Transference and Countertransference Paradigms with Adoptees

Janet Zuckerman & Betty Buchsbaum. Handbook of Adoption: Implications for Researchers, Practitioners, and Families. Editor: Rafael A Javier, Amanda L Baden, Frank A Biafora, Alina Camacho-Gingerich. Sage Publication. 2007.

Patients who are adopted are often highly resistant to exploring their adoptive status as well as the experience of adoption itself in psychotherapy. The mores of our culture typically discourage the openness required to help members of adoptive families work through their difficulties (Nickman, 1996a). Clinicians who work with such patients are well aware of this phenomenon, and the literature on psychotherapy with adoptees documents the difficulty in exploring patients’ conflicts about adoption (Kernberg, 1985-1986; Sherick, 1983; Soll, 2000). The subject of adoption is not uncommonly brought up by the patient at the beginning of treatment, prematurely closed by patient and parent, and never discussed again (Kernberg, 1985-1986). Though therapists are aware that adoption exerts profound effects on identity formation (Glenn, 1974), object and self-representations (Brinich, 1980, 1995; Glenn, 1985-1986), superego formation (Kernberg, 1985-1986), and sexual identity (Kernberg, 1985-1986), finding a foothold to apply such knowledge clinically can be daunting.

This overall difficulty in accessing adoption concerns is often intensified where (a) a child manifests acute symptoms that significantly interfere with effective functioning (Deering & Scahill, 1989); (b) the adoptive family is invested in maintaining the child’s insecurity about her adoptive status as a smoke screen for other family pathology (Deering & Scahill, 1989; Kirschner, 1990); (c) couples have struggled with the psychological sequelae of infertility (Nickman, 1985; Nickman et al., 2005); (d) adoption is treated as a nonevent by parents lacking psychological insight (Kirschner, 1990); and (e) therapists’ negative attitudes toward adoption preclude or interfere with an empathic therapeutic connection (Nickman et al., 2005).

We contend that a pivotal way to traverse the patient’s resistance to speaking about adoption is to understand and explore the transference-countertransference relationship as it brings to life the patient’s internal experience of adoption. The literature reviews prototypical dynamics and behaviors of the adoptee in therapy (Jones, 1997; McDaniel & Jennings, 1997); however, few articles highlight the unique role of transference in the treatment, leaving both the relational dimension and the specific meanings of the adoptee’s behavior largely unelaborated.

We will review the literature on psychotherapy with adoptees, describing the few transferential patterns discussed, and propose a variety of transferences that could accompany the behavioral trends illustrated. We will thereafter describe the treatment of a 9-year-old adopted girl, where transferences discussed in the literature are highlighted and new transference-countertransference constellations are proposed. Our hope is to provide additional channels to access patients’ conflicts about adoption.

Literature Review

We have organized this overview around three categories of transference found in the clinical literature with adoptees: negative, positive, and unstable.

Negative Transference

Many authors have observed different aspects of one of the most pervasive phenomena observed in adoptees—namely, their intense belief that they are unwanted and defective and their repeated efforts to prove it (Brinich, 1990, 1995; Derdeyn & Graves, 1998; Kernberg, 1985-1986; Nickman, 1985; Nickman et al., 2005; Parkhill, 2004; Sherick, 1983; Wieder, 1978). Such feelings of defectiveness in the adoptee derive initially and most profoundly from having been relinquished by one’s biological parents. Feelings of defectiveness can thereafter be compounded by (a) unconscious identifications with defective biological parents (Nickman, 1985); (b) self-blaming to excuse the actions of rejecting biological parents (Kernberg, 1985-1986; Parkhill, 2004); and (c) projections onto adoptees of their adoptive parents’ negative fantasies about biological parents (Derdeyn & Graves, 1998; Glenn, 1974; Nickman, 1996b; Nickman et al., 2005; Samuels, 1990).

The adoptee’s intense feelings of defectiveness are described in the literature; however, descriptions of the transferences enacted around such feelings are few. Kernberg (1985-1986) provides one notable exception when she observes in passing that patients may come to view the therapist as a monster since it is too much of a burden to view themselves as one. The authors propose that chronic feelings of unworthiness can result in a variety of negative transferences to the therapist, including the patient’s belief that the therapist (a) is disapproving and critical of her assumed defectiveness; (b) is as unworthy and defective as she believes she is; and (c) lacks vision because the therapist sees the patient as a person of value.

Several authors discuss another common dynamic among adoptees, their intense anger at both biological and adoptive parents, which can be projected (Brinich, 1995; Hughes, 1997; Kernberg, 1985-1986; Nickman et al., 2005) and displaced (Sherick, 1983) onto the therapist. Driven by this dynamic, the patient might come to transferentially view the therapist as angry and rejecting, reflecting her own projected self-states as well as her expectation that others will resemble her biological and adoptive parents. In a related dynamic, the patient may allow herself to experience rather than project such intense affects. In this case, the patient may fear that due to her rage, (a) the therapist may become dangerous and retaliate with harm as she may fantasize her biological parents did in rejecting her (Sherick, 1983; Silverman, 1985-1986); (b) she herself will drive the therapist away or annihilate her, as she may believe occurred with her biological parents (Silverman, 1985-1986); or (c) the therapist is weak in contrast to her own overpowering affects.

