiming Children and youth, 17(3), 38-43. https://www.researchgate.net/publication/237346956_The_Neurosequential_Model_of_Therapeutics 

Purvis, K. & Cross, D. (2018). TBRI 101: A Self-Guided Course in Trust-Based Relational Intervention. Fort Worth, Texas. 

Qualls, L. & Corkum, M. (Hosts). (2019, August 20). The Truth About RAD with Karen Buckwalter (No. 51) [Audio podcast episode]. In The Adoption Connection. The Adoption Connection. http://www.theadoptionconnection.com/episode-51/ 

Riley, D., & Singer, E. (2020). Adoption. American Association for Marriage and Family Therapy. https://www.aamft.org/Consumer_Updates/Adoption.aspx 

SMART Moves. (2018, September 20). The SMART approach. https://smartmovespartners.com/smart-therapy-approach/ 

Somatic Experiencing International. (2020, November 25). About us https://traumahealing.org/about-us/ 

The Theraplay Institute. (2020, March 12). Core Concepts. https://theraplay.org/what-is-theraplay/core-concepts/