10 Questions to Ask When Searching for an Adoption Competent Therapist

Provided by adoption therapist, Leslie Pate Mackinnon, who recently appeared on Katie Couric’s show as the “American Philomena.”

Leslie Pate Mackinnon, L.C.S.W., has maintained a private psychotherapy practice for more than 38 years and she speaks internationally on issues that impact families conceived through adoption and third-party reproduction. She has been on Good Morning America with Robin Roberts, and on CNN discussing the impact of the internet on adoption.

She recently appeared on Katie as the “American Philomena,” and shared what it was like to be separated from her firstborn son. That son, Pete, whom she’s been reunited with for 14 years, appeared on the show too. During the talk, Katie asked him if he’d had a longing to reconnect with Leslie.

His response is one many adoptees might relate to: “Always. You always do. You tread lightly because you don’t want to upset your adoptive family, you don’t want to make them think you’re unhappy, but there’s just something there. . .”

We had the pleasure of meeting Leslie at a Donaldson Adoption Institute sponsored screening of Ann Fessler’s film A GIRL LIKE HER last year. Her personal story is included in the film, and in Fessler’s book The Girls Who Went Away. Leslie was drawn to social work, and in particular adoption work, after placing her two firstborn sons for adoption when she was a teenager.

Today, she works with all members of the adoption triad and educates therapists as well. “I get so many calls from folks all over the country looking for an ‘adoption competent’ therapist that I developed a questionnaire to use when interviewing potential therapists,” she said.

The following are Leslie’s ten suggested questions to ask a potential therapist:

1. What is your experience working with the triad? Are you familiar with the term?

2. Have you worked mainly with adopted children, or also with adult adoptees and birth parents?

3. Do you have experience working with international and trans-racial adoptees?

4. What are the top books you would recommend to learn more about the issues inherent to adoption? (Primal Wound, and 20 Things Adoptive Kids Wished Their Parents Knew are two)

5. Since little is mentioned about adoption or foster care in undergraduate programs, have you received post-graduate certification in an adoption clinical competency program?

6. Do you attend conferences related to adoption needs and concerns? (These are typically held by the American Adoption Congress, Child Welfare League of America, and North American Council on Adoptive Children)

7. What are your thoughts on open versus closed adoption? (Should favor open across the board with the exception of very contentious situations.)

8. What is your experience with clients reuniting with their birth families? (Favorable in supporting search & reunion?)

9. What is your thinking about minor children meeting their birth parents? (Should support; obviously with supervision of adoptive parents)

10. Do you know of any local support groups for adoptive parents, adoptees or birth parents?

For more information on Leslie’s work as a therapist and speaker, visit lesliepatemackinnon.com. For additional resources, see our list of Organizations Making a Difference.

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21 Responses to “10 Questions to Ask When Searching for an Adoption Competent Therapist”

  1. It is so sad that fathers were not honored or recognized back then as having an equal right to know, to decide to be involved. I made that mistake. I had a one night stand literally and did not have an emotional connection and denied the birth father because I was in love, or so I thought, and sexually active with another man. Once she was born I knew right away since she was white and looked just like him and the other boy I was with was black and very dark. It was too late, he had gotten married and I did not want to ruin his life as we were both Catholics. I pray you will find your son and please feel free to contact me for any assistance as I am a private investigator.

  2. […] of comments, a fascinating discussion and debate is taking place in the comments section of 10 Questions to Ask When Searching for an Adoption Competent Therapist. Leslie Pate Mackinnon (whom I originally spoke with for the piece) recently responded to a […]

  3. Sweet says:

    I feel like seven, eight, and nine are completely subjective, especially number nine! You have no idea about the circumstances that created the need for adoption and looking for a therapist who routinely is in favor of allowing minor children to be exposed to birth parents doesn’t make them a good choice for therapist. Even with adult supervision, you don’t know what a birth parent might say that will forever scar those minor children, things you can’t take back or have precious little ears “un-hear.” I know whereof I speak. These might be good questions to ask your potential adoption-aware therapist, but this article does have such a clear bias about what the “right answer” is. I strongly relate to the commenter above, Janice, who said, “It is not helpful to most clients if a therapist states a definitive opinion- sort of closes the door for further conversation sometimes.” Your opinions here are actually so set that it makes people who’ve had negative reunion experiences or who were counseled against it feel like they made the wrong choice. Every case is different and finding a therapist who is open to the CLIENT’S needs and opinions is what matters most.