Other authors cite the adoptee’s desire to reject her adoptive parents (Kernberg, 1985-1986) as part of her effort to put into active form the loss she was forced to endure passively (Novak, 2004). We would extrapolate that where such a dynamic is at play, the adoptee may enact the rejecting parent to the therapist’s helpless child, seeking to master her rejection and heal profound feelings of vulnerability (Kernberg, 1985-1986). Transferentially, the therapist would be viewed as the helpless and passive victim whom the patient is repeatedly able to coerce and denounce despite genuine effort by the therapist to connect and stay alive.

Glenn (1985-1986) and others (Derdeyn & Graves, 1998; Jones, 1997; Parkhill, 2004; Treacher, 2000) observe another prototypical challenge for adoptees, their incomplete identificatory picture. Associated feelings of anonymity may result from having had to live in a “virtual witness protection program” (Homes, 1996) as a result of having been adopted. Applying these observations, we might envision a transference, where the patient feels intense envy toward the therapist, who seems to possess a complete life story and clear social and familial status. Adoptees may also view the therapist transferentially as an omniscient and withholding object who possesses answers to the vital question of who she really is but sadistically retains them. In this regard, Glenn (1974) notes that adoptees sometimes explore the therapist’s records fantasizing that they contain vital identifying information.

Other authors (Derdeyn & Graves, 1998; Parkhill, 2004; Sherick, 1983) note the tendency of adoptees to chronically lie or play with the truth, leaving the therapist uncertain about actual data. The adoptee may do this (a) to deny or ease the pain of her rejection by birth parents, for example, by pretending that the adoptive parents are her birth parents or that she is the biological child of her adoptive parents; (b) as a consequence of the pressure to disavow reality and live as if adoptive parents are biological parents, repressing yearnings for the latter (Lifton, 1990; Samuel, 2003); and (c) as an enactment with the therapist where the lie can reveal as much as it conceals (Wilkinson & Hough, 1996). We propose that, transferentially, a patient prone to such a dynamic may doubt the therapist’s credibility and mistrust her. That is, where adoptees themselves alter reality, they will expect others to act in kind, yielding the experience of an untrustworthy therapist. In addition, the patient may view the therapist as puzzled or helpless in the face of the uncertain reality that has been presented. This may afford secondary gratification to patients, who can (a) taunt the confused therapist or (b) convince themselves that the therapist is useless due to the failure to understand the patient.

Positive Transference

In addition to the negative transferences discussed, the adoptee may enact a variety of positive idealizing transferences. One such variation reflects the adoptee’s defensive mission to preserve her biological parents as good objects and avoid the greater pain of knowing their limitations. Fairbairn (1943/1990, chap. 3) and others thereafter (Kernberg, 1985-1986) elucidate this dynamic where abused children idealize their parents, unconsciously assuming all responsibility for familial trauma in a dissociated fragment of self to avoid the more painful experience of acknowledging parental limitations. Owing to this dynamic, the patient may come to view the therapist as a perfect and idealized object who makes no mistakes and is never hurtful. Patients may protect the therapist by rushing to take the blame for inevitable errors that arise in treatment or deny being hurt by suboptimal actions of the therapist.

In another variation of an idealizing transference, patients may come to view the therapist as the lost biological parent who can finally provide the love and comfort of which they have been deprived (Brinich, 1990, 1995; Jones, 1997; Lush, Boston, Morgan, & Kolvin, 1998; Nickman et al., 2005). This idealization is often magnified further by the possibility that given the anonymity of the adoptee’s biological parents, the patient may think the therapist actually is the lost parent. In a related dynamic, Nickman (1985) notes that adoptees’ reality-fantasy distinction is often muddied by the fact that anyone in their life might actually be a biological parent. Seeing the therapist as the lost biological parent is also enhanced by the family romance dynamic (Freud, 1908; Derdeyn & Graves, 1998) in which all children sometimes imagine the parents they live with are lowly, adoptive parents as against their original parents seen as regal, exalted people. This is an easy leap for the adoptee, who actually has two sets of parents and may develop powerfully fueled ideas that the therapist is this idealized, biological parent (Nickman, 1985).

Unstable Transference

The adoptee’s reactions to the therapist are typically intense and conflicting. They often alternate between extremes such as idealization and devaluation and/or a desire to attach and a need to distance for fear of abandonment (Samuel, 2003). The adoptee’s therapeutic connection is therefore likely to become wildly fluctuating and unstable (Nickman et al., 2005). While such upheaval is an opportunity to enter into and therapeutically survive inevitable enactments in the work, its intensity can also dangerously erode the minimum levels of safety and security required for a viable therapeutic relationship. Reeves (1971) describes one such transferential pattern among adoptees that originates in empathy and engagement on a deep unconscious level with the therapist but is inevitably interrupted by a negative reaction that consistently disintegrates into disillusionment and alienation. Reeves views this pattern as an enactment of the adoptee’s original experience of attachment followed by rejection, which leads to subsequent fragile connections that reenact this original experience.

