Skip to content

Find adoption answers, support, training, or professional resources

Beneath the Mask: Adoption through the Eyes of Adolescents

Adoption Advocate No. 124

The statistics are revealing. A third of adolescents referred for psychotherapy are adopted. Adolescence is the peak period for psychiatric referrals in the life of the adoptee. Approximately 5–17 percent of adolescent adoptees receive mental health services, although they represent only 2 percent of the population.1 While research suggests that these statistics may reflect the fact that for a variety of reasons, adoptive parents may be more inclined to seek out services for their teens, it is also true that many adopted teens need specialized support. Adolescence is a time when adoptees struggle with an extra layer of challenges related to their identity, their future, and their past. The “normal” or typical developmental tasks of the teen years are intensified by adoption, particularly if teens are being raised by parents of a different race or culture.

This article addresses how adoption influences healthy separation from parents, identity formation, and decisions related to sexuality by focusing on six key areas of vulnerability around the adoption experience as highlighted in my book, Beneath the Mask: Understanding Adopted Teens. This article addresses the unique challenges represented in each of these six themes, referred to as “the six spots where teens get stuck.”

I have been treating adolescents for over 35 years, working exclusively with teen adoptees and their families since co-founding the Center for Adoption Support and Education in May 1998. Focusing my clinical career on this population has been enormously rewarding. I appreciate adolescents’ honesty, no-nonsense attitude, and their deep desire to be understood. Listening intently to the teen adoptees I have been fortunate to work with, I learned so much about what matters to them and their unique struggles and challenges related to their adoption experience. These teens have allowed me to peek inside their adoption journey and uncover conflicting thoughts and feelings of uncertainty, confusion, and ambivalence that lay beneath the surface.

As they shared their stories, exposing their thoughts and feelings, my insights deepened into the common key areas of vulnerability they faced around the adoption experience. I also understood how lonely they often felt because no one seemed to understand them—not parents, previous therapists, friends, or other significant adults in their lives. I realized that articulating these themes—for my clients, for parents, and for other clinicians working with adopted teens—was critically important for helping teen adoptees work through their unique challenges.

I created the concept of “the six spots” as a framework for helping to address the core issues prominent in an adolescent adoptee’s life. These “spots” effectively guide the treatment of teen adoptees in both individual and family therapy, helping to explore what lies behind “presenting problems” such as: behavioral acting out at home; self-destructive/harming behaviors including substance abuse and cutting; school failure; impaired relationships with parents, siblings, peers; anxiety/depression or other mental health issues. These “spots” help teens also understand their struggles to master the developmental tasks involving identity formation, separation and individuation, and sexual maturity. Our work together also strengthens their attachment to their adoptive family as well as understanding what they need in terms of birth family relationships. Getting “unstuck” helps teens to move forward.

It is important for parents who are reading this article to understand that even though you are parenting a teen, they still need you to be an instrumental part of therapy. The therapist’s role is to help guide the joint exploration and provide a safe, supportive setting to help teens express their struggles as to where they are stuck. Often, parents can recognize and realize their own challenges around these very same themes—their own “stuck spots” which can interfere with effectively being able to meet their teen’s needs and assist their teen with challenges.

The Six Stuck Spots that I am about to describe each emphasize a theme of questions, concerns, and challenges. However, they are often intertwined and while one may resonate more than others, for many teens, several may be important because of how they are interconnected. It is also important to understand that there is no hierarchal order to the movement from one spot to the next.

Stuck Spot #1 | Reason for Adoption

For many teen adoptees, adolescence is a time when they are seeking a deeper understanding of the reasons surrounding their relinquishment. They are cognitively aware that adoption means that someone chose not to raise them, or they were removed from birth parents because of the parent’s inability to parent. As children and teens grapple with the underpinning of this separation, they are often managing varying feelings; they may feel a deep sense of rejection and abandonment, and anger. In voluntary placement, someone didn’t want them. In involuntary placement, they weren’t worthy enough for the parent to meet their needs, keep them safe, or put their needs above those of the parent. No explanation for the adoption is a “good reason” for some adoptees in the case of voluntary placement.

Some of the stories behind the reason for adoption can raise many questions regarding sexuality for teen adoptees. Was my relinquishment due to a teen pregnancy, one-night stand, or marital affair? Many adoptees are told that their birth mother did not know who their birth father was, that he is “unknown.” They may wonder, “Is this because she had multiple partners, had been engaged in prostitution, or even raped?” Some stories may involve domestic violence between parents or partners. These “reasons” can have a significant impact upon a teen’s sense of self, feeling that they were not brought into this world with love. It can impact personal decisions around their own sexuality, and their romantic relationships…which is all integrated into their sense of identity. It is critical that teens have the opportunity to explore the meaning they attach to their adoption story. As the teens consider the complexities of their birth parents’ decisions and behaviors, they can realize that their birth parents’ choices do not have to define who they are or impact decisions they make for themselves.

