Revista de Asistență Socială, anul XXII, nr. 3/2023, pp.

117-126
www.swreview.ro

Emotional, Moral Distress, Eustress

Experienced by Adoption Social Workers
according to the Romanian Adoption Law
Ionuț Militaru*

Adoption has become a reflection of the horror

and the generosity of our recent history.
Laura Briggs

Abstract. The term stress has an omnipresence in many situations in everyday life, but
especially in professional activities. In some areas, such as the adoption field, the labor
of a social worker involves specialized intervention in accordance with the legislation
specific to the domain of activity. One of the segments of this type of intervention requires
understanding and analyzing the particular needs, motivations, requirements, difficulties,
concerns, personal motives, beliefs, hopes, uncertainties, stereotypes, misconceptions,
in order to assess the capabilities of the person/family (material conditions and moral
guarantees) to meet the specific needs (behaviors or conditions secondary to abandonment
trauma) of a child declared by the court suitable for adoption process. Subsequently, the
social worker from the adoption department ensures support, empowerment, provides
counseling to clients and supervise them at all stages of the procedure until its completion
(from matching a child to post-adoption monitoring to case closure process). Certain
situations from those described above, in relation to the steps applied to the legal provisions
in the institutional environment may lead to experiencing some forms of stress (moral/
emotional distress, eustress, psychosomatic manifestations, burnout, moral dilemma, cognitive
bias, problematic ethical aspects of the social worker practice).

Keywords: emotional/moral distress, eustress, adoption

Introduction
Since knowledge of man is never final or absolute, the social worker in his application of this
knowledge takes into account those phenomena that are exceptions to existing generalizations
and is aware and ready to deal with spontaneous and unpredictable in human behavior.
(Gordon, 1965, 32)

The intervention of the social worker involves an increased degree of adaptation carried out
quickly in accordance with the situational peculiarities and a spontaneous decision-making

* University of Bucharest, Faculty of Sociology and Social Work, Schitu Măgureanu 9, District 1,
https://sas.unibuc.ro; E-mail: ionut-costin.militaru@s.unibuc.ro
118 Ionuţ Militaru / Emotional, Moral Distress, Eustress Experienced by Adoption Social Workers
according to the Romanian Adoption Law

process, with efficient effects, respecting the rights and freedoms of the needy person, in
accordance with the legislation regulating the type of intervention. This way of providing
support requires an overuse of the social worker’s capabilities, leading in time to emotional
imbalance and alteration of the mental state.

Abandonment
As with the terms “stress” and “adoption”, the concept of abandonment cannot be accurately
described. Its use in the media has led to a deterioration in the scientific value of the term.
Being a social construct, like “childhood”, requires holistic approaches to get closer to a
concrete definition (Panter-Brick, Smith, 2000).
There are certain definitions, but none are exhaustive and, given the ambiguity of the
concept, neither the syndrome of the abandoned child is postulated. According to Tamikia
S. Lott “Child abandonment is not simply a matter of leaving a child unattended. The age
of the child, the time of day or night the child is left, the mental and physical capacity of
the child, and whether or not a parent leaves adequate provisions for the child all factor
into determining abandonment” (Cousins, 2014, 3).
In our circumstances, the term “abandonment” is used to define the child who, for various
reasons (abuse, neglect), was in a situation of separation from the biological parents or the
extended family for which it was decided that he could not be reintegrated into the biological
family, thus it was ordered to open the adoption procedure.

Child adoption
According to the provisions of art. 451 of the New Code of Civil Procedure in Romania
“Adoption is the legal operation that creates the bond of lineage between the adopter and
the adopted, as well as kinship ties between the adoptee and the adopter’s relatives” (Law
287/2009).
I set out to present some situations where the social worker who carries out his professional
activity in the field of child adoption experiences emotional or moral distress and, additionally,
I want to briefly describe the possible causes of these manifestations, as well as possible
ways to cope with the difficult situations we face in working with the specific beneficiaries
of the aforementioned segment of activity. This category includes:
• Children who have been abandoned, but they are currently declared by court adoptable
(the case manager proposed adoption as a finality of the individual protection plan after
the failure of the child’s reintegration process into the biological family);
• Individuals/families who are in the process of evaluating their capacities to adopt or
those who have obtained the certificate of person/family able to adopt and are waiting
for a match with a child or are in more advanced stages of the procedure (persons/
families who have a child entrusted to them during a period of accommodation or who
have completed the process and are now being monitored post-adoption);
• The biological parents of the abandoned children who are currently in the process of
being adopted.
 Revista de Asistenţă Socială, nr. 3/2023 119

Defining the concepts

It’s not stress that kills us, it is our reaction to it.
Hans Selye

The term stress was used in the past in other fields prior to its use for scientific purposes,
until 20th century when researchers like Walter B. Cannon or Hans Selye highlighted its
addressability and set its usefulness in clearer goals (Lazarus, Folkman, 1984).
Fight-or-Flight response was described among the first time by Walter B. Cannon and
involves situations in which certain triggers activate the body’s biological response to
stressors, conditioning for confrontation for facing the danger, confrontation (fight) or
avoidance, escape (flight) (Milosevici, McCabe, 2015).

