Foster care and adoption involve unique emotional journeys that can profoundly impact children, birth families, and adoptive or foster families. Children in foster care are at high risk for immediate and long-term psychosocial-educational problems. Professional counseling and therapeutic support play a crucial role in helping all parties navigate the complex emotions, trauma, and transitions inherent in these experiences. This page explores various counseling approaches, therapeutic interventions, and support services available to those touched by foster care and adoption.
The journey through foster care and adoption often brings challenges related to attachment, identity, trauma recovery, and family dynamics. In 2024, the number of adoptions dropped from 5,693 domestic and 628 intercountry adoptions in 2010–2011 to 3,580 domestic and 449 intercountry in 2023–2024. In the US, the number of looked-after children who were adopted during the year went down from 3,000 in 2010 to lower numbers in recent years. Understanding these challenges and accessing appropriate therapeutic support can make a significant difference in outcomes for children and families. Mental health professionals trained in adoption and foster care issues can provide specialized interventions that address the unique needs of this population.
Table of Contents
- Understanding Mental Health Needs in Foster Care and Adoption
- Therapy for Foster Care and Adoption Issues
- Adoptive and Foster Family Therapy
- Trauma Therapy for Adopted and Foster Children
- Play Therapy for Adopted and Foster Children
- Attachment-Based Interventions
- Adoption Support Groups
- Case Example: Therapy for Adoption and Foster Care Issues
- Frequently Asked Questions
- How Therapy Can Help / Find a Therapist
Understanding Mental Health Needs in Foster Care and Adoption
Children who have experienced foster care or adoption often face higher rates of mental health challenges compared to their peers. Children entering foster care are at high risk of poor mental health. This further confirms the need for treating children with previous adversities differently than control groups. These challenges may stem from early adverse experiences, including:
- Trauma and neglect: Many children enter care due to abuse, neglect, or family crisis
- Attachment disruptions: Frequent placement changes can impact a child's ability to form secure relationships
- Identity issues: Questions about birth family, cultural heritage, and personal history
- Grief and loss: Separation from birth families, siblings, and familiar environments
- Behavioral challenges: Adopted children may exhibit behavioral issues ranging from oppositional behavior to emotional outbursts. Common problems include attention deficits, tantrums, and difficulty adapting to change. Emotional distress symptoms such as anxiety, depression, and mood swings often appear, rooted in past experiences of loss or instability.
Recent statistics highlight the scope of mental health needs: The AFCARS report presents adoption and foster care data each fiscal year. The newest report covers data from fiscal year 2024 (October 1, 2023 - September 30, 2024). In general, fiscal year 2024 reflects the continued downward trends seen since 2019 across several key areas, including the number of children entering foster care, exiting foster care, awaiting adoption, and being adopted. The Adoption and Foster Care Analysis and Reporting System (AFCARS) estimates there are 328,947 children in the child welfare system in their most recent report on fiscal year 2024. Children can exit foster care for various reasons, including family reunification, adoption, guardianships, or aging out of the system. According to AFCARS, 45% of exits in 2024 were due to reunification, 27% were due to adoption, and 11% were due to guardianship. In 2024 adoption data, adoption accounted for 27% of foster care exits, translating to 46,935 adoptions.
