About the Four Stages of Adaptation

The Four Stages of Adaptation model was developed by Dr. Nancy Miller, a psychotherapist and social worker. She worked with four moms over a period of five years and distilled their experiences into the book Nobody’s Perfect: Living and Growing with Children Who Have Special Needs. The model came from conversations with the moms, experiences working with families, and the writings of many parents and professionals.

Dr. Miller’s book was published in 1997. It is highly recommended, but as of June 2014 it is not currently in print. Look for it at your local library or used book store, or look for a used copy at online booksellers.

This article covers the first stage of adaptation, survival. Be sure to read the articles on this site covering the other three stages:

Stage 2: Searching

Stage 3: Settling In

Stage 4: Separating

Surviving includes coping and reacting

“Being in a state of Surviving doesn’t last forever. It just seems that way at the time.” from Nobody’s Perfect: Living and Growing with Children Who Have Special Needs by Nancy J. Miller, PhD, MSW

Surviving is what you do to keep going when you feel completely overwhelmed because something totally out of your control has taken away your child's equal chance at life.

You have something new and frightening to deal with, and you have to begin adapting to an uncertain future. The severity or lack of severity of your child's needs does not make them any harder or easier to deal with. When you become aware that your child has a problem, is developing a problem, or is at risk for a problem, you begin to deal with this information in two ways—you cope and you react.

Coping is doing what you have to do to get by, dealing with one problem at a time.  Coping always feels like you are just keeping up with what you have to do, with little energy for getting ahead of your problems. This is because you are using most of your energy to deal with your emotional reactions to your situation.

Reacting drains your energy and diminishes your feelings of control over your life. You have no sense of direction. There are so many aspects of this experience that you may not have expected, and that may frustrate and disappoint you.

Typical reactions

These reactions are the way many people feel upon hearing sad or frightening news. Anyone who tells you that you "should not" have any of these reactions has not been where you are. No one has the right to judge how you feel. These reactions are temporary, although some stick around longer than you would like. Most of the feelings get resolved or fade as you find you are ready to move on and as you begin to feel you have control of your life once again. Some of the typical reactions are:

  • Shock
  • Bodily stress and symptoms—Fatigue and other physical symptoms, such as headaches, stomach aches, chest pains, loss of appetite, lack of sexual interest, feelings of weakness, fragility, and vulnerability
  • Grief and loss—Grief, feelings of helplessness and being alone, sadness, depression
  • Confusion and fear—Confusion and chaos, uncertainty and ambiguity, fear, preoccupation with your child, worrying, asking questions that appear to have no answers
  • Guilt and self-doubt—Guilt, self-absorption, self-pity, self-doubt, shame and embarrassment
  • Anger—Resentment and envy, blaming, feelings of betrayal
  • Denial—Chosen denial, unconscious denial

Steps to easing the Surviving Process

  • Understand that your feelings are normal
  • Try to make time for yourself
  • Create and use your support system

From the Article: A NICU Mother’s Reflection

“Premature babies have premature parents. We were not ready. There was so much grief. We were not allowed to feel it. It was like a death, but no one had died. Just our dreams of the perfect child we had waited 12 years to have. The first month in the NICU was a fog. We were numb. More than anything, I wanted a peek into the future to know we had survived.
I held Laura in my arms for the first time when she was two months old. The doctor didn’t know I nursed her. The nurse looked the other way. That was the day that I started believing that I could take care of her. I could be her mother. I could love her.
Laura has brought us joy. We still revisit grief now and then. But our moments of joy are frequent and intense. Laura will be graduating in the top quarter of her class and was recently recognized by her teachers as one of the 'Who’s Who' of her senior class. I couldn’t be more proud of her. Or myself.”