Survey for Mothers Whose Children Were Adults When Their Father Left
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 the father’s leaving affected his relationship with your child(ren) as well as your role in it so I can help the adult children in this complex situation. I greatly appreciate your participation and hope that you’ll find the experience of telling your story meaningful.

In order to participate, the following two criteria need to be met:

1) Your child’s father, step-father, or other father figure ended the relationship with you
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 father 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

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 father before the separation? *
How long has it been since the separation? *
How would you describe your child’s relationship with his/her father before he left? *
As far as you know, what is your child’s relationship with his/her father at this point? *
As far as you know, what is the level of contact your child has with his/her father now? *
As far as you know, the current state of the relationship between your child and his/her father is due mostly to: *
What do you think is affecting your child’s current relationship with his/her dad? (Select all that apply) *
What are your thoughts about your child’s relationship with his/her dad? (Select all that apply) *
If there is a girlfriend/wife in your ex’s life, how does that affect you with regard to your child? (Select all that apply) *
What kind of relationship do you have with your ex-husband? *
What do you think, if anything, might improve the situation between your child and his/her parent? *
I hope to be interviewing some of the participants by Zoom about the child's relationship with a parent. 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 child's relationship with his/her parent). *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy