[The adoption problem in treatment of a 15-year-old boy]

In a brief review of the literature, the typical psychological problems associated with adoption are summarized. There is a marked discrepancy between the positive prognosis for adoption seen in the prospective studies on the one hand and the often dubious outcome of clinical treatment on the other. Our case study suggests that the apparently ubiquitous "issue of adoption" needs other co-factors to become a "pathology of adoption". Clinical experience underlines the difficulty in and importance of finding an adequate therapeutic setting for severely disturbed adolescent adoptees: outpatient treatment is sometimes overtaxed by the tendency of the family to reject the adoptee and the noisy often dissocial behaviour of the adoptee, but an inpatient setting may repeat the trauma of separation, and often there is not a sufficient period of time for treatment. In this "therapeutic dilemma" where there is a high risk of personal relationships we see the need for a better connection between inpatient and outpatient treatment: The inpatient therapist should be able to continue treatment on an outpatient basis after the patient is discharged.