Recently, researchers and clinicians have noted a third reaction – freezing –, thus have begun
using the term fight, flight, or freeze response. The freeze response involves being rendered
immobile when confronted with a potential threat (e.g., the person’s muscle may become tense
and no visible movement occur). This reaction is particulary associated with posttraumatic
stress disorder (Milosevici, Molak, 180).

According to George Fink, this type of response “was later recognized at the first stage
(acute stress response) of a general adaptation syndrome (GAS) postulated by Hans Selye
to be a universal stress response among vertebrates and other organisms” (2010, 3).
Lazarus which is considered one of the most significant behavioral scientists, famous
for his contribution in the area of studying emotions and highlighting them in psychology,
states in the chapter titled My epistemological and metatheoretical principles that “the
concept of threat, for example, arises when a person with an important goal faces an
environmental condition that endangers the attainment of that goal. This is a meaning a
person constructs from the confluence of personality and environmental variables. We say,
for example, that because the environmental conditions obstruct their goals and beliefs such
persons are threatened by psychological harm, which seems imminent or is, at least, a
distinct possibility in the near future” (1999, 12).

Cognitive perspectives on stress focus upon the cognitive decision – making and information
processing strategies that describe and explain the perception, experience, interpretation and
resulting effects of stress (Bartlett, 1998, 19).

In his book Social Work Under Pressure social worker Kate van Heugten is using the
term stress “to indicate the effects of those impacts, which may be physical, cognitive,
emotional and behavioral”, and considered that “it is important, however, to note that neither
the demands, nor the consequences are necessarily negative. Some degree of pressure can
be a motivator, and even relatively high levels of pressure may be felt to be challenging by
some social workers” (Heugten, 2011, 16).
I believe that the effects of stress are generally negative for a person’s overall functioning,
but looking from certain perspectives, I think it can bring benefits to personal development,
for some people representing a motivational factor that pushes them towards initiating,
continuing or completing actions.
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Stress may induce both beneficial and harmful effects. The beneficial effects of stress involve
preserving homeostasis of cells/species, which leads to continued survival. However, in
many cases, the harmful effects of stress may receive more attention or recognition by an
individual due to their role in various pathological conditions and diseases (Yaribeugi et al,
2017, 1066).

Although stress has been classified into three stages:

• acute – involves activating the body’s reaction for a certain period and returning to
homeostasis);
• moderate – alters the biological state to create adaptability to stressors;
• severe or chronic – it implies long-term exposure to stress factors and the appearance
of allostatic load (Fink, 2000).

Summary of the conceptual debate between distress

and eustress
It needs to be noted that stress is not always bad, It is, in fact, a basic ingredient of life. Our
system is equipped with certain innate “stress alarms” that allow people to function effectively
in many situations. Without undergoing any stress there would not be constructive or creative
activity. We need to reduce the amount of negative stress (distress) enjoy and appreciate
positive stress (eustress). (Misra, 1999, 26)

Distress
The notion of moral distress was introduced by the philosopher Andrew Jemeton in his
book on nursing ethics and describes the type of situations in which there is a mismatch,
an antagonistic relationship between institutional policies, practices and requirements and
moral values and the right actions in the practitioner’s view (Jameton, 1984). “The
repeated experience of moral distress can lead to the accumulation of “moral residue” or
“that which each of us carries with us from those times in our lives when in the face of
moral distress we have seriously compromised ourselves or allowed ourselves to be
compromised” (Webster Sc Baylis, 2000, 218, as cited in Oliver, 2013, 206).
In order to be delimited by the previous similar terms (strain, stress, distress, biological distress),
the psychological distress was attributed five defining characteristics by Walker and Avant:
1. perceived inability to cope effectively (if coping intervenes and manages, the phenomenon
of psychological distress has not set in);
2. change in emotional status;
3. discomfort;
4. communication of discomfort;
5. harm. (Ridner, 2004)

