About Adoptee Rage

Statistics Identify large populations of Adoptees in prisons, mental hospitals and committed suicide.
Fifty years of scientific studies on child adoption resulting in psychological harm to the child and
poor outcomes for a child's future.
Medical and psychological attempts to heal the broken bonds of adoption, promote reunions of biological parents and adult children. The other half of attempting to repair a severed Identity is counselling therapy to rebuild the self.

Monday, April 20, 2015

Grief In Child Adoption By Pauline Boss


Grief In Adoption   By Pauline Boss

Grief in Adoption: Conversation with Pauline Boss

By Geneva Anderson
Written from Summer 2009 PACER newsletter
On January 19, 2009, I spoke with Dr. Pauline Boss about her work with ambiguous loss as it pertains to adoption issues. Here is the transcript of our conversation.
Background and relevance to adoption issues:
1. Geneva Anderson: Do you, Dr. Boss, have any direct personal or counseling/therapeutic experience with adoptees or those touched by adoption?
Pauline Boss: Yes, lots. For over 30 years, I have worked with adult adoptees who are hungry to find their birth parents and also with cases where the adoptions are not working out, which is one of the saddest cases in the world. Adoption has also touched me personally. I was married to an adoptee and there are adoptees in my extended family, so I do have first experience as well.
2. Is there anything in your theoretical framework for Loss, Trauma and Resilience: Therapeutic Work with Ambiguous Loss that is unique to adoption?
Pauline Boss: When you devise a theoretical framework, nothing is ever a perfect fit. The user—adoption focused in your case—has to see what fits and what doesn’t fit.
What I think helps most is that I’ve given it a name–the stress that comes along with adoption for all parties concerned. Birth parents have given up a child and may wonder where it is at times, if not constantly. The adoptee may wonder where is my birthmother or my birthfather, what is my DNA, what is my cultural heritage?  The adoptive parents may also have stress over something that could interfere with them keeping the child or how their relationship may change, whether or not the child will still love them, if they do express an interest in their birth parents.  From what I’ve seen, the ambiguous loss seems to sit most heavily with the birth parents who gave up the child and with the adoptee who wonders where the birth parents are.
Defining ambiguous loss and core terms in the adoption context:
3. What is ambiguous loss and how does ambiguous loss manifest itself for adoptees, birth parents, and adoptive parents?
Pauline Boss: Ambiguous loss is simply unclear loss, not a death, but somebody is lost and can’t be found.  It manifests itself for adoptees by knowing that there’s a birthparent who gave them life and whose DNA they carry but they don’t know where or who this birthparent is if it’s a closed adoption. The situation with the birthfather is particularly stressful because sometimes the birthmother doesn’t know who he was or has trauma around him. And if you have donor sperm, that is a new complicating factor.
In fact, there is a practical reason for needing to know this, not just psychological. Illnesses that are generational or genetically-carried or just frustrating curiosity about who you are, your identity— the ambiguity has some solidity behind it.
There are two types of ambiguous loss: physical absence with psychological presence and physical presence with psychological absence. Both types have the potential to traumatize and lead to feelings of abandonment.
Let’s say I am an adoptive parent and I have a child I have mothered and she’s now 16 or 17 and preoccupied with finding her birthmother and who she really is. She may be so preoccupied with that that she is psychologically absent in our home, sort of separated from her adoptive father and mother who raised her. I’ve worked with families like that where the teen is experiencing a great deal of curiosity about who they are and sometimes there is tension because they also feel loyalty to their adoptive parents.
Everyone has a “psychological family” but that’s a very controversial term. I have written about it and I have seen that people do relate to it. It is not always consistent with the legal family and, in the case of adoption, this seems a natural occurrence—wondering why they were given up, why? That’s the biggest question that is brought into my therapy practice.
4. Do you acknowledge this “psychological family” as a healthy construct?   My experience is that we adoptees are often expected to address and to live with reality, not fantasy, but we do fantasize wildly.
