This article addresses the particular nature of the internal worlds of adopted children and their families, and the ways in which ongoing relationships are affected by these internal factors. The complexity of family life lived in the shadow of often multiple painful prior experiences of families is described. Clinical examples are used to explore issues of ‘contact’, the placement of siblings, the impact of parental trauma on a child’s development as seen in psychotherapy, and the opportunities for ‘working through’ afforded by adoption. The article suggests the potential helpfulness of individual psychoanalytic psychotherapy for adopted children and their parents in coping with psychic pain.