Article Published: February 24, 2026
In last month’s article, Sara Bailey, PhD, NCC, LCMHC, shared information about problematic language and popular misconceptions concerning adoption. With this knowledge, Counselors can begin working to improve their competency to treat this population.
Dr. Bailey is a researcher on the topic of counseling individuals who were adopted. As someone who was adopted herself, she brings lived experience to her clinical work. She offers valuable insights to help Counselors improve their competency to work with people who were adopted.
“If I was going to give any advice to a Counselor who’s serving a person who’s adopted, I would say first believe their story,” says Dr. Bailey. “Because their story is unique. It may be similar to other adoptee stories, but it’s also similar to other folks’ stories when we’re talking about trauma and feelings of otherness and feelings of not quite fitting in. Be curious. Be empathetic. Learn as much as you can. Start noticing what society tells us about adoption.”
Dr. Bailey notes that working with the adopted population is simply not covered in a typical Counselor Education program or textbook: “I would challenge anyone to find integration of adoption into standard Counselor Education textbooks. It just isn't there.”
Because Counselors are not likely to receive training on working with the adopted population during their education, they will need to seek out resources.
“The impact of adoption is not a one-time event,” says Dr. Bailey. “It is lifelong. If we can get Counselors to recognize that, that is powerful and that will be corrective to a population who up till now has not been addressed well in the research or in practice recommendations.”
Although counseling-specific training options may not be available, Dr. Bailey recommends the Center for Adoption Support and Education (CASE) Training Institute, which offers programs designed for mental health professionals, including free options.
“For generalist Counselors who want to have some understanding, this is a really good place to start,” says Dr. Bailey. “CASE also has something they call the W.I.S.E. Up! program, specifically designed for children who are adopted to help them navigate some of the intrusive questioning and some of the insensitive remarks that are often directed at adopted children.”
Dr. Bailey also recommends the work of Susan Branco and colleagues, who developed the Adoptee Consciousness Model (2023) to help conceptualize the experience of a client who is adopted.
“Susan Branco and colleagues have created a beautiful adoption consciousness model, and within that model, it’s a nonlinear kind of iterative model of how adopted people may experience coming to awareness of their own experiences,” explains Dr. Bailey. “They may learn that instead of buying into the standard understanding of adoption, that they may actually feel differently about it, and that that’s OK. . . . She just published some research on testing that model, and there’s been some adjustments to it. She’s doing some robust scholarship on that."
Knowledge can come from sources closer to home as well. It’s important to learn from others’ experiences with adoption. Counselors may be surprised at the adoption experiences of people they know, says Dr. Bailey.
“I would have conversations with other Counselors and have conversations with other friends and colleagues,” explains Dr. Bailey. “Because what often will happen is there are people in your circle who are adopted or who have been impacted by adoption who have never spoken those words before. Create a space for that conversation.”
In addition to personal interactions, many people who were adopted are publicly sharing their experiences through social media and other online platforms.
“Read the words written by adoptees,” recommends Dr. Bailey. “Even if what you're doing is getting on a Substack or looking on Instagram, hear what adoptees are saying, because there are a lot of adopted folks out there who are developing platforms and are shouting from the rooftops: See us, acknowledge us, recognize us. Yes, we can be successful. Yes, we can have vibrant lives.”
Reliable data on adoption is scarce, says Dr. Bailey: “It is really hard to get a clear picture of what’s actually happening when we’re looking at adoption research and we’re looking at population research and adoption."
What the research does consistently show is that people who are adopted have higher risks of mental health disorders, substance use disorders, and suicidal behaviors.
“What we think we know . . . is that adopted people are about one and one-half times more likely to experience anxiety disorders or depressive disorders,” says Dr. Bailey. “They may be as much as twice as likely as their kept peers or non-relinquished peers to experience substance use disorder. Depending on the research source, we believe to be true that adoptees are between 4 and as much as 35 times more likely to engage in suicidal behaviors.”
These alarming statistics reinforce the need for additional research and for Counselors to improve their competency, says Dr. Bailey: “Even if we were ‘only’ talking about two times likelihood of engaging with suicidal behaviors for any population, don’t you think we’d want to give a little bit more attention to that population?”
The reasons for these higher rates of mental health and substance use disorders are not well understood, explains Dr. Bailey. Some people in the adoption community have posited that adoptive parents are more likely to seek early professional treatment for potential issues.
“By the time you have that child placed in your family, you probably know at least one social worker or care worker or adoption caseworker or Counselor or case manager. So, an argument that’s been going on for a long time is that parents of adopted children are more savvy when it comes to seeking resources.”
However, Dr. Bailey sees other factors contributing to these higher rates of mental health and substance use disorders.
“Adoption trauma and adoption grief will be experienced differently by every person,” says Dr. Bailey. “They are real, and those experiences can feel unwieldy and out of the norm in a world in which so few people even recognize that they are possible.”
Counselors should approach each client with an open mind and evaluate their unique experiences.
“Don't presume pathology,” says Dr. Bailey. “Presume complicated grief. Expect mixed experiences of that grief. Sometimes grief shows up as anger—anger toward systems, anger toward blocked access to history, to knowing anything about your past. But grief, which we as Counselors are taught, is real and complicated and part of the developmental process for every single human on the planet. Grief experienced by adopted persons is often going to be complicated to the point that adoptees may not even be able to put words to it. This existential sadness of ‘I don't know who I am’ is not an uncommon refrain from an adopted person.”
The grief associated with adoption can have many causes and facets. Different aspects of the adoption experience may present a source of grief for different individuals.