Pauline Boss:  I try to keep judgment out of this, it has no place. Blaming gets you no where. This type of mental reckoning is a way of coping with stress. Trying to find a human culprit—people in our lives or our past lives who are responsible– overlooks the true culprit which is the ambiguity that you are left with.  If you focus on people, you can and will waste your time being angry and then guilty over the anger and it will cycle. It is not a functional way to go.
In the coping literature, they make it very clear that you cannot cope with something until you know what it is. When things are ambiguous, it’s worse than a death. People can cope with a death because there are rituals, ceremonies, a coroner who gives an official death certificate. Although it’s very painful, there is a lot more understanding of how to cope with death than ambiguous loss such as with adoption–there are no Hallmark cards, no rituals, no cakes, no hot dish (as we say here in Minnesota).
I think a lot of people come to support groups thinking they will get closure and understanding and then get on with their life. They may become frustrated because they are not getting through it with a few meetings.  This because it is chronic and there is no end. You can learn to manage the stress better though.
Closure is a myth with ambiguous loss. The hunger for closure comes from a society that is very mastery oriented, problem-solving oriented. But is this case, there is no period at the end of the sentence. There is no clear answer to the problem. Adoption is fraught with ambiguity and that’s the way it is always going to be (just as divorce is, by the way). What we need to do, instead of searching for closure, is to increase our tolerance for ambiguity and that’s what the book is designed to do.
5. What is “frozen grief” or “unresolved grief”?
Pauline Boss:  They are the same…it’s when you feel paralyzed or immobilized. You cannot move forward because you are stuck in feeling that is very difficult to manage. A birthmother may be thinking—Where is that child?  Is that child ok?  Did I do the right things?  etc., etc. That is unresolved grief and loss.  I also believe there can be trauma in this—so it’s also the same as traumatic loss which will cause frozen or unresolved grief. By traumatic, I mean there is pain in it and it immobilizes you.
What I’ve learned, however, that needs to be stated up front is that some people are not as troubled by things as others are.  Since 9/11, we’ve learned a lot more about trauma and traumatic loss and we know now that some people cope by not talking about it. I realized this about a year after 9/11 and I now believe it is perfectly healthy.
6. There has been an assumption in the adoption community that some people don’t choose to search because they are afraid of what they’ll find and that somehow this is not healthy, that this it is a coping mechanism that needs to be blasted away.   The idea is that everyone needs to know this information to become truly healthy or to actualize their true essence.
Pauline Boss:  That’s a judgment that is not true. Everyone needs to know they can pursue it if they want to but not everyone needs to do that to be healthy.
(Geneva Anderson)  Within PACER, many of our members have made the decision to search and what unfolds from there can keep them in PACER for quite for some time.  I have seen it get tricky.  Wounding, showing up in control issues, can drive someone to insist that searching or not searching is the best course for another person.  Sometimes you can lead a horse to water and he will not drink because he is not thirsty.  Adoption is so hard to navigate, fraught with deep attachments to beliefs and judgments. Historically, it has been entrenched in secrecy and notions about protecting people—it’s one huge knot.
Pauline Boss:  Even very compassionate people get confused about control and trying to show others the right or better way. I am, of course, speaking about adults here, not an adult and young child. There is no way that one adult can know with certainty what is right or wrong for another adult in this regard.  Insisting can become pressure and that can also be painful.  The insister is not getting his way and the recipient of the pressure is feeling more and more pressure to do something he may not want or need to do.
Ambiguous loss, attachment disorder, PTSD
7.  What distinguishes ambiguous loss from an attachment disorder or from PTSD?  Can a person have a combination of these at once?  How does the therapeutic approach differ?  I believe that I have seen triad members suffering from ambiguous loss thrown into full-blown PTSD when something like a break-up, a divorce, a miscarriage, or even the death of a beloved pet causes trauma…it becomes too much to bear.
Pauline Boss: I like to explain it this way—If you were to line all these things up and label them A,B,C,D,  where A is the situation and B,C, and D, are the outcomes, ambiguous loss is the situation. Someone is partly here and partly gone. An attachment disorder could exist with ambiguous loss, as could PTSD.
