by Sloan Nova, Psy.D.

2024

“I don’t think the trauma ever goes away fully. I think you either are lucky and you learn how to deal with it, or it takes you out.”

The quotes in this article are from interviews with adoptees about their lived experiences of being placed in lockdown residential treatment during adolescence. ^[1]

A common story

A child is born and separated from their biological kin. An agency arranges for the child to be placed with new caregivers, strangers—perhaps in a land and culture foreign to their own. Adoptive parents, full of hope, excitement, and anxieties, embrace the child into their lives. They are provided, however, with little to no ongoing guidance navigating the unique challenges of adoption. Over time, the adoptee’s sense of distinctness takes shape—consciously or unconsciously. Family roles solidify, reinforcing a sense of contrast between the adoptee and the rest of the family. As tensions rise, family conflict and dysfunction center around the adoptee, who internalizes their position as the patient, the scapegoat, the problem. In response to an increasing sense of injustice, the adoptee’s pain emerges in angry, indignant, or even destructive behavior.

Parents, feeling lost and fearful for their child’s well-being and the family’s stability, turn to trusted professionals who recommend residential care, promising swift, effective therapeutic intervention. Separation appears to be the only way to protect their child from an uncertain, unhealthy, and unsafe future. But for many adoptees, being placed in residential care feels like another deep wound—another rejection and abandonment, another separation. Isolated and locked away, without meaningful connection to loved ones, they endure alone. Upon leaving, whether to another facility or back to unresolved dynamics at home, the impact of isolation lingers. Many stumble; some, tragically, do not recover.

Thinking twice about a second removal

Parenting an adopted adolescent experiencing severe emotional and behavioral distress is no simple task. Adoptive parents frequently consider residential treatment as a last resort after feeling they have exhausted all other avenues. This decision is often rooted in deep concern and love, driven by a desire to restore stability and well-being for their child, family, partnership, and themselves.

However, it’s essential to recognize the context within which this choice occurs. Adoptees, who often contend with complex issues of identity, loss, and belonging, are significantly overrepresented in residential treatment centers (RTCs). Despite comprising only 2% of the U.S. population, adoptees represent as much as 30% of adolescents in residential treatment. This disparity highlights the unresolved emotional burdens adoptees carry—not only from adoption but from the trauma of feeling “twice removed,” abandoned first by their families (and possibly cultures or countries) of origin, and then again by adoptive families.

Before pursuing residential care, it is vital to consider not solely the difficulties you face as a parent, but also the profound, complex internal struggles your child may be enduring. For many adoptees, the experience of being placed, often without their volition, in residential programs compounds feelings of alienation, abandonment, and loss that can reverberate throughout their lives.

As a transracial, transnational adoptee who experienced lockdown residential treatment in my youth, I am deeply committed to supporting adoptees and their families in building stronger, more resilient bonds. My lived experience inspired me to pursue a doctorate in Clinical Psychology, where I focused my research on the experiences of adoptees in lockdown RTCs—a significant gap in the literature. My hope in sharing this work is to provide adoptive parents with tools to assess family dynamics, explore alternative interventions, and, if necessary, evaluate the quality and safety of residential programs. It is with immense gratitude that I amplify adoptees’ voices, whose lived experiences offer crucial and at times painful insights.

I invite adoptive parents to move beyond fear and lean into the multilayered, intricate experiences of adoptees. Before considering residential care, take measures to assess and address family dynamics, seek adoption-sensitive therapy, and engage in your own therapeutic support. By exploring these approaches, and in-home and community supports, new pathways to understanding and connection may emerge. As stewards of your child’s well-being, you hold the responsibility to seek out programs that will honor their complex history and provide the attuned, competent care required to address the needs behind their behavior. Ensuring that trauma does not multiply in care requires a commitment to discernment—asking difficult questions, visiting programs firsthand, and engaging with therapists well-versed in the impacts of adoption and re-separation (see Assessing Residential Treatment Care for Adoptees).

