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Copyright 1994 by Phillips Graduate Institute. All rights reserved. No part of this document may be reproduced in any form--except for brief quotations (not to exceed 500 words) in any review or professional work--without permission in writing from the publishers. Davidson, Michelene K. Healing the Birthmother's Silent Sorrow. Progress: Family Systems Resarch and Therapy, 1994, Volume 3, (pp. 69-89). Encino, CA : Phillips Graduate Institute. Eight women who surrendered their children for adoption more than ten years ago were interviewed to determine how birthmothers' relinquishment experiences have affected their relationships with themselves and with the significant people in their lives. Through analysis of the interviews, common themes of unresolved issues were identified. The results indicated that birthmothers still struggle with low self-esteem, reproduction and parenting issues, failed relationships, and dreams of reuniting with their lost children. The findings suggest that the loss extends further than indicated in the existing literature and may encompass more issues such as alcoholism and physical and sexual abuse in the families of origin. Treatment strategies and techniques for helping people heal unresolved grief were researched and a treatment plan is presented. When a woman discovers she is pregnant, she naturally begins a process of life-altering change. If the pregnancy is unplanned, not only is the woman's life altered, but the negative repercussions are great. These include dealing with the experience of loss and trauma, affecting the woman's relationship with herself, her family, her community, her school or work, her health, and her social as well as her spiritual life (Panuthos and Romeo, 1984; Sorosky, Baran, Pannor, 1984; Stiffler, 1991). She will eventually be forced to address the serious issues of her circumstances and to choose among potentially painful and difficult alternatives (Arms, 1983). One of the traditionally accepted alternatives for an unwanted pregnancy is adoption. Adoption has a profound and permanent effect on the lives of all members of the adoption triad: the birthparents, the adoptee, and the adoptive parents (Arms, 1990; 1984; Berman & Bufferd, 1986; Sorosky, et al). Most of their issues have to do with loss that is often denied or suppressed (Chapman, 1986). Frequently adoption issues go untreated in the therapy room because many therapists are unaware of the farreaching impact it has made on clients who are part of the adoption triad (Rosenberg, 1992). Unfortunately, the failure to identify adoption as an important issue eliminates the possibility of addressing therapeutic issues resulting from adoption, thus maintaining the secrets and keeping hidden and unresolved the losses suffered (Silverman, 1981). This omission increases the likelihood that the unhealed wounds and the behaviors that surround them will be passed on to the next generations, to perhaps repeat the cycle once again (Rosenberg, 1992). This study focuses on the birthmother, the woman who chooses to resolve her pregnancy dilemma by relinquishing her child to someone else to parent. Our culture has not only failed to provide rituals which support the birthmother in grieving the losses she suffers, it hasn't even given her permission to grieve (Roles, 1989). Thus, many women who have relinquished a child have suffered alone, feeling guilty, ashamed, and unworthy of consolation and healing (Gediman & Brown, 1991; Panuthos & Romeo, 1984). This study explores the birthmother's current perceptions of how her choice to relinquish, has affected her relationships with herself and with others. It also explores whether or not she feels resolved about the losses she has suffered; and when she doesn't feel resolved, it looks at how her sorrow might still be

currently manifested in her life. Existing studies of the birthmother confirm overwhelmingly that there are long-enduring effects of having experienced the loss of a child to adoption (Berman & Bufferd, 1986; Chapman, 1986; Deykin, Campbell & Patti, 1984; Gediman, 1991; Roles, 1989; Rosenberg, 1992; Silverman, 1981; Sorosky, Baran & Pannor, 1984; Stiffler, 1991) One of the pioneer studies about the post-adoption experience of the birthmother was conducted by Deykin, Campbell and Patti (1984). They determined that those unhealed loses manifested themselves in areas of troubled, failed or multiple marriages, infertility, struggles with parenting, and low selfworth. Stiffler (1991) suggests the birthmother may experience emotional numbness, a sense of powerlessness and emptiness, and may suffer from low self-esteem. She can be wrought with feelings of guilt, shame, and anger, and may suffer from anxiety, depression, agoraphobia, eating disorders, or chemical dependency (Stiffler, 1991). She may have an unconscious fear of sex and may experience discomfort being around children (Silverman, 1981). If she has subsequent children, she may become either overprotective and possessive or perfectionistic and distant, feeling she is inadequate at being a mother (Silverman, 1981). Whatever her circumstances, she has neither forgotten, nor stopped loving her child, and her grieving is a potentially life-long process (Stiffler, 1991). One study estimates that one out of fifty women living in the Western World has chosen to relinquish her child for adoption (Stiffler, 1991). Because of the social stigma attached to relinquishing a child, it has been accepted practice to encourage the birthmother to bury the experience and quickly "get on with her life" (Gediman, 1991). The general agreement among those who offer suggestions for healing is to assist the birthmother to free herself from the secrecy with which she has lived, to validate her feelings and express her denied emotions, to create rituals for grieving, to develop new relationships