Supporting Adults With Misattributed Paternity: Insights From U.S.-Based Counselling Professionals

Abstract

Commercial DNA testing has led to an increase in individuals discovering misattributed paternity (the discrepancy between the genetic and social fatherhoods outside of adoption and donor-assisted reproduction), posing significant emotional, identity-related, and relational challenges. Despite this growing prevalence, no studies currently exist on how counselling professionals can support individuals navigating this experience. Our study examines the experiences of eight U.S.-based counselling professionals working with clients who discovered their misattributed paternity as adults. Using reflexive thematic analysis of semi-structured interviews, we found that such discoveries present complex clinical scenarios marked by trauma-like emotions, grief, identity, and relational challenges. These situations necessitate multifaceted therapeutic interventions and a high level of professional competence. Relationally attuned counselling and social support are particularly important. The study underscores the need for targeted professional training, the expansion of peer and community support networks for individuals affected by misattributed paternity, and continued advocacy and research efforts.

Action Editor: Alex L. Pieterse

Significance of the Scholarship to the Public

Advances in commercial DNA testing have led to more people discovering that the man they believed to be their father is not their biological parent—a situation known as misattributed paternity. These discoveries can trigger profound emotional, identity, and relational challenges, yet many individuals struggle to find mental health professionals who understand this experience. This study is the first to examine how counselling practitioners support adults navigating such discoveries. The findings highlight the importance of empathic, relationally attuned counselling; peer and community support; and greater professional training and awareness to ensure that individuals affected by unexpected DNA discoveries receive informed and compassionate psychological care.

Misattributed paternity—the discrepancy between the genetic and social fatherhoods outside of adoption and donor-assisted reproduction (Cerfontyne et al., 2024)—is a phenomenon of growing public significance due to the rise of commercial DNA testing, offered predominantly by U.S.-based companies such as 23andMe and AncestryDNA (International Society of Genetic Genealogy, 2022). Over 40 million people have already taken a DNA test (Becker et al., 2024) with its innate potential to uncover a lack of genetic relatedness (Moray et al., 2017). Coupled with the estimated prevalence of misattributed paternity being between 1% and 10% (International Society of Genetic Genealogy, 2022; Larmuseau et al., 2019), between 400,000 to 4,000,000 people may have already discovered or are about to discover their misattributed paternity.

Emerging research indicates that adult discoveries of misattributed paternity are marked by significant psychological and relational challenges. Those who learn that their presumed father is not related to them genetically may feel intense emotions, such as shock, anger, emotional pain, betrayal (Grethel et al., 2022), grief and loss (Becker et al., 2024), a sense of disorientation (Lawton et al., 2023), and struggle to perform their usual daily activities due to heightened anxiety and depression (Avni et al., 2023). They may also deal with a sudden identity crisis and process new ethnic or racial information or changes to their medical history (Grethel et al., 2022, 2024). Further, misattributed paternity affects not only the person who has it but also the parents and the whole family system. Often, there are competing views on whether to disclose misattributed paternity within one family unit, and individuals with misattributed paternity feel torn navigating these differences (Grethel et al., 2024). Moreover, the need to connect with the paternal bloodline after discovery may create additional tension within the family one was raised in. These challenges may be further compounded by various emotions in anticipation of the response from the biogenetic father and or his family.

The described experiences should be considered within their sociocultural contexts. Although misattributed paternity is a phenomenon of global relevance, with prevalence studies suggesting it occurs across diverse regions, from Mexico to New Zealand (Bellis et al., 2005), it is currently studied through a predominantly Western lens (e.g., Grethel et al., 2024; Lawton et al., 2023). This dominance reflects both the origins of most published scholarship and the demographics of commercial DNA testing, with North America being the leading market for genetic testing (Makhnoon et al., 2024). Situating the present study within a Western, specifically U.S.-centric, context is therefore consistent with existing research and with the sociocultural locations in which DNA testing is most prevalent. At the same time, we recognize that this focus limits the transferability of the findings to racially and ethnically marginalized populations, whose experiences may differ substantially and require dedicated inquiry.

Counselling Experiences of Individuals With Misattributed Paternity

The scarce empirical research on misattributed paternity and counselling has likewise been conducted primarily with Western, and particularly U.S. populations. These studies suggest that professional counselling plays an important role in supporting individuals post-discovery. For example, Lawton et al. (2023) reported that a third of their participants sought help from a mental health professional to navigate their discovery. Similarly, Grethel et al. (2024) found that their U.S.-based participants viewed specialized counselling as helpful in reducing emotional distress, guiding healthy coping strategies, and managing changing familial relationships.

Yet, there appears to be a substantial mismatch between the need for counselling following misattributed paternity discoveries and the current state of clinical practice. Adults with misattributed paternity often report difficulty finding practitioners who understand the psychological and relational implications of their experience. For instance, Lawton et al. (2023) found that participants rated their therapists’ training in this area as below average, while Grethel et al. (2024) reported that a lack of specialized knowledge among counselling professionals can result in insensitive responses and even retraumatisation. Acknowledging these risks, scholars have called for increased counselling competency and expanded psychological support tailored specifically to this presentation (Avni et al., 2023; Becker et al., 2024). Accordingly, there is an urgent need to develop specialized, culturally sensitive frameworks and evidence-based interventions that are responsive to the psychological, relational, and sociocultural complexities of misattributed paternity discoveries.

Supportive Approaches for Misattributed Paternity Discoveries

Given the limited counselling literature on misattributed paternity, insights from the more established field of adoption may offer a useful starting point (Sánchez-Sandoval et al., 2020). Adoption-sensitive counselling is recognized as a vital source of support for adoptees and their adoptive and birth families (the adoption triad; Baden et al., 2019). It forms part of adoption-informed care, which equips practitioners with specialized skills to support the adoption triad across the lifespan. This approach addresses trauma, grief, and loss in a culturally sensitive and nonpathologizing manner, promoting both psychological and relational well-being (Toland et al., 2024).

Specialist training and knowledge of adoption-related matters are central to adoption-informed care (Baden et al., 2018). Examples of such knowledge are age-dependent developmental trajectories of adoptees (Toland et al., 2024), being sensitive to racial issues experienced by transnational adoptees (Strand & Hillerberg, 2024), or the importance of searching for one’s genetic origins (Baden et al., 2019). To facilitate adoption-informed care, practitioners are recommended to use attachment-focused, family-systems-based, and trauma-informed therapeutic modalities (Toland et al., 2024). Further, identity-oriented approaches, including narrative therapy (Stokes & Poulsen, 2014) and grief and loss modalities (Sánchez-Sandoval et al., 2020), are recommended to address difficulties related to adoptees’ relationships and increase understanding of how various family members contribute to a specific family dynamic, including through family counselling (Toland et al., 2024).

It is important to acknowledge that most adoption-related counselling research is focused on adopted children, adolescents, and their adoptive and birth families (Sánchez-Sandoval et al., 2020). However, knowledge specific to adult adoptees and their counselling needs also exists. Studies with adult adoptees show that the need for mental health support continues throughout life, with adoptees in their 20s and 90s also seeking counselling (Sánchez-Sandoval et al., 2020). They prefer a practitioner with specialized training in adoption (Baden et al., 2018), an adoptee counsellor, or a counselling professional with relevant lived experience (Strand & Hillerberg, 2024). Similarly, individuals with misattributed paternity often rely on peer support networks to feel less alone and to reconstruct relational meaning (Lawton et al., 2023). What appears to be most helpful in counselling is validation and support of their individual adoption experiences (Baden et al., 2019).