Other qualities of the adoptee described in the literature can translate into an unstable transference to the therapist. Some authors point to the adoptee’s chronic fear of abandonment and compromised sense of safety deriving from the experience of losing one’s original parents (Glenn, 1974; Jones, 1997; Lanyado, 2003; Nickman et al., 2005; Samuels, 1990; Silverman, 1985-1986). This dynamic coexists with the adoptee’s intense desire to attach (Lanyado, 2003; Novack, 2004). We propose that such fears could result in the patient’s view of the therapist as untrustworthy and thereby difficult to embrace as a potentially soothing object. We would expect the adoptee’s fear of abandonment and danger to intensify as loving, intimate, or dependent feelings emerge in treatment and the therapist becomes a more essential figure. These collective anxieties pose a serious threat to the patient’s growing ability and motivation to connect to the therapist on an ever-deepening level.

An unstable therapeutic attachment may also result from the adoptee’s often-noted difficulty in achieving the developmental task of integrating good and bad parts of self and others (Bartram, 2003; Glenn, 1985-1986; Kernberg, 1985-1986; Samuel, 2003). This challenge can be burdened for the adoptee by having two sets of parents (Riley & Meeks, 2005), since each can be conveniently thought of as all good or all bad. To the extent this integrative task is unfinished for adoptees, it may manifest in gross fluctuations in their view of the therapist, potentially weakening the therapeutic support structure. Sudden reversals in the patient’s view of the therapist may also reflect the struggle with conflicting loyalties noted by Nickman (1985). He and others (Quinodoz, 1996; Samuel, 2003) discuss the often divergent representations that adoptees have of their two sets of parents (typically, bad biological, good adoptive). This conflict can manifest in therapy as a “double” transference characterized by opposing and shifting views of the therapist that further destabilize the therapeutic relationship.

Clinical Example


Lisa is a Black child of Caribbean descent reportedly born to a teenage mother residing in a group home. Lisa was given up at birth to a foster agency and soon thereafter taken in by a foster family with whom she lived for the first 3 years of her life. Little is known about these early years. We know only that Lisa had foster siblings in this home but experienced the loss of most of them as they were chosen “over her” for adoption by other families. Additionally, she was reportedly in a special needs nursery during this time. Since so little is known about Lisa’s early years in foster care, we are unsure of their impact on her life. We do know, however, that having been in foster care compounded Lisa’s experience of loss as she was forced to sever ties with foster parents and siblings when she was adopted at age three.

Lisa’s adoptive mother, Adele, is also of Caribbean descent. She became interested in adopting a child to provide companionship for her biological son, Steven, given many unsuccessful attempts to bear a second child. In addition to losing multiple pregnancies to miscarriage, Adele also lost her second husband of 7 years, the father of her biological child, 5 years prior to Lisa’s arrival. Adele divorced her first husband in her country of origin, reportedly over physical abuse.

During early visits to her home, Adele remembers Lisa as quiet, clingy, disinterested in play, and cloaked in a blank stare. At times, she destroyed Adele’s things. Although she believed Lisa would be difficult, Adele proceeded with adoption 6 months after visitation began. Lisa was then three, and Steven was six. While Adele was in the process of adopting Lisa, Lisa’s maternal grandparents were attempting to do the same. The court reportedly granted adoption rights to Adele, representing yet another loss for Lisa. They reasoned that Lisa’s biological grandparents had difficulty raising their own daughter, Lisa’s biological mother, and thus might not be reliable parents.

Lisa began attending regular nursery school on arrival at Adele’s home, where school personnel were quick to report, “She’s no Steven.” By the time she reached kindergarten, Lisa had already stolen snack money from other children as well as from the teacher. Adele recalls feeling she was unable to discipline and set consequences for Lisa as she “cared about nothing.” In first grade, Lisa was recommended to see a school psychologist, which she did through the time of referral to our clinic.


The following presents aspects of Lisa’s treatment emphasizing transference and countertransference developments that have been raised or implied in the literature as well as those newly observed in our clinical work. It is of note that descriptions of countertransferential reactions with adoptees are infrequent in the literature (Kernberg, 1978) and even where raised are usually not elaborated. Countertransferential reactions in the work with Lisa are understood to reflect potential problem areas for the therapist as well as possible parallels to Lisa’s internal states and those of her primary objects (Racker, 1968).

We wish to clarify that when transferences and countertransferences are described in this chapter, either as companions to common behavioral patterns of adoptees or arising anew out of our clinical material, we do not mean to suggest a one-to-one relationship between a given transference-countertransference constellation and a complementary adoption issue. This would be particularly illusory in discussing treatment with adoptees, where isolating conflicts around adoption is always questionable since they are typically unacknowledged by the patient (as in our case). In addition, particular transferential patterns may represent conflicts not only about adoption but also about issues related to the specific therapeutic pair. Thus, descriptions of transference and countertransference are offered and analyzed in this chapter to suggest clues rather than answers to the way adoption issues have been psychologically incorporated. By proposing connections between particular transference-countertransference developments and specific adoption issues, clinicians can work “backward” to access warded-off adoption concerns.