Eustress
Terminologically, the concept of eustress exhibits volatility because it has not been given
a clear, precise, steadfast definition. In some models of stress, it can be described as absence
 Revista de Asistenţă Socială, nr. 3/2023 121

of negative effects, or adaptive effects of stress reactions, or as a “positive cognitive response

to a stressor”. There are also opinions that support the idea that eustress and distress do not
manifest themselves independently, being identified simultaneously in our response to
stressful stimuli (Kupriyanov, Zhdanov, 2014).
Researchers like Bienertova-Vasku, Lenart, Scheringer in their article published in 2020,
entitled “Eustress and Distress: Neither Good Nor Bad, but Rather the Same?”, are considering
that the adaptation reaction of the organism in relation to the environment cannot be positive
or negative, suggesting that the concepts of “eustress” and “distres” are vague and have
created ambiguity in their application in different fields and disciplines, proposing that
“stress” be the only term used to describe situations in which the term eustress is currently
used in particular (Bienertova-Vasku, Lenat, Scheringer, 2020).

Possible situations generating emotional or moral distress

in the practice of social workers within the field of adoption
Empathy is one fundamental principle/skill necessary in the exercise of the profession of
social worker. Dona Peach states in Developing Skills and Knowledge for Social Work
Practice that empathy is an intrinsic element of social work (Rogers, Whitaker, Edmondson,
Peach, 2016).
Mihăilescu et al set out to “asssess the relationship between emotional distress (stress,
anxiety and depression) and cortisol levels in the period of acute stress” in their study,
published in Romanian Medical Journal in 2011, called “investigation of emotional distress
and salivary cortisol in young healthy subjects in the period of acute stress”. They concluded
that the emotional distress of the subjects proved to be correlated with the decrease of their
empathy (Mihăilescu et al., 2011).
In her book about the contemporary practice of social work, Kate used the term emotional
attunement to explain empathy and remarked that “is is not uncommon in a one-to-one
situation, such as interviews with service users, for social workers to find their own body
language mirroring that of the service user” (Wilson et al., 2008, 298).
By exercising the main specific professional roles, the social worker can experience
dissonance between ethical responsibilities and the limits of the legislative, administrative
framework, which can create moral distress. In the volume edited by George Neamțu called
The Encyclopedia of Social Work, Nicoleta Neamțu and Camelia Condor gathered data from
the writings of certain authors who were concerned with enunciating specific roles in the
practice of social workers resulting in a list of the most relevant: social broker, mediator,
educator, advocacy, empower, intermediary, adviser, case manager, administrator, game
changer, negotiator, coordinator, consultant, public speaker, public relations, initiator,
facilitator, planner, arbitrator, fundraiser (Neamțu, 2016).
In the practice of social work in the field of adoptions, the specialist mainly performs
the following roles:
• social broker, establishes the connection between individuals /families and the institutions,
agencies, services that they must access in order to solve their requests;
• mediator, ensures the mediation of situations in which adoptive families and professional
foster carers have divergences (due to the ways of approaching the child, the changes
that occur on the affective relationships) by focusing on the common interests (child’s
well-being);
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• educator, providing the necessary information to adoptive families in order to learn,

empower and assume the role of parent of an adopted child;
• advocacy, signals possible procedural flaws, trying to streamline the process;
• empower, respecting the right to self-determination (ISFW, 2018), the social worker
facilitates change by accessing the client’s potential;
• advisor, provides guides, particular tips to the field to facilitate the process;
• case manager, the social worker can be appointed case manager for the child or for the
adopting family, in these situations the specialist in charge ensures the correct conduct
of the bureaucratic process and makes fundamental decisions legally regarding the steps
of the procedure;
• public relations, provides information, satisfies uncertainties, guides, takes requests from
petitioners.
In child protection domain, a social worker provides support services to beneficiaries
(children and adults) with specific needs and problems. Most cases require quick, delicate,
precise but decisive interventions, bringing a strong emotional impact for the clients, as
well as for the person who’s providing the support. “Social workers are witness to many
other dire situations that negatively impact a person’s life for which the social worker may
have no solution” (Jaskela, Guichon, Page, Mitchell, 2018).

Social workers can take pride in the claim that social work is a trauma-oriented profession
with knowledge and skills to offer trauma-informed practice and trauma treatment, with
cumulative and complex traumas, as well as social action in preventing the oppressions of
preventable traumas (Turner, 2017, 567).