Adoptees and individuals with misattributed paternity share similar experiences that may help inform counselling practitioners. Both groups experience loss, shame, guilt, grief, identity challenges, a loss of agency, and relational difficulties (Baden et al., 2019; Becker et al., 2024; Lawton et al., 2023). They also have a strong need for contact with their genetic family (Baden et al., 2019; Grethel et al., 2024) and often encounter practical and emotional barriers in establishing contact with their biogenetic relatives (Becker et al., 2024; Sánchez-Sandoval et al., 2020). Both groups rely on peer support to process their experiences, especially since finding a suitable practitioner for their presentation can be challenging (Lawton et al., 2023; Sánchez-Sandoval et al., 2020; Strand & Hillerberg, 2024). Given the parallels between adult adoptees and individuals discovering misattributed paternity in adulthood, adoption-informed care can be a useful starting point for counselling practitioners.

However, important distinctions remain. Unlike adoption, misattributed paternity is not a socially sanctioned child welfare practice but often an “unwelcome” (Malek, 2013, p. 45), shame-laden family event (Grethel et al., 2024). Those affected may face additional challenges due to the lack of professional and legal frameworks to support their search for biogenetic origins (Cerfontyne et al., 2024). Limited societal and professional awareness (Lawton et al., 2023) often leads to misunderstanding, insensitive comments (Grethel et al., 2024), stigma, and a loss of familial belonging (Becker et al., 2024). Such negative experiences can deter individuals from seeking counselling, for fear of further distress or invalidation.

The Current Study

There is a significant gap between the support needs of adults discovering misattributed paternity and current counselling knowledge. Although studies exploring counselling experiences of individuals discovering their misattributed paternity are emerging (e.g., Lawton et al., 2023), no research to date has examined how counselling practitioners navigate this presentation in practice. To address this gap, we will draw upon the experiences of counselling professionals working within Western, U.S.-based contexts who specialize in supporting adults discovering their misattributed paternity, as this approach facilitates access to in-depth, context-rich clinical knowledge (Meuser & Nagel, 2009) and is particularly valuable in an emerging domain with limited empirical evidence (Drescher et al., 2013). More specifically, we aimed to answer the following research question: How do counselling professionals approach their work with individuals discovering their misattributed paternity in adulthood?

Method

Participants

The study involved eight participants (M_Age = 55.44 years), all of whom identified as women, predominantly White (one participant identified as Jewish), and based in the United States. All participants were licensed mental health professionals. Table 1 details the participants’ characteristics, including professional designation, the highest level of relevant education, years of professional practice, identification as a person with misattributed paternity/paternal discrepancy, lived experience with misattributed paternity/paternal discrepancy, and years of counselling clients with misattributed paternity.

Table 1.

Characteristics of Counselling Professionals

Pseudonym	Professional designation	Highest level of relevant education	Years of practice	Identification as a person with misattributed paternity/paternal discrepancy	Other lived experience of misattributed paternity/paternal discrepancy	Years working with misattributed paternity clients
Cathy	Licensed marriage and family therapist	Master’s degree	4+	No	Yes, parent of children with paternal discrepancy	5
Emily	Therapist/Counsellor	Master’s degree	2–4	Yes, misattributed paternity		4
Jannet	Therapist/Counsellor	Master’s degree	4+	No	Yes, grandchild of an adopted person	2
Joanne	Psychologist	Doctorate	4+	Yes, misattributed paternity		9
Kellie	Licensed marriage and family therapist	Master’s degree	4+	No	Yes, parent of children with paternal discrepancy	2
Kendra	Licensed marriage and family therapist	Doctorate	4+	Yes, adopted		2
Lilian	Licensed clinical social worker	Master’s degree	4+	No	Yes, parent of children with paternal discrepancy	10
Mandy	Therapist/Counsellor	Master’s degree	4+	Yes, adopted		17

Participant Recruitment

Following institutional ethics approval, recruitment took place May to June 2023, using purposive and snowball sampling to ensure that participants were counselling professionals with relevant experience (Etikan & Babtope, 2019). Such sample specificity increases the study’s information power and contributes to its methodological rigour (Malterud et al., 2016). To recruit, we directly contacted professionals who advertised their expertise in misattributed paternity online or were known to us for their work with this population. We also invited practitioners through recruitment announcements circulated by professional counselling associations, yet no participants were recruited via these channels. Although our call for participants was international in scope, all eligible and willing participants who responded were based in the United States.

Eligible participants were required to be registered and licensed in their country, provide regular counselling to clients with misattributed paternity, and speak English. All participants received an explanatory statement detailing the study’s purpose, procedures, confidentiality, risks and benefits, voluntary participation, and contact details for the research team and ethics committee. All participants also provided written informed consent. Pseudonyms were used, and identifying details were removed to protect confidentiality. Although we offered compensation in the form of gift vouchers, only three participants accepted.

Recruitment ceased after the eighth interview due to both the time-limited nature of the study (conducted over 2 months) and the high information power of the dataset, supported by the study’s focused aim, the specificity of the sample, and the rich, practice-based insights provided by participants (Malterud et al., 2016). As is consistent with reflexive thematic analysis, we did not seek saturation; instead, we assessed whether the data collected sufficiently addressed the research question and offered interpretative depth (Braun & Clarke, 2022).

Data Collection

We conducted individual semistructured interviews to gather qualitative insights into how counselling professionals working with clients who discovered their misattributed paternity in adulthood approach this presentation. The interviews took place via the teleconference service Zoom and lasted an average of 68 minutes. The interview questions were developed based on a literature review on misattributed paternity discoveries, insights from the lead author’s dual perspective as both a counsellor and a person with lived experience of misattributed paternity, and findings from a separate study involving interviews with individuals who had discovered their misattributed paternity and reflected on their counselling experiences (reported separately). Specifically, the questions related to: (a) the context of counselling individuals with misattributed paternity, for example: What led you to work with individuals with misattributed paternity? (b) counselling approaches and strategies in working with clients presenting with misattributed paternity discoveries, for example: What specific interventions and techniques do you find to be most helpful? (c) presentation of clients with misattributed paternity, for example: What are the reasons why clients with misattributed paternity seek counselling? and (d) professional development and competence, for example: What training, literature and other resources have you relied upon in preparation for counselling clients with misattributed paternity?

Data Analysis

We transcribed and analyzed the interviews via NVivo (Lumivero, 2024). For the data analysis, we used reflexive thematic analysis (Braun & Clarke, 2022), guided by an objectivist ontology and a subjectivist epistemology within the overarching action research methodology—that is, while an independent reality is acknowledged, knowledge of it is understood as co-constructed through individual perspectives shaped by historical and cultural contexts (Brannick & Coghlan, 2016). Our analysis was primarily inductive, while also informed by the literature review and the methodological goal of the study to generate “practical knowledge” (Reason & Bradbury-Huang, 2007, p. 4). The lead author began by familiarizing herself with the data through repeated readings and listening to recordings, noting initial reflections as transcript annotations or in a reflexive journal. Codes were generated organically through this process rather than from a preestablished coding framework. An example of preliminary coding is provided in Appendix A. The data were then organized into broad categories, such as practitioner experiences, client presentations, counselling strategies, and professional training, which informed the development of the initial codebook. Although all authors of this paper engaged with the data, we did not seek coding consistency or interrater reliability. Instead, the co-authors’ insights and interpretations were helpful in broadening the lead author’s understanding of the data and surfacing nuanced perspectives, in line with the focus on depth rather than agreement in reflexive thematic analysis (Braun & Clarke, 2022). After the initial codebook was developed, the lead author refined and finalized the codebook by reviewing the entire dataset in a different order to ensure rigour. Theme generation followed, involving the aggregation of meaning across the data and the identification of nine candidate themes. These were revised and structured into themes and subthemes for clarity. For example, trauma-informed counselling, grief and loss, identity and relational challenges were initially stand-alone candidate themes, merged later together into the broader theme “It’s trauma, it’s grief, and it’s identity crisis,” underscoring the complexity of this clinical presentation. Themes were then defined in relation to the research question and named using participant quotes to capture their subjective experiences.

