Art therapy and adoption services

Training to be an art therapist came late for me. I studied sociology at university and initially taught in further education. I then trained to become a social worker  because I needed a secure job.

I had mixed feelings about my role as a generic social worker. I liked some of the work with the elderly and disadvantaged adult groups, where there was some possibility of providing support and offering something helpful. It was very difficult work when the role involved being a party to removing a child from their family: I witnessed the life of children in care and knew of the devastating effect this could have.

At the time children often ended up being removed from their birth families at a young age and remaining in care for the rest of their childhood. Adult accounts, from people who had experienced a childhood in care at this time, describe the lack of clear plans and psychological support. They lived the rest of their lives suffering the consequences of the structural weaknesses of the ‘care system’ at that time.

After four years, I took on a more specialist role in the fostering and adoption unit of Bradford social services where I stayed for 11 years. I hoped to be part of something more reparative for a child in care by becoming actively part of the system around them. The unit assessed foster and adoptive parents, made placements of children and, crucially, supported foster and adoptive parents in the difficult job they were doing. We also provided some post-adoption counselling for adults who had been adopted. The legal right to access birth records only came about in 1976. By the 1980s, the adoption landscape was rapidly changing, moving away from the adoption of babies of single mothers to mostly children from the care system who were being placed for adoption.

The majority of approved adoptive parents at the time were mixed gender married couples who were unable to have children. Many realised they might wait years to adopt a baby, so they agreed to a placement of an older child who had experienced what we would now understand as complex developmental trauma. Although we knew that parenting children who had this background needed different parenting approaches and often long-term support, there was very little post-placement support available.

I reached the point where I knew I didn’t want to be a party to placing another child for adoption within a system that provided so little long-term support to either adoptive parents or their adopted children.

I became part of a small but dedicated group of activists within the local adoption world, comprising both professionals working in the field of adoption and people whose lives had been personally affected by adoption either as a birth or adoptive parent, or as an adopted adult. Our mission was to establish a regional after adoption service that would provide the support unavailable in local authority settings. In 1987, the first independent post-adoption service in this country had been set up in London and it was recognised that the changing patterns of adoption required post-adoption support services to be independent of the agency that had made the placements.

It took the action group three more years to secure funding to set up After Adoption Yorkshire. I was appointed to head the new service. It provided counselling, mainly for adult adopted people and birth parents who had lost children through adoption between the 1940s and 1970s, but also for those losing children through the care system at the time. Counselling services were offered by social workers seconded from the regional adoption agencies and trained volunteers from the adoption sector.

What led you from this role to pursue a career in art therapy?

Art therapy first appeared on my radar after I read an art therapy assessment report on a boy I’d placed for adoption. The report provided an enlightened understanding of the boy’s internal world through his experience of art therapy. It gave me and his adoptive parents new insight into his difficulties. I thought, ‘how brilliant that art therapy can provide such insight. I want to learn to do that!’

Around the same time, on a short trip to Ethiopia to visit my brother, I saw an established Ethiopian artist run art workshops for street children in Addis Ababa. Seeing the children absorbed in playing and creating with the simplest of materials added to my desire to train as an art therapist.

I had an art A-level and had kept my interest in art alive since schooldays. I started a part-time, three-year fine art and craft diploma for mature students. Halfway through this course I was offered a place on the Sheffield art therapy training programme.

My art therapy placement was in Leeds Child and Adult Mental Health Service (CAMHS). My professional background as a social worker gave me confidence working with adults, parents and children and an understanding of the systemic skills needed by art therapists, so I could focus on the fundamentals of the theory and practice of being an art therapist.

During the three years of training, I was also managing the After Adoption Yorkshire service. Through that role I met some of the leading creative therapists in the country working with adoptive families. With this group of creative therapists, I also helped to co-found Attachment in Action, an organisation that ran conferences and training seminars to improve services for adopted children and their families. After qualifying as an art therapist in 1996, I joined Leeds CAMHS, where I worked for 12 years, becoming a principal art therapist.

Could you expand on the needs of individuals affected by adoption, and where art therapy can best respond?

Adoption is one of the most extreme state interventions. It involves losses, it is lifelong and it is different from being fostered or separated from some of your birth family. Acknowledging these things is often the key to a better outcome for an adopted person.

Thinking about the losses involved:

The birth parents of an adopted child lose the right to parent and in many cases to have any direct contact with their child throughout the rest of their childhood and potentially their life. This affects not only the child and the birth parents but grandparents, aunts, uncles and possibly siblings too.

The adopted child loses the right to be parented by their birth family and often ceases all direct contact with them. When the court makes an adoption order, they lose their original birth certificate. It is no longer a valid legal document. Their new adoption certificate becomes their valid ‘birth’ certificate for all purposes such as obtaining a passport; it includes no acknowledgement of any life before the adoption; it names the adoptive parents and the child’s new name(s) but there is no mention of their birth family name. There is currently a move amongst adopted adults to change this and have the original birth family information included on a new adoption certificate. The adoptive parents have ‘lost’ the first few weeks, months or, in many cases, years of their child’s life. They can never know for sure what happened to their child before they came to live with them.