Therapy for Foster Care and Adoption Issues
Therapy can address a wide range of concerns related to adoption and foster care. Evidence-based approaches have shown significant effectiveness in helping individuals and families navigate these challenges. Key areas where therapy provides support include:
Exploring Identity and Belonging
Adopted individuals and those with foster care experience often grapple with questions of identity. Therapy provides a safe space to explore:
- Birth family curiosity and search decisions
- Cultural and racial identity, especially in transracial adoptions
- Feelings of belonging and connection
- Integration of adoption story into personal narrative
Processing Trauma and Loss
TF-CBT is an effective treatment for pediatric PTSS as well as for depressive, anxiety, and grief symptoms. It is superior to control conditions, supporting international guidelines recommending it as a first-line treatment. Therapeutic interventions specifically designed for trauma include:
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment
- EMDR (Eye Movement Desensitization and Reprocessing): Helps process traumatic memories
- Narrative therapy: Assists in rewriting personal stories in empowering ways
Addressing Behavioral and Emotional Challenges
Many adopted and foster children display behavioral difficulties that may be rooted in early experiences. Therapy helps by:
- Teaching emotional regulation skills
- Developing healthy coping strategies
- Addressing underlying anxiety and depression
- Building self-esteem and resilience
Adoptive and Foster Family Therapy
Family therapy is often essential for adoptive and foster families, as it addresses the family system as a whole. Trauma-focused cognitive behavioral therapy (TF-CBT) effectively addresses trauma-related symptoms and improves overall well-being. This study aimed to investigate long-term changes in trauma-related symptoms among children and youths who underwent TF-CBT due to family violence. Research shows that involving the entire family in treatment leads to better outcomes.
Key Components of Family Therapy
Building Attachment and Trust
Findings indicate that young children's attachment systems are capable of reorganizing and flexibly adapting to new caregivers after earlier relationships are disrupted. Specifically, most children who are placed in adoptive or foster homes appear to consolidate attachments to their new caregivers within a few months. Moreover, these children show substantial recovery in attachment quality, as the prevalence of attachment security is considerably higher among adopted children than among children in maltreating homes or institutional settings. Family therapy focuses on:
- Creating safe, predictable environments
- Developing consistent, nurturing responses to children's needs
- Understanding attachment behaviors and their meanings
- Strengthening parent-child bonds through structured activities
Communication Enhancement Effective communication is crucial for adoptive and foster families. Therapy helps families:
- Discuss adoption or foster care openly and age-appropriately
- Navigate difficult conversations about birth families
- Express emotions safely and constructively
- Develop family narratives that honor all parts of a child's story
Managing Transitions and Changes Foster families especially face frequent transitions. Family therapy provides support for:
- Preparing for new placements
- Processing feelings about reunification or adoption
- Managing relationships with birth families
- Coping with placement disruptions
Trauma Therapy for Adopted and Foster Children
Many children in foster care and adoption have experienced significant trauma. Over the past few decades, numerous Randomized Controlled Trials (RCTs) have demonstrated the effectiveness of TF-CBT, with a recent meta-analysis reporting a large effect size (Hedges' g = 1.14, 95% CI: 0.97–1.30) indicating a large reduction in posttraumatic stress symptoms (PTSS) compared to control conditions. The success of TF-CBT has led to its widespread dissemination and implementation across the US, Europe, and Africa. Despite strong evidence for its efficacy, dropout and persistent PTSD symptoms continue to affect a substantial group of severely traumatized children. Specialized trauma-informed approaches are essential for healing.
Evidence-Based Trauma Interventions
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Therapies like trauma-focused cognitive behavioral therapy (TF-CBT) are designed to reduce anxiety and improve emotional regulation. They teach children techniques such as deep breathing, mindfulness, and relaxation exercises. TF-CBT has shown remarkable effectiveness for children who have experienced trauma. Key components include:
- Psychoeducation about trauma responses
- Relaxation and stress management skills
- Emotional expression and modulation
- Cognitive processing of trauma
- Creating a trauma narrative
- Enhancing safety and future development
Complex Trauma Treatment Children with histories of chronic trauma may need specialized approaches addressing:
- Developmental trauma impacts
- Disrupted attachment patterns
- Emotional dysregulation
- Dissociative symptoms
- Interpersonal difficulties
Cultural Considerations in Trauma Treatment
Trauma therapy must be culturally responsive, particularly for:
- International adoptees adjusting to new cultural contexts
- Transracial adoptees navigating identity issues
- Children from diverse ethnic and cultural backgrounds
- Families integrating multiple cultural perspectives
Play Therapy for Adopted and Foster Children
Play therapy offers a developmentally appropriate approach for younger children who may struggle to verbalize their experiences and emotions. Effective treatment of foster youth must prioritize the basic need for children to experience continuity, stability, and permanency in attachment to a healthy adult(s). Short-term, symptom-focused interventions are inappropriate for this population of ethnically diverse, socioeconomically disadvantaged, underserved, multiply traumatized youths with complex psychiatric comorbidity. We describe a long-term, psychoanalytically oriented, relational play therapy intervention for foster youth and present initial empirical results describing the impact of this approach.