Rigour and Trustworthiness

In this study, we used two strategies to enhance the study’s trustworthiness through confirmability and credibility (Ahmed, 2024). First, the lead author maintained a reflexive journal and engaged in monthly debriefing meetings with the co-authors to review interpretations and minimize possible bias. For example, one discussion focused on the theme of validation. Although all team members agreed on its importance, the interpretations differed: one co-author viewed it as a generic counselling skill, while the lead author, informed by personal experience and counselling intuition, emphasized how validation can be particularly critical as a corrective emotional experience in cases of misattributed paternity. Second, the lived experience of the lead author with misattributed paternity, combined with the professional counselling experiences of all three authors, helped the researchers gain nuanced insights into the collected data that might not be immediately apparent to those without these experiences.

Positionality and Reflexivity Statement

In the spirit of reflexivity, we acknowledge our positions in relation to misattributed paternity, counselling, and the study’s context. The lead author is both a professional counsellor and a person who discovered her own misattributed paternity in adulthood, making her an insider to the practitioner group but without direct counselling experience in this area, placing her at the outer edge of insider positionality (Fleming, 2018). Her personal experiences of seeking counselling support for her own discovery also served as a key motivation for this research. The co-authors are counselling psychologists with practical and academic expertise in family relationships, identity, and grief, but without direct experience supporting clients with misattributed paternity, positioning them similarly in relation to the research topic. The co-authors did not identify as people with misattributed paternity, offering a balancing perspective to the lead author’s lived experience and supporting critical reflection throughout the analytic process.

All authors were trained in Western counselling traditions, which shaped the professional knowledge and assumptions we brought to the study. Two authors, including the lead author, are also parents, a perspective that informed our sensitivity to both the parental role and the experience of being a child in the context of misattributed paternity. The lead author’s personal investment in the topic further guided the focus on identity, family, and counselling practice, while our collective commitment to improving mental health care shaped the interpretive lens applied to participants’ accounts.

Given that our participant sample, unintentionally, consisted primarily of White women living in the United States, we recognize the cultural specificity of the study and its findings. At the same time, as a research team, we bring diverse genders, ethnicities (including White European), both Western and non-Western cultural backgrounds, and lived experiences across the globe, including the United States. These perspectives enriched the reflexive process and provided opportunities to challenge assumptions and reduce the risk of overly narrow interpretations.

We also acknowledge the potential for misinterpretation or harm. Research on misattributed paternity may inadvertently reinforce gendered stereotypes, pathologize mothers, or privilege genetic ties over other forms of kinship, thereby narrowing understandings of family and belonging. Our study is further limited by the lack of cultural and ethnic diversity among participants, constraining inclusivity and potentially distorting the picture of the wider counselling field. Recognising our responsibility as researchers, we sought to mitigate these risks by situating the findings within a Western/U.S. context, explicitly acknowledging sample limitations, and engaging in reflexive consideration of our own positionalities.

Findings

Six themes captured how counselling practitioners supporting clients with misattributed paternity approached their work. Table 2 provides an overview of the identified themes and their descriptions.

Table 2.

Identified Themes

Theme	Theme description
“I know what it does to people, and the general population doesn’t get it”: The importance of lived experience	Lived experience with misattributed paternity, adoption or donor-conception was the main source of information for practitioners on the needs and experiences of their clients. Lived experience also set them apart from the rest of the counselling profession, which the participants viewed as lacking specialist training and experience to work with misattributed paternity discoveries.
“It’s trauma, it’s grief, and it’s identity crisis”	The practitioners viewed adult discoveries of misattributed paternity as a complex clinical presentation requiring specialized care. The presentation included: (a) a trauma-like intense emotional experience, (b) grief and loss, (c) self-doubt, (d) an identity crisis or identity reorganization, and (e) challenges in navigating the relationships with the family of origin and the newly found paternal blood relatives.
“A little of this and a little of that”: Integrative counselling	The complexity of the presentation requires a combination of counselling approaches and techniques. Trauma-informed approaches, cognitive-behavioral therapy (CBT), and solution-focused and identity-orientated techniques were among the frequently used ones.
“Give it the credence and the validation that it deserves”: Person-centred counselling	Regardless of a specific therapeutic modality, the practitioners underscored the importance of being person-centred and empathy driven. The participants emphasized the critical role of validation, compassion, empathic and non-judgmental listening, and respecting their clients’ unique experiences and beliefs.
“It’s not a straight line”: A more flexible counselling process	There was no consistency in frequency and duration of sessions. A non-linear pattern of the counselling process with irregular and on-demand sessions was common.
“We need community. We need others”: Social support outside of counselling	In addition to individual counselling and sometimes instead of individual counselling the practitioners recommended various forms of social support: From attending book clubs and having a dedicated support person to joining a peer support community and group therapy.

“I Know What It Does to People, and the General Population Doesn’t Get It”: The Importance of Lived Experience

All interviewed counselling professionals had some level of lived experience of either misattributed paternity, adoption, or donor-assisted reproduction. The lived experience often motivated practitioners to engage in this line of work, played an important role in rapport building, and served as a key source of therapeutic guidance.

Lived Experience Motivates Practitioners

For many participants, working with misattributed paternity was their “deep calling” and “passion,” indicating a high level of both personal and professional engagement. Often, such dedication was born in intense emotions of “wrestling” with personal experience of misattributed paternity or adoption, either one’s own or within the family. As Mandy put it, “I didn’t go through the things that I’ve gone through not for somebody else to benefit from that.” Others felt compelled to improve the quality of available therapeutic support:

I kept hearing from a variety of clients and then people in the support groups about how dismissive clinicians were being. And that was really disappointing to me because we are, by nature of being therapists, supposed to be an empathic group, and we're supposed to be able to meet anybody where they are rather than dismiss them. (Joanne)

The need to improve the quality of therapeutic support available to individuals with misattributed paternity was raised by many participants. In their view, the general counselling profession and even those who work in the field of paternal/parental discrepancies without relevant lived experience do not understand the support needs of this group of people. Jannet shared, “I’ve talked to a lot of my colleagues about it, and I have to say there’s a frustratingly large number of them who are like, ‘What’s the big deal?’” Other participants were more direct in their evaluations of the therapeutic community’s competency in supporting individuals with misattributed paternity, describing it as “pitiful” and “mediocre” and stressing that “definitely more training is needed.”