Adoption is a lifelong experience for all parties: after an adoption order has been made, even if the child leaves their adoptive family and returns to the care system, their adoptive parents remain their legal parents and the birth parents do not regain their parental rights. There is a great difference legally between adoption and fostering or step-parenting.

Adoption can have a significant impact on identity formation, particularly during adolescence, and answering the question, ‘what part of me is formed from my experience of being adopted and what part of me has genealogically come from my birth parents?’ can be difficult. The phrase ‘genealogical bewilderment’ describes a part of this difficulty; it refers to adopted young people looking at themselves and their particular physical characteristics, such as the shape of their toes, facial features, or skin tone and wondering where they come from, because they are not mirrored by their adoptive parents. Many people grow up being separated from some part of their birth family but do not have this extreme experience of genealogical bewilderment.

Therapy can best respond to the needs of individuals affected by adoption – whatever party to an adoption you are working with – by holding in mind that loss and difference will come up in therapy in some shape. Clients will not necessarily have the words for the profound nature of what has happened to them, but this is the gift art therapy can bring. Unspeakable or unknown things will be held somewhere in the body and may appear in the artwork. The fact of adoption brings some specific things into the arena of therapy.

Being aware of triggers in terms of ordinary life events is important too. Birthdays; Mothering Sunday; being asked to make a family tree at school; having incomplete medical background information – all can be very problematic. Approximately 80 per cent of adoptive parents come to adoption because of infertility and there will be key moments in the parents’ lives when their infertility re-surfaces, for example, when their teenage children become sexually active or when their adult adopted child has a baby and they become grandparents to a child with whom they have no genetic link. This can also cue the adult adopted person to think ‘my birth parent went through this but then didn’t parent me’, and can trigger a need to pursue information about their birth family and possibly seek contact.

Could you elaborate on how dyadic art therapy evolved?

During the 1990s our understanding of complex trauma and its long-term impact on development was limited. I knew a lot of adoptive parents felt undermined, misunderstood and blamed following therapy experiences they were offered in CAMHS at this time.

The specialist adoption practitioners whom I knew around the country were offering different approaches and a deeper understanding of adoption. I introduced these approaches to the CAMHS team in Leeds, including the potential for working with the parent and child together in art therapy. At the time I called this work ‘parent–child attachment therapy’ but later it became known as dyadic parent–child art therapy. We established a specialist adoption clinic in Leeds CAMHS.

There were established models of therapy focused on enhancing a parent’s sensitivity to their child, such as Theraplay and Watch, Wait and Wonder, which were useful learning models. However, I believed art therapy had something unique to offer that could suit some parent–child dyads. I knew this model of working did not conform to what I had learnt in my training. However, collaboration and support from other creative therapists working in specialist adoption settings, including ideas from Joy Hasler, Alan Burnell and Jay Vaughan allowed me a degree of confidence to develop this way of working.

I began to understand that the attachment disturbance, which had been the key element to our understanding of the difficulties in adoption relationships in the 1990s, was just one part of a much larger whole. As Bessel Van der Kolk and Bruce Perry’s research and understanding became more widely known, their ideas were incorporated into the therapeutic model of work. The dyadic therapy offered had to match the developmental needs of the child regardless of their chronological age.

What are some of the factors an art therapist needs to consider when working in this way?

A key consideration when thinking about parent–child dyadic work is whether the care-giver/parent has sufficiently resolved issues in their own past to be able to focus on the child’s needs in the therapy. Dyadic work can often fail because the parent is not ready for it. The therapist must also acknowledge that they are the therapist for the relationship, not for the parent or for the child. This represents a shift in the orthodoxy of a traditional therapeutic alliance when working individually. Before you start this work, you need to be able to answer the question ‘why am I making this shift to dyadic work?’

Lizzie Taylor Buck developed the online manual describing Dyadic Parent-Child Art Therapy as part of her PhD research. It was from her research and my experience of working dyadically with adoptive families that the three approaches of Child-Led, Joint Engagement and Coherent Narrative were named and described.

What is your vision for the future of dyadic art therapy and how do you see it evolving?

Dyadic work, at the moment, is focused on parent–child work because that is where it has evolved. But there’s a huge potential for dyadic work to develop with care workers and adults with a range of difficulties. The three approaches we have outlined may need extending to suit the needs of different client groups and ages. I would like to think that dyadic art therapy will broaden out in this way.

Learn more about dyadic art therapy 

If you are a trainee or qualified art therapist and would like to learn more about dyadic parent-child art psychotherapy, you can book onto our course running in January 2025.

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