Although many ways exist to form a family, international adoption offers a special and unique perspective. It is both rewarding and challenging to integrate the adoption experience into a lifetime, and an international adoption presents additional dimensions highlighting differences in politics, nationality, race, ethnicity, disabilities, culture, and language. How these differences are experienced depends on the family’s beliefs, past experiences, comfort with change, support systems, and knowledge base. Internationally adopted children have additional concerns (suppressed grief, loss, and often lack of racial/cultural models); children experiencing international adoption may encounter problems in identity formation, attachment, and social-emotional development. This chapter focuses upon the process by which families are formed, relational health, developmental needs, and clinical considerations. The need to develop family ties and healthy relationships is emphasized as families prosper from the benefits derived and ability to overcome the challenges of international adoption.