Lisa was almost nine when Adele brought her to therapy at our clinic, where she remained in a once-a-week psychoanalytically-oriented treatment for one year. At the outset, Adele had a lengthy list of complaints about Lisa, including her constant attention-seeking behavior, difficulty in getting along with others, and disruptiveness and disobedience at home and in school. Adele’s laundry list of complaints mirrored the tendency of adoptive parents to experience and express significant distress about the adoptee’s behavior (Derdeyn & Graves, 1998; Leiberman, 2003). Lisa reportedly destroyed and stole objects from teachers and peers, denied responsibility for her actions, and acted in sexually provocative ways with boys. She also reportedly attached to people indiscriminately with inappropriate intensity. Adele described her bitter disappointment that things were not working out as she had hoped with Lisa. She did not see herself as contributing to such problems, however, reasoning that her biological child seemed well-adjusted. During Adele’s first visit with the therapist, she reported that Lisa had announced she intended to search for her birth mother when she grew up. Adele explained that she did not pursue this topic with Lisa, believing “the past was better left alone.”

Lisa began therapy with a decided air of excitement and hope. As her feelings of safety steadily grew during these early months, Lisa began to reveal more and more of her secrets, including the way she stole money and food from schoolchildren and teachers and stashed food from her home refrigerator in her room until it would rot. She quickly developed idealized notions about the therapist (Janet Rivkin Zuckerman), which soon escalated into a full-blown idealizing transference as Lisa basked in the warm glow of the therapist’s sustained attention and interest. There was a strong sense that Lisa needed to view me as perfect and unerring (Kernberg, 1985-1986) and worked hard to uphold this vision by forgiving me or turning a blind eye to mistakes or omissions I made. When Christmas approached still early in treatment, Lisa announced that she had asked her mother for a red coat just like mine. Our interactions were soaked in the feeling that Lisa wanted to be like me and belong to me, as if I might be her long-lost parent (Brinich, 1990, 1995; Nickman, 1985) offering love and comfort she had never before known. My countertransference at such times involved both a desire to rescue Lisa (Treacher, 2000) and the fear that I would abandon her and fail to satisfy her intense and poignant longings (Lanyado, 2003). Kernberg (1985-1986) alludes to this experience, noting that when the family romance dynamic is actualized in the transference, “this in turn exerts inordinate pressure on the analyst not to let down the abandoned child for a second time” (p. 297). We would expand this observation to say that fears of failing the adoptee exist in a broader scope across the countertransferential field. Given the adoptee’s painful early history, along with intense pressure on the therapist to be the good restorative object, there is a potent and persistent countertransferential fear of repeating the patient’s traumatic past particularly given the therapist’s circumscribed role in the patient’s life. This countertransferential fear also reflects the often fragile quality of adoptees’ relationships with the therapist as well as with others in their lives. At other times, countertransferentially, I felt the desire to reject Lisa owing to my extreme discomfort at her efforts to get inside of me, physically and emotionally, and to idealize me. Reeves (1971) similarly discusses his tendency to feel a fusion with adoptees, experienced as so intolerable that on more than one occasion he unconsciously disengaged from its hold by calling the patient the wrong name.

Where the therapist experiences such an idealizing transference with an adoptee and its accompanying countertransferential anxieties, it can be useful to consider and, where appropriate, introduce potentially relevant adoption issues. These can include feelings of loss toward unknown biological parents as well as a need to protect imagined defective biological parents.

Lisa’s idealization was short-lived, as she quickly bumped into the reality that I was not always available to her and that our relationship had palpable limitations. She also began to realize that our emerging alliance posed new and uncomfortable threats to her connection with her adoptive mother. Following one session where both Lisa and Adele had been present in the room, Lisa collapsed into panic and despair after I declined Adele’s request to have Lisa’s adoptive brother Steven join our session. Witnessing the tension between such important figures in her life was terrifying for Lisa and jeopardized her sense of connection to each of us. Devaluation, rage, and disappointment emerged in Lisa as she felt betrayed by my behavior in her mother’s presence. But as she hated me, she also worried that I would reject her as a consequence of her fury. Adding further to these already complex and intense affects were Lisa’s fears of abandonment and diminished sense of object constancy. At the end of our sessions, she would sometimes ask, “Will we ever see each other again?” Such concerns are typical for adoptees who suffered the loss of their original parents (Glenn, 1974; Lush et al., 1998; Samuels, 1990; Silverman, 1985-1986).

