Exploring attachment state of mind, trauma, reflective functioning, and the lived experience of mid-life adoptees

  • Natasha Dalton

Student thesis: Doctoral Thesis


BACKGROUND: According to recent statistics, 95 children enter the care system in the United Kingdom daily. The total number of children living in care is at an all-time high. Studies have demonstrated that extended periods spent in care can result in long-term impacts on an individual's outcomes. Equally, exposure to adverse factors that give rise to concerns about the child's safety and well-being while living with their birth family, such as incidents of maltreatment, can also have long-lasting effects (Thomas et al., 2019; Angelakis et al., 2019). Adoption offers permanence, allowing the child to form attachments with new caregivers (Raby & Dozier, 2019). However, the permanence adoption provides means that it also fundamentally alters the rest of an individual’s life. Research on attachment in adoptees has mainly been conducted in children, using quantitative measures (Field and Pond, 2018). Only some studies have examined adoption in older (30+) adoptees, despite the recognition that adoption is a lifelong process (Brodzinsky et al., 1998; Lifton, 2002). This research has produced contradictory results however, making it unclear what impact adoption has throughout the entire lifespan.

METHODS: This thesis aimed to investigate the attachment state of mind and lived experience of older adoptees (n=17) (30+ years). A primarily qualitative mixed-methods exploratory sequential design was adopted to achieve these aims. The Adult Attachment Interview (AAI) was the primary data collection tool with the data analysed using four methods: the manualised AAI coding and classification system, Reflexive Thematic Analysis (RTA), the Reflective-Functioning (RF) coding manual, and the Complex Trauma Questionnaire (ComplexTQ).

RESULTS: Most participants had an insecure state of mind with respect to attachment (76%). The four-way distribution of the sample showed that 53% of participants were classified as unresolved (U/d) and cannot classify (CC). The most prevalent organised state of mind among participants was insecure preoccupied. Participants also showed a low average RF score (M=2.71, SD=1.99). All participants had experienced some form of trauma before age 14, as assessed by the ComplexTQ, with neglect being the most common type of trauma experienced. Adoptive mothers were responsible for more total trauma occurrences than fathers, except in cases of domestic violence and separation. Insecure participants had higher mean trauma scores across all forms, and only those with an insecure state of mind experienced further separation. RTA enabled the identification of three distinct themes: (i) 'Coming out of the fog' (ii) Unresolved Grief (iii) Living in Fear, and four additional subthemes. These themes enabled the definition of adoption trauma, defined here as the cumulative direct and indirect consequences of being an adoptee. Direct consequences include events such as removal from the birth family, placement into care, and arrival into the adoptive home. Indirect effects refer to experiences and mental states arising from those events, such as lack of control, feelings of difference, and maltreatment. The impact of these consequences is subjective and depends on individual coping mechanisms and personal meaning. Our findings emphasise the enduring and ongoing nature of adoption and the importance of acknowledging the complexities associated with adoptive status to inform and guide practitioners.

CONCLUSIONS: Overall findings highlight the prevalence of trauma in the lives of older adoptees and the impact this has on their attachment state of mind. Loss is a central theme in the adoption experience and can contribute to lasting trust, attachment, and relationship issues. Adopted children may need their parents to be especially sensitive and attuned to their needs to effectively address the difficulties of caring for a child who has experienced trauma. Therefore, it is crucial to be mindful of ambiguous loss and disenfranchised grief when working therapeutically with care-experienced individuals. These findings highlight the importance of sensitive adopters with an educated awareness of the impact of trauma on child functioning and an ability to separate the child's behaviour from the child empathically. Finally, the lack of gold-standard attachment measures used within the care system context can lead to severe implications for adoptees, such as incorrect assessments of the child's attachment quality with birth or adoptive parents and hinder the development of targeted treatment and support plans. Adding gold-standard attachment measures to the adoption process will ensure accurate and consistent assessments, leading to better outcomes for adoptees and their families.
Date of AwardJul 2023
Original languageEnglish
SupervisorMarian McLaughlin (Supervisor) & Tony Cassidy (Supervisor)


  • Adoption
  • Trauma
  • Adult attachment interview
  • Qualitative research
  • Attachment theory
  • Mentalization

Cite this