Adoption and Foster Care

Adoption and foster care may be necessary in some circumstances, such as when a child is removed from their family for safety reasons, or given for adoption in the hope that another family can provide a better life. For most children, being placed in foster care and then adopted by a loving family results in positive outcomes.

However, for some children, especially those adopted when they are older or from overseas, adjusting to a new family can be challenging. Research suggests that adopted children may be more vulnerable to emotional and behavioral difficulties. (1) This can be distressing for the child as well as for the foster or adoptive family.

If you are a foster or adoptive parent experiencing challenges or worry about a child’s wellbeing, consider enlisting the help of a therapist. With the appropriate support, most children adjust to life with their new families, develop supportive relationships, and live rich and fulfilling lives.

Adoption and foster care statistics

According to the Adoption and Foster Care Analysis and Reporting System (2), around 440,000 children in the United States were in foster care in 2017.

Adoption was planned for 27% of these children, and long term foster care for 2%. These children had spent an average of 20 months in foster care, although 6% of the children had been in foster care for 5 years or more.

The circumstances associated with the removal of the children from their families (with multiple factors involved for many children) were:

  • Neglect (62%)
  • Drug abuse by a parent (36%)
  • Caretaker inability to cope (14%)
  • Physical abuse (12%)
  • Housing (10%)
  • Child behavior problem (9%)
  • Parent incarceration (7%)
  • Alcohol abuse by a parent (5%)
  • Abandonment (5%)
  • Sexual abuse (4%)
  • Drug abuse by the child (2%)
  • Child disability (2%)
  • Relinquishment (1%)
  • Parent death (1%)

Many issues can create difficulties for children in foster care or adoptive families:

  • Trauma history: Some children have been removed from families where they were exposed to physical abuse, neglect, or other adverse circumstances, like those listed above.
  • Disrupted attachment: Attachment is an important aspect of a child’s development, wellbeing and sense of safety. However, foster care and adoption disrupt this process due to the frequent changes in caregiver. Many children are still able to develop a secure attachment once they have a consistent caregiver meeting their needs. You can learn more about attachment here.
  • Birth family relationships: Many adopted people have difficulty deciding whether to seek contact with their birth parents, or struggle to find information about them. Being in contact with birth parents can also be difficult. For example, some people experience ongoing conflict between birth and adoptive families.
  • Impact on the adoptive family: Adoptive parents can experience post-adoptive depression, and families may struggle to adjust. The impact on the family can be exacerbated if the adopted child is also experiencing behavioral or emotional difficulties.

Children react in different ways when faced with stressful situations. Adoption and foster care can undoubtedly be stressful events with lifelong impacts. Many children will experience feelings like guilt, shame and rejection, as well as other challenges, such as:  

  • Anxiety: The child may feel anxious for many reasons, such as being unable to rely on receiving consistent care, or due to frequent changes in their circumstances.
  • Depression: Children may feel sad, hopeless or depressed. Adoptive parents can also experience depression after adopting a child.
  • Trauma: Given the prevalence of adversity, many children arrive in their new families with a trauma history and may experience symptoms of post-traumatic stress disorder. The separation from their family can, in itself, be traumatic.
  • Grief: It’s common for children to experience a sense of loss or grief upon leaving everything that was familiar to them, even if their previous circumstances were unsafe.
  • Stress: The processes of foster caring and adoption are understandably stressful. People may feel tense, have difficulty sleeping, or experience other symptoms of stress.
  • Relationship problems: Many factors associated with adoption and foster care, such as the lack of stability in relationships, can contribute to social difficulties and challenges forming new relationships.
  • Identity and sense of self: Some children feel that they don’t know who they are, particularly if they don’t know their biological parents. This might be experienced as an identity crisis.
  • Behavioral challenges: Adopted children appear to be at greater risk of behavior problems. Conduct Disorder and Oppositional Defiant Disorder are relatively common examples.
  • Self-esteem: Adopted children often experience lower self-esteem. This may be related to feeling different, unsure of their identity or feeling rejected. (3)

What to do if you experience issues around adoption or foster care

There are many steps you can take to look after yourself, your family, and the wellbeing of your adopted child. Consider a combination of the following:

  • Therapy: Therapy can be helpful for the child, adoptive parents, or family. It can improve relationships, address mental health or behavioral challenges, and help the child to heal from trauma. Therapists can help children to make sense of their feelings and provide them with support and strategies. Types of therapy to consider are discussed further, below.
  • Support groups, for parents or for the adopted person: Many people benefit from joining a support group, whether you are an adoptive parent, or an adopted adult. Sharing experiences and learning from people in similar situations can be encouraging and helps people to feel that they are not alone. You can use the directory on the Child Welfare Information Gateway’s website to search for parent support groups near you.
  • Read and learn: The Child Welfare Information Gateway, for example, has some helpful resources for parenting children who have experienced abuse or neglect. You can also learn about the subsidies, services and training available to help parents and children throughout the adoption process on the Adopt US Kids website here.
  • Hotlines: If you need immediate support, call 1-800-273-8255, or go the National Suicide Prevention Lifeline website. If you think a child is in danger or at risk, contact the Childhelp National Child Abuse Hotline at 1-800-422-4453.