While the future may feel unclear, hope is not lost for your child and your family. However, true healing must begin with a deep understanding of the intersecting complexities adoptees and their families face.

Letting adoptee voices lead

“Evidently there’s no research about the effects of sending adopted kids to these places. Go figure.”

Despite the historically recognized overrepresentation of adoptees in RTCs, I found no existing research that highlighted their firsthand experiences of lockdown treatment during adolescence and the specific, often concealed challenges they withstand. To rectify this gap, I conducted in-depth interviews with 11 adult adoptees placed in lockdown RTC during adolescence, exploring how adoption and the experiences before, during, and after lockdown shaped their identities. Analysis of this data revealed significant themes around adoptee identity, family relations, the lockdown experience, and impact of the intersection of their adoptions and experiences of RTCs on their current sense of self.

A cry for help

“It’s [the adoption’s] just always there with me, I’m always reminded of it… It’s like, it’s a thing, as if a wound was stitched up, but it was not stitched up properly. So every time you move, it pulls, and it hurts.”

All the adoptees I interviewed reported being profoundly affected, “damaged” and defined by their adoptions. Adoption was a core self-identifier, associated with feelings of “defectiveness,” “shame,” and “loneliness.” The unhealed wound served as the “driving force” behind emotional and behavioral difficulties. Most described engaging in behaviors like self-harm, substance abuse, truancy, or promiscuity as outlets for their internal suffering.

“My drug use was mostly solitary, and it was done for relief. It was done to just turn things off. It was desperate. It was scary. I didn’t really like them. It was, ‘I can’t exist in this world, so I need to go into this one.’”

Of the five transracial adoptees I interviewed, four discussed the significant impacts of encountering prejudice, racism and racialized bullying in their adoptive homes, schools and communities, which magnified their sense of “differentness” and enhanced feelings of not belonging.

A question to ask before considering RTC is: Has your child been connected with an adoption-sensitive therapist? The complexity of the adoptee experience necessitates clinical care that addresses the potentially long-lasting impacts of the early traumatic losses associated with adoption–relational, cultural, and geographic. The overrepresentation of adoptees in lockdown RTC and in mental health services at large highlights the need for holistic, attuned, culturally-aware clinical interventions for this particularly vulnerable population. Clinicians must attend to the specific needs of the individual while paying particular attention to common issues such as annihilation anxiety, identity diffusion, insecure attachment, low self-worth, unresolved grief, dissociation, and unhealthy family dynamics within the biological, foster, and/or adoptive family constellations.

“A lot of what my therapist and I talked about was that I just wanted to be held. The same reasons that led to me using or that internal thing in me I think I’ve always had… I wanted to know I was loved….And if I couldn’t, I wanted to forget… It was a means of escape.”

The role of family

“The person who’s sent away sometimes is just the designated hitter for the rest of the team, which is a family, and the family is usually f-ed up as a unit. I was just the designated hitter…”

A question to ask before considering RTC is: What underlying family dynamics may be contributing to conflicts between you and your children? The vast majority of adoptees I interviewed reported being labeled as the “scapegoat” or “black sheep” in their dysfunctional family systems, furthering their sense of not belonging. They described their role as the identified patient, often beginning in early childhood through medication management, additional school supports, and mental health diagnoses, wherein the adoptee acts out the family dysfunction behaviorally. The stories shared made plain that their disruptive behaviors at home took place within the context of the family system:

“I just remember getting into a lot of physical fights with my dad and with my mom….I was definitely looking to them for comfort, ’cause they were all I had. And I wasn’t receiving that, and they weren’t understanding what I was going through. So I think that….every time I felt like I wanted to react with violence, it was because I felt completely ignored…”

Lacking a sense of real emotional connection, adoptees described their adoptive parents’ materialistic approach to communicating love and affection that left them longing for meaningful emotional contact.