with supportive people, to participate in support groups with other birthmothers, and, if she feels the need after her healing has begun, to search for her child (Gediman & Brown, 1991; Panuthos & Romeo, 1984; Roles, 1989; Silverman, 1981; Stiffler, 1991). Existing information about how deeply the birthmother has been affected by the relinquishment of her child will help society become more aware about how to deal with adoption in the future. Since the literature falls short of providing suggestions for services for birthmothers who want to heal, the next step is to raise the consciousness among the mental health community about her needs and create services for her recovery. METHODOLOGY In an attempt to understand the unresolved issues which might still be affecting the birthmother's relationships with herself and with significant people in her life, eight birthmothers, who relinquished their children ten or more years ago, were asked about their pain, how their relationships have been affected, and what they need in order to heal. The participants were recruited through newspaper ads and through personal invitation extended to friends and acquaintances of the researcher. An information form asking about demographic factors and adoption experience was obtained from each subject who then participated in a one-to-two hour, audio-taped interview with the researcher.

Patterns uncovered in the data collected from the information forms and from the interviews were used to develop theoretical perspectives on treatments for the birthmother's long-term effects of relinquishment and to generate hypotheses for future research. RESULTS The women interviewed are well-educated and have their own incomes. All are Caucasian. Six have been divorced and seven were in their teens or early twenties when they relinquished their children. Among the eight birthmothers there had been twenty-six pregnancies and four step children. Five children were lost as a result of divorce and five were lost due to miscarriage. Nine children were lost as a result of surrender for adoption, one of which was regained three years after the adoption, only to be lost again through divorce. One mother had five pregnancies, yet no children of her own. Instead she helped to raise her husband's four children. Six of the women have either kept touch with the adoption agency and/or the adoptive parents, or have, with greater or lesser degrees of success, searched for their children. Three of the birthmothers have reunited with their adult children and have developed and maintain ongoing relationships with them. All expressed concern and care about their children. Case Studies of the Participants The following are case studies of the participants from the study. In order to preserve the participants' confidentiality, some names and details of their stories have been changed. Marty, a special events coordinator at a state university, now in her mid-forties, had her daughter when she was sixteen. She was painfully aware that her parents, who viewed her as their perfect, precious only child, were disillusioned and deeply hurt by her pregnancy. After the relinquishment, she never spoke about the "incident" again. However, throughout her adult years she thought constantly of her daughter. She would search through crowds, hoping to recognize one of the children she saw as her own. Marty experienced panic attacks and nightmares about children who were abused or killed or injured in automobile accidents, questioning how she would ever know if anything ever happened to her daughter. She never had another child. Finally, she searched for and reunited with her daughter. They have been developing a relationship based on the knowledge that they are two adults whose souls have been connected all their lives. "I would say that I didn't learn very much about myself as a result of the relinquishment until I found her; and then I learned a lot, and I am continuing to learn. I found a voice that I didn't know I had. I found myself. I learned about love. I learned about the prices we pay for allegiance to our secrets, the prices other people ask you to pay for their comfort." Marty today is a self-proclaimed radical and is active in the adoption movement, speaking out against the secrecy and misconceptions that have surrounded adoption, raising people's awareness about its effects, and working to reform the adoption system. She is currently attending school to earn a bachelor's degree. Jane, a fifty-five year old computer programmer, was 45 when she discovered she was pregnant again after having already raised three children, one of which was only fifteen and had just run away from

home, was very troubled and in psychotherapy trying to work it out. The other two children were not happy. Jane felt like she had failed as a mother. Her first pregnancy at age 24 had also been unplanned, but she had decided to marry and to keep this first child. Even though she loves her children very much and feels they have "turned out pretty well", she continues to question if it was the right decision, if she should ever have been a mother at all. "I always felt that I had ruined five lives -- my childrens', mine, and my husband's....I couldn't do anything for that child (the relinquished child)....I think I did the best thing for him. I feel good that he has a mother and a father who both wanted him." Jane continues to feel like her decision was the best one for her son's well-being, as well as her own and her other children's best interests. She expresses her concerns that her son is okay, sends him "good thoughts", and has made herself available through her records should he ever need to contact her. Valerie, a fifty-one year old marriage and family therapist, became pregnant when she was seventeen and went to a home for unwed mothers to have her daughter. After the delivery, she returned home and, at the