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.

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/