Survey for Adult Children Whose Dad Left Mom
Hi! I'm a family therapist who’s studying the relationship between fathers and children who were adults when their dad left their mom. The purpose of this study is to explore how your relationship with both of your parents has been affected by your dad’s departure. I greatly appreciate your participation and hope that you’ll find the experience of telling your story meaningful.

In order to participate, you must fulfill the following two criteria:

1) You’re from a family in which your father, step-father, or other father figure ended the relationship and separated from your mother
2) You were 18 years old or older when your parents separated

Although it’s not required, it would be great if I could receive surveys from all three parties - your father, mother and yourself. If you think one or both of your parents might be open to participating, email me with the contact info and I’ll send the appropriate survey to him or her. I will not share your answers with the others.

By completing and returning this survey, you indicate your agreement for your answers to be used anonymously in the preparation and promotion of an article, blog or book on the topic that may include direct quotes. Please rest assured that your identity will never be revealed.

Many thanks!

Vikki Stark, Psychotherapist
info@vikkistark.com
www.vikkistark.com
www.sincedadleftmom.com

The survey is estimated to take around 10-15 minutes to complete. In the final question, "Tell Me More", please add thoughts, details or stories that will better help me understand your experience.

The survey uses the binary him/her designation and assumes that the affair partner, if there was one, is a woman. If this is not the case for you, please clarify your situation in the "Tell Me More" section.
Your first name *
Your email *
Gender *
Current age *
How many years had your parents been together before the separation? *
How long has it been since the separation? *
How would you describe your relationship with your father before he left your mother? *
How would you describe your relationship with your father now? *
What is the level of contact you have with your father now? (Select all that apply) *
Required
The current state of the relationship with your dad is due mostly to: *
What’s affecting your current relationship with your father? (Select all that apply) *
Required
If your father has a girlfriend or new wife, how has that affected you? (Select all that apply) *
Required
How has your father leaving affected your relationship with your mother? (Select all that apply) *
Required
How has all this affected you in your personal life? (Select all that apply) *
Required
More thoughts . . . (Select all that apply) *
Required
What do you think, if anything, might improve the situation? *
I hope to be interviewing some of the participants by Zoom. Would you be willing to do an interview with me? *
Tell me more! (Please add more thoughts, details or stories to better help me understand your experience). *
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