advice of her parents and the adult "experts" involved, pretended nothing had ever happened. She went on to finish school, got married, raised two children and never mentioned her "incident" again for thirty years. Then she decided to search for her child and found, not only her daughter, but discovered she had a granddaughter as well. "It's like a piece of my soul was all scrunched up. Now it's back. There is energy I didn't know I had until I went through this process of talking about it....I have been dealing with the feelings that are there, the grief. A lot of things I thought I'd handled, I had forgotten, are surfacing now. It comes up in layers. Each time I talk about it, another layer of healing takes place." It has now been two years since Valerie found her daughter and began the process of integrating her existence into her life. She has been slowly and cautiously developing a strong and meaningful relationship and has begun to expand that relationship to include other family members as well. She is currently working on her doctorate degree in psychology and is an active participant in the adoption movement, speaking at conventions, conducting and participating in support groups, and sharing her experience with others. Annie, a fifty year old writer and appraiser of patchwork quilts, was raised in a physically, sexually, and mentally abusive home as a child. She escaped her abuse by accepting an offer of marriage at age seventeen. By age 21 she had three children in spite of her being extremely ill with a chronic kidney disease and no help from anyone to care for the children. She tried to commit suicide several times during the five years of her marriage. She feared she would somehow accidentally injure her children while trying to kill herself. She left her home, knowing she could not take her children with her. Her husband gained custody of the children and threatened if she ever tried to see them again he would have her arrested. Her mother's rage with her for leaving the children was so out of control that she became verbally abusive and violent. When Annie refused to return with her mother, the mother picked up a heavy ashtray and proceeded to bash in Annie's skull, creating a big cave in her head. "I can just remember driving down the highway and being so totally traumatized with blood running down my face, and feeling so ashamed and so absolutely terrible about myself, so terribly decimated, I never tried to see my children again."

Today, through working in therapy and self-help programs and by providing herself with an education and developing talents and skills, Annie has put together a meaningful and serene life for herself. She has come to terms with the abuse in her childhood, has developed a loving and supportive relationship with her boyfriend, and has re-established a respectful, though cautious, relationship with both her mother and her father. The one thing that remains an open wound is the loss of her children. She cherishes the memory of them and longs to know how they are, what they have become, and to bring them back into her life. Up until recently, she has felt paralyzed by fear of rejection and recrimination to make any attempts to find them. However, since participating in this research project, she has enlisted the cooperation of her parents to provide her with information about her children, has educated herself on how to search for lost love-ones, and has successfully made contact with her daughter. Sheila, a twenty-nine year old housewife, became pregnant when she was seventeen. Her parents did not like the father. He came from an alcoholic family and was himself an alcoholic. Sheila, too had begun drinking excessively. Her parents, she believes, were alcoholic, but did not admit to it. She stayed at home throughout her pregnancy and endured emotional, and sometimes even physical abuse from members of her entire family. For example, her sister was so angry with her about the turmoil the pregnancy had caused that she would punch her in the stomach as she passed her in the hallway. "They all took it (the pregnancy) very personally. And I was in no position to go tell my parents (when my sister would hit me) because they didn't care. I had to just take it kind of silently....I know it hurt people, but it wasn't intentional. The people that I felt closest to, I wasn't able to talk to at all--my grandfather and my parents." Sheila is comfortable with her decision to relinquish her child for adoption. She feels it was the most loving and responsible thing she could have done for him at the time. She thinks of him often, keeps herself informed as to how he is doing through the agency, and on Mother's Day and Father's Day she thinks of his mom and dad and feels good she made it possible for them to celebrate being parents. Lisa, a forty year old medical assistant, had her daughter when she was seventeen. Initially, she kept her to raise by herself with the help of the baby's grandmother. But by the time the baby was nine months old, Lisa's mother had convinced her that she, Lisa, was too young to raise a child and should relinquish the child to Lisa's mother, the baby's grandmother, for adoption. Lisa took her mother's advice and reluctantly relinquished her child and lived together with her as a sister instead of her mother. Two years later Lisa married and soon became pregnant again. This time she gave birth to a son. It was shortly after her son's birth that Lisa's husband, father of her son, but not of her daughter, convinced Lisa that they should take her daughter back and raise her with their son. The grandmother refused to give up the child, but Lisa and her husband won her back in a court battle because of a technicality in the law. All eight of the brothers and sisters took sides with the grandmother and turned against Lisa. For a few years Lisa enjoyed what seemed the ideal family life. However, the marriage began to fail and, eventually, ended in divorce. Lisa entered into another hotly contested court battle to be a mother, but this time, tragically lost custody of both of her children. She found herself alone, without a family. "I wish I could go back to my mom and have her be my friend, but I don't think that could happen. Even though we both have reasons why we did what we did, it doesn't solve the pain the hurt and the