Making sense of their adoption story involves being able to process and grieve for all the possible significant losses a teen has suffered that result from being placed for adoption: loss of birth family and extended kin, loss of genetic continuity, loss of racial/ethnic/cultural/religious heritage; loss of country; loss of other caregivers, friends, community, and school relationships. It is important for parents to understand that loss is an integral component for many adoptees as they embark upon this quest of understanding the reasons for their relinquishment. They must be given the opportunity to grieve. With the grieving process will come a myriad of emotions including anger, sadness, confusion, acceptance, and forgiveness.

Stuck Spot #2 | Identity

Figuring out “who you are” is one of THE major tasks of adolescence. Identity formation encompasses attributes involving personality, physical traits, values, interests, talents, beliefs, and sexuality. In developing their sense of self, teens spend time considering how they are like and different from their parents. Adopted adolescents have the complex challenge of having TWO families to consider—their adoptive and their birth families—as they work to determine their identity. This task is often further complicated when adoptees have little or no information about their birth family, or when their birth and adoptive families are very different regarding race, ethnicity, religion, or socioeconomic status.

Transracially adopted teens often struggle to make sense of who to identify with when they are the only person of their cultural/racial background in their family. This challenge is even more profound when their access to others representing their racial background is limited or non-existent. If adoptive parents have not incorporated the teen’s racial/ethnic heritage into the family culture, the teen’s “racial identity and socialization” can be severely compromised. For example, some Asian adoptees have shared that throughout their childhood they identified as “white” and were unprepared when they went away for college to find their peers identifying them as “Asian.”

As they begin to weave the fabric of both adoptive parents and birth parents into their identity, how birth parents have been presented will impact this tapestry. Negative attitudes toward birth parents can adversely impact a teen’s sense of self-esteem and identity development. There is much adoptive parents can do to help. Parents must consider what attitudes they convey towards birth parents. Are birth parents honored and respected? Do adoptive parents work to give a rounded picture of birth parents—not just their “mistakes and shortcomings?”

Do parents embrace and give permission for their teen’s positive identification with birth parents—by their dress, their choice of music, their interests? How do they respond to negative identification that results in risky behavior or challenging choices? Parents can be helped to understand effective ways of working with their teen who may be trying on different identities in their quest to discover who they are and want to be.

Stuck Spot #3 | Difference

I always say, “Feeling different is the worst curse of adolescence.” Most teens want so badly to “fit in” and “be accepted” and while being different and unique may be desired in adulthood, it is usually peppered with pain in adolescence. Most teens are not adopted, so just being part of an adoptive family can create a sense of difference with peers. As noted above, teens may choose to be different from their parents and family. In adoption, teens may not have that choice—they may be different because of their inherited characteristics which influence their personalities, interests, talents, values, beliefs, or academic abilities. They don’t look like their families; they may be a different ethnicity or race, speak another language, or have been born in a different country. Maybe they lived in foster care or orphanages before adoption. Maybe they have relationships with birth family. Making sense of those differences and feeling a sense of belonging with family and with peers can be quite a struggle.

These adoption-related experiences may be compounded by other family formation factors that make their family “different” from the norm. In addition to transracial adoptive families, adopted teens in single parent, LGBTQ families, kinship families being raised by grandparents or other relatives, even single child families, may struggle with concerns or fears around how others respond to those differences.

It’s no surprise that many teen adoptees will need help to navigate these differences. Parents’ ability to positively embrace their teen’s differences will help them encounter a less tumultuous journey. How do parents help teens pursue their individual talents and interests? How do they adjust their personalities and expectations to make room for their teen’s way of being in the world? For those parenting transracially, it is important to consider…who is at the family dinner table? Does the family have strong relationships with people who share their teen’s ethnic/racial/cultural heritage? Parents are encouraged to find ways to ensure their teens feel a sense of belonging, of fitting in the family by not only embracing differences, but also identifying the similarities and commonalities between the adopted teen and the rest of the family.

Stuck Spot #4 | Missing or Difficult Information

Everyone has a story. Adoptees have a narrative beginning with their birth. For many, the stories have complex origins, some with very painful histories. At the time of placement with their adoptive family, little or no information may be available about what happened to the child prior to placement and/or the people who brought them into the world. For example, babies who were left in the fields in China were left to be found with no identifying information. Children placed at older ages carry the memories of the past with them, struggling to make sense of what happened. Coping with difficult and disturbing aspects of their story and making sense of what it means about them can be really hard. It can impact one’s sense of self, complicating the task of identity formation. For those who have no information, or very little, this search for self can be an arduous journey. As one of my clients shared, “Figuring out who I am without any information is like asking someone to run without legs; you can’t do it.”

