Survey for Fathers Whose Children Were Adults When He Left Their 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 survey is to explore how your relationship with your child(ren) has been affected by your departure. I greatly appreciate your participation in this study 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 are either a father, step-father, or other father figure who ended the relationship with the mother
2) Your child was 18 years old or older when your relationship ended

Although it’s not required, it would be great if I could receive surveys from all three parties - your child, your child’s mother as well as yourself. If you think the others might be open to participating, email me the contact info and I’ll forward 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 might include direct quotes. Please rest assured that your identity will never be revealed.

If you have more than one child, please answer this survey with just one of your children in mind. If you’d like to complete additional surveys for other children, you’re welcome to do so.

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 *
Current age *
How many children do you have? *
How long had you been together with your child’s mother before the separation? *
How long has it been since the separation? *
How would you describe your relationship with your child before the separation? *
How would you describe your relationship with your child now? *
What is the level of contact you have with your child now? (Select all that apply) *
Required
The current state of the relationship with your child is due mostly to: *
What’s affecting your current relationship with your child? (Select all that apply) *
Required
If you have a girlfriend/new wife, how does that affect your relationship with your child? (Select all that apply) *
Required
What kind of relationship do you have with your ex-wife? *
How has the situation with your child 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 with your child? *
Would you agree to being interviewed by me by phone or Zoom? (Note: I may not be able to contact everyone) *
Tell me more! (Please add more thoughts, details or stories to better help me understand your experience with your child). *
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