anger and the animosity....Now I found out that my daughter was molested by her (step) father and her (step) grandfather. I'm looking at my loss through her loss. So it's like a continuous thing, and I think somewhere it has to end." Lisa has since reunited with her brothers and sisters as well as her mother. Through frequent visitation, she continued a long distance relationship with her children throughout their growing years. Now her daughter lives nearby and has a daughter of her own that Lisa helps care for. Kathy, a forty-six year old secretary, not only relinquished her first daughter, but two years later, at age seventeen, found she was pregnant again and relinquished that daughter to adoption as well. Her mother had been abusive and rejecting during the first pregnancy, but the second time she became violently abusive. She signed custody of Kathy over to the state. Her father was accepting and sympathetic of her but could not stand up to his domineering wife in order to protect Kathy. He quietly offered his love and his support. After her second relinquishment, she never returned home again. She began a pattern of abusive relationships with one alcoholic man after another. She never had any other children. Finally, she sought help in therapy and support groups for birthmothers. "That's when things really broke loose for me. I was in a room full of people who were just like me. What mattered was that we weren't invisible any more." Kathy has stopped her pattern of being in relationships with abusive men. She has a long-term, loving and nurturing relationship with a man who helped her search for her daughters. She has since located both, one of whom is reluctant to meet her. Kathy is patient and is willing to wait for her daughter's own sense of timing and need to reunite. Meanwhile, Kathy is enjoying the development of a relationship with her younger daughter. "She calls me mom when she's in a playful mood; and she calls me Kathy when she's in a more serious mood; and that's fine. I just am glad when she calls me." Linda, a forty-six year old registered nurse, had an abusive and neglectful relationship with her alcoholic mother who reacted intolerantly to Linda's pregnancy. Her father had died when she was nine and her sister, who was struggling in her marriage to an alcoholic, was unable to offer any help. Linda moved to the city to stay with a friend's parents until, at the age of nineteen, she gave birth to and relinquished her daughter. When it was all over, she went back to nursing school and went on with her life, never again mentioning what had happened. In spite of having had four other pregnancies, she never had any children of her own. Instead, she married a man who had children she helped to raise. She loves her husband's children very much, but raising them did not fill the emptiness as she had hoped it would. "There is still a part of me that is ashamed, and that just aches....My fantasy has always been that one day my daughter will come....I don't know whether this pain would be alleviated if I were more assertive about searching for her or what the repercussions on the rest of my life would be. But it's real hard to think that finding her would be okay--that my need to know is more important than her need to decide for herself (about having me enter her life)." Linda longs to connect with her daughter. She has done some searching herself; and, although she has not yet been successful at finding her, she has registered her name with a national registry. She remembers when she signed her relinquishment papers -- being told by the social worker that she had relinquished all rights to know anything about her daughter, that she was to forget her, that it would be a terrible thing if she ever intruded into her daughter's life and upset her family. Meanwhile, Linda

continues to struggle with the conflict between that advice and her longing to have her daughter be a part of her life. Summary of the Themes One objective of the interviews was to identify factors associated with birthmothers' unresolved grief resulting from the relinquishment of their children for adoption. Another objective was to describe how these factors might be negatively affecting their relationships with themselves and with the significant people in their lives. Discussed below are themes related to family of origin issues, relinquishment experience, self regard, marriage and intimate relationships, fertility and sexuality, parenting, and relationship with the relinquished child/ren. Family of Origin The remarkable themes regarding participants' families of origins were patterns of alcoholism, emotional and physical and sexual abuse, rejection, having jealous and domineering mothers, as well as quiet, passive, and yet sometimes supportive fathers. Most reported feeling the parenting they received was inadequate. "I was thinking how I never really knew mothering from my mother. She was never a close mother, and didn't teach me so many little things that mothers especially teach their daughters in an intuitive level--a sort of femaleness that a woman learns through her relationship with her mother". Their relationships with siblings and other extended family members tended to be distant. The illtimed pregnancies tended to shatter already fragile family structures, and emotional cut-off was prevalent in most of the families represented. Relinquishment Experience The mothers' reactions to their daughters' pregnancies