Journal of Child and Adolescent Mental Health 2013, 25(2): 119–130 Copyright © NISC Pty Ltd

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C H I L D & A D O LES C EN T M EN T A L H EA L T H
ISSN 1728-0583 EISSN 1728-0591
http://dx.doi.org/10.2989/17280583.2013.790823

Clinical Perspective

Will you leave me too?: The impact of father absence on

the treatment of a 10-year-old girl
David Strauss

LCSW, 100 State St. Suite 2A, Teaneck, New Jersey 07666, USA
Email: dwstrauss@hotmail.com

This paper addresses the impact father absence has on child development and the nature of the
transference between father absent, child and therapist. A review of psychoanalytic concepts and
theories that relate to this topic are applied to a case study of a preadolescent girl with an incarcerated
father. Specific forms of transference that occurred between the client and her male therapist are
articulated in an effort to demonstrate the power of working in the transference with girls who struggle
with their feelings about having an absent father.

Introduction

The purpose of this paper is to explore how father absence affects both child development and
the therapeutic process with a preadolescent girl. Particular attention is given to the transferen-
tial relationship between a 10-year old girl, Christine (the names of all individuals mentioned in the
clinical illustration have been modified to protect the identities of the respondents), and myself as
her male therapist. Christine’s transference in the therapeutic relationship was influenced by the
paternal absence in her life. I explore how this absence manifested in her development and how
the treatment relationship helped address some of its negative effects. The literature review begins
with a brief overview of psychoanalytic perspectives on the father’s role in child development. This
summary serves as the foundation for discussing how father absence can affect children and girls
in particular. This portion of the literature review also considers how mother–child relationship is
influenced by father absence. The literature is applied to my work with Christine through the theories
of Klein, Winnicott, and Fonagy and Target to illustrate how the therapeutic relationship has served
some of her developmental needs.

Literature review

The father’s role in psychoanalytic theory

Fathers have been termed “The Forgotten Parent” (Ross 1979: 21) because of the comparatively
minimal attention given to fathers in psychoanalytic literature. Freud’s discussion of the father was
largely limited to his role as prohibitor and rival in the oedipal triad (Liebman and Abell 2000). Jung
(1909: 737), in referring to a boy’s development, stated that the father represents: “an anticipa-
tion of [the boy’s] own masculinity, conflicting with his wish to remain infantile.” Furthering these
thoughts on the father’s role as facilitator of increased independence, Mahler et al. (1975) and
Abelin (1975) introduced the notion that the father was intricately involved during preoedipal
development as the first ‘other’ outside of the symbiotic relationship between mother and child. The
father in the Mahler and the Abelin theories helped the child tolerate the regressive ‘pull’ back to

Journal of Child & Adolescent Mental Health is co-published by NISC (Pty) Ltd and Routledge, Taylor & Francis Group
120 Strauss

the mother during the separation/individuation phase of development. Others (Pruett 2000, Jones
2008) viewed the paternal potential beyond that of a ‘second object’, and asserted that he has the
capacity to be a nurturing primary caregiver. Recent psychoanalytic literature (Jones 2008, Harris
2009) recognises both the importance and flexible nature of the father–child relationship.
Target and Fonagy (2002) remarked that one of the important functions of the father