“Yes, I’ve been given every opportunity that anybody would dream of… But at the same time, the emotional and the mental stuff that I needed, I didn’t get….My mom tried, but when I tried to talk about how I didn’t feel good, she wouldn’t listen.”

Four of the five transracial adoptees discussed challenges related to their families’ responses to or avoidance of their racial differentness and emerging multicultural identities—a finding supported by data suggesting that transracial adoptees frequently contend with identity confusion, awareness of racism, alienation from white families and peers, and lack of familiarity with their culture of origin.

Trauma multiplied

“My mother was very angry at my dad working a lot… To this day when her and my dad are in a fight, she’ll lash out at me…”

A question to ask before considering RTC is: As a parent, have you sought out individual, couples, and/or family therapy?

Parents are uniquely positioned to guide their family toward healing by examining how their own patterns and responses shape family interactions. Individual or couples therapy can provide parents with a safe space to explore their own experiences, uncovering how past challenges, stress, or unresolved personal issues may influence their approach to parenting. Through self-reflection, parents can identify and address behaviors that might contribute to family tension, paving the way for a more attuned, reliable, and nurturing environment.

The adoptees I interviewed shared that conflict within their adoptive families often felt deeply personal, intensifying feelings of insecurity and disconnection. Many described relationships with their adoptive mothers as strained by emotional instability, inconsistency, and an absence of attunement, leading to a sense of emotional distance. Relationships with adoptive fathers were also marked by struggles, with several adoptees describing emotional or physical absence, while others recounted memories of anger or violence associated with paternal substance use.

“For a really long time there was just this inability to connect [with my mother].…It was just easier to remove herself from the situation. She couldn’t relate to me… We were close when I was young and then I kind of hit that 11, 12 mark and it just shot off in this totally other direction… [T]he word that I most commonly land on when I think about how I felt before lockdown is lonely.”

The majority of interviewees reported enduring emotional, physical and/or sexual abuse while living in their adoptive homes, experiences which exacerbated their internal distress as they searched for a sense of safety, belonging, and unconditional love. Several linked the abuses they endured to the intergenerational trauma and abuse suffered by their adoptive parents. For most, the abuse was unbelieved, unaddressed and/or untreated in residential treatment. When families encounter trauma beyond the adoption experience, it becomes essential to engage in compassionate, clinically guided exploration to nurture healing and strengthen resilience.

Pursuing individual, couples, or family therapy can enhance the family’s ability to face difficulties together. Participating in therapy can disrupt cycles of misunderstanding and disconnection and offer a powerful alternative path—one that fosters reconnection, shared accountability, and a sense of safety and trust, without the need for separation.

The lived experience of lockdown residential treatment

“I can’t wrap my head around it. It just seems so against everything I feel as a human, that you could do that to children, children who are in pain and confused.”

In stark contrast to the cheerful images and family-centered language used by RTC marketing, the adoptees I interviewed characterized their experiences in residential care as “abandonment,” “barbaric,” and a “nightmare.” All reported ineffective, detrimental, and damaging experiences in lockdown RTC, and described a therapeutic modality structured around behavioral modification, manualized treatment (a standardized, structured approach), social isolation, and fear tactics.

“The second lockdown I was in was cognitive behavioral…..Fix your behavior, we need to train you not to do this. So, we’re gonna take away everything you like and we’re gonna restrict you in every possible way. We’re gonna isolate you, we’re gonna make you hate the consequences of your behavior so much that you won’t touch the fire again.”

“They were really quick to give you medication. The first time I went to [RTC] they gave me a sleeping pill.… They give everybody that. Apparently it was their standard. I remember being in the shower the next morning and passing out…”

“I just felt scared. They scared me. And so, they scared me into getting better. I don’t think they did a good job of intrinsically motivating me. But I just wanted to….get out of there.”

