Overview

Before you ask a single question, your intake form has already told the client something.

Most forms assume one family. "Father's age, mother's age, sibling ages" presumes a single set of biological parents. An adoptee filling that out has a choice your form didn't name, and they resolve it silently: the adoptive family, because that's what the form seems to want; the biological family, if they know it; notes in the margin; or blanks. Whatever they choose, they've already learned something about whether this practice has thought about people like them.

Medical history carries its own weight. Family history of heart disease, cancer, diabetes, mental illness. For many adoptees the honest answer is "unknown," and they have written it on every form of their lives. It accumulates. A clinician who names it directly, something like "I know these forms can be hard for adoptees who don't have biological family medical information, and I'm glad to work with whatever you have access to," changes that experience in about eight seconds.

Forms with room for both adoptive and biological family, or that let a client describe their family in their own terms, make both available for the work that follows. Some adoptees find a first-session family tree genuinely useful, one that holds the whole picture. A participant in the research that grounds this course described it plainly: having a family tree filled out in the first session helps, because she doesn't discriminate, the same person can be her aunt and also her aunt.

The first session

You don't have to ask about adoption directly to make it available. Open questions do the work: "Tell me about the people who have been important to you, growing up and now." Or "Are there parts of your background you think might be relevant to our work that we haven't covered?" Both leave the client room to name whoever they want, including biological family they may or may not know, without pressing them through the door.

When adoption appears on the intake form, name it briefly without making it the focus. Something like: "I see on your intake that you were adopted. I wanted to mention that I noticed, and that adoption is a topic we can talk about whenever it feels relevant to you, including today or never." That acknowledges what they gave you, signals that you recognize adoption as possible clinical material, and leaves them in control of when and whether.

Questions that imply their own answer close the material down at the start. "Did you have a good adoption experience?" assumes a verdict. "Have you ever wondered about your biological family?" presumes a curiosity not every adoptee has. "How has adoption affected you?" treats adoption as the relevant factor before the client has said it is.

The range of how clients present

Adoptee clients vary widely. Some come in wanting to work on adoption directly, and they've often done some recognition work already, through community, earlier therapy, or a period of active reorganization. Asking what they've already worked on and what they want this therapy to add is a useful early move.

Others minimize adoption from the start. That can mean several different things: they absorbed the cultural narrative that it isn't significant, they're in the fog, they've decided adoption isn't relevant to what they came in for (a legitimate decision you should respect), or they're testing whether you'll leave it alone. Acknowledge briefly that adoption is available, then work on what they came for. If it surfaces later, recognize it without making the moment feel like your hunch was right.

Most fall in between: adoption as background but not central, surfacing only when something specific brings it up, engaged differently at different points in the same therapy. How a client engages over time is itself information. What you avoid, in every one of these presentations, is importing an interpretation the client doesn't hold. Clients who minimize adoption aren't necessarily in denial, and clients who center it aren't necessarily over-identifying.

Keep — one-page takeaway

Intake is where the client learns what kind of work this will be. The aim is to make adoption available as ongoing material without pressing for it.

The form

• Give room for both adoptive and biological family, or let the client describe their family in their own terms. Standard "mother's age / father's age / sibling ages" presumes one set of biological parents.
• Add a line by the medical history: "If you don't have access to biological family medical history, that's fine, put what you have." Adoptees have written "unknown" on these forms their whole lives.
• Consider offering a first-session family tree that holds the whole picture, biological and adoptive, without ranking them.

The question set

• "Tell me about the people who have been important to you, growing up and now."
• "Tell me about the people in your life, and how you came to be in family with them."
• "Are there parts of your background you think might be relevant to our work that we haven't covered?"
• "What is your adoption like for you right now?" (if and when adoption is in the room)
• If it's on the form: "I see you were adopted. I wanted to mention that I noticed, and that it's something we can talk about whenever it feels relevant to you, including today or never."

Questions to drop

• "Did you have a good adoption experience?" assumes a verdict.
• "Have you ever wondered about your biological family?" presumes a curiosity not everyone has.
• "How has adoption affected you?" makes adoption the relevant factor before the client has.

Reading the presentation

• Centers adoption: often has done recognition work already. Ask what they've worked on and what they want this therapy to add.
• Minimizes adoption: could be the cultural narrative, the fog, a legitimate decision that it isn't relevant, or a test of whether you'll leave it alone. Acknowledge it's available, then work on what they came for.
• Don't import an interpretation the client doesn't hold. Minimizing isn't necessarily denial; centering isn't necessarily over-identification.

Continued considerations

• Pull up your own intake form. What does it assume, and what would an adoptee have to do to answer it honestly?
• If a client never raises adoption, how would you know whether that's their choice or your silence?
• Sit with this: what's the difference between making a topic available and pressing for it, in the actual words you'd use?

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