Regarding the social care of the individuals/families who choose to adopt, most of them
have mental trauma caused by medical conditions such as sterility, infertility or are motivated
to adopt as a result of the death of the biological child, which requires a state of mental and
emotional balance of the specialist. One of the ethical responsibilities that a social worker
must fulfill is the assistance she has to provide to clients who present difficulties or the lack
of the ability to make decisions (NASW, 2021).
Also, in working with abandoned children who are declared adoptable by the court, the
social worker encounters situations where children have been neglected and sometimes
abused. Also the members of the biological family, who did not express their consent for the
adoption, are predominantly in conflict with the representatives of the adoption department.
Therefore, “the nature of social worker’s” jobs and the high-impact decisions they make
can also have profound impacts on the workers themselves. This may include immediate
reaction that can reach up to allostatic load (Regehr, 2018).
Doing an interview with individual or family who have been diagnosed with sterility of
infertility, or talking to a parent about how they lost their child, emotionally overload you
and leads to certain effects felt, such as physical somatization or biological, hormonal
changes that have implications for the body that you cannot notice of feel for the moment
and that over time generates emotional or moral distress and certain stress-related conditions.
There are situations in which the period of custody of the child in the adoptive family
is revoked, being necessary to institutionalize the child again leading to the reactivation
of traumas, disorders in the spectrum of abandonment/separation. This type of procedure
brings with it a certain degree of emotional distress, incapacity, professional dissatisfaction,
 Revista de Asistenţă Socială, nr. 3/2023 123

disappointment, various somatizations, moral dilemmas. Moral dilemmas are defined by

Walter Sinnott-Armstrong in Encyclopedia of Ethics by “situations in which an agent
morally ought to adopt each of two (or more) alternatives separately but cannot adopt
both (or all) of them together” (Becker, Becker, 2001). As for ethical/moral dilemmas,
they are frequently encountered in the practice of a social worker, there are numerous
situations in which you cannot respect fundamental principles (such as personal autonomy,
self-determination), being forced to impose a measure that has positive consequences for
the client, although he does not want it, even if it is obvious that his condition requires
your intervention in disagreement with his desire.
In certain areas in the practice of the social workers, there may be external factors that
favor the appearance of emotional/moral distress, especially those related to the way in
which the organization manages the activity. An example may consist of the excessive
workload caused by the difficult planning/assignment of tasks. The role conflict seen as a
concept of social psychology has three classifications: personal role conflict, interrole
conflict and intrarole conflict (Kumar, 2020).
Finne, Christensen and Knardahl have demonstrated in a study on Norwegian organiza­
tions that a wide range of psychological and social work factors affect mental distress, the
most relevant risk factor being the role conflict, and the factors that constitute positive
aspects are the support provided by the superior, the fair leadership and the positive
challenge, which I associate with the concept of eustress (Finne, Christiansen, Knardahl,
2014).
Sophia Fantus in Moral Distress in the Health Professions describe what implications
does the concept of emotional distress have for social workers who are members of multi­
disciplinary teams in the health care system, exclaiming “poor collegial support, inadequate
supervision, and a lack o inclusivity and collaboration with social workers may foster moral
distress” (Ulrich, Grady, 2018, 36).
From occupational stress perspective, “if stress in not used for a variable name, it is
recommended that stressor refer to environmental stimulus variables in the workplace that
are thought to be causal and that strain be the term for variables referring to the individual’s
aversive health or welfare reactions to stressors” (Beehr, 1995, 10).

Ways to cope
Stress and the coping capabilities for dealing with it are significant variables in child welfare
practice. (Laird, Hartman, 1985, 126)

For me, the most effective coping strategy with the stress generated by certain moments in
the practice of a social worker is knowledge. In my opinion, the more knowledge you have,
theoretical or practical, the more your ability to solve the case faster and effectively
increases, without having to waste so much time and psychic resources, to be in uncertainty
(which causes anguish, anxiety), to turn to other people for guidance (posture of addiction).
This “knowledge” means for me understanding the needs, problems, causes that determine
the behaviors, frustrations, constraints that have amplified the state of imbalance, vicissitudes,
various blockages, states of insolence, nonconformist.
“The subjective experience of stress evokes coping efforts. And coping expresses a
person-environment relationship because it requires both personal and environmental
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resources for effectiveness.” (Laird, Hartman, 1985, 126-127) “Because psychological stress
defines an unfavorable person-environment relationship, its essence is process and change
rather than structure or stasis. We alter our circumstances, or how they are interpreted, to
make them appear more favorable – an effort called coping.” (Lazarus, 1993, 8) “Coping
shapes emotion, as it does psychological stress, by influencing the person-environment
relationship and how it is appraised. Coping involves both (a) attempts to change the person-
environment realities behind negative emotions (problem-focused coping) and (b) attempts
to change either what is attended to or how it is appraised (emotion-focused coping).”
(Lazarus, 1993, 16)