Lived Experience Promotes Rapport

Other participants referred to their lived experience as giving them “a leg up,” “street cred,” and “an automatic plus one to your scoreboard,” highlighting the perceived significance of the practitioner’s lived experience for credibility and rapport building with clients. Some used self-disclosure during the counselling process to facilitate sharing and strengthen rapport. Even though the life stories of the counselling professional and the client may differ, simply being a member of the paternal discrepancy community was considered valuable for clients. Kendra shared: “You’re a member of a tribe that they don’t have. You [are] trusted because they know that you’ve been through it. Even though our experiences could have been different.”

Many participants recognized that their relevant lived experience was advantageous in attracting clients. For example, Joanne, like other participants, openly stated her misattributed paternity on her website and other advertising platforms. In Joanne’s view, this information draws prospective clients to her as it signals that they will be understood, “[The clients think] I'm not going to have to explain this [experience] because I don't understand it myself, but she'll get it.” Emily echoed Joanne’s view and viewed having relevant lived experience as “one of the criteria” for choosing a therapist.

“Understanding the Community Is the Resource”

Participants often viewed their lived experience as a “resource” that uniquely informed them in understanding the client’s experiences and therapeutic needs. Emily shared, “Understanding the community is the resource… your resource. You know the resources, you know what everybody else is.” Kendra expanded:

I'm probably just a step or two ahead of the people that are just behind me. I haven't quite figured it all out yet, but I'm a little further down the road than some people that are new to their discovery. So, I think that makes a difference.

Joanne emphasized the powerful combination of her lived experience and therapeutic training and felt “uniquely equipped” to help clients with misattributed paternity:

From my own experience, I knew pretty immediately what I was going through. I knew it was grief and trauma, and then I knew eventually that I was experiencing an identity crisis. And I figured, I actually know what all of this is, and I know what to do to treat it.

Lived experience also facilitated insider access to the wider misattributed paternity community with its knowledge and information. Through these networks, the participants knew of available support options and therapeutic resources or could obtain client referrals and practical help with understanding DNA matches.

Lived Experience is Not Everything

Although the lived experience was “very helpful” to the practitioners, they did not rely solely on it. Most of the participants spoke about extensive professional training they either already had or undertook to provide counselling and therapy. They also emphasized their years of being in practice and having specialized training, for example, in family counselling, adoption-informed care, or trauma-informed modalities. Additionally, some professionals emphasized the importance of many years of being “immersed” in their communities and learning from them as the basis for their therapeutic competence.

Relatedly, the participants expressed the view that practitioners without lived experience can also work effectively with misattributed paternity if they are trained in certain therapeutic modalities and meet the clients where they are. For example, having training and experience in attachment, trauma, and grief-informed practices was mentioned as a good starting point in the absence of lived experience. “Plain old experience,” being person-centred, open-minded and curious, getting involved with the community, listening to the voices from the community and taking a collaborative approach to therapy were deemed to be beneficial too. Joanne summarized this perspective:

I don't think that you have to have personal experience with [misattributed paternity] in order to be an effective clinician… I've never had cancer, but I've talked with many people who have or who have lost someone to cancer. And if you're a good therapist, you're meeting them where they are, and you don't have to have every single experience they have.

It may also be important to consider that despite its numerous advantages, lived experience may interfere with therapeutic work. As Cathy put it, “Many of us were patients and many of us [still] are.” Her words suggest that practitioners with lived experience might struggle to separate their own stories from the ones of the clients. This could affect the practitioner’s judgment. For example, if a client does not express the need to know their biogenetic father, the therapist interested in finding their genetic roots could impose this perspective onto the client: “I don't know if somebody who's walked the walk and maybe did the search… Are they going to be able to really accept the autonomy of somebody who made a very different choice?” (Cathy)

“It’s Trauma, It’s Grief, and It’s Identity Crisis”

Regardless of whether the practitioners had direct lived experience with misattributed paternity or not, all of them agreed that discovering misattributed paternity in adulthood is a complex clinical presentation requiring specialized care. Mandy summarized this view: “I would not send [a client with misattributed paternity] to a generalist because I think the situation here is so complex.” The complexity of the presentation appeared to consist of five interlinked layers making up the overall presentation: (a) an intense, trauma-like emotional experience triggered by the discovery; (b) grief and loss; (c) self-doubt; (d) an identity crisis or identity reorganization; and (e) challenges in navigating relationships with the family of origin and the newly found paternal blood relatives.

“It is a Genuine, Legit Trauma”

All practitioners highlighted the discovery’s profound emotional impact on their clients. As Lilian put it, “their whole world exploded,” resulting in “a big psychological effect, like one of the biggest [effects] you can have.” According to all participants, this psychological effect often involves feeling lost and disoriented. Kendra provided a vivid metaphor to describe this experience:

A lot of them will describe a fog over them. And not knowing where [they are] like they were lost, like literally dumped off in a desert and don't know where they are and how to get back to where they need to be.

In Kendra’s opinion, this is “the fog of depression,” and other participants shared that their clients felt depressed and, at times, suicidal as a result of the discovery. Anxiety was reported as well, for example, caused by not knowing how to navigate this unexpected situation, feeling alone or questioning their own experiences. The level of anxiety can be very high, manifesting in an “almost manic” drive to do something that might resolve the emotional discomfort and regain control over the seemingly incomprehensible situation. Emily described this experience of her clients: “‘What do I do? I just found out yesterday… My friends said I should find a therapist. And so here I am. What do I do?’ That feeling of being disorientated.” The changes in familial relationships can be anxiety-provoking as well: “There's loyalty issues. There's deep-seated hurt with [the] family that you love. And so, there's all sorts of conflicting emotions with deep, important relationships” (Mandy).

Connecting these emotional experiences to established psychological conditions, nearly all practitioners viewed this presentation as trauma, either directly from the discovery or past attachment injuries that were reactivated by the discovery. Kendra emphasized the clinical importance of applying a trauma lens to misattributed paternity discoveries:

It is a genuine, legit trauma, but it's different [to] other trauma that we as clinicians typically work with. We have a rape victim or somebody who was a victim of [a] crime or something [traumatic]. It exhibits the same symptoms or similar symptoms, but it's a completely different circumstance. But it's still classified, I would say, as a trauma. The first thing we [as practitioners] need to understand is… that [it] is traumatic.

Grief and Loss of Connection

Grief and loss of belonging were other clinical terms used by the participants to frame the presentation. In Joanne’s words, this is “grief over having lost family connections, whether perceived or actual genetic connection.” Kendra offered an evolutionary explanation of this “different kind of grief”:

… human beings, we are tribal… We need to be in a group. That's how we are genetically, right? So we go through life, we develop this tribe, which starts with our family. Then we incorporate school friends or church friends or whatever. But that's our tribe. To find out that you're not really a part of that tribe, 50%. It untethers you from that tribe, and then you're left isolated… You're completely alone. So that's the grief.

Many participants anticipated that recognising this presentation as trauma and grief would be hard for practitioners without specialized training or lived experience. Understanding why the discovery has such a profound impact can also be hard for clients, potentially exacerbating their emotional distress. Lilian shared: “If they look out, nothing’s different on the surface, but everything on the inside has turned upside down, and it’s like, ‘Am I crazy?’” Other practitioners shared how their clients would cry or feel like they “got run over by a train” but could not understand the reasons for these experiences.