and/or relinquishment experiences were, for the most part, rejecting, abusive, and sometimes violent. Two mothers tried to induce spontaneous abortion. The fathers tended to shun their daughters with silence. Siblings were not included in discussions about the pregnancies or relinquishments. The decision to relinquish was, in most cases, made by the birthmother's mother. The "care" they received from the medical and legal communities, from the adoption agencies, and from counselors were generally described in terms of lack of awareness of or concern for their needs, an attitude of coldness and scorn, being deceived about the placement of their children, and the insensitivity with which they were treated. "....And I remember going up to the nurse's station and saying 'I've changed my mind. I want to go see my child'....well, they could tell me no, and I was dirty. That's the word they used. You're off the OB floor so you're contaminated and you can't get back in. So that kind of reinforced the idea that I was dirty--unclean." Two of the women felt their experience had drawn them closer to their fathers. "He saw her (the baby) and thought she was real pretty, and told me, 'You did a good job, Kid'....If anything could have brought us closer together, that did. I knew that no matter what, he absolutely loved me. It was unconditional love". The two women who experienced their mothers as supportive before the pregnancy enjoyed that support throughout the pregnancy as well. Not surprisingly, these same two women are both currently well-grounded in their lives, have resolved many of their relinquishment issues, have both found their

surrendered children and incorporated them into their lives, and are vocal advocates of the adoption movement. Self Regard Four of the eight women interviewed admitted that they had, at one point in their lives, been suicidal. All felt their self-esteem had been damaged in their struggle with an untimely pregnancy, and all have sought help through therapy or clergy to sort out their lives. "I haven't totally ever given up. I've been suicidal, and I've been very depressed, but I haven't killed myself, have I?" Six felt they have raised their level of satisfactory functioning as a result of the work they have done. All expressed that there are still unresolved issues. Marriage and Intimate Relationships Not only is divorce a common theme among the women interviewed, but they also tend to have been in multiple, abusive relationships with alcoholic men. The ones who are in relationships now report that the current men in their lives are loving and supportive, but their relationships have been affected by the relinquishment. "He was upset because of the whole myth of damaged goods, but he decided he loved me anyway....But through the years, we never talked about it....So it was a secret....I have some residual feelings of anger about that and not just at him but at the whole patriarchy....some of it spilled over into some things in our relationship because I wasn't a whole person through those years." The ones who are not in relationships appear to be content with that decision. Fertility and Sexuality The theme of reproduction appears very much in the focus of these women's lives. There were a total of twenty-six pregnancies and four step children. All eight women have had multiple pregnancies, many that ended in miscarriage or abortion, in addition to their relinquishment pregnancies. Some were simply unable to conceive and/or carry to term another child which represented an additional loss to them. "And having no children was like having nothing to keep me any place. After I lost the ability to have children, I used to fantasize about being able to have an implanted womb and being able to get pregnant." Two women reported having had hysterectomies during their child bearing years. Four of the women described incest experiences in their childhoods and six described sexual promiscuity. All but one of the women have had multiple sex partners, some of whom were abusive. Parenting All but one birthmother had some parenting experience. Five described their parenting experience as a struggle, or felt they were not or would not have been good parents. Three had the opportunity to parent their children for only a short time before losing them. All considered themselves mothers. Two women had no children of their own, and yet helped to parent someone else's children. Three women described themselves as good mothers or someone who would have been a good mother. Two of these women were the ones who described their relationships with their own mothers as supportive and loving. Relationship with Relinquished Child/ren All eight birthmothers reported having frequent and ongoing thoughts about their relinquished children throughout their lives. "Of course, around her

birthday or other significant times, I would get very sad and very depressed. Sometimes I would just be inconsolable, but I wouldn't talk about it." Six of the eight birthmothers changed their minds later in their lives about having relinquished the rights to include their children in their lives. As a consequence, four of them have searched for and reunited with their children and are developing ongoing relationships with them. Two women entertain fantasies of reuniting with their lost children, but have not yet overcome their fears of what consequences search and reunion might have on their own lives, the lives of the members of their families, and the lives of the children they have not forgotten. Since this project was completed, one of these two women has reunited with one of her three children. One mother has found one of her daughters, but has been disappointed in the response to her efforts to establish a relationship. Two birthmothers express love and concern for their children, currently appear satisfied with the status of their adoption