The Language of Clients Who Are Adopted

People who have been adopted face higher risks of mental health issues and substance use disorders (Keyes et al., 2008; Yoon et al., 2012;). Because this population is likely to require counseling services, Counselors should be prepared to treat people who were adopted. However, little research has been done specifically for this population and its treatment.

Sara W. Bailey, PhD, NCC, LCMHC, is a researcher on the topic of counseling  individuals who were adopted. As an adopted person herself, she brings lived experience to her clinical work and has important guidance to help Counselors prepare for treating clients who have been adopted.

“We don’t have good data, but we think persons who were adopted represent about 2% to 3% of the population of the U.S., and adoption crosses all other identity factors,” says Dr. Bailey. “So Counselors are working with clients who were adopted, whether they know it or not. And people who were adopted are more likely to show up in mental health treatment and substance use disorder treatment. There are many reasons for that. So, Counselors need to be at a minimum receptive and seek greater awareness.” 

A fundamental step in serving any population is to clarify the language around it—what is appropriate and clear, and what is offensive or misleading? The language surrounding adoption requires careful attention.

“The most important thing to remember in any population of individuals, and all the Counselors know this, is that language is never static," says Dr. Bailey. “Language will morph and change as a client grows and changes and as a Counselor gets to know their client better. I find myself shifting in my own language. So that’s something for Counselors to recognize, that if they notice their clients changing the language, that’s . . . probably part of the process for that adopted person.”

The language around adoption is complex, and each individual has their own preferences. A thoughtful approach and certain principles can guide a practitioner to safe and effective terminology. Communication is key.

“Certainly person-first language is always a good approach,” says Dr. Bailey. “Broaching language is really important as well, because unlike other populations, the adopted population doesn’t have a lot of research backing or sort of sociocultural awareness behind it. So, you’ll have adopted clients come in who don’t even know the language that they prefer because they’ve never spoken about their adoption before.” It is important to allow the client to guide you in the language that feels right for them. Exploring the nuances around language can be a helpful part of the therapeutic process.

Some words and phrases may be offensive and should be avoided. This includes certain words that are commonly or traditionally used to describe the circumstances surrounding adoptions.

“Illegitimate is a word that a lot of people use for children born out of wedlock,” says Dr. Bailey. “Obviously, don’t use that word. It’s pejorative. It’s not helpful. But this is where language gets tricky. Some of the more active and ardent adopted folks out there actually sometimes use the word ‘bastard’ to reclaim it to define themselves. As a counselor, I would never use that term. If a client used it, however, I might inquire about it.”

Other common phrases like “given up” or “given away” for adoption may also be offensive. Dr. Bailey cautions: “The client may bring those in, and that’s fine, but I would never use those [without them doing so first].”

Similarly, Dr. Bailey advises Counselors to avoid terms like “natural parents” or “real parents.”

“You think about what the opposites of those words are: natural—unnatural. Real—fake, false, pretend,” explains Dr. Bailey.

Dr. Bailey also cautions against common positive phrases and aphorisms, which may be inaccurate, condescending, or even harmful. A strengths-based approach when talking about adoption should reflect the individual’s experience and not rely on clichés.

“Be careful of terms or phrases that may seem positive and uplifting,” says Dr. Bailey. “Things like ‘you were chosen’—That’s actually rarely true for people who were adopted. There’s not like this baby buffet that interested adoptive parents can peruse to pick their kid. That’s not how it works. And it’s not helpful either, because being chosen indicates a specialness that is not necessarily true. Every one of us is special. We all can agree on that. Being adopted is no more special than being born into and being kept by a biological family.”

Particularly problematic is the common tendency to attribute motivation to a person’s biological parents. It’s a common refrain, in Dr. Bailey’s experience, that “your parents chose adoption because they loved you so much.”

“It can create this dissonance,” explains Dr. Bailey. “The thought of ‘I was loved so much that I was relinquished, or I was let go, or I was placed for adoption.’ Well, what does that say about love? That links love and abandonment.”

Appropriate language varies between clients. Each individual has their own preferences, and those preferences can change over time.

“The term that I use to describe the experience of my biological mother making the decision for me to be adopted, the way I conceptualize that, is ‘relinquished,’” says Dr. Bailey. “But for some people who have been adopted, that, and even as I say it out loud, I can see how it could feel like rejection.”

Fundamentally, finding the right words comes from communication and sincerity.

“The language we use in counseling is indicative of the relationship we have with our clients, and coming from a humble, curious, empathetic place and asking our clients what language they would like to use,” says Dr. Bailey. “I think that would be my most central advice and guidance to Counselors serving people who were adopted.”