Benefits of Play Therapy
Natural Expression Through Play
Childhood play assumes a myriad of forms, each offering a unique canvas for growth. Physical play builds motor skills and body awareness, while imaginative play nurtures expression, creativity, and conflict resolution. Social interactions within a play therapy environment foster cooperation, empathy, and social understanding. Cognitive development is stimulated through problem solving; emotional development is nurtured through expression of emotions. Play therapy allows children to:
- Express complex emotions through symbolic play
- Process traumatic experiences at their own pace
- Develop emotional vocabulary through guided play
- Build trust with therapists in a non-threatening environment
Types of Play Therapy Approaches
Several types of play therapy are actively employed by child therapists to address disorders in children. However, the most appropriate approach varies based on the child's emotional needs. Factors to consider include whether the therapy should be non-directive or cognitive-behavioral, conducted in a group setting or one-on-one, and the level of structure needed. Non-directive play therapy, one of the first structured approaches to play, grants the child freedom to explore toys, art, and their imagination. Various approaches have shown effectiveness:
- Child-Centered Play Therapy: Non-directive approach allowing children to lead
- Directive Play Therapy: Therapist-guided activities targeting specific issues
- Theraplay: Structured play focusing on attachment and relationship building
- Sand Tray Therapy: Using miniatures and sand for expression and processing
Research on Play Therapy Effectiveness
Recent studies demonstrate positive outcomes: Finally, the studies reviewed demonstrated effectiveness of play in different timeframes. One-time play sessions are commonly used to reduce situational emotional symptoms. Systematic play sessions contribute both to the negative symptoms reduction and emotional development. Prolonged non-therapeutic play exposure leads to an effect after only 6 weekly sessions.
Attachment-Based Interventions
Attachment difficulties are common among children who have experienced early relationship disruptions. Practitioners and researchers have made attachment-based interventions integral to therapeutic approaches for supporting foster and adoptive families. Rooted in attachment theory, these interventions aim to help parents increase their responsiveness, emotional availability, and sensitivity, thereby fostering secure attachments between caregivers and children. Several evidence-based programs, including Attachment and Biobehavioral Catch-up (ABC), Video-Feedback Intervention to Promote Positive Parenting (VIPP), and Parent-Child Interaction Therapy (PCIT), have yielded promising results in improving parenting behaviors, child development, and overall psychosocial adjustment. These interventions differ not only in content but also in delivery models. Some experts deliver them in the home, emphasizing naturalistic caregiver–child interactions and on-the-spot parenting practice (e.g., ABC, VIPP). Evidence-based attachment interventions help rebuild secure relationships.