decision, and yet express being open to being found. In summary, the birthmothers who participated in the study generally came from families who were alcoholic, abusive and rejecting. The relinquishment experience was traumatic and left damaging scars on battered self-esteems. Since the relinquishment experience, the birthmothers have suffered divorce and many failed relationships. They have struggled with reproduction and parenting issues and have dreamed of reuniting with their lost children. DISCUSSION AND CONCLUSIONS The findings of this research are consistent with the information reviewed from existing literature describing the birthmother's unresolved grief, but, for these women at least, also suggest that the trauma may be more severe than suggested and may encompass more issues such as alcoholism and physical and sexual abuse in the families of origin. Of course, the qualitative nature of the study suggests caution in generalizing the findings beyond the sample study. The birthmother's primary source of pain has been in the area of loss. She has not only suffered the loss of her child/ren, but the loss of her sense of wholeness, her sense of control over her life, and loss of self-esteem. In some cases she has lost a home or has lost or suffered damaged relationships with members of her family. Often she has lost identification with her mother as a role model. She has suffered loss of being accepted by society and loss of her adolescence, as well as loss of her sense of trust and self-worth. This magnitude of loss is, to say the least, difficult for her to overcome. Sometimes the best a birthmother can do is to remain in denial and numbness for the rest of her adult life, unconsciously encumbered by her silent sorrow. For those who seek help, it is up to the mental health community to give them the permission and tools for grieving that they have long been denied. IMPLICATIONS AND RECOMMENDATIONS Because of society's unawareness of and insensitivity to the birthmother's losses, she has kept her relinquishment experience a secret and still suffers from the effects of those losses. It appears important in the field of marriage and family counseling that therapists include adoption and unplanned pregnancy issues in assessment of clients during intakes and use this information when working with families as well as with individual clients.

Future research may explore the possible correlation between alcoholism and physical and/or sexual abuse in the birthmother's family of origin and the severity of her symptoms of unresolved grief. Another topic not addressed adequately in this study and needing further exploration is the extent to which the birthmother's sexuality and fertility issues have been complicated or impaired because of her relinquishment experience. Suggested Treatment Program Given the complexity of the birthmother's needs, a three part treatment plan is recommended for longterm, thorough healing. The plan includes individual counseling, an experiential group workshop, and a three-phase support group system. Individual counseling is recommended as the first step in the healing process. Since self-esteem has been, in many cases, shattered, it will be especially helpful to provide the birthmother with one-on-one attention in which she can tell her story and be heard without judgement, have her feelings validated as normal, and begin to release her denied and suppressed emotions in a safe atmosphere. Construction of a genogram is recommended in order to assist her to bring up memories, set them within time frames, and observe any multi-generational patterns that might exist in her family. This also is the time to assess for and deal with any other crises that are common among birthmothers, including possibly playing another role in the adoption triangle such as also being an adoptee or adoptive parent. Other areas to explore are issues related to divorce or relationship discord, parent/child difficulties, fertility or sexual issues, suicidal ideation, substance abuse, depression, anxiety or eating disorders, guilt, hidden anger, and low self-esteem. Part of the therapist's work at this step is to teach the birthmother self care, and to validate her sense of her own goodness and humanity, her inner wisdom, her own instinctive drive towards health, and her belief that healing can truly take place. This step is the beginning work, to break the silence about her secret and to raise her level of self esteem. The goal is to lay a foundation for her to feel comfortable working in a group with other birthmothers and to share her experience with other people in her life. A Workshop for Birthmothers is the second step of the treatment plan. In the workshop, the birthmother has the opportunity to hear informative material about relinquishment, adoption, and losses which result from that experience. She is given resource materials for additional literature and support services and learns about ways in which it is possible to heal. During the workshop, video tapes about adoption and experiential exercises and meditations are recommended. Both the videos and the exercises should help the birthmother recall the details of her experience and assist her to get in touch with the feelings associated with it. An especially important aspect of this stage of treatment is to give the birthmothers an opportunity to share their experiences with each other. It also provides an environment in which each birthmother can form new relationships within the adoption community and learn to accept support from others. It is during the process of the workshop that the birthmother can take responsibility and be validated for her decision to relinquish, and re-evaluate her suffering as an opportunity for reflection and growth. The last task of the workshop is to form "family" support groups which are designed to meet weekly for the six to twelve months.