Identity Challenges

Another dimension in the experience of misattributed paternity discoveries identified by the participants were identity-related psychological processes. Nearly all participants shared that their clients go through an existential crisis of who they are, try to integrate the new ancestral, ethnic and/or racial (Bellis et al., 2005) information and redefine their new identity. Jannet shared: “The commonality between [clients] has been really struggling with a shift in their identity. Like, ‘How do I incorporate this news into my sense of who I am and where I come from?’”

Relational Challenges

The clients’ relationships—past, existing and new ones—were reported to be another common source of emotional turmoil. The discovery can open old wounds, triggering “a tidal wave of history”:

Outside of the community [with lived experience], people don't understand how much about someone's childhood or upbringing or relationships with family can be triggered by this. The trauma may or may not be the actual surprise of [discovering misattributed paternity], but it might be a tidal wave of history. Like a tidal wave of abuse flashbacks, now muddled with this confusion of DNA. (Emily)

Existing relationships can also cause hurt and confusion. For example, the participants reported that their clients often experience a lack of understanding from others: “[The clients are] feeling alone and questioning their experience because other people… minimize it” (Jannet). Further, individuals with misattributed paternity may feel “manipulated into taking responsibility for this whole thing and that they should keep the secret.” Practitioners also shared that new relational challenges arise when those learning about their misattributed paternity have to balance their family-of-origin relationships with contact with the paternal bloodline. Navigating these new biogenetic connections can be uneasy, as they cause anxiety due to fear of rejection. Many of these relational challenges do not have a straightforward solution and can take years to resolve, often making the discovery of misattributed paternity a difficult, prolonged, and even life-long journey.

The Need for Specialized Care

Given the complexity of the presentation and its duration, it is unsurprising that many practitioners viewed their clients as very vulnerable and needing “a lot of handholding through” this experience. However, such “scaffolding” requires “somebody who really knows their stuff and knows what they’re doing,” as Mandy put it. Kendra echoed this view, summarising the essence of this theme:

It's trauma, it's grief, and it's [an] identity crisis. As a clinician, generally, we get somebody in, and they may be dealing with one of those subsets. Maybe they're grieving. They lost their husband… We're not usually working with all three of those things and whatever else comes in with them. [For] a clinician, it's a different, very complex [presentation].

“A Little of This and A Little of That”: Integrative Counselling

The complexity of the misattributed paternity presentation in counselling can also be evident from the variety of therapeutic approaches and techniques the practitioners employed. Trauma-informed approaches, cognitive-behavioral therapy (CBT), and solution-focused and identity-orientated techniques were among the frequently used ones. Most practitioners used an “eclectic” approach to therapy––the one that Lilian described as “a little of this and a little of that.” One participant developed a more systematic treatment protocol for counselling clients with misattributed paternity discoveries based on her own experience and academic studies. Still, her approach also represents a mix of therapeutic modalities and models and comprises “the combination of narrative object relations, cognitive, behavioral and some family system stuff, and a little bit of social solution-focused work.”

Trauma-Informed and Emotion-Focused Techniques

Many participants used trauma-informed techniques, such as eye movement desensitisation and reprocessing (EMDR), brainspotting, amplification of emotions, and psychoeducation on trauma. For example, to prevent self-doubt and avoidance, Lilian uses amplification of her clients’ experiences:

In the beginning, I am reinforcing with the person [who's] just made this discovery how huge it is… because the person is already starting to backtrack. “Well, it shouldn't be that big of a deal. And I love my dad. And, you know, he's always been a good father, and I don't want to hurt him. I don't want to make a stink”… And I'm like, “Nope, nope, nope. The lid’s come off, and this is bigger than you'll ever know.”

Journaling and therapeutic letter writing to either oneself as a child or to a parent were recommended for emotional processing and reflection. Practitioners also used experience-specific open-ended questions to encourage reflection and assist with meaning-making. They also recommended drawing a family genogram and a timeline of family events to explore the family history and relationships through the discovery prism. Visualisation techniques can help with a positive reframing of the experience. Kendra shared: “If I have someone that's super negative… I may have them do a vision board just to get them in a different space of thinking. ‘What do you want your life to look like?’”

CBT Techniques

Cognitive-behavioral strategies were often used to reduce uncertainty-driven anxiety. They also helped contain the difficult experience, giving it a cognitive boundary: “In my experience, people appreciate having a container that looks like a tangible understanding of a process as opposed to [it being] shapeless. They want some sense of direction” (Emily).

Other practitioners agreed that clients with misattributed paternity discoveries appreciate a more directive approach—or, as Emily put it, “a more prescriptive experience.” This can help them gain a sense of direction and progression, which can be challenging due to feeling overwhelmed and physically exhausted from the experience. Joanne shared: “Clients are most helped by a practical approach because they are so emotional… Everything feels larger than it is. Everything gets distorted.”

CBT was helpful for recognising “how you’re talking to yourself and how you’re thinking about things” (Joanne) and facilitating active engagement with one’s experience instead of avoidance. Kendra recommended behavioral activation to her clients and active processing of the discovery: “Go buy a puppy. Get a plant. It’s just something that keeps [them] going… Just engage them in some reflective activity… As long as they continue to stay engaged rather than suppressing those memories.”

Practitioners also recommended finding ways to assist others in similar situations, for example, by becoming “an activist” and raising awareness of misattributed paternity in society or helping others to search for their genetic origins. Such active coping strategies were seen as helpful in finding a sense of purpose and regaining control over one’s life.

Solution-Focused Techniques and Psychoeducation

Solution-focused techniques appeared to be particularly useful in navigating relational challenges. For example, the practitioners used these techniques to explore the level of contact with their biogenetic family that clients viewed as beneficial, how to approach newly found relatives, and how to navigate boundaries and manage expectations. To assist with the exploration of various outcomes, one practitioner used brainstorming of an “if-then” action plan to create “a road map that they can hold on to.”

Other recommendations included education, for example, on DNA or the importance of shared genetics. Practitioners also equipped their clients with various resources, such as books, articles, websites, and other information, to “educate” themselves on this subject. This information was deemed useful for normalising and explaining the client’s experience. Some practitioners taught their clients “some pretty practical communication skills” and discussed safety strategies around disclosing personal information.

Identity-Orientated Techniques

An important part of counselling individuals with misattributed paternity was helping them incorporate their discovery experience into a coherent sense of identity and make sense of the discovery. Emily summarized the key aspects of this work: “Who are they? What does it mean? Ancestry. Inheritance. Bloodlines. Genetics. What does all that mean to them?” When working with identity issues, Cathy emphasized that it is important not to “dismantle” who one is but rather “add to it.” This can be achieved, for example, by starting with where the client is today and what shaped their identity before the discovery and then exploring how their identity changed after the discovery. This exploration could be particularly relevant when clients are faced with different ethnic and/or racial information than the one previously known:

In some cases, it's significant [to learn] that somebody is half Jewish or they're not Italian… What does that mean? For some, it might not have as much meaning, and for others, it really changes their lives. There are some very public [people] who talk about discovering that they are half Jewish [and] who end up converting. (Cathy)

Narrative therapy was commonly mentioned as a helpful modality for undertaking identity work and finding purpose and meaning through this experience. In Joanne’s view, the narrative approach helps clients to find agency through taking control over their own story: “[It is] a kind of empowerment that came with using the narrative approach to change the meaning behind [the discovery experience].” Additionally, applying a family systems perspective can be useful in exploring the roles and interactions within the clients’ families and can “help understand patterns of relating in your original family, to know where you got certain messaging… to know family rules and how [they] played out and how you develop narratives about yourself in the world around you” (Kendra).