8. What is the difference between an attachment disorder and PTSD?
Pauline Boss: Without looking at the DSM in front of me, an attachment disorder results from early loss, in infancy or childhood, not having attached to a primary love object, like a mother, so it is a relations disorder. Everyone needs someone who is crazy about them and regularly in their life—this doesn’t mean one mother, but it means a handful of similar people around them day after day—father, mother, grandmother, a care provider—who create or co-create a consistent and predictable environment for the child. That person is not angry one day and different the next day, the environment is stable and loving.
PTSD (post traumatic stress disorder) happens in adulthood and it’s a traumatic life-threatening pain that happened to you or that you have witnessed. A solider in battlefield or a witness to a homicide may experience stressors and the extreme trauma that bring on PTSD. PTSD is chronic and can involve flashbacks, nightmares, sleep problems, etc. The symptoms can cause significant problems in important areas of functioning, such as work and relationships
9.  In a support group meeting, if someone has experienced something traumatic, can they be triggered by the present situation and go into a PTSD-type reaction?
Pauline Boss: I cannot answer this as it is case specific. I do know that most of us will flashback to our own pain or injury or loss when we hear someone else tell their story and hopefully that’s not harmful.  For example, I understand that when JFK died, therapists around the country were busy because people came in to talk about losses that had occurred years before.  His funeral was right before our eyes, it was public, and the loss was national. I don’t know without seeing someone if it is PTSD. What we do need to know is that, after a disastrous event, 2/3 to ¾ of people do not get PTSD, even though they are experiencing a traumatic loss and so we shouldn’t over-pathologize.  Some people can navigate fine on their own with family and community support. I love the idea of your support groups by the way. Others do need serious help but is just 1/3 to 1/4.
10.  Can a person essentially compartmentalize ambiguous loss–exhibit wounding in one part of their life due to adoption and not experience spill over into other areas in subtle ways?  Could ambiguous loss explain why many triad members report finding themselves in a series of unfulfilling interpersonal relationships—it impacts their way of relating emotionally, interpersonally?
Pauline Boss: Let me answer that first question clinically, no. Without looking at the specifics of an individual’s personal experience, I can only say this–it generally spills over into other relationships as trust issues. You might not trust a peer relationship or you might blow-up at a point where you did not expect to and it has got little to do with the present; it’s a flashback. If this is distressing to a person, he/she should deal with it because stress is never good for any of us and we really cannot bear it. It comes out in all sorts of ways and you don’t want it to impact your work or relationships, but often it can.
I am using a stress model and not a psychiatric model. Let’s say the adoptee was left too long in a ward without much attention. He will have issues with attachment but trust is more subtle and it spills over into friendship and intimate relationships. The goal for all of us is to become more fully human and to deal with the anxieties and stresses we have and identify what triggers us, so we can deal with it. This, by the way, is very hard work.
11. What is the “psychological family” and how does it pertain to adoption trauma and healing in a child?  Wouldn’t it be very complex to try and get a young child to talk about his or her “psychological family?”
Pauline Boss: Play therapy is much better for children because they do not know what’s in their mind.  Gaining insight on this is possible with an older child through experiential therapies, more abstract things to label what’s going on and what is the distress. The psychological family does not have to be a bad thing—you have a “both and.” You can have this family in mind and the family you are at the dinner table with every night.  This can be healthy.  The problem is when you have unrealistic expectations and dreams about the psychological family and put it on a pedestal.
Here’s what I see as the purpose of the psychological family—it’s where you share your joys and your sadness. Some people tell me that God is part of their psychological family and they share their joys and sadness with Him, as well as with their own families. If someone is having an inner conversation with their birthmother whom they’ve never met about their joys and sadness, there’s no harm in that as long as they are also sharing with their adoptive mother. The main point is that there is some interaction, conversation with the family that is present and the psychological family should be the one with whom you share your joys and sadness and also your birthday parties and your rituals, etc. If on those days, you know you are adopted, you might light a candle for your birth parents wherever they are.
