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The meaning of being adopted is a process that needs to be reworked throughout the life cycle. Therapists ought to be familiar with the concerns that are pertinent to patients who are adopted but must be careful not to place adoption at the center of the therapy if this is not why patients are seeking help. The object relations of the adopted person will play an important role in therapy, given that the person has two sets of parents, one real and another that may exist only in fantasy. The most commonly reported negative self-representations of patients in treatment who are adopted include feelings of being unwanted and therefore undesirable. In patients in which adoption plays a central role, there are seven core issues that can be used as a guideline in psychotherapy with an individual affected by adoption: loss, rejection, guilt and shame, grief, identity, intimacy, and control. It is very difficult to predict the risk for psychopathology and long-term outcomes of adoptees because of the many variables and their complex interplay, yet research findings reveal that the majority of adoptees are functioning well. Research studies support the advantage of adoption over placement in foster care, in institutions, or with uncaring, abusive, or neglectful biological parents.