The majority described experiencing emotional and/or physical abuse in lockdown; they also reported experiences of public shaming, insults, humiliation, isolation, name-calling, invalidation and trivialization of traumatic events, gaslighting, false accusations, invasion of privacy, and verbal abuse from staff members responsible for fostering a therapeutic milieu. Several disclosed being subjected to medical neglect and excessive physical punishment.

“If you don’t feel safe in a place, how are you supposed to open up? How are you supposed to build trust?”

The majority of interviewees described feeling “retraumatized” through living in a “constant state of fight or flight” while in lockdown RTC. Several remarked on the inherently retraumatizing nature of being sent away due to the initial traumas of their adoptions.

“I personally had a lot of abandonment issues come up. A lot of fear…”

Numerous adoptees discussed experiencing significant symptoms of depression, including feeling “incredibly lonely,” isolated, unable to feel pleasure, and hopeless, as well as a sense of pervasive, learned helplessness. They perceived the milieu staff as lacking the necessary credentials, training, relevant experience and multicultural awareness to provide appropriate care.

“I was so desperate at that place, I would literally do or say anything to get out… I think that that was definitely the lowest point of my life….I think that [lockdown] was definitely the moment I lost my soul.”

The majority discussed the long-lasting harmful effects of being prohibited from communicating with peers in a developmentally appropriate way, outside of the direct supervision of staff.

“[S]ince those programs, I have really struggled with, just, social interaction… that’s kind of just a patch that’s sewn into you….I feel like it gets implanted in you at that age, the socialization age, and then it’s really difficult to undo that.”

Three of the transracial adoptees I interviewed cited a strong desire for increased racial diversity and multicultural sensitivity of lockdown RTC providers.

“I would like some diversity in the staff. I should have been able to speak to some black person… Like, just black with a psychology degree, you know what I mean?”

When asked if and how lockdown addressed the impacts of adoption, the majority reported dissatisfaction with attempts to explore issues related to their adoption therapeutically. They reported having been placed in therapy groups for adoptees, but questioned these groups’ effectiveness due to their large size, impersonal nature, and lack of an adoption-focused agenda. Two reported having a primary therapist known as the facility’s “adoption expert,” who initiated a search for their birth families without their consent, but with the support of their adoptive families, as the “main course of treatment.” Both discussed being given less than 24 hours’ notice before meeting their biological families and described these involuntary meetings as “traumatic.”

There were occasional bright spots. A number of adoptees expressed being positively impacted by interactions with certain staff and individual therapists. Many reported creating strong, “bonded” friendships with peers in treatment that “made life bearable.”  Some expressed that gaining physical space and geographic distance from “abusive,” “toxic,” and “harmful” dynamics within the adoptive household was a positive aspect of being sent to lockdown.

The story continues

Several of the adoptees referenced the “RTC mill,” or the common trajectory of many adolescents sent to treatment who attend two or more facilities owned by the same parent company. This often occurs due to the obscured financial relationships between RTC programs (most of which are run as for-profit businesses), the mutually beneficial relationships between RTC providers and those making referrals, and the exploitation of frightened families.

All of them described “disruptive” experiences and feeling “dropped” during their transitions out of lockdown RTC. Of the 11 interviewees, six were sent to another facility and four returned to their adoptive homes (one was sent to a non-therapeutic boarding school). The term “treatment robot” is used by ex-lockdown residents to describe the ways in which one becomes institutionalized internally, resulting in learned helplessness, fear of punishment, a sense of overwhelm when constraints are lifted, inability to make independent choices, and a considerable decrease in interpersonal skills. The majority of the adoptees I spoke with reported feeling uncontained, “directionless,” “more of a mess,” and “out of control” after leaving lockdown, which led to a period of self-destruction or “rock bottom.”

“I had no support from those places once I left. There was no guidance as to like, maybe it’s a good idea to see someone, maybe it’s a good idea to participate in groups, maybe ease yourself out of this, as opposed to, BAM. Now you’re just in this terrifying world where you haven’t been able to have these important years in. And now you’re an adult. Like, what do you do?”