“Give It the Credence and the Validation That It Deserves”: Person-Centred Counselling

Regardless of the specific counselling approaches used, all practitioners emphasized the importance of being person-centered and empathy-driven in supporting clients with misattributed paternity. The participants emphasized the critical role of validation, compassion, empathic and nonjudgmental listening, and respecting their clients’ unique experiences and beliefs. Jannet shared:

A lot of times, they just want to talk… and need somebody to listen and validate them. That’s really been my experience that a lot of times I just need to shut up—which isn't always easy for me—and just listen.

Cathy provided an example of validating the importance of the biogenetic father’s identity for the clients: “I do a lot of validating and a lot of confirmation that they’re entitled to information [about the biogenetic father].” Another example of a judgment-free presence was provided by Mandy: “Honestly, what has helped the most is completely nonclinical. Like allowing them to just be pissed about the experience.”

In contrast, the participants considered lack of validation and challenging the client’s experience highly detrimental to the therapeutic process and often the reason why clients discontinue counselling. Comments like “your father is still your father,” “nothing has changed,” and trying to rationalize the experience or explore it from the parent’s perspective rather than the client/child’s perspective were often cited as diminishing, invalidating, and even retraumatizing. Many practitioners shared their own negative experiences with such comments as counselling clients. As Emily put it: “[Such reframing] is well-intentioned, but to [a client with misattributed paternity] something like ‘nothing is different’ can feel dismissive.” Jannet also emphasized the critical nature of approaching this presenting issue with unconditional regard: “Take it seriously. Whether you understand why it's so big [or not], just know that it's thick. Give it the credence and the validation that it deserves.”

“It's Not a Straight Line”: A More Flexible Counselling Process

The practitioners also shared their diverse experiences of the therapeutic process. The frequency of sessions ranged from regular weekly sessions to inconsistent bookings, driven by the client’s needs. Most practitioners commented that a nonlinear therapeutic process without a consistent pattern is common for this presentation. Joanne shared:

… with this population, it's not been a traditional clinical approach where they make [regular] appointments [and] feel like they need it. They take a very long time in-between sessions to practice everything that we've gone over. And then they'll make an appointment, oftentimes several months later, to go back over “here's what happened, here's what I'm struggling with, or I feel so much better. I haven't felt like I needed to come in because at least somebody validated what I was going through.”

Joanne’s comment suggests that, at times, just a bit of validation and emotional support is enough for clients to keep moving through the journey on their own. Other practitioners explained the “waxing and waning” of the therapeutic process by the nature of the discovery experience. They noted the many twists and turns on the postdiscovery journey, which consists of several issues and numerous events that can be difficult to navigate in a set number of regular sessions. Some practitioners explained the nonlinear therapy process by connecting it to traumatic avoidance triggered by the emotional and physical intensity of the experience that cannot be sustained over many weeks of counselling. Mandy shared:

They can live in this place for a little while, and then it's so heavy, they kind of have to go like, “I need a minute.” And then they take breaks… We start seeing some pullback or some resistance to coming to counselling all of a sudden.

Kendra echoed this perspective, adding, “I find with [misattributed paternity discoveries], it's not a straight line… It's going to come in at various times. A song, a smile, a something could remind you… That's how trauma is triggered.” To avoid overwhelming clients, Mandy recommended counselling over shorter but more intensive periods, for example, two or three days before taking a break.

However, the practitioners also reported a more linear pattern of counselling sessions. Some of them recommended regular weekly or fortnightly sessions within the first 12 weeks to 6 months, followed by less frequent sessions afterwards.

“We Need Community. We Need Others”: Social Support Outside of Counselling

Even though the practitioners were highly motivated to work with misattributed paternity discoveries and considered themselves well-equipped to support such clients, they all emphasized the importance of social support outside of counselling: “We need community. We need others; we need that attachment” (Kellie). The participants recommended various forms of social support, from attending book clubs and having a dedicated person “to talk to about this discovery on repeat” to joining peer support communities and group therapy.

The social support appeared to have several functions. First, it seemed to provide a sense of attachment and belonging. As Kendra put it, “It’s like the place that you get tethered down to while you’re figuring out all the other stuff.” Second, social support can facilitate a reflective space for processing the experience that is not constrained by the boundaries of a therapeutic relationship, such as the nature, timing, duration of contact, or having to pay for it. Joanne shared:

People feel a certain way about paying for [counselling]… Sometimes, they just want to be able to go on and on and on for a couple of hours without having somebody say, “Our time is up”… It's having it at their own pace. And I guess a little bit more equal to whoever they talk to rather than feeling, okay, this is how things are done. And my therapist dictates what we do here.

Third, support from others can be an important source of validation and normalisation. Validation can come from a friend or a romantic partner who listens empathetically and without judgment, or from other people who have lived experience. Many participants underscored the “healing” nature of connection with other individuals with misattributed paternity who “understand.” This contact helps normalize the experience by showing that there are others going through it. The misattributed paternity community also serves as a “counterbalance” to those who do not understand and seek to silence or undermine the person with misattributed paternity:

It's so helpful to know I'm not going through this alone, and I'm not crazy for what I'm feeling because it's very easy to fall prey to other family members saying, “Shame on you, this is all your fault.” And then you start to internalize this narrative about how bad you are. (Joanne)

Fourth, social support, especially its quality, seemed to influence the time it may take to process the discovery:

It depends on the level of other support that they have. If they have parents that are saying all those things like “stop asking questions” or “you should be grateful you're here,” it's going to take a little longer. But [if] they have the support of other people in their lives, even a spouse who says “go for it,” obviously they're going to need me less. (Cathy)

Many practitioners recommended that clients attend group therapy sessions to harness the benefits of social support. Some practitioners also facilitated them, conducting individual sessions at the beginning of the counselling process before transitioning the clients into a group format. Lilian, like some other participants, viewed such peer support groups as more helpful than individual counselling, possibly due to the isolating nature of the discovery experience:

I always have a group that I adjunct their work to… because I think they're going to get as much, if not more, from the other people on their same journey… They don't really need… heavy-duty therapy for 10 years for this stuff. They need to be in a healing community. They need to be doing activism, and then they need a therapist.

Discussion

Our study aimed to explore how counselling professionals approach their work with adults learning about their misattributed paternity with an overarching goal of improving counselling support for these individuals. To our knowledge, this is the first study on this subject.

In summary, adult misattributed paternity discoveries present a complex clinical picture, marked by trauma-like emotional responses, grief and loss, shame, identity disruption, and relational challenges. Our findings underscore the relational dimensions in the psychological experiences of individuals with misattributed paternity, with all facets of this presentation having a pronounced interpersonal aspect. The traumatic experience may come from one or both parents keeping misattributed paternity a secret; the loss may involve losing familial connections, and identity challenges can stem from reestablishing one’s social belonging. Further, individuals who discover their misattributed paternity are likely to confront these psychological challenges while simultaneously navigating a complex relational landscape.