Given this multiplicity of intense and shifting feeling states, the seeds were sown for a fundamental instability and mistrust in our relationship. These sudden affective shifts mimicked Lisa’s overall tendency to experience herself and others in extreme and unmodulated ways. This dynamic emanated from a home environment that tolerated few mistakes and failed to provide models of soothing or modulation of affect. On one occasion, Lisa tentatively disclosed some of her misdeeds but became anxious about her revelation, commenting, “I don’t tell these things to anyone.… I tell only the Devil or the angels.” For Lisa, these were the only choices, and transferentially we each oscillated repeatedly between them. Lisa’s intense and shifting emotional states resemble those typically ascribed to adoptees, including (a) Reeves’s description of a transference that originates in deep affective engagement but inevitably deteriorates into disillusionment and alienation, recapitulating the original traumatic loss, and (b) the clashing of ego ideals described by Nickman (1985), where extreme and rapidly shifting views of the therapist may symbolize a struggle to reconcile widely divergent views of biological and of adoptive parents. Such a conflict was suggested when Lisa would address me as Dr. Zuckerman in the midst of a fitful rage, explaining that her adoptive mother would disapprove if she called me by my first name.

When faced with a rapidly shifting transference in work with adoptees, the therapist can consider and potentially introduce dialogue about adoption themes. Key issues include reenactment of the adoptee’s journey from attachment to loss as well as symbolic efforts to reconcile conflicting parental representations.

Well into the middle phase of treatment, my sessions with Lisa became heavily punctuated by Lisa’s anger, oppositionality, and disillusionment. Hatred of me, as well as hatred of herself, were now more fully present in the therapy room. At times, Lisa became so filled with fury that she would turn and face the wall, speechless for most of the session. On other occasions, she provoked me continually with outbursts and attacks, such as “You look disgusting … you disgust me,” as though committed to enacting the rejection that was so familiar to her. Provocations could include manipulation and demand (“Hurry up and move, I don’t have all day!”), assigning me the role of helpless victim that she more typically inhabited. Transferentially, I was seen as disapproving and rejecting or pitifully helpless. Countertransferentially, anxiety along with a strong sense of rejection and anger arose in me as intense affects were projected and displaced onto me, triggered by my own personal vulnerabilities (Wilkinson & Hough, 1996). At such times, I could experience the anger of the abuser that Lisa feared but at the same time provoked. This created extreme discomfort in me and also hinted at the quality of Adele’s internal states. When immersed in rejection, I could feel the profound internal disruption that resulted from the other’s rage and insensitivity, as Lisa presumably did.

These provocations served many possible masters, including Lisa’s need to (a) recapitulate her own rejection by birth parents, (b) assure herself that she was the damaged object rather than her parents or the therapist, (c) unconsciously maintain an identification with her devalued biological parents through her unacceptable behavior, (d) test the therapist with outrageous behavior to see if the latter would reject her (Hopkins, 2000), and (e) lock herself into a destructive but predictable sense of worthlessness and confirmation of her fundamental defectiveness. Any of these dynamics, intimately connected to the patient’s adoptive identity, may be considered and explored when experiencing such a critical, rejection-tainted transference along with the accompanying countertransferential feelings of rejection, anger, and abusiveness.

Adding to this already difficult phase was the fact that Lisa’s initial and noteworthy symptomatic improvements were regularly and readily dismissed by her mother as nonexistent. Setbacks were viewed as a hopeless return to an irreparably damaged core: “How else can you explain why someone who had to eat out of the garbage all her life but now doesn’t have to, would continue eating out of the garbage?” Adele’s reactions dampened the positive feelings gained in treatment and fueled Lisa’s feelings of self-loathing. Powerful cultural, racial, and ethnic differences between Lisa, Adele, and me created intense countertransferential challenges at these junctures. Clashing values regarding education, discipline, religion, and work ethic were painfully at play. Adele’s mistrust of therapy, my competence, and my values, along with her unconscious sabotage of the treatment (missed appointments, late arrivals, criticism of me to Lisa) due to its profound threats (Bartram, 2003), seriously strained the therapeutic relationship. Adele’s tendency to undermine the treatment in these ways eroded Lisa’s confidence in me, communicated that it was not safe to make a real connection, and eventuated in my doubting my own efficacy. Countertransferentially, I struggled to control my anger and frustration, which I did by hiding behind a pleasant affect or distancing myself emotionally. Maintaining a neutral stance, if ever possible, was all the more impossible. Adele’s anger and my resulting anxieties caused me to avoid addressing critical issues such as our racial and social status differences. Ultimately, these forces further burdened the already difficult task of understanding the impact of adoption on Lisa and Adele.

Lisa was also growing notably uncomfortable with my attention, nonjudgmental attitude, and commitment to repair empathic failures. At times, she angrily asked, “Why are you so nice to me?” or “Why are you smiling at me?” and stated, “Don’t look at me that way, with that smile.” Kind treatment was destabilizing as it challenged Lisa’s fundamental assumptions about who she was and how the world operated. Though tempted to engage more fully with my invitation to become close, Lisa usually withdrew in favor of the more familiar position of mistrust and distance. At times, she sat for entire sessions in her buttoned-up coat, determined to keep me at bay. Countertransferentially, I felt impotent as Lisa seemed stubbornly committed to rejecting the only tools I had to offer.

