Table 1.

Themes and subthemes, with brief descriptions.

Barriers

Limited knowledge and interest among therapists Healthcare staff often lack insight into the lived reality of transnational adoptees and can be reluctant to address the topic.

Colorblindness and unwillingness to address racism Experiences of racism are downplayed or excused in an invalidating manner, in society at large but also in healthcare. Very few have had a chance to discuss issues related to racism with a therapist.

A narrative of gratitude Adoptees are expected to be grateful for being adopted, which limits attention to negative post-adoption experiences and prevents help seeking.

Breaches of integrity Experiences of being treated as “public property” and being expected to answer questions that would not be posed to other groups. Also includes sudden sentimentality among otherwise professional therapists when the topic of adoption is brought up.

A dichotomous view of adoptees as either deeply traumatized or entirely well-adjusted Support might be needed even if you are not severely unwell of deeply traumatized. A view of transnational adoption as a “success story” might also contribute to an underestimation of the severity of mental health problems.

Infantilization Being seen and labeled as an “adoptive child” in adult age is diminishing and contributes to feelings of not being taken seriously.

Lack of support from adoptive parents Adoptive parents are sometimes unwilling to support adoptees in seeking help, possibly based on defensive reactions, limited compassion, or fear of being judged.

Financial costs There is often a reliance on private psychotherapy, which is expensive. Traveling to one’s country of birth and seeking one’s roots—aspects that can be important for healing and health—are also costly.

Involvement of adoptive parents, adoption organizations, or adoption-related authorities Knowing that various stakeholders in adoption are involved in efforts of support might limit trust, due to negative personal experiences and reports about illicit activities.

Resources

Helpful therapy Examples of therapists who have understood and addressed adoption in a helpful manner.

Fellow adoptees Support from other adoptees, often through organizations or social media platforms where adoptees share experiences and help each other.

Exposure of illegal adoptions News reports about illegal adoptions might be tough to face, but more than anything they validate long-held suspicions and raise hope for justice and accountability.

Changing attitudes in society There is an increasing awareness of and openness to discuss problematic aspects of transnational adoption.

Needs and Suggestions

Therapist identity Many express a wish to see an adoptee therapist or a therapist of color; someone with personal insight into the lived reality of transnational adoptees that they will not need to “educate”. However, some experience seeing an adoptee therapist as potentially awkward, note that this does not guarantee understanding and compassion, and highlight therapeutic skill regardless of identity.

Designated resource center There is general support for the establishment of a resource center for transnational adoptees, with various relevant competencies within the same organization. However, there might be barriers to successful implementation that need to be considered. Ensuring easy access to information about currently available resources is also important.

Improved knowledge Knowledge about the potential challenges that adoptees face should be strengthened by addressing the topic in the training of healthcare staff, decolonizing psychotherapy, etc.

More than cognitive-behavioral therapy The “here and now” focus of cognitive-behavioral therapy might not adequately address adoption trauma. Complementary psychotherapeutic perspectives can be necessary.

Applying a life-stage view Different aspects of transnational adoption become relevant during adolescence and early adulthood, as a parent, in old age, etc.

Education and support for adoptive parents Adoptive parents need assistance in order to be better prepared for potential challenges, such as navigating racial differences and standing up to racism.

Follow-up during childhood and adolescence Adoptees should be offered some form of structured follow-up during childhood and adolescence. A continuous offer of counseling can be helpful for teenagers, even for those who are not necessarily interested at first.

Support groups Meeting other adoptees, sharing experiences, and seeing yourself in others can be helpful for some.

Addressing adoption experiences during pregnancy and as a new parent Being pregnant, giving birth, and becoming parents can be particularly emotional and triggering for adoptees and should be addressed in healthcare.

Access to medical check-ups, blood tests, and genetic counseling Extended medical examinations and testing should be offered, instead of merely noting that not much can be said about heritable disorders and diseases.

Better knowledge about medical conditions that more often affect persons with a non-European background Including competency in the assessment of melanin-rich skin.

Economic resources Financial support for psychotherapy, visiting one’s country of birth, and seeking one’s roots should be offered in some form. Many highlight the fact that adoptive parents, but not adoptees, currently receive economic support.

Support for children of adoptees Although needs differ substantially, children of adoptees are in a sense a “second generation” that shares background and experiences with the adoptee parents.