Therapy types to consider

Many types of therapy could be considered for yourself and your child for challenges with adoption or foster care. The type you select will depend on what your main concern is. For example, are you primarily worried about addressing relationships, managing behavior problems, healing from trauma, or helping with mental health challenges? Therapy types include:

  • Family therapy: All family members are involved in therapy, exploring how each person is feeling and coping, and working together to find resolutions. Family therapy can help to build attachment relationships and improve communication between family members.
  • Cognitive Behavioral Therapy (CBT): CBT helps change unhelpful thoughts and behaviors, and create more balanced perspectives. CBT can help adults and children with mental health symptoms associated with adoption or foster care issues, such as anxiety or depression.
  • Trauma-Focussed Cognitive Behavioral Therapy (TF-CBT): TF-CBT involves the participation of the child and a caregiver (such as an adoptive parent) to help reduce the child’s trauma symptoms. Other types of trauma-informed therapy can also help.
  • Parent-Child Interaction Therapy: This helps parents of children with behavioral issues and provides coaching. Both the child and parent/caregiver participate in therapy. (4)
  • Dyadic Developmental Psychotherapy: Once again, both the parent/caregiver and the child participate in therapy. This therapy is for children with trauma or complex backgrounds and helps them to engage with their new parent and form attachments (5).
  • Sand Tray Therapy or other types of play therapy: Sand tray therapy can be particularly helpful for enabling children to express themselves nonverbally.

What to look for in a therapist for challenges associated with adoption or foster care

The best-fitting type of therapist depends on individual factors, symptoms, your location and finances. You’ll want to consider whether you are seeking therapy for yourself, your child, both, or with the whole family. Then consider the following therapist factors:


It is important to look for a licensed mental health professional. This ensures that the therapist you work with has undertaken the appropriate education and training.

Personal fit

As is the case when you are seeking therapy for any reason, it’s important to consider the potential for developing a strong working relationship with your therapist. The trusting working relationship with a therapist is called the therapeutic alliance, and it’s the number one indicator of treatment efficacy.

Children who have experienced trauma or have experienced instability may feel unsafe and see the world as a more dangerous place. Therefore, it’s particularly important to look for a therapist with whom they feel comfortable.

Specialized training and experience

Look for a therapist who has specialized training and experience working with children as well as foster and adoptive families.

  • Look for a therapist type specialized in working with children, such as a child psychologist. This means that the therapist will have an expert understanding of developmental and attachment issues and how adoption can affect a child.
  • The Center for Adoption Support and Education provides specific training for mental health professionals working with foster and adoptive families. You might want to look for a therapist who has completed this course, called the Training for Adoption Competency (TAC) program, or another type of relevant training.

Talk in advance

The best way to judge how you might feel about your prospective therapist is to ask for a preliminary phone call. Most therapists will be happy to oblige. This gives you the opportunity to ask about:

  • Their qualifications and experience working with children and adoptive or foster families
  • Any ongoing training they are participating in that relates to adoptive or foster care issues
  • What type of therapy they suggest and what that will be like
  • Whether they work with the whole family or just individuals
  • The limits of confidentiality. Ask them whether they will give you (the adoptive parent or caregiver) updates on the progress of the child.
  • Their participation in insurance plans and cost of therapy

Try to speak to a few different therapists before making your mind up.

Zencare can help you to find a therapist who is a good personal fit. You can browse the videos of our vetted therapists and book a free phone call. This can help you to figure out whether you feel comfortable discussing difficult issues with the therapist, and gives a sense of what the therapist’s approach is like.

New to therapy? Learn about how to find a therapist here.


  1. The Mental Health of U.S. Adolescents Adopted in Infancy
  2. Adoption and Foster Care Analysis and Reporting System (AFCARS)F 2017 data, AFCARS Report #25
  3. Children’s Bureau, “Impact of Adoption on Adopted Persons” (PDF)
  4. Child Welfare Information Gateway, “Choosing Therapy for Adopted Children and Youth
  5. Quality Improvement Center for Adoption & Guardianship Support and Preservation, "Dyadic Developmental Psychotherapy"
  6. Child Welfare Information Gateway, “Finding and Working With Adoption Competent Therapists” (PDF)