    • I certainly understand your concern. Perhaps, I did not provide enough information when clearly sharing a bias that connection is good for adoptees. Being introduced to the idea of “opening the adoption of minors” some 20 years ago, I was terrified and extremely skeptical. I trained with Dr. Joyce Pavao, a well known adoptee who holds two graduate degrees from Harvard. When she said opening the adoption of an ‘acting out adolescent’ helped to calm things down, not only was I in disbelief, I was terrified it would contribute to increased chaos.

      Children (especially girls) begin to question the circumstances of their adoption during latency. Helping them make connections in those early years helps provide answers and supplies the information needed to master ‘identity formation,’ which is the task of adolescence. It is nigh to impossible to formulate one’s identity, w/o having all the pieces to the puzzle.

      Experience and training have given me confidence to recommend helping a child make connections whenever possible. This is the recommended standard of care for those of us who work within adoption today. Currently I train therapists and social workers across the U.S. on how to make connections with birth relatives, even those who’ve had their children removed. Clearly the recommendation is made only when the biological relatives are willing to work in tandem with the adoptive family. And the degree of connection varies greatly. It may only be letters, or it may grow into more. The surprise for me has been that it’s possible to make some type of connection in most (though certainly not all) cases. Sometimes the connection is with a stable biological grand parent, who can provide family history.

      The internet has changed adoption more than any other entity. In working with numerous families whose pre-teens have found birth relatives on Facebook, I recommend adoptive parents get ahead of the curve and help their kids get the answers they seek with supervision, versus getting into situations completely over their heads. I hope sharing more detail is useful. Without a doubt, no “one size” fits all, but we know today that connection is far more healthy than amputation of one’s personal story and familial history.

    • Yes true I was horrified after my step daughter who stayed out of our lives due to her lifestyle and maybe fear we would get her other children then came back into our open arms only to shatter our adopted daughter by telling her at her precious age of 11 that I stole her and that she wanted her back and tried everything when those were lies. She never did anything to even bond with her, hardly came to see her when we lived a mile away and she was always welcome, and then to do that! Our daughter went to the filing cabinet and got the adoption paperwork out and brought it to her bookcase because I guess she felt she had a right to it and I found it there accidentally and she said she just wanted to know, almost if she wondered if she was not adopted at all but stolen.

  4. Von says:

    As an adoptee for nearly 70 years, around 20 of those in or after reunion (both sides) and with experience in receiving psychotherapy, counseling and with training and experience in family therapy and counseling and a continuing interest in the live issues post retirement, I feel able to comment on what makes a qualified counselor and what to look for in attempting to find one. They are few and far between in my country, Australia, and also I understand in America and the UK.
    I am immediately alerted by the use of the words ‘adoption triad.’ When we understand the nature of the disempowerment in adoption it is not possible to use this term, because it indicates clearly that the user does not recognize that adoptees have no power in adoption. We were without choice and therefore unequal, so that a ‘triad’ which implies equality of position, is not appropriate or accurate. It may be convenient, but it suggests a fundamental disconnect from the real issues of adoption – disempowerment, loss, trauma, grief, ambiguous loss, identity. In seeking counseling or appropriate support, these will be the areas in which a practitioner will need expertise. It is important for a practitioner to have had appropriate training and experience, to have read the ‘right’ books, such as Pauline’ Boss’s on ambiguous loss, to have had experienced mentoring and to have experience and an open mind. Experience with transnational or other adoptions may not be necessary for some adoptees – some of us were adopted within our own communities! It is important that a practitioner recognizes all aspects of open and closed adoptions -not just the ‘good’ but the difficulties and the downsides also. I find your list very prescriptive – a useful practitioner assists the client/person to discover for themselves what their important issues are and what they will do about them and how they will resolve what is important to them.