Key Attachment-Based Approaches
Attachment and Biobehavioral Catch-up (ABC)
Developed in the United States, the Circle of Security Parenting® (COS-P) program is a promising attachment-based intervention designed to enhance caregiver sensitivity, parental reflective functioning, and the quality of the child's attachment to their caregiver. This manualized intervention, with both educational and therapeutic components, empowers caregivers to better understand and respond to their child's needs, fostering secure attachment. This intervention focuses on:
- Increasing parental nurturance during distress
- Following the child's lead during play
- Reducing frightening behaviors
- Building synchrony in parent-child interactions
Dyadic Developmental Psychotherapy (DDP)
Dyadic Developmental Psychotherapy (DDP) is designed to help children with attachment issues, particularly those who have experienced trauma or disruptions in early relationships. The goal of DDP is to improve emotional regulation and foster strong, healthy attachments. Through guided interactions, this therapy aims to rebuild the child's sense of safety and connection. DDP emphasizes:
- Playfulness, acceptance, curiosity, and empathy (PACE)
- Co-regulation of emotions
- Repairing relationship ruptures
- Creating coherent narratives
Parent-Child Interaction Therapy (PCIT)
Pilot data demonstrating the effectiveness of PCIT with adopted children is provided. This paper reviews the tenets of an attachment-based approach to treatment and describes how one evidence-based treatment, Parent–Child Interaction Therapy (PCIT), conforms to all expectations and requirements prescribed by attachment theory and research. A recent meta-analysis of PCIT clinical trials demonstrated the effectiveness of PCIT for reducing externalizing behavioral problems and parenting stress. In addition, research demonstrates success using PCIT with physically abusive parents, depressed mothers and foster children, suggesting the potential benefit of PCIT for children experiencing disrupted or sub-standard parent–child relationships. PCIT helps adoptive and foster families by:
- Teaching positive parenting skills
- Improving parent-child communication
- Reducing challenging behaviors
- Strengthening the attachment relationship
Addressing Reactive Attachment Disorder
Reactive Attachment Disorder (RAD) presents significant challenges for adopted children and their families. This disorder stems from severe attachment disruptions, often seen in children with early neglect or trauma. Attachment-based therapeutic interventions are essential in managing RAD. They focus on creating consistent and supportive environments, helping children form stable attachments. Therapists work closely with adoptive parents, offering strategies to stabilize the child's emotions and behaviors. By promoting empathy and understanding, these interventions aim to reduce anxiety, enhance bonding, and facilitate positive interactions within the family. Children with severe attachment disruptions may need intensive intervention focusing on:
- Safety and predictability in relationships
- Consistent, therapeutic parenting approaches
- Processing early trauma and neglect
- Building capacity for trust and connection
Adoption Support Groups
Support groups provide crucial peer connections for all members of the adoption triad. Research has shown the enduring and varied impact of closed adoption on adoptees' needs. Yet support tends to be informal, often in the form of peer-led groups. As this topic has attracted limited research, this scoping review sought to synthesize the available evidence. The review shows benefits and challenges of peer-based group support. It provides a synthesis of common themes: efficacy and outcomes, barriers and facilitators, participant characteristics and experiences, intent and types of groups. Further research is needed to evaluate the efficacy of peer-based group support. Research demonstrates their effectiveness in reducing isolation and providing practical support.
Benefits of Support Groups
For Adoptive and Foster Parents
Following intervention, there was a general trend of improvements in carer understanding, enhanced skills, better carer responsiveness and more satisfied carer–child relationships. Although there seems to be a perceived benefit from carers, no consistent pattern of change was noted in child psychopathology or challenging behaviors. We found that from the carers' perspectives, there were improvements in their understanding of children's needs, better relationships and an increase in carer skills and confidence following participation in such interventions. However, children's behavior and attachment patterns weren't reflective of this. In general, interventions delivered to groups were reported to enhance support, promote shared learning and were more cost-effective. Support groups offer parents:
- Validation and normalization of experiences
- Practical strategies and resource sharing
- Emotional support during challenging times
- Connection with others who understand unique challenges
- Information about community resources
For Adopted Individuals
Findings suggest that perceived social support was significantly positively related to perceived empathy. This research brief investigated the impact of social support, information seeking effectiveness, and homophily on perceived empathy. The purpose of this brief was to examine the impact of perceived social support, information seeking effectiveness, and homophily on perceived empathy within a pilot-phase virtual support group for adoptive parents. All told, findings from this study suggest that homophily may be a more important aspect of support group function and outcomes (i.e., empathy), not perceived support or information seeking effectiveness, among participants. This finding supports that entities proffering support groups with the purpose of promoting empathy should focus on cultivating homophily among group members. Adult adoptees benefit from groups that provide:
- Space to explore identity and belonging
- Support for birth family searches
- Processing of adoption-related grief
- Connection with others who share similar experiences
For Birth Parents Support groups help birth parents:
- Process grief and loss
- Navigate open adoption relationships
- Find community and reduce stigma
- Access resources and counseling
Types of Support Groups
In-Person Groups Traditional face-to-face groups offer:
- Direct interpersonal connection
- Structured meetings with facilitators
- Activities and workshops
- Child care during meetings
Virtual Support Groups
To facilitate participants' attention and facilitators' efficiency, for each e-Connect group, preferably no more than 10–12 video tiles should appear on the screen. Research with e-Connect conducted in Canada and Italy suggests positive outcomes with this online adaptation as with the in-person one, suggesting its use is promising when parents can have difficulty accessing in-person programs. For instance, the online intervention could be fruitful for adoptive and foster families, often residing in decentralized areas, while adoption/foster services are usually in urban centers and the overload of commitments partly resulting from adolescents' problems can be a barrier to accessing support services. Online groups provide:
- Accessibility for rural families
- Flexibility in scheduling
- Anonymity options
- Connection across geographic boundaries
Research on Support Group Effectiveness
Studies show that effective support groups share common characteristics:
- Professional facilitation or structured peer leadership
- Regular, consistent meeting schedules
- Clear group guidelines and confidentiality agreements
- Balance of support, education, and social connection
- Respect for diverse perspectives and experiences
Case Example: Therapy for Adoption and Foster Care Issues
Building Resilience Through Comprehensive Care: Marcus's Journey
Marcus, age 12, entered foster care after experiencing severe neglect and witnessing domestic violence in his biological home. His early years were marked by chronic hunger, lack of supervision, and exposure to his parents' substance abuse. After entering care at age 6, Marcus experienced multiple placement disruptions due to aggressive behaviors, property destruction, and difficulty trusting caregivers.
When Marcus was placed with the Johnson family—experienced foster parents trained in trauma-informed care—they immediately sought comprehensive therapeutic support. The initial assessment revealed:
- Reactive attachment challenges
- Complex trauma symptoms including hypervigilance and emotional dysregulation
- Learning difficulties possibly related to early neglect
- Significant grief over separation from siblings
The treatment team developed a multi-faceted approach:
Individual Therapy: Marcus began weekly Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) sessions. His therapist used a combination of play therapy techniques and cognitive work to help him process his traumatic memories safely. Over time, Marcus created a trauma narrative that helped him understand his experiences weren't his fault.
Family Therapy: The Johnsons participated in attachment-based family therapy, learning to:
- Recognize Marcus's behaviors as trauma responses rather than defiance
- Respond with patience and consistency during emotional outbursts
- Create predictable routines that helped Marcus feel safe
- Celebrate small victories in building trust
School Support: The treatment team collaborated with Marcus's school to develop an Individualized Education Program (IEP) addressing his learning needs and emotional regulation challenges. The school counselor provided additional support during difficult transitions.
Parent Support: The Johnsons joined a foster parent support group where they found encouragement and practical strategies from other families navigating similar challenges.
After 18 months of consistent therapy and the Johnsons' committed care, Marcus showed remarkable progress:
- Decreased aggressive behaviors and increased ability to express emotions verbally
- Improved academic performance with appropriate supports
- Beginning to form secure attachment with his foster parents
- Successful supervised visits with siblings
The Johnsons eventually adopted Marcus, and therapy continued to support the family through this transition. Three years post-adoption, Marcus continues to thrive, demonstrating the power of comprehensive therapeutic intervention combined with committed, trauma-informed parenting.
Frequently Asked Questions
When should adoptive or foster families seek therapy?
Families benefit from therapy at various points:
- Preventively: Before or immediately after placement to prepare for challenges
- During transitions: When children first arrive, during reunification attempts, or when considering adoption
- When concerns arise: Behavioral problems, emotional difficulties, attachment issues, or family stress
- For specific events: Birth family contact, developmental milestones, or identity questions
Early intervention often leads to better outcomes, so seeking help sooner rather than later is recommended.
What qualifications should therapists have for adoption/foster care issues?
