Intercountry adoption, trauma and dissociation: Combining interventions to enhance integration

Although intercountry adoption, according to systematic reviews as well as meta-analysis, is from a perspective of child protection, a successful intervention, this often comes at the cost of lengthy therapy and support. Both in studies as in clinical practice intercountry adoptees are overrepresented in mental health services worldwide (Barroso, Barbosa-Ducharne, Coelho, Costa, & Silva 2017; Palacios & Brodzinsky, 2011; Van IJzendoorn & Juffer, 2006; Rutter et al., 2009). From my clinical experience, the focus on classifying the problems and using highly standardized treatments are not enough to help intercountry adoptees and their families (Vinke, 2011, 2012). In this practice-based article, I propose to use the concept of Van der Kolk's Developmental Trauma Disorder to describe the problems intercountry adoptees face in combination with Waters’ Star model (Waters, 2016; Van der Kolk et al., 2009; Gindis, 2019). Although not an official DSM-5 disorder, DTD has been embraced by many clinicians as a valid concept to approach the diversity of symptoms seen in patients coming from severe deprivational backgrounds such as intercountry adoptees. Both have proven useful in my small private practice2DTD and the Star model prove helpful especially when dealing with dissociative symptoms. In 2004, the ISSTD published guidelines on evaluation and treatment of dissociative symptoms in children and adolescents, yet dissociation is hardly ever mentioned in diagnostical evaluations. This strikes as odd since in daily life of adopted families, in clinical practice, in peer supervision, when discussed, dissociative behaviours seem often very present. Still they are hardly ever referred to in research, assessment or treatment in relation to intercountry adoptees. In this article, I will focus on trauma related dissociation in intercountry adoptees and present a theoretically informed, practical approach to this phenomenon with respect to intercountry adoptees that integrates insights from developmental, trauma and neurobiological research. The approach is illustrated by using some clinical case-examples.

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