During the past five decades, adoption practice has been characterized by secrecy and denial. This closed system of adoption has its roots in the assumption that adoption is a one-time legal event. More recently, professionals are recognizing that adoption is a life-long process with profound effects for adoption triad members throughout their lives. The authors present practice and treatment issues and outline interventions for this specialized population. These issues are reviewed in the context of the experience of adoptees, birth mothers, and adoptive parents. Case anecdotes are used to elucidate points.