    • Von,

      I respect your opinion and always look forward to your posts across the adoption information that I read on line. I love Pauline Boss and have done some training with her. I like to recommend books about loss and grief that are not within the realm of adoption per se. Another good one is Truth Heals; What You Hide Can Hurt You by Dr. Deborah King.

      I agree that the use of “triad” is a total misnomer. It is anything BUT balanced and equal. I use it in the same way ‘birthmother’ is still used on the internet because it is so generally recognized as a buzz word when people are searching for information. Training therapists in the U.S., I can tell you we are so woefully behind, that most have not even heard the word triad and will pronounce it ‘tree-ad.’ Many therapists tell consumers they work with adoption all the time. What that means is that they’ve had a goodly percentage of clients over the years somehow related to adoption. That does not mean they have a clue about the issues/concerns that might need to be addressed. So using ‘triad’ is a quick way to weed out therapists who have no clue about this field at all.

      Language is powerful and my hope is that we can change the terminology that has institutionalized adoption. We still have so much to do. I appreciate your input and the candid and concise points you make.


      • Leslie and Von,

        Thank you both very much for taking the time to share your insightful perspectives on adoption terminology and what it means to find an adoption competent therapist. Leslie, you wrote: “Many therapists tell consumers they work with adoption all the time. What that means is that they’ve had a goodly percentage of clients over the years somehow related to adoption. That does not mean they have a clue about the issues/concerns that might need to be addressed.” Unfortunately, I know many adoptees who have had this experience, which makes me all the more appreciative for this candid discussion, and the opportunity to offer adoptees insight into what to look for in a therapist. Many thanks.

      • Von says:

        Thanks Leslie. It’s always a work in progress! I do find it extraordinary that America, long recognised as ‘the founding home’ of therapies of various kinds, therapists and skilled people who have shown the way, and the home of so many adoptees, has not been able to develop some world-shaking therapeutic techniques to help us all in our journey. Perhaps, as with many areas of harm, loss, stigma and trauma we will need to develop them ourselves to meet our very special needs. We do indeed still have so much to do and it would be wonderful to see a world-wide alliance of therapists and those committed to the therapy and therapeutic techniques we need to nurture, develop and use.

  5. […] addition, a few therapists weighed in on 10 Questions to Ask When Searching for an Adoption Competent Therapist with opinions regarding open adoption.  The questions were provided by adoption therapist, Leslie […]

  6. Kendra says:

    I think that all of you make valid points. In my humble opinion, the therapist needs to have a basic understanding of adoption and how it is mired in grief and loss. I am an adoptee and a therapist. I work with families when their children are having an acute mental health crisis. So often the presenting crisis doesn’t glaringly identify the underlying adoption issue.

    It is heartwarming to read some of the previous posts from adoption professionals. I am glad that you are out there.

    • Von says:

      As is so often the way, but it is always a valid and early question worth asking – what was your birth like?

  7. Janice Baer says:

    I am a therapist who is an adoptee, adoptive parent and works with all members of the adoption triad professionally. While I think this list is helpful to parents my comment is in reference to your words in parentheses- I do believe you are trying to be informative but I have found it helpful and most often the case that every situation requires individual judgement and the opinions of the therapist is not important as long as they meet the client where they are at and help them sort out their situation. It is not helpful to most clients if a therapist states a definitive opinion- sort of closes the door for further conversation sometimes.Like with the opinion of open vs closed adoption- In theory I am for it when it is under ideal circumstances but that can often not be the case. I think being open to any circumstance is the most helpful to clients not giving out a definitive opinion.