Lisa was also suspicious of me, doubting my acceptance of her, my credibility and smile. In part, this view may have derived from her own tendency to lie (Sherick, 1983) and blur reality (e.g., she often referred to her adoptive mother’s boyfriend as “daddy”), to soften or deny the traumas of her life. This pattern often evoked countertransferential confusion and mistrust about what was and was not real. Was Lisa’s household in fact emotionally and physically abusive as she sometimes suggested it was but usually later denied? Was Lisa perpetrator, fabricator, or victim? A fuzzy reality, puzzlement, and doubt ensued, echoing Lisa’s experience of not being solidly anchored in what was and was not real, and the disorientation resulting from such a state. When presented with the adoptee’s lies and suspiciousness and the therapist’s concordant confusion and mistrust, it can be valuable to consider and perhaps introduce the idea that the adoptee may engage in this behavior as a way to stave off the pain related to her adoptive identity.

Hints of shame and curiosity about Lisa’s unknown origins began to emerge in treatment. This was contrasted with Lisa’s view of me as possessing all the fundamentals she lacked. In one session, she spoke of Edgar, Adele’s first husband. Momentarily confused, I asked, “Do you mean your biological father?” Lisa responded, “Oh, I don’t have one of those. My mother never married.” On another occasion, she commented that I had three names. I answered that she also had three names, referring to her biological name and adoptive name; however, Lisa refused to further engage around this topic. She sometimes expressed interest in my files (Glenn, 1976), pretending she was the omniscient therapist equipped with knowledge of her identity and making entries into her records. Transferences that incorporate such identity themes provide a potentially useful way to engage adoptees’ conflicts about their unknown origins.

New Faces of the Transference

As discussed, we observed new transference-countertransference patterns in this case not yet described in the clinical literature. One salient new piece of transference emerged from a theme Lisa introduced in the earliest stages of treatment and returned to throughout. She would beseechingly ask me, “Who are you?” and “What is your name, I don’t remember?” She repeatedly insisted, “I don’t even know you.” In this powerful repetitive enactment, Lisa seemed to view me as a stranger who had inexplicably entered her life. Once, as I touched her shoulder while we walked together to another room, she recoiled and ordered, “Don’t touch me, only people in my family touch me, you’re a stranger!” (see Hughes, 1997, where the adoptee insisted that the therapist ask permission before touching him). This confusion about my identity continued throughout Lisa’s treatment, when she continued to insist, “I don’t even know you!” In such moments, we were truly “strangers in a strange room,” with all traces of our relational history momentarily erased.

Countertransferential feelings of rejection and abandonment sometimes followed Lisa’s retreats, informing me of the kind of loneliness and disconnectedness that must accompany the experience of being handed over at a pivotal point in life with no tools to comprehend the experience. On other occasions, I could also feel invisible as a result of Lisa’s repeated insistences that I was a stranger who was having no impact on her. Reeves (1971) briefly describes a similar experience of remoteness in working with adoptees, which is “like the feeling of being engulfed with another person in a blanket of fog” (p. 160). I felt lacking in identity and presence, as if my words were falling on deaf ears.

We may consider this transference-countertransference pattern as a projection of Lisa’s fundamental anxiety and ungroundedness about who she is in the world and how she arrived. Her insistence that I am a stranger may also reenact her ignorance of her unknown mother, her belief that her mother could be anyone, including me, and her tentativeness about everyone in her world.

Lisa’s insistence that I was a stranger also served to deny a growing closeness between us. Maintaining a relational gulf posed less of a threat to her relationship with her mother, minimized fears of my retaliation, maintained her identity as an outsider, and helped Lisa maintain the status quo. How could she be expected to discuss an issue as profoundly intimate and disturbing as her adoption with someone she didn’t really know? Countertransferentially, even when experiencing myself as having a deep connection with Lisa, it was inevitably interrupted so abruptly and profoundly that I often doubted its initial efficacy. This was dramatically experienced in one session, when Lisa initiated the game of Hangman. Coded game messages began as mundane references to daily life but quickly evolved into communications about deep feelings of what had been missing from her life and what she needed to be healed: “I love you.” “Do you love me?” “You make me happy.” “Love is what I need from you.” I responded with messages that confirmed our mutually special feelings for one another, deeply touched by what was evolving. However, in one vignette, I unwittingly guessed Lisa’s Hangman code too quickly. She became instantly infuriated and withdrew into isolation, refusing to communicate for the remainder of the session. I was caught by surprise and unsettled by Lisa’s reaction as it was not at all apparent to me how I had triggered it. Although I had several broad hypotheses about what precipitated this rupture (poor timing on my part, Lisa’s fear of intimacy and intense feelings for me), I could not use any of them as Lisa shut down completely, refusing to meet any of my efforts to understand and repair this rift (see Bartram, 2003, where the adoptee was unable to tolerate any comment by the analyst that reflected on what was occurring in the room). Weeks later, she could only broadly allude to how I had hurt her. The tenuousness and variability of my connection with Lisa caused me to doubt my continuing viability in her eyes and, ultimately, to feel like an ineffectual failure. This state helped me better understand Lisa’s experiences of powerlessness and ineffectualness in her world, where all efforts to establish herself as a viable agent remained unrealized.