“The grief also can show up in the knowledge that for whatever reason, we were not parented by our biological families, and there’s sadness there,” says Dr. Bailey. “There can be grief associated with, depending on our family’s story, the fact that we were our parents’ second choice in the sense that they couldn’t have biological children, so they chose to adopt instead. There can be the grief associated with, in later life, the knowledge that you will never know who your biological families were because you’ve run out of time. There can be grief not knowing about your past.”
Grief related to adoption can manifest in many ways, with some behaviors observed to be more common.
“We recognize that there’s a grief there that can show up through the lifetime as attempts at people pleasing, attempts at morphing into what other people want, really overperforming to guarantee that we’re not relinquished again,” explains Dr. Bailey. “That is a form of reaction to grief.”
Alongside grief, there is the lack of knowledge of one’s family history. This can have effects throughout the lifespan. Children may be put on the spot and feel othered by such seemingly innocuous occurrences as school genealogy projects.
“It’s hard to quantify, but I believe that anything that makes us feel like we don’t belong or that we’re inherently different, I think that can take a toll,” says Dr. Bailey.
In many states, people who are adopted have restricted access to documents pertaining to their birth. This blocked access may pose medical risks and contribute to anxiety around medical history.
“Another thing, and I think this is something that deserves a lot of research and maybe one day I'll have the capacity to do this, is the threat to mental health when it comes to blocked access, and I mean blocked access to things like your original birth certificate, blocked access to genetic history, blocked access to health history.”
Dr. Bailey provides a personal anecdote of the medical dangers of blocked access.
“I was able to search for and reunite with my biological families when I was in my 40s,” she says. “At that time, I learned of an easily screenable, preventable, fatal disease that at that point I could start screening for. I’m never going to have a problem with that because I know to screen for that.”
As with other aspects of adoption, the research has not yet explored the mental health effects of these challenges.
“So holistically, if you think about that for an adoptive family, not knowing genetic history, not knowing developmental traits and tendencies,” says Dr. Bailey. “Although we don't have good research of this, I would predict that that also contributes to potential negative mental health outcomes for adopted people.”
In light of the lack of research and resources for counseling adoptees, how can Counselors know effective techniques and interventions to apply? Dr. Bailey sees a starting point in the common ground between adoptees and other populations.
“Within adoption, we have the sense of otherness,” she says. “Other populations have experienced that as well. Within adoption, there is loss and grief. There is loss and grief in other populations as well. There are questions about who we are, where we fit in, how we belong, what is our history. Those are not unique to adopted persons. So instead of thinking about serving adoptees as this monolith of the adopted experience, I think what we need to do is see where there are crossovers and maybe start there.”
As with other populations, Counselors must be aware of their own biases and preconceptions when working with clients who are adopted, explains Dr. Bailey.
“Being aware of your own beliefs about adoption, kind of coming into the work, aware that what we feel about adoption as clinicians can impact our clients,” she says. “That’s really important too, to be aware that we’re not putting our beliefs into the session, but that we’re being receptive to the beliefs and experiences of adoptees.”
Giving space for clients who are adopted to reveal this information during intake makes for more informed and effective counseling. Key to this is avoiding assumptions about family and upbringing in the intake process and paperwork, says Dr. Bailey.
“If on an intake form you ask a client to describe their childhood, there is often an assumption that they’re describing a childhood in which they grew up with their biological parents.”
Making intake forms more adoption-friendly could be as simple as adding a checkbox for whether a client was raised by biological parents or not. The specifics may vary by counseling practice and situation. Another simple step is to first ask if a client knows their family health history, rather than assuming the details are known.
“Creating space for that normalizes the experience for an adopted person, so they don't feel like they’re making an exception,” says Dr. Bailey. “If you’re doing a more informal intake conversation with a client in the first session, you might introduce questions about childhood by broaching. ‘What was your experience?’ opens the door.”
Dr. Bailey advises Counselors to seek out conversations with people who are adopted and ask how to improve the intake process: “Have that conversation, because I promise the answer is going to be different for each person, but using all those insights, you can create a process that is more welcoming to your adopted folks.”
After intake, broaching becomes important for building the therapeutic relationship and understanding how a client conceptualizes and speaks about their adoption. (See our previous article for more on the language of adoption.)
“Broaching adoption in session doesn’t have to be a ‘big reveal,’” says Dr. Bailey. “When you feel that broaching adoption is therapeutically beneficial, simple and open-ended is best. Because so many adopted persons have never talked about their experiences before, you want to give your client a safe exit if they aren’t ready to talk about their adoption. You might say, ‘In our first session, you mentioned you were adopted. That experience is different for everyone, and I’m curious what it’s been like for you.’ Or you might ask, ‘What role has being adopted played in your life?’”
Not every client who was adopted will want to talk about it right away, or possibly at all. As a Counselor, it’s important to not assume that adoption underlies a client’s presenting concerns, but to hear the client out.
“Don’t be surprised or alarmed if a client shuts down your invitation with, ‘I don't know what you're talking about. My adoption was great,’” advises Dr. Bailey. “If that happens, accept it at face value. The client either truly doesn’t see their adoption as a concern, or they aren’t ready to go there yet. Either way, they now know you are a Counselor who isn't afraid to talk about it if they ever change their mind.”
It’s important not to overly focus on a client’s adoption if they do not perceive it as crucial to their presenting issues. As with other elements of working with this population, the key is to recognize the client’s experience and personal context.
“Because not every adopted person will want to talk about their adoption,” says Dr. Bailey. “That is often not the most salient part of their presenting concerns. For you as a Counselor, though, remembering that there may be some connections there, even if they’re never voiced, to help you conceptualize your client, I think that can be a real gift in the clinical space working with adopted people.”
References
Branco, S. F., Kim, J., Newton, G., Cooper-Lewter, S. K., & O’Loughlin, P. (2023). Out of the fog and into consciousness: A model of adoptee awareness. International Body Psychotherapy Journal, 22(1), 53–66.