The adoption process itself and ambiguous loss
12. What can be done to minimize the impact of ambiguous loss during the adoption process?  What can the adoptive family do to minimize ambiguous loss for the adopted child?
Pauline Boss: First, tell the child.  In my generation, I am 74, we did not tell the child and that was cruel and then they heard it in the halls in school. I don’t think that’s much of an issue now as we know it’s healthy to have this openly acknowledged.  Second of all, share when the time is right, share everything you have about health, genetics and if possible, culture.  In other words, gather as much information as you can for the child. Teach the child “both and.” You are our child and, somewhere out there, are birthparents, so that the child is not torn in a loyalty issue.
Before we can do that for a child, we need to be able to do that for ourselves and in our society we are taught linear thinking—based on science, that it’s either this or that. In the case of adoption it is not either this or that, it is “both and”—you belong to this family, we are your parents and somewhere out there, there is also someone who gave you birth and your DNA. If you teach this to a child, it actually lowers stress. It means you are avoiding closure. The idea of closure is so harmful and stressful. If you teach your child that you are our child now, so forget about that, that is closure and it’s dangerous and it won’t work.  That model was wrong. I don’t think it helps to tell you this, but it was a mistake and I regret our profession pushed that.
13.  Do you suspect that open adoption mitigates some of the impact of ambiguous loss?  There is research that suggests that with open adoption trauma may begin even earlier because open adoption can be very stressful.   For example, many open adoptions have failed because the birth mother is not able to sustain contact and may withdraw and disappear or the adoptive parents may not be able to handle their own feelings when the birth mother wants contact or is inconsistent with contact.  All this can put tremendous pressure on the child who may be aware of meetings being cancelled, etc.
Pauline Boss: I would refer you to the research of Harold D. Grotevant, Rudd Family Foundation, Chair in Psychology, UMass Amherst. Grotevant aims to establish UMass Amherst as a leader in research on the psychology of adoption. He supervised a study on openness in adoption arrangements. (http://psych.umass.edu/adoption/key_findings/relationships_within_the_adoption_kinship_network/)
I am quoting Grotevant: “Relationships between the adoptive family and birthmother have also been examined through the lens of boundary ambiguity, which is said to exacerbate family stress because of family members’ inability to determine who is inside and who is outside the family system (Boss, 1988).  Boundary ambiguity occurs when a family member is physically absent but psychologically present, or vice versa.  Fravel (1995) examined the psychological presence of the birthmother in the adoptive family system, and found that boundary ambiguity is almost inevitable in adoptive families but that it manifests itself differently by level of openness. Management of the psychological presence of the birthmother may also vary according to both level of openness and some personality characteristics and relationship tendencies of the adoptive parents such as tolerance for ambiguity (Fravel, Grotevant, Boss, & McRoy, 1993; Fravel, 1995).”
In other words, personalities do come into it. They studied 3 levels of openness in adoption—totally closed, somewhat open and totally open–and they found that it depended not only on degree of openness but also on personality characteristics and relationship tendencies of the adoptive parents. Some people can’t handle it. There is a lot more ambiguity, boundary ambiguity, in an open adoption and that needs to be addressed up front. Read Grotevant.
14. What can be done to mitigate the impact of ambiguous loss when it comes to foreign adoptions, when the child has been relinquished to an orphanage and the adoptive parents are getting a child whose history is unclear and who may be a toddler when they meet for the first time?
Pauline Boss: I would in the very least take the child to their country of birth and get them culturally connected, so it may not be with the birthparents but they have a link with their heritage. Even if it’s as general as educating them about their heritage. If you haven’t got the money, take them to a museum and connect them in some way to their culture. There is always a way.
Banishing closure, embracing “both and” thinking
15. You have written that we need to re-evaluate closure as a goal–that we should not expect people with ambiguous attachments to reach closure because being in a state of chronic limbo makes that impossible.  Can you expand on this? If we do not strive for closure, what is healthy healing then in the adoption context when ambiguous loss is present?