Look for therapists with:
- Specialized training in adoption and foster care issues
- Experience with trauma-informed approaches
- Knowledge of attachment theory and interventions
- Understanding of cultural competence and transracial adoption issues
- Familiarity with the child welfare system
- Training in evidence-based treatments like TF-CBT or attachment therapies
Adoptive families treated by clinicians who completed TAC experience greater parental involvement in treatment and a broader range of therapeutic interventions. Treatment was more adoption relevant featuring greater focus on adoption core issues and normative adoptive family development and greater use of psychoeducation and parenting skills development. These families sustained treatment over a higher average number of sessions and report significantly stronger therapeutic alliance with their therapists.
How long does therapy typically last for adoption/foster care issues?
Treatment duration varies significantly based on:
- Severity and complexity of issues
- Child's age and developmental stage
- Type of therapy being provided
- Family engagement and consistency
- External supports available
Some families benefit from short-term interventions (3-6 months), while others need long-term support extending over years. Many families find periodic "check-ins" helpful even after formal therapy ends.
Can therapy help with birth family relationships?
Yes, therapy can be invaluable for navigating birth family relationships by:
- Preparing for searches and reunions
- Processing complex emotions about birth parents
- Managing open adoption relationships
- Helping children understand their adoption story
- Supporting healthy boundaries
- Facilitating communication between families
What if my child refuses to go to therapy?
Resistance to therapy is common and can be addressed by:
- Starting with family therapy rather than individual sessions
- Finding a therapist who specializes in engaging reluctant children
- Using creative approaches like play or art therapy
- Allowing the child some choice in therapist selection
- Being patient and consistent about the importance of support
- Addressing any misconceptions about therapy
Does insurance typically cover adoption/foster care counseling?
Coverage varies by insurance plan, but many do cover:
- Mental health services for diagnosed conditions
- Family therapy sessions
- Trauma treatment
- Some specialized adoption services
Beyond outreach, faith-based programs can offer practical support through counseling and emotional guidance for birth mothers facing difficult decisions. Financial assistance with pregnancy-related expenses, legal fees, and adoption costs can significantly alleviate stress and empower birth mothers to make informed choices. Additionally, providing material aid such as housing assistance and childcare resources can be crucial in facilitating successful adoptions. Furthermore, faith-based programs can act as vital intermediaries, connecting pregnant women with potential adoptive families within their communities who share similar values and beliefs. This tailored approach can increase the likelihood of successful placements and foster long-term positive outcomes for all parties involved.
Check with your insurance provider about:
- Coverage for specific diagnoses
- In-network providers with adoption expertise
- Number of sessions covered annually
- Whether preadoption counseling is covered
Many therapists also offer sliding scale fees or work with adoption assistance programs.
How Therapy Can Help / Find a Therapist
Professional support can make a profound difference in the lives of those touched by adoption and foster care. New research from C.A.S.E. confirms that adoption-competent mental health care makes a measurable difference in family outcomes, yet access remains limited. Explore our national survey and multi-state effectiveness study to see what families are saying, and why it's time for bold systems change. Whether you're an adoptive parent seeking support, a foster family navigating challenges, an adopted individual exploring identity, or a birth parent processing your experience, specialized therapy can provide:
- Safe space to process complex emotions without judgment
- Evidence-based strategies for managing specific challenges
- Skill development for better communication and relationships
- Trauma healing through specialized interventions
- Identity support for questions of belonging and self
- Family strengthening through improved dynamics and attachment
Finding the Right Therapist
When searching for a therapist, consider:
- Asking for referrals from adoption agencies or support groups
- Checking with your insurance for covered providers
- Looking for therapists who list adoption/foster care as a specialty
- Interviewing potential therapists about their experience and approach
- Trusting your instincts about therapeutic fit
Taking the First Step
Reaching out for help demonstrates strength and commitment to well-being. Whether you're facing a crisis or simply want to build stronger foundations, therapy offers valuable support for the unique journey of adoption and foster care.
Remember: Every family's journey is different, and there's no "one-size-fits-all" approach to healing and growth. The most important step is recognizing when support would be helpful and taking action to access it.
Connect with a therapist through the GoodTherapy directory to find professionals in your area who specialize in adoption and foster care issues. You deserve support that understands and honors your unique experience.
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