    • Janice,

      You raise a good point. It is not a therapists’ place to tell someone “definitely” what they should do. However, when it comes to open adoption, I myself have done a 180 in the past twenty years. In the past I would have said open, if feasible. However, I now make a disclaimer and tell clients, there is one thing you will find that I am biased about and that is openness in adoption. I remind them that they are welcome to throw my recommendation out with the bath water BUT if they are contracting an adoption in the best interests of the child, they’ll want to figure out how they can have an open adoption while maintaining safety. I have clients who take their daughter to visit her first mom in prison twice a year. Totally safe! I have clients who maintain openness with the bio grandparents. I have clients who might have a rare visit at the agency or at a McDonalds.
      A child needs their story, in as much living color as possible, the good the bad and the ugly. In the best cases, the child actually feels love emanating, is not merely told ‘she loved you so much she gave you up.’ The statement that adult adoptees often loathe. In the worst cases, the child can see for themselves why adoption was necessary and may be lucky enough to recognize at least a few good attributes of the person whose DNA they carry.
      I talk all over the country on the topic of how the internet has changed the face of adoption. I’ve had clients as young as 11 find their first parents. I’ve had a father who found the 14 y.o he’d placed. I “do not” think FB reunions are the way to go, and in my opinion it is wise of adoptive parents to get out in front of that possibility by answering their child’s curiosity while they are still in their care. I hate seeing all the young adults who come to my Search & Support group who are too afraid to let their parents know they are searching. If they have a ‘good reunion” they keep it from their folks and if they have a ‘bad reunion’ they have to deal with it alone.
      So I’m sorry to be so long winded but after 40+ years of doing therapy, every now and then I find not every situation adheres to what I was taught in school. And for me, openness in adoption is one of those. You raised an excellent point which I think holds true, in most situations between client and therapist. However I couldn’t hide my bias if I tried, and I’m comfortable that it’s based on years of sound adoption practice.


  8. […] addition, an adoption counselor from Phoenix had this to say about our 10 Questions to Ask When Searching for an Adoption Competent Therapist piece. The questions were provided by adoption therapist, Leslie Pate Mackinnon, who recently […]

  9. Beth Kozan says:

    I am an adoption counselor in Phoenix, AZ. I hope your list of questions will be widely circulated, as well as the information that there are specialists who work with adoption. Oftentimes I’ve had people come to me who were told by counselors who don’t know adoption issues that ‘they should be over this by now.’ Adoption is a lifelong event, not an event that is short time focused.

    • Beth, thank you for making that excellent point. Leslie mentioned that research shows it typically takes someone 10-11 tries before they find someone capable. Hopefully her list can help shorten that considerably.

  10. grant says:

    I am just starting the process of finding my son, born Jan 4 1969 in Toronto Ont.to a US citizen. The child was adopted via the Catholic Childrens aid and in so doing was sent back to the USA. I was not listed as the father, however there is now more than a reasonable series of evidences as to the true paternity. Why the family did not list me, I do not know and can only speculate.

    • Grant, thanks for taking the time to comment. When you say you were not listed as the father, is that in the adoption paperwork or on the original birth certificate? Unfortunately, I think it was very common at that time not to list the father. Both Heather and I do not have our birth fathers listed on our OBCs. Best of luck with your search for your son. Our fingers are crossed.

    • Grant,

      I gave every detail about Pete’s father. In those days, they did not put the father’s information on the birth certificate unless you were married. It was a punitive era when women who were not “legitimized” by marriage, were treated very unkindly. I was not allowed to be in the labor room with the other women in labor because I was unmarried. I had to labor in the hallway with everyone passing by.

      Good luck in your search!


  11. The Girls Who Went Away is on my to-read list.
    These are great questions to consider.