Pauline Boss: Banish the word “closure.” It’s a bad word, a bad concept and only creates more pain.  Instead, what you want is tolerance for ambiguity, tolerance for unanswered questions. You want to find meaning without closure because closure is the wrong goal.
Usually people are stuck between holding out rigidly for return of the lost person and wanting absolute closure to loss…The healing synthesis manifests in being comfortable with unanswered questions, moving forward slowly to attend to other attachments while still thinking of the lost person. …Gradually, as people see that complete letting go is not the goal and that they can hold onto to the lost person even while moving forward, the desire to put life on hold diminishes.
Yes, you do need to find meaning. What is my identity? Who am I? Where did I come from? If you can’t find the exact birth parents, find the culture, the community, the country—find something that helps the adopted child put together an identity which also would be coming from the adoptive parents and their culture and rituals as well. It’s a knitting together of some things that are clear and some things that are unclear and will remain unclear perhaps forever. It’s more of a collaboration without closure and clarity.
16.  You have found that individual resiliency is the key to cope with the chronic stress of ambiguous loss. How does this resiliency concept apply to adoption? When a triad member has had initial rejection but wants to live with the hope that things may be better in the future, how can they manage that?  Sometimes, they may feel guilty about shutting the door on a relationship because they know that rejection often results from wounding in the person rejecting them and they want to hold the door open for healing to occur. What is healthy in a situation like this? It seems unhealthy to wait for someone else to make a decision about whether or not they want a relationship with you—what is a healthy way to approach this?
Pauline Boss: Without going into details of specific situations, I like to use this bridge analogy. Stress means the bridge has pressure on it, strain means the bridge is shaking but holding and resiliency means the bridge is bending in response to the stress on it but can absorb this pressure without incurring damage.  When there is ambiguous loss, individual resiliency depends on the ability to live comfortably with the ambiguity. The individual’s ability to sustain this comfort relies not just on how well he/she tolerates ambiguity in the present but can sustain this into the future. Having to manage with a loved one being both present and absent…to live well without having absolute certainty about absence of presence. The ultimate resiliency comes from being able to bend and flex and stay healthy in such times and not being undone by the less-than-perfect absence or presence of people we care about.
17. You also write that the definition of resiliency has changed from more than coping or overcoming to thriving under adverse circumstances, maintaining one’s physical and emotional health and one’s spirit for living life with joy. This seems like a tall order for people who not only have to manage their emotional self but are also often subjected to family member’s anxiety, expectations, and passive-aggressive manifestations of what they should or should not do about their adoption situation. What does resiliency look like in the context?
Pauline Boss: It looks like “both and” thinking.  It’s the only way to navigate this. You say I both hope that this other person will change their mind but I am also strong enough to know that if she doesn’t, I am strong enough to know that I will be ok.  So you continually do self-talk, or, if you’re in your support group, you would support each other to do “both and” thinking.  Linear thinking won’t work here because there is just too much ambiguity. Linear thinking works when you have 2 + 2 = 4, but that just doesn’t apply here.
In general, we have been trained to be linear thinkers in this culture. You will find pockets of people in this country, such as Native Americans, who have no problem with this at all. In general, I’ve found that artists have little problem with this because they see the world more creatively and, of course, that’s why they are not mathematicians.  You say, this could be true, but this could also be true, so it’s more relativistic thinking. It’s the only way to get around these questions, to teach yourself and each other how to hold two opposing ideas in your mind at the same time.
18.  How do we get to the place where we are thriving under adverse circumstances?
Pauline Boss: You don’t want to just suffer and say I can handle the suffering…no. You want to go a step beyond that and say, I actually have a pretty good life. So resiliency means you are doing more than “white knuckling it,” that you are actually happy at times. You are happy and you have well-being, even given you’ve had trials and this glitch, this unresolved loss there all the time.
19.  How does “revising attachment” work for an adoptee and how would this be done in a non-therapeutic process, for someone who, for example, could not afford therapy?
Pauline Boss: I have found that people are getting a lot out of the book by using it in a kind of serious reading club setting, with an agenda, working their way chapter by chapter through the book. The book is written in a way so that one can follow it and discuss his/her reactions with others.