Although the study’s analysis was primarily inductive, connecting the findings to existing theoretical frameworks can enrich their interpretation and situate them within broader counselling discourse. Relational-cultural theory (RCT; Miller, 1976) offers a particularly relevant lens, given its emphasis on relationships, power, and cultural context in human development. Developed at the Stone Center for Women in the 1970s, RCT reflects feminist voices—predominantly White (Jordan et al., 2004), which resonate with the perspectives represented in this study. RCT rejects the pathologizing of individual responses and the privileging of autonomy, emphasizing instead growth-fostering relationships that provide validation, emotional safety, and opportunities to reconstruct disrupted relational images (Miller & Stiver, 1997), aligning with counselling as a vehicle for healing. With its emphasis on mutually empowering and authentic relationships (Duffey & Somody, 2011), RCT also aligns with our sample composition, which included practitioners with varied degrees of lived experience of misattributed paternity. Further, RCT’s orientation toward relational and cultural attunement makes it particularly well-suited to understanding counselling approaches for misattributed paternity discoveries, which are frequently characterized by secrecy, power imbalances, and relational trauma (Cerfontyne et al., 2025; Grethel et al., 2024).

Implications for Practice

Trauma-Informed Approach

In line with prior research (Avni et al., 2023; Lawton et al., 2023), clients with misattributed paternity often report depression, suicidality, anxiety, restlessness, disorientation, and self-doubt—responses aligned with trauma symptomatology (Wang et al., 2023). Most counselling practitioners in our study conceptualized this experience as traumatic, echoing Grethel et al. (2022) and Cerfontyne et al. (2025). Whether the trauma stems from the discovery itself or reactivates earlier wounds, such as attachment injuries or childhood neglect, a trauma-informed approach appears clinically imperative.

Transgenerational trauma should also be considered, as psychological wounds associated with misattributed paternity can be passed down through genetic and social connections (Danieli et al., 2016; Kellermann, 2013). For example, a lack of genetic and familial clarity when the identity of the biogenetic father remains unknown can be psychologically disruptive for the children and grandchildren of a person with misattributed paternity. Similarly, uncovering misattributed paternity in families where this circumstance was concealed due to shame or cultural norms may reactivate historical traumas of the previous generations. Practitioners may find it helpful to explore family-of-origin narratives and intergenerational patterns through a trauma-informed lens.

Grief, Disenfranchisement, Identity Renegotiation

Many reported symptoms align with complicated or traumatic grief (De Stefano et al., 2021) and sudden bereavement (McDonnell et al., 2022). Clients with misattributed paternity may grieve the loss of secure belonging, family ties, lost opportunities for connection with their paternal bloodline, or imagined life paths. As these losses are intangible and may be hard to comprehend even for those who experience them, as reported in our study, it may be useful to consider disenfranchised grief, grief that is societally unacknowledged and disqualified (Doka, 1989). Prior research (Cerfontyne et al., 2025; Lawton et al., 2023) and our findings confirm grief as a central feature, with counselling practitioners endorsing this perspective.

Emotional turmoil may also stem from a sudden loss of identity shaped by family and parental ties (Scabini & Manzi, 2011). Losing this foundation can severely impact self-concept and well-being (Ergün, 2020), contributing to the disorientation described in our study and others (Cerfontyne et al., 2025). Although our participants did not emphasize racial or ethnic identity processes, other studies have shown that misattributed paternity discoveries can also trigger profound racial or ethnic identity renegotiations, particularly for multiracial or multiethnic individuals (Lawton et al., 2023). Identity-focused approaches, including those sensitive to racial and ethnic identity dimensions, such as narrative therapy (DeVance Taliaferro et al., 2013), may offer meaningful support.

Relationally Attuned Practice

Within an RCT framework (Duffey & Somody, 2011; Jordan, 2010), the psychological toll of misattributed paternity can be understood as a rupture in relational connectedness. These ruptures are relational in origin and require relational repair, especially as misattributed paternity is not solely a personal issue but a multi-family one, often disrupting relationships in both the social and biogenetic families (Grethel et al., 2024). Our findings suggest that clients face complex relational challenges involving family, partners, friends, and newly found paternal connections. In line with RCT, counselling practitioners should be attuned to these disconnections (Jordan, 2010), assess relational quality (supportive/problematic), and support the repair of damaged relational images. In some cases, family counselling may be beneficial (Lawton et al., 2023).

The RCT lens also helps explain the importance of the therapeutic alliance and the practitioner’s lived experience, as underscored in our study. Individuals with misattributed paternity often experience rejection and misunderstanding from others, including those who help professionally (Cerfontyne et al., 2025). Like others with socially unacknowledged experiences, they also often feel isolated, ashamed, and confused about their experience (Grethel et al., 2024), consistent with the concepts of shame and disconnection central to RCT (Jordan, 2010; Jordan et al., 2004). Validation from someone who understands their journey, such as a practitioner with lived experience, can offer powerful relational repair and reduce feelings of isolation through the transformative capacity of mutual empathy (Jordan, 2010). However, restoration of damaged relational images can also occur without practitioners’ lived experience. Our findings suggest that micro-skills, such as validation, empathic presence, judgment-free listening, and encouraging sharing, are key, while challenging clients’ views or exploring opposing perspectives may feel dismissive.

A flexible, client-led approach to the counselling process can also strengthen rapport and aligns with the empowering ethos of RCT (Duffey & Somody, 2011; Spencer et al., 2019). Warm, humanising gestures, such as making clients a cup of tea, checking in on them outside of sessions, or giving a hug when appropriate, may also help counteract shame and anticipated rejection (Wright et al., 2022). Collaborative strategies, such as co-setting goals and joint brainstorming of solutions, can further reduce power imbalances and enhance therapeutic engagement (Spencer et al., 2019).

Importantly, practitioners need to prioritize decreasing clients’ isolation through social support. Our findings suggest that individual counselling alone is insufficient for a healthy adjustment to the discovery experience and should be supplemented by supportive contact with other individuals who have experienced misattributed paternity or someone who can provide an empathic presence without the limitations of the counselling process. This echoes previous research that underscored the importance of social support and peer contact postdiscovery (Lawton et al., 2023) and aligns with the RCT tenet of mutual empathy (Jordan, 2010). For example, practitioners can help clients by identifying a suitable support person within the client’s social circle or recommending peer support communities and events. Group therapy can also be beneficial and has been found effective for individuals experiencing challenging life transitions, including those belonging to minority groups (Agin-Liebes et al., 2024; Lavi Wilson et al., 2021).

Implications for Education and Training

The complexity of misattributed paternity experiences highlights that practitioners interested in working with this presentation need to consider their level of professional experience and competence in counselling for these specific issues before engaging in this line of work. This perspective was also shared by the participants in our study.

Our findings revealed several parallels between counselling experiences of adoptees and individuals with misattributed paternity, such as the presence of trauma, identity challenges, relational difficulties, and confusion about their experiences (Sánchez-Sandoval et al., 2020; Strand & Hillerberg, 2024), as well as the importance of validation and preference for practitioners with relevant training or lived experience (Baden et al., 2018, 2019). This suggests that adoption-informed care may provide important guidance in developing counselling and training programs for the misattributed paternity presentation. Similar to adoption-informed care (Baden et al., 2018; Sánchez-Sandoval et al., 2020), such training should include an understanding of trauma, grief, genealogical bewilderment, and the search for biogenetic kin. It should also be sensitive to the unique experiences of individuals with misattributed paternity, both prediscovery and postdiscovery. For example, the training might involve knowledge of the common factors leading to misattributed paternity, the consequences of misattributed paternity for the affected families, and the unique challenges faced by individuals with misattributed paternity and their social and biological families.

