'Full of insight and reflection'.

Simmonds, John

Understanding Adoption: Clinical work with adults, children and parents Kathleen Hushion, Susan B Sherman and Diana Siskind (eds) Jason Aronson 2006 259 pages US$26.95

Adoption support has become a prominent issue in adoption practice, reinforced by its new legislative framework and the wide-ranging needs of those affected by adoption. It is also a subject that stirs up controversy, from users who struggle to identify services that are effective and adoption sensitive, to agencies equally concerned with both effectiveness and cost, and clinicians and researchers who debate what effective interventions are and should look like. In part, this last issue depends heavily on the practice and clinical frameworks in use, about which there are often strongly held views.

This book is strongly in the psychoanalytic and psychodynamic tradition, with all the contributors practitioners based in the USA. The themes that run throughout are loss, change, trauma, identity and the dynamic interchange between children, adoptive parents and birth parents around these powerful emotive issues. One theme that will resonate with those familiar with the Coram adoption studies in the UK is the impact of adopters' unresolved loss or trauma on their capacity to hold a child's anxieties and preoccupations sensitively in mind. Detailed clinical examples give insight into the way these issues affect the child's development, the adopter's views about the child and the adoption, and the resolution of these issues through therapeutic intervention. It is particularly helpful that these examples are drawn from a wide range of placement types typical of the US adoption landscape--babies placed from birth, international adoptions and children placed from foster care (complex adoptions). The children range in age from latency through to adolescents and adulthood. The impact and consequences on birth mothers are an important part of this.

Nobody could read this book without recognising and being affected by the intense emotional and behavioural struggles in many adoptions and the value of adoption-sensitive services in addressing these. It is important not to infer that all adoptions run into such serious difficulties and the book helpfully reminds us of the crucial need to take a balanced approach, neither overly preoccupied, nor unhelpfully dismissive, with adoption as symptomatic in itself. The clinical framework underpinning this book will not satisfy everybody either; hard evidence for the effectiveness of psychodynamic approaches is difficult to construct and hard to come by. And some will frustratingly ask whether such sensitive clinicians and services exist in their locality. Nonetheless, this is a book full of insight and reflection, real people and commitment. What more could one ask?

John Simmonds is Director of Policy Research and Development, BAAF