Discussions
From my point of view, the intervention of a social worker is carried out with certain
pressures, inducing the state of emotional or moral distress, to be able to make the necessary
decision to the beneficiary, within the limits of the resources and conditions imposed by
the organization, legislation and in accordance with accessing the potential of the person
receiving the support. Social work cannot be fully patterned, it cannot be carried out
according to a equation or following a recipe, a template.
In all cases, it is necessary to identify and adapt the way of relating to the people who
receive support depending on the circumstances of the intervention, their physical, mental,
economic, housing, crisis state. However, dissonances stem from the conflict between the
beliefs, desires, perspectives of clients and your axiological system, they can create situations
where you experience moral or emotional distress.
One piece of advice provided by researchers Rushton, Caldwell and Kurtz in their
article “Moral Distress: A Catalyst in Building Moral Resilience” in which they aimed to
offer an alternative perspective on the effects of moral distress, on the ethical aspects that
produce distress as chances to develop and strengthen moral resilience (Rushton, Caldwell,
Kurtz, 2016): “Practice awareness of your somatic, emotional, and cognitive responses
to ethically complex situations. Notice any patterns that precipitate your symptoms. When
symptoms arise, pause and ask yourself about their meaning.” (Rushton, Caldwell, Kurtz,
2016, 47)
Particularly in the professional field, knowledge is related to the understanding of the
motivation of individuals/families to adopt, the prejudices, stereotypes, traumas, fears,
ambiguities, as well as the disorders/conditions secondary to the life history of the abandoned
child, his peculiarities in relation to his age and degree of development, his rights and
freedoms. All this specific knowledge, powered by eustress, facilitates the matching process
between the child and the adopting person/family and provides the ability to “predict” the
integration and adaptation of the child within the new family climate.

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Legislation
Legea nr. 273 din 21 iunie 2004 privind procedura adopției r3, cu modificările și completările
ulterioare. LEGE 273 21/06/2004 – Portal Legislativ (just.ro) [Law no. 273 of June 21, 2004
r3 regarding the adoption procedure, with subsequent amendments and additions. LAW 273
06/21/2004 – Legislative Portal (just.ro)]
Legea nr. 272 din 21 iunie 2004 privind protecția și promovarea drepturilor copilului. Lege (R) 272
21/06/2004 – Portal Legislativ (just.ro) [Law no. 272 of June 21, 2004 regarding the protection
and promotion of children’s rights. LAW (R) 272 21/06/2004 – Legislative Portal (just.ro)]
Legea nr. 292 din 20 decembrie 2011 asistenței sociale. Lege (R) 272 21/06/2004 – Portal Legislativ
(just.ro) [Law no. 292 of December 20, 2011 on social assistance. LAW (R) 272 21/06/2004 –
Legislative Portal (just.ro)]
Hotărârea nr. 798 din 28 iulie 2021 privind modificarea anexei la Hotărârea Guvernului nr. 579/2016
pentru aprobarea Normelor metodologice de aplicare a Legii nr. 273/2004 privind procedura
adopției, pentru modificarea și completarea Hotărârii Guvernului nr. 233/2012 privind serviciile
și activitățile ce pot fi desfășurate de către organismele private române în cadrul procedurii adopției
interne, precum și metodologia de autorizare a acestora și pentru modificarea Hotărârii Guvernului
nr. 1.441/2004 cu privire la autorizarea organizațiilor private străine de a desfășura activități în
domeniul adopției internaționale. Hotarare 798 28/07/2021 – Portal Legislativ (just.ro) [Decision
no. 798 of July 28, 2021 regarding the amendment of the annex to Government Decision no.
579/2016 for the approval of the Methodological Norms for the application of Law no. 273/2004
regarding the adoption procedure, for the amendment and completion of Govern­ment Decision
no. 233/2012 regarding the services and activities that can be carried out by Romanian private
bodies within the internal adoption procedure, as well as their authorization methodology and for
the amendment of Government Decision no. 1.441/2004 regarding the authorization of foreign
private organizations to carry out activities in the field of international adoption. DECISION 798
28/07/2021 – Legislative Portal (just.ro)]
Legea nr. 287 din 17 iulie 2009 privind Codul civil. Lege (R) 287 17/07/2009 – Portal Legislativ
(just.ro) [Law no. 287 of July 17, 2009 regarding the Civil Code. Law (R) 287 17/07/2009 –
Legislative Portal (just.ro)]