Further, counselling professionals should understand how misattributed paternity is experienced at various life stages. For example, certain transitions, such as pregnancy and postpartum, can be particularly stressful for adoptees (Strand & Hillerberg, 2024). Individuals with misattributed paternity might have similar experiences that counselling professionals need to be aware of. Like for adult adoptees (Sánchez-Sandoval et al., 2020), the search for the paternal bloodline is often an emotionally and logistically challenging experience (Becker et al., 2024; Lawton et al., 2023). Our study highlights the need for practitioners to be aware of the common desire to search for one’s biogenetic father, familiarize themselves with various search options, and understand how the search process may impact an individual with misattributed paternity.

Echoing the strong relational-cultural nature of misattributed paternity experiences, training for this presentation should emphasize the importance of relational dynamics and sociocultural aspects in counselling affected clients. Our findings suggest that the RCT framework (Miller, 1976) is highly suitable for this presentation. Further, it is important to practice cultural humility and build stigma awareness, as misattributed paternity remains highly stigmatized and unacknowledged in many societies (Grethel et al., 2024; Malek, 2013). Honing rapport-building micro-skills and learning from practitioners with lived experience, such as through supervision or professional networking events, can also be beneficial.

Implications for Advocacy

Despite changing societal attitudes towards what defines a family, misattributed paternity and the experiences of individuals affected by it remain a blind spot within professional, academic, and policy-making circles (Cerfontyne et al., 2024). Affected individuals also lack structured supports in accessing their genetic information and navigating the postdiscovery experiences. Such invisibility contributes to what Rob Nixon (2011) called “slow violence,” which “delayed destruction that is dispersed across time and space” (p. 14), with detrimental psychological outcomes. Therefore, it is critical to raise awareness of misattributed paternity and acknowledge it as a valid and challenging experience worthy of societal, psychological, and policy support both within and beyond the therapy room.

Like adoption-informed care intends to provide a life-long network to promote the well-being of adoptees in a sensitive, nonpathologizing way (Toland et al., 2024), similar support systems are needed for individuals with misattributed paternity. A good starting point can be connecting those who discover their misattributed paternity with existing peer support communities to foster growth-fostering relationships (Lenz, 2016). Counselling practitioners can assist by collecting and providing such information to their clients. The support needs of social and biogenetic parents should also be considered, for example, by acknowledging their unique experiences and establishing dedicated support resources for them.

Furthermore, it is important to continue promoting an inclusive perspective on families and relationships, as the stigma surrounding misattributed paternity often stems from outdated societal norms and expectations (Turney, 2005). Given that the client’s search for their biogenetic origin is a common postdiscovery need, noted in our study, ensuring access to genetic information is crucial. This information represents an essential aspect in preventing mental health issues associated with stigmatisation, such as depression, stress, and psychosomatic concerns (Reinka et al., 2020). The right to know one’s genetic origins is recognized as a fundamental human right (United Nations Convention on the Rights of the Child, 1989), and it is a matter of social justice to ensure such access for those with misattributed paternity that counselling practitioners can advocate for.

Implications for Research

As the first study of its kind, our research underscores the need to continue exploration into the experiences of individuals with misattributed paternity and the development of effective counselling support. Our study has identified several strategies endorsed by practitioners, yet we do not know their comparative effectiveness or how clients evaluate them. Quantitative studies using established psychometric measures can assess the effectiveness of counselling approaches identified in our study. Longitudinal and comparative designs can help determine the trajectory of counselling experiences and identify the optimal duration, format, and frequency of sessions. Future studies involving clients with misattributed paternity can validate or contrast our practitioner-informed findings. Furthermore, research involving practitioners without lived experience can provide new insights into counselling practices and highlight the differences between practitioners based on their levels of lived experience. Such contrasting research can also clarify whether the findings of our study were influenced by practitioners’ lived experience or not. Similarly, studies conducted by researchers without personal or professional experience with misattributed paternity can contribute to a more objective and comprehensive understanding of counselling for misattributed paternity experiences. Given the close alignment of our findings with RCT (Miller, 1976), studies specifically exploring RCT-informed care for this presentation would strengthen both practice and theory.

Importantly, expanding research to include more racially, ethnically, and culturally diverse counselling practitioners is essential for developing truly inclusive and effective practice. Counseling theories and interventions have historically been shaped by Western, White-majority perspectives, which may not reflect the lived realities of clients from marginalized or non-Western communities. Without diverse voices, the field risks reproducing narrow definitions of family, identity, and healing, and overlooking how cultural norms, systemic inequities, and historical traumas shape experiences of clients with misattributed paternity and those supporting them professionally.

Although our study found some parallels between counselling for misattributed paternity and adoption-informed care, the application of adoption-informed interventions to individuals and families affected by misattributed paternity requires empirical validation. Relatedly, research comparing adoption and misattributed paternity counselling experiences can clarify shared and divergent clinical features, relational impacts, and psychosocial outcomes (Baden et al., 2019; Becker et al., 2024). Longitudinal studies can be particularly insightful, as our findings suggest that misattributed paternity discoveries require ongoing, long-term support, similar to that provided for adoption (Strand & Hillerberg, 2024).

Strengths and Limitations

Our study is the first to explore the experiences of counselling professionals working with adults who discover their misattributed paternity, addressing a key gap in how to support this population. It builds on existing research about affected individuals (Avni et al., 2023; Cerfontyne et al., 2025; Grethel et al., 2024; Lawton et al., 2023) by adding practitioner perspectives.

The study’s practical implications are strengthened by the participants’ lived experiences with misattributed paternity, adoption, or donor conception. This background, combined with professional training, can result in a deeper understanding of the presentation that an outsider might miss or misinterpret (Brannick & Coghlan, 2016). The lived experience also stimulated the participants’ engagement and sharing, resulting in rich data with detailed insights into specific counselling strategies and interventions. The study also benefited from the inclusion of participants from diverse mental health professions, which offered multiple perspectives on practice, consistent with Denzin’s (2012) notion of triangulation, enhancing the depth and credibility of the findings. Their high qualifications, including two doctorates, supported critical engagement and helped mitigate the potential bias often associated with insider research (Fleming, 2018). Nonetheless, one participant noted that lived experience could also cloud clinical judgment, suggesting a need for future research involving practitioners without such backgrounds.

The study has several limitations. First, it is limited by the absence of research on counselling for misattributed paternity discoveries and the dearth of research on the experiences of individuals with misattributed paternity in general. Although the sample size is sufficient for qualitative exploration due to its high information power (Malterud et al., 2016), the findings are limited in their transferability by the study’s narrow U.S.-based cultural setting. The predominantly White sample further constrains the scope of the findings, limiting insight into how counselling for misattributed paternity may be approached in racially, ethnically, and culturally diverse communities. Given the global variation in concepts of kinship, identity, and fatherhood (Bellis et al., 2005; Larmuseau et al., 2019), future studies should intentionally recruit more diverse practitioners and clients to strengthen cultural inclusivity and ensure the global relevance of counselling knowledge.

Conclusion

Counselling individuals who learn about their misattributed paternity in adulthood is a novel and multifaceted practice area. With the growing prevalence of DNA-based ancestry testing, many counselling professionals are likely to encounter clients with misattributed paternity discoveries. To facilitate ethically sound and competent counselling care, we must develop a comprehensive understanding of how to support these individuals through counselling. Our study represents the first step in this direction.