Support groups comprise an important ongoing element in the birthmother's healing process. A support group with other birthmothers is the third step in the treatment program. This final step is broken down into three phases with different goals describing each of the phases, including: affiliation, catharsis, and skill building; search and support; and, finally, reunion support. During the initial phase, it is recommended that the group be facilitated by a trained therapist. The "Birthmother's Worksheets" (Roles, 1989) can be used as a vehicle for recalling memories and feelings in a semi-structured pattern that allows the members of the group to work at their own individual pace and yet keep the group focused on the goals of therapy. The worksheets are divided into five different categories: pregnancy and birth experience, decision-making, going home from the hospital, grief, and self-esteem. Topics can be presented and worked on as the group is ready to move along. While working on the worksheets, group members have an opportunity to learn about group process. In the support group the birthmother has the opportunity to tell her story over and over again, for as many times as she needs, to acknowledge and validate her life-long bond to the child she relinquished, and to accept the fact that the loss has made a permanent impact on her life and her sense of self. By sharing and interacting with each other and accepting each other, participants finally have the opportunity to give themselves and each other permission to grieve. Part of the work in the "family" group is to create rituals for their grieving process and to further develop life skills such as communication, assertiveness, and boundary setting. Additionally, the expression of feelings and emotions through creative talents such as painting, journaling, music, poetry, dance, and crafts should be encouraged. After memories and feelings about the actual birth and relinquishment have been addressed, it is recommended that inner child work be done to continue healing and raising self-esteem, and in order to learn to become more self-accepting. Again, this work should be done with a trained therapist facilitating the group. Use of one of the existing inner-child workbooks as a guide is recommended. Once this work is completed, the birthmother may want to consider the process of search, which leads to phase two of the group work. In phase two, the birthmother has healed herself enough that she can begin to think about searching for her child. The birthmother is normally cautioned to resist beginning a search before this phase of treatment because the groundwork for success has not yet been laid. This groundwork includes education about the needs and losses of the adoptee and the adoptive parents and how to insure dignity and respect for all members of the triad, as well as their families. There are excellent organized support groups and search consultants throughout the United States (see Resources for Birthmothers) that offer valuable information, instruction, and support in searching for missing loved-ones. The final phase takes place after reunion. Once contact and new relationships have been formed, many birth parents, adoptees, and adoptive parents feel a need to sort through intense feelings, behaviors, and emotions. There are organized support groups designed to help the members of the adoption triad deal with these issues as well. Continued participation in support groups is encouraged. RESOURCES FOR BIRTHMOTHER ISSUES BOOKS Arms, Suzanne (1983). To love and let go. New York, Aldred Knopf. Arms, Suzanne (1990). Adoption: a handful of hope. New York, Aldred Knopf.

Bowlby, John. (1980). Loss. New York: Basic Books. Campbell, Lee (1979). Understanding the birthparent. Concerned United Birthparents. Colgrove, M.; Bloomfield, Harold H.; and McWilliams, P. (1976). How to survive the loss of a love. New York: Bantam. Fisher, Florence. (1973). The search for anna fisher. New York: Fawcett Crest Books. Gediman, Judith S. and Brown, Linda P. (1991). Birth bond: reunions between birthparents and adoptees-- what happens after... Far Hills, NJ: New Horizon Press. Hayford, J. (1986). I'll hold you in heaven. Healing and hope for the parent who has lost a child. Ventura, CA: Regal Books. Ingalls, K. (1984). Living mistakes: mothers who consented to adoption. Winchester, MA: Allen & Unwin. Krauss, P. and Goldfischer, M. (1988). Why me? Coping with grief, loss and change. New York: Bantam Books. Kubler-Ross, E. (1975). On death and dying. New York: MacMillan. Lifton, Betty Jean. (1989) (rev. ed.). Lost and Found. New York: Harper and Row. Monserrat, C.; Lindsay, J. (1989). Adoption