Teens need support to manage the disappointment of not having information, and when there is information, the assurance that when developmentally appropriate, parents will share what they know. Too often, parents are ambivalent about sharing difficult information as they fear their teens will be hurt. What teens have told us time and time again is that not having the information is more hurtful. By adolescence, teens seek the facts surrounding their relinquishment and need this information to integrate it into their narrative of who they are and where they came from. Parents need to assist their teens as they come to terms with this information. Sometimes the knowledge needed is met through search and reunion with birth family. Parents must join the journey and ensure that teens do not strive to uncover information or locate birth family members on their own, especially through social media.

Stuck Spot #5 | Loyalty

As teens continue to make sense of their story and strive to integrate aspects of their history into a cohesive sense of self, the connections, whether psychological or physical, to birth parents seem to deepen during adolescence. As they desire some connection with birth family, issues of loyalty can surface. Teens who think about, care about, and even identify with their birth parents, even if they never “knew” them or don’t remember them, may feel guilty about these thoughts. Teens fear that their adoptive parents will feel hurt or threatened by the teens’ feelings for birth parents; they worry their adoptive parents will then become angry and reject them. Teens may worry even if adoptive parents have never conveyed messages of feeling threatened.

Conversely, teens who had relationships with birth family members may feel disloyal to those they are now separated from as they attach and love new parents. Sometimes these divided loyalties can negatively impact their ability to attach to their adoptive parents. Loyalty conflicts can impact sibling relationships as well—either when a teen has biological siblings living with birth family, or in other adoptive homes. Relationships with other siblings in their adoptive family, whether they were also adopted or are the biological children of their adoptive parents, may be impacted as well. Grieving for the loss of birth parents can be difficult if adoptive parents feel threatened about what that means for their teen’s attachment to them. Parents can love more than one child, but are adopted teens allowed to love more than one set of parents? Many adopted teens wrestle with that question endlessly.

There is much parents can do to help with this stuck spot. Teens need encouragement to openly express their loyalty conflicts and parents need to repeatedly convey permission to love and identify with both sets of parents. Working through loyalty issues is critical for healthy identity development, as previously discussed. When parents honor their teen’s birth parents and convey an understanding of their importance to their teen, parents pave the way for healthy integration of all aspects of who their teen is.

Stuck Spot #6 | Permanence

As reflected earlier, teens understand that adoption means someone “gave me away.” They are vulnerable to reasoning, “If it happened once, it could happen again.” Teens who have experienced multiple placements and who may have been placed at an older age are understandably at greater risk for feeling insecure about the permanency of their families.

As they approach adulthood and independence, some teens wonder what their family belonging means. As they mature and perceive their parents’ role is coming to an end, they wonder what that means for their family relationships. Separation can feel like abandonment, and support for independence can feel like rejection, triggering familiar adoption-related themes. Some teens may begin to act out, setting the stage for their rejection of their parents, trying to thwart yet another rejection. Parents of these teens can benefit from learning attachment-focused, trauma-informed parenting approaches that help parents to remain steadfast and present in the face of their teen’s attempts to get their parents to reject them. This struggle can impact a teen’s journey to gain the confidence to separate from parents in preparation for adulthood and independence. Fearing yet another rejection, some teens may sabotage steps that are in place for their emancipation; you may see teens whose grades are considerably slipping in their senior year, or teens who exhibit a pulling back in completing college applications, fear touring college campuses, or who will not consider more secure vocational opportunities.

David Kirk, author of Shared Fate, had an adopted son who stated, “Adoptees are like loose boards that need nailing down.” And that’s what parents can do in a variety of ways—by communicating unconditional, permanent love, reinforcing that they will always be their parents.


Adolescence is a developmental journey that is complex for all teens and even more complex for those who joined their families through adoption. Nevertheless, teens can successfully navigate potential challenges when they are provided sensitive, informed parenting and have access to adoption-competent therapeutic support when needed, as offered by the Center for Adoption Support and Education (C.A.S.E.).

I hope this article provided you with a greater awareness of the places where your teens may become “stuck” and what you can do to help support them. If you would like to learn more about these “Stuck Spots,” I encourage you to read Beneath the Mask: Understanding Adopted Teens, and I am excited to share our new companion workbook, Beneath the Mask: For Teen Adoptees/Teens and Young Adults Share Their Stories. Twenty contributors, ages 12–34 share their heartfelt, personal stories of struggle and triumph with these six stuck spots. The book was written for teens to help them know they are not alone and learn how other adoptees “got to the other side.” Activities and exercises contained in the workbook help teens reflect on their own adoption journey and learn ways of coping with their powerful emotions. Both Beneath the Mask books may be purchased from our website. Please visit for more information. The teen workbook may also be purchased on at