The majority reported being forced to leave their adoptive home after returning from lockdown. Those who returned home immediately following lockdown described being met with “high expectations” and “zero-tolerance” parenting. The majority described experiencing adverse effects from the intensive changes in environment and “unfamiliar freedoms” due to a lack of an effective exit plan, ongoing therapeutic support, or long-term goals.

At the time of the interviews, the majority of adoptees disclosed participating in individual therapy; several reported taking prescription medication, and two were residing in sober living facilities. Most discussed the ongoing presence of self-hatred, self-doubt, self-blame, and hopelessness due to their accumulated experiences. They continued to experience significant symptoms of post-traumatic stress, depression, anxiety, distrust, and low self-worth, inhibiting their ability to pursue meaningful personal and professional goals.

“I don’t let people get close to me… And yeah, I feel like residential treatment killed whatever remaining trust was there with my family. Completely killed it because they literally just locked me up.”

Regarding their current family relationships, while a couple of the adoptees had resolved past wounds with adoptive parents who had demonstrated personal responsibility and a commitment to personal growth, more were estranged from their adoptive families due to the persistent dysfunctional family dynamics. Adoptees grappled with a conscious goal of shedding the role as the family scapegoat and sought solace in supportive relationships and communities that acknowledged, accepted, and unconditionally loved them.

“My family looked the part. We looked like a happy little suburban family and it’s like I got everything that I wanted on the outside and none of it on the inside.”

Additionally, the majority reported a conscious desire for separation from established dysfunctional family dynamics, including that of the adoptee as the role of the family “punching bag.”

“It’s so powerful to have emotional distance from my parents’ emotional issues. I’m so happy that I got there because I think without that ability to see things from that lens, I would have still been trapped in this narrative where I was the bad guy, and I was the one creating destruction around me.”

Moving beyond fear

For many adoptees, life is a journey shaped by profound loss, longing, and an unceasing search for home that stretches far beyond physical walls. The removal from family and placement in residential care — a second departure, another fracture yet to heal — deepens an ache that words fail to capture. Adoptive parents hold a sacred duty: to find the compassion and courage to look beyond outward behaviors to see the tender wounds they conceal.

Though the path toward healing may appear daunting, it is essential to remember that your child’s behaviors, even when they feel like a personal rejection, often signal a profound need for genuine connection and safety. As leaders of your family, you bear the responsibility to engage in the inner work required in order to create a sanctuary in which your child feels seen and understood, especially if they return home after being sent to residential care. This is a vital opportunity to serve as a secure base as your child explores their pain, confronts their fears, and begins to rebuild a sense of self, belonging, and unconditional care. In fostering a haven of understanding, you offer the assurance they seek, laying the foundation for a bond that transcends shared history. May you and your child come to know that love, steady and enduring, is the truest homecoming.

Sloan Nova (she/they), Psy.D., is a licensed clinical psychologist and assistant clinical professor at the University of California, San Francisco, Department of Psychiatry and Behavioral Sciences. At UCSF Benioff Children’s Hospital Oakland, Sloan is developing a trauma-informed family therapy model and program designed to support families impacted by trauma. They completed their pre- and postdoctoral fellowships at UCSF, where they specialized in the treatment of acute and complex trauma across diverse family systems involving children and adolescents. Sloan brings her unique perspectives as a clinician, researcher, activist, parent, and transracial, transnational adoptee devoted to her work, with a deep commitment to enhancing care for system-involved youth and families.

 

[1] For the purposes of this article, “lockdown residential treatment centers” are defined as secure, highly restrictive facilities providing intensive care for youth with severe behavioral or emotional challenges. Lockdowns involve constant supervision, restricted movement, and removal of the option to leave—often seen as a “last resort” following other, unsuccessful interventions.