awareness, a guide for teachers, nurses, counselors, and caring others. Buena Park: Morning Glory Press. Musser, Sandra (1979). I would have searched forever. Cape Coral, Fl: Jan Publications, a Division of ATM, Inc. Musser, Sandra (1979). What kind of love is this? Cape Coral, Fl: Jan Publications, a Division of ATM, Inc. Panuthos, C. and Romeo, C. (1984). Ended beginnings: healing childbearing losses. New York: Bergin and Garvey. Roles, P. (1989). Facing teenage pregnancy. A handbook for the pregnant teen. Washington, DC: Child Welfare League of America. Roles, P. (1989). Saying goodbye to a baby; volume I- the birth parents' guide to loss and grief in adoption. Washington, DC: Child Welfare League of America. Roles, P. (1989). Saying goodbye to a baby; volume II--the birth parents' guide to loss and grief in adoption. Washington, DC: Child Welfare League of America. Rosenberg, E. (1992). The adoption life cycle. New York: The Free Press, A Division of Macmillan, Inc. Schaefer, C. (1991). The other mother. New York: Soho Press, Inc. Silber, Kathleen; Speedlin, Phyllis (1983). Dear birthmother. San Antonio, TX: Corona Publishing Co. Silverman, P. (1981). "The grief of the birthmother" Helping women cope with grief. Beverly Hills, CA: Sage Publications. Sorosky, A.; Baran, A.; Pannor, R. (1984) (rev.ed.). The adoption triangle. New York: Doubleday. Viorst, J. (1986). Necessary losses. New York: Fawcett Gold Medal. Walsh, F. and McGoldrick, M. (1991). Living beyond loss. New York: W. W. Norton & Company. Winkler, Robin C. and van Keppel, M. (1984). Relinquishing mothers in adoption. Melbourne, Australia: Institute of Family Studies. ARTICLES & PAPERS Anderson, C.; Campbell, L.; Cohen, M. A. (1981). Eternal punishment of women: adoption abuse. Des Moines, IA: Concerned United Birthparents, Inc. Baran, Annette, Reuben Pannor, and Arthur Sorosky, "Birthparents who relinquished babies for adoption revisited," Family Process, Vol. 17. No. 3, September 1978. Baran, Annette, Reuben Pannor and Arthur Sorosky, "The lingering pain of surrendering a child," Psychology Today, Vol. 11, No. 1, 1977. Bernstein, Rose, "Are we still stereotyping the unmarried mother?", Crisis Intervention: Selected Readings, Howard J.

Farad, Editor, Family Services Association of America (c.1965). Also published in Social Work, Vol. 5, No. 3, 1960. Blanton, T. L. (1988). Birth mother's grief: a look at the post-adoptive experience in light of open versus confidential adoption. Master's Thesis, The University of Texas at Arlington. Berman, L. C.; Bufferd, R. K. (1986). "Family treatment to address loss in adoptive families. Social Casework, Vol 67, No. 1, Jan. 1986. Chapman, C.; Dorner, P.; Silber, K.; Winterberg, T. S. (1986). "Meeting the needs of the adoption triangle through open adoption: the birthmother." Child and Adolescent Social Work, Vol. 3, No. 4, Winter, 1986. Deykin, Eva Y.; Campbell, L.; and Patti, P. (1984). "The postadoption experience of surrendering parents." American Journal of Orthopsychiatry, 54:2, April, 1984. Faigel, H. (1982). "Late social and psychological after effects of pregnancy in adolescence." Journal of Adolescent Health Care, 2:3, March, 1982. Leyne, Cynthia (1980). "Factors influencing the decision to keep or relinquish one's child." Child Psychiatry and Human Development, Vol. 11, Winter. Millen, L.; Roll, S. (1985). "Solomon's mothers; a special case of pathological bereavement." American Journal of Orthopsychiatry, 55, 441-448. Pannor, R.; Baran, A.; and Sorosky, Arthur D. (1978). "Birth parents who relinquish babies for adoption revisited." Family process. Vol. 17, No. 3. September, 1978, pp. 329-37. Richards, K. (1970). "When biological mothers meet adopters." Child Adoption, Vol. 60. Rynearson, Edward K. (1982). "Relinquishment and its maternal complications: a preliminary study." American Journal of Psychiatry, 139:3, March, 1982. pp. 338-40. Stiffler, L. H. (1991). "Adoption's impact on birthmothers: 'Can a mother forget her child?'" Journal of Psychology and Christianity, 1991, Vol. 10, No. 3, 249-259. Watson, Kenneth W. (1986). "Birth families: living with the adoption decision." Public Welfare, 44 (2), 5-10. Spring, 1986. SEARCH AND SUPPORT GROUPS AND ORGANIZATIONS Adoptee-Birthparent Support Network (ABSN) P.O. Box 23674, L'Enfant Plaza Station Washington, DC 20026 Phone: (301) 464-5755 Adoption Connection 11 Peabody Square, Room 6 Peabody, MA 01960 Adoption Forum 6808 Ridge Avenue Philadelphia, PA 19128 Adoption Triangle Ministries (ATM) Box 1860 Cape Coral, FL 33910 Phone (813) 542-1342 ALMA Society - Adoptees' Liberty Movement Association P.O. Box 154, Washington Bridge Station

New York, NY 10033 Phone: (212) 581-1568