Such persistent characterizations by the patient of estrangement in the therapeutic relationship, and the ensuing countertransferential feelings of invisibleness and ineffectiveness, provide a potentially useful entrée into the adoptee’s world. We propose that relevant issues associated with feelings of ungroundedness, powerlessness, and ineffectualness in therapist or patient include the fact that the adoptee was uprooted and shifted from adult to adult as a near-anonymous object.

In a related transference, Lisa sometimes revealed her view of me as someone who was different and alien from herself. She would enumerate many areas of our differences, neglecting other things we had in common. “You don’t celebrate Christmas like I do,” “You’re Jewish, I’m not,” and “You’re white, unlike me.” Countertransferentially, I felt helpless in bridging the gulf she felt compelled to inject between us. Her preoccupation with uncovering our differences is reminiscent of Nickman’s (1985) assertion that adoptees who are of different origins are unconsciously directed toward distinguishing themselves particularly from their adoptive parents in an intense pursuit of their own identity. Persistent attempts by adoptees to focus on differences between themselves and the therapist, and the accompanying feelings of distance and resignation in the therapist, may provide a useful therapeutic springboard to adoptees’ concerns and discomfort about their unknown origins.

Another new transferential pattern involved Lisa’s perception that I was the mother of myriad children whom I actively favored over her (see Goldberg, 2000, discussing how the adoptee may feel tortured by exclusion from the therapist’s real family to a degree never felt by the nonadoptee). Lisa’s anxieties about sibling competition were deepened by her loss of multiple foster siblings selected “over her” for adoption and the presence of an adoptive brother who was a favored biological child. Lisa’s concerns were reflected in a persistent return to references, questions, and comparisons with other children’s drawings on my office walls, along with intense curiosity about the identity of those children and of my biological children. Her preoccupation with sibling rivalry and her rejected child status surpassed that usually seen among children in treatment. Such a transferential stance may encapsulate Lisa’s anxiety about (a) being a second-class citizen because she is adopted and (b) the impending rejection owing to such second-class status. It may thus be useful to explore the adoptee’s preoccupation with sibling issues in treatment against the backdrop of her insecure identity within and beyond her adoptive family.

Lisa’s hypervigilance was another new dynamic in this case. Lisa often studied my expression from moment to moment and came within inches of my face to inspect me, creating extreme countertransferential self-consciousness and discomfort at this intrusion into what I considered my personal space. She searched my expression for signs of my real feelings, asking, “Are you mad?” or “Why are you always smiling?” Lisa might have been worried that I could disappear at a moment’s notice (like her biological mother) and was working overtime to “keep an eye on me.” As stated elsewhere, she also believed that I stood in constant judgment of her. Her hypervigilance can thus be thought of as her early warning system against impending rejection. Finally, Lisa’s searching stare seemed to embody her experience of me (and potentially herself) as not completely whole, real, or graspable. She seemed to stare and study in an effort to put me all together. Thus, hypervigilance and its accompanying transference-countertransference manifestations may provide a gateway to the adoptee’s unresolved issues of early abandonment and rejection along with related difficulties in seeing self and others in an integrated way.

Another new pattern observed in the work with Lisa was her tendency to offer and then retract salient pieces of information about her life. She communicated information about her adoptive mother’s emotional abuse and Adele’s boyfriend’s dysfunctionality, only to deny and withdraw it. She explained that I was not part of the family and should not be told. She fluctuated about whether I could discuss this disturbing information with Adele, initially giving permission but inevitably retracting it for fear of betrayal by me and revenge from her mother. At some level, she desperately wanted to share her secrets with someone safe but ultimately found it too terrifying to complete the process.

This pattern seemed to contain a transferential view of me as someone who (a) threatened her relationship with her mother, (b) could undo the safety of the status quo, and (c) could betray or reject her with this inflammatory information. This perspective was intensified by Lisa’s mother, who was visibly unsettled by our developing alliance and preached values such as independence and impenetrability, which conflicted with Lisa’s experience of the therapeutic relationship. Accordingly, Lisa withdrew her disclosures about family pathology, realigned with her mother to avoid internal conflict, and commanded, “Don’t say anything about what we talked about, look happy!” Countertransferentially, I felt paralyzed at such times between the temptation to ignore crucial data to ensure Lisa’s safety and the therapeutic mission of unearthing these deeply disturbing developments. Thus, the adoptee’s patterns of offering and retracting affectively rich information paired with countertransferential feelings of confusion and paralysis are noteworthy. They may provide a signal to explore the adoptee’s fear that therapy might further jeopardize her already tentative position within the adoptive family.