Another area for attention is the many misconceptions surrounding adoption that permeate our culture and appear in the media.

“Other misconceptions have to do with the motivations behind adopting on the part of adoptive families and parents,” says Dr. Bailey. “A lot of times, adoptive parents are described as selfless and courageous and brave. As if taking in someone else’s child as their own is this act of courage, and underpinning that are some of the other misconceptions around adoptees, such as ‘You don’t know what you’re getting.’”

This often unspoken message has a long history in the popular perception of adoption, explains Dr. Bailey.

“Historically, we know that children born to unwed parents, or children who were abandoned, or children who were orphaned—there’s this underlying fear of them throughout millennia,” she says. “The notion that if a child was abandoned, it was likely that their parents were somehow dysfunctional, were dangerous or criminal, and that that criminality or danger would then be transmitted down into the child.”

In contemporary times, this fear is propagated by the media in films such as The Bad Seed (1956), The Omen (1976), and The Orphan (2009). All three films are concerned with an adopted child who is discovered to be dangerous or evil.

“I’m going to invite the readers to take some time and notice how frequently in television series and movies . . . the perpetrator of crimes is adopted,” says Dr. Bailey. “And this is something we don’t talk a lot about. But as an adopted person, I notice this. I can’t unsee it.”

Many popular ideas around adoption highlight positive aspects of adoption. However, some positive misconceptions or stereotypes also have the potential for harm, especially in combination with the overtly negative messages. One example is that common aphorism that adopted people are “special” or “chosen.” Taken together, these common ideas deliver mixed messages to adoptees, which may contribute to a conflicted self-image.

“We hold up adoption as this beautiful family-building tool. At the same time, we also hold up adoptees as unpredictable and dangerous. And so, the misconceptions are on both sides, which puts the adopted person kind of in the middle of ‘Who am I? How does society view me?’ Because it depends on who’s viewing you and the motivations.”

Research is lacking on the effects of the popular perception of adoption and its portrayal in media, says Dr. Bailey: “But what we do know—even if that research doesn’t exist—what we do know is that the repetitive effect of negative perceptions of any group of individuals has an impact, especially when it’s not countered or when it’s not addressed.”

Such concerns around language and conceptions of adoption may present a challenge for Counselors who lack specific training for this population. However, the answer to this challenge lies in common counseling principles. Counselors should listen to their clients, educate themselves, and seek supervision to better serve their adopted clients.

“Language continues to be complicated,” says Dr. Bailey. “It needs to be complicated. And as a Counselor, I need to do my due diligence to learn what my clients need from me and to continually reassess and check myself and give my client permission to correct me when I get it wrong. In anything we do in counseling, we need to be open to feedback from our clients and especially if we’re working with someone who is adopted, whether we were adopted or not, we need to create space for that, and frequent check-ins on language I think can be really important.”

For additional reading around this topic, review Dr. Bailey’s article “Adoption Is History: Enhancing Counselor Awareness of Adoption as a Legal and Sociocultural Practice” (2024).

Next month, Dr. Bailey shares more advice for working with adopted clients, including resources, intake practices, and more.

Sara W. Bailey, PhD, NCC, LCMHC, (she/her) is a counselor educator, researcher, collaborator, and counselor with a clinical and research emphasis on issues of adoption, addiction, aging, and andragogy. She believes in and practices defying stereotypes and engaging in radical reflection in community with others. She is an Associate Professor and the Counselor Education Program Director at the University of Lynchburg and a counselor at Full Life Counseling and Recovery, PLLC. As an educator, Dr. Bailey seeks to demystify content knowledge and present novel material with humor, humility, and ample opportunity for engagement.

References

Bailey, S. W. (2024). Adoption is history: Enhancing counselor awareness of adoption as a legal and sociocultural practice. The Family Journal, 33(2), 195–201. https://doi.org/10.1177/10664807241292054

Keyes, M. A., Sharma, A., Elkins, I. J., Iacono, W. G., & McGue, M. (2008). The mental health of U.S. adolescents adopted in infancy. Archives of Pediatrics & Adolescent Medicine, 162(5), 419–425. https://doi.org/10.1001/archpedi.162.5.419

Yoon, G., Westermeyer, J., Warwick, M., & Kuskowski, M. A. (2012). Substance use disorders and adoption: Findings from a national sample. PLOS ONE, 7(11), Article e49655. https://doi.org/10.1371/journal.pone.0049655