20.  So a supportive and compassionate community such as we have in PACER can be very healing?
Pauline Boss: Yes, immensely. And you can agree or disagree, chew on it, but the very fact that it’s out of the bag and on the table lends itself to finding meaning out of this ambiguity that probably won’t go away for most of you.
21. You write on page 165 (Loss, Trauma and Resilience: Therapeutic Work with Ambiguous Loss) that revising attachment means not needing to have closure with a lost person but also not denying the loss. Furthermore with ambiguous loss, there is no linear way of letting go.  The revision of attachment means shifting other relationships to take into account the ambiguity surrounding the loss.  Ultimately, resiliency depends on discovering when and how to modify and revise attachments to those who are physically or psychologically missing from their lives.  In adoption then, hoping that the baby you gave up or the mother who relinquished you will one day enter into relationship with you is something we struggle over but should not obsess over.
Pauline Boss: I would do the “both and” thinking first.  Because if you tell someone that they’ve got to stop thinking about their birth mother, they can’t do it that way. So instead you say, you keep thinking about your birthmother but at the same time, go out and go to a movie with your friends, go to a support group, work on this project…so it’s a “both and” situation. That way, the person tends to have the current part of their life outweigh the preoccupation with the lost object, the birthmother or child.
It says I don’t want you to give her up but I also want you to do this and think about her no more than 10 minutes a day and then 5 and then 1, so that the thought of the lost mother isn’t the most preoccupying or predominant thought in the person’s mind, which is dysfunctional when the preoccupation becomes more important than living life in the present.
22.  It’s very difficult for people to control what they think about though and there is an obsessive nature in this. When people first start to confront their adoption issues, thoughts about the adoption tend to dominate.  I’ve seen relationships end, addictions triggered—all sort of things come up.
Pauline Boss: Well, during that decision period of whether to search or not, it will be predominant. But later on, there needs to be a way to manage the stress over time. We actually can train how we think and that’s what cognitive psychology is all about.
You can use behavior modification on yourself. Put a rubber band on your wrist and if you start thinking about this too much, just snap it—that’s a very negative reinforcement and I don’t use that very often.  I like to think in terms of positive reinforcement, which is a better experience for most.  If you do this project without letting this sadness or unresolved loss sabotage you from the task at hand, then get yourself a small pleasant reward. Yes, we can play and we can re-train our minds. We know that from smoking cessation and AA programs which address addictions. Yes, cognitive psychology or happiness psychology which is out right now (Dr. Martin Seligman, Director University of Pennsylvania, Positive Psychology Center).  You can actually teach yourself to be more optimistic if you happen to be pessimistic. The trauma part is the more primitive part and that part may be with you forever but don’t let it predominate, let the frontal lobe predominate. The gurus from the East have practiced this for some time and yoga is a very positive practice that can be very helpful in managing stress.
23. I wanted to ask you about the modality of the inner child, the primal wound, and the nurturing of our inner child. How does that fit into your ambiguous loss modality?
Pauline Boss: Primal wound goes like this–if the people who should have nurtured you, your birthparents, aren’t in your life and hopefully your adoptive parents have nurtured you well, but there is still is this longing and this little hole, this little hole can contain an enormous pain. I liked this language in the past: it acknowledges that if you are wounded as a child, you have to become your own nurturer, you have to put your arms around yourself and hopefully find other people in your life who have nurtured you well and that does work. It’s second best but it works.
Since the MRI came out, we have learned a great deal about the brain, so the language is more cast in terms of neuro-psychology which says that a traumatic loss registers in a more primitive/primal part of the brain and it leaves a mark there. If it’s not dealt with, it can predominate. We prefer to have the frontal lobe predominate because it carries reason, judgment and with that part, can nurture the other part.  So this is different language for essentially the same thing. We do have to nurture ourselves and we do have the mechanism to do this. And, the good news is that the more we engage in this self-nurturing behavior, the more we manage stress that results from ambiguous loss. The more we do this, the stronger, more resilient, we become.