Another new trend emerging in this case was Lisa’s pattern of enacting conflicts around death and dying. In treatment, Lisa elaborately described her grandmother’s funeral in the Caribbean, which she would soon be attending, only to later tell me that this was all a ruse. After expressing deep affection for me on another occasion, she asked whether I would bother to attend her funeral should she die. In newly developing projective play, Lisa was eating food with her family at a fun-filled party that suddenly and shockingly turned into a funeral.

In these moments, when Lisa seemed to be working through some of the most fundamental losses of her life, she was successfully using me as a new and safe object in her life to accompany her through this painstaking process. Greenberg (1991) discusses the idea of the therapist as a new and safe transferential object, stating, “First, the analyst works to facilitate the feeling of safety that allows the observing self to tolerate more … of early experience that has been warded off” (p. 209). The analyst thus differentiates herself from the patient’s dangerous objects of early experience and establishes herself as someone new, though the analyst should not be too safe, as this can inhibit the emergence of negative transference. Greenberg advocates “a kind of balance between the patient’s experience of the analyst as a safe and as a dangerous presence” (p. 217). A similar portrayal of the therapist is offered in Frankiel (1993), where the therapist positions herself as an “ally” (p. 353) reliably present through the patient’s pain without attacking or interfering with her ability to work through her history of early separation or traumatic loss (see also Downey, 2002, discussing the analyst who sits with the patient as when one “sits shiva,” thereby reactivating the patient’s mourning process).

As this working through began to take hold for Lisa, a new feeling was palpable in the treatment room. She seemed more and more tolerable to herself, even when experiencing intense affects. She began to view me differently as well. Phrases like “I’m scared of you,” “I think I’m beginning to like you,” and “I want to come back and see you” slowly emerged, evoking parallel countertransferential feelings of therapeutic efficacy and overall goodness. At this time, Lisa also began to engage in projective play for the first time, whereas previously, she was rarely, if ever, able to leave the safety and structure of board games. Nickman (1996b) and others (Derdeyn & Graves, 1998; Treacher, 2000) remind us of the importance of helping adoptees experience in consciousness their sadness and grief about absent birth parents and relationships that never were and never will be. Moments when the adoptee is able to experience the therapist as new and safe, and the therapist feels aligned with the fundamental therapeutic task, are essential steps in the adoptee’s journey of mourning a family that was never known and uncovering a new self in the process.


Adoptees who seek psychotherapy typically have difficulty acknowledging and discussing issues related to adoption in an elaborated way (Nickman, 1996a). As such, any tools that might further the clinician’s ability to stimulate dialogue about adoption would be quite valuable. In this chapter, we contend that transference and countertransference enactments provide such a tool since they often incorporate adoption-related conflicts, providing a rich means of accessing these otherwise warded-off issues. We have discussed transference and countertransference developments with adoptees from several angles. Initially, we discussed transferential patterns presented in the literature, noting that while adoptees’ behavior/ characterological patterns have been extensively described, this kind of elaboration has not extended to transferential patterns. Where only behavioral descriptions exist, we have proposed ways in which they may manifest within the therapeutic relationship.

Thereafter, we presented portions of a treatment with a 9-year-old adopted girl, incorporating patterns discussed in the literature and proposing new transference-countertransference constellations. We recognize that it would be oversimplifying the complexities of the clinical picture to suggest that a given transference-countertransference development would always signify a specific adoption conflict. On the contrary, we mean to posit potential relationships between particular transference-countertransference events and possible adoption concerns.

Given that transference and countertransference configurations are invaluable aids in accessing patients’ warded-off feelings about adoption, we recommend continuing research into (a) transference-countertransference manifestations that arise during psychotherapy with adopted patients; (b) the frequency with which these manifestations appear; (c) the particular circumstances of the adoption situations in which these manifestations arise; (d) the adoptee’s dynamics and conflicts that are potentially symbolized by particular transference and countertransference patterns; and (e) whether accessing and exploring adoption issues are consistently enhanced through a focus on transference and countertransference issues. The inventory presented in this chapter can help clinicians begin to experience transference and countertransference within an adoption context, thereby enhancing their ability to generate dialogue about an otherwise unmentioned and unmentionable subject.

Best Practice Ideas

It is essential that the therapist who works with adoptees (a) closely monitor the patient’s transferential reactions as they yield invaluable clues to access and understand her feelings about being adopted; (b) closely monitor his or her own countertransference reactions as they too yield invaluable clues to access and understand the patient’s feelings about being adopted; and (c) have a detailed understanding of the core issues with which adoptees typically struggle, to help the therapist view transference and countertransference reactions through the lens of the adoptee’s central concerns.

Reflection Questions

  1. Did the therapist’s awareness of this patient’s transferential reactions facilitate the exploration of her adoption issues? What aspects of the adoption experience were exposed? How else might these issues be uncovered?
  2. What additional clues might there have been in the transference and countertransference patterns of this therapeutic dyad that might have furthered the work on adoption in this case?
  3. How did you feel about the way problems with the patient’s mother were managed by the therapist, and how might you have handled them differently?
  4. How successful was the therapy in helping the patient contact her feelings about having been adopted?
  5. What are some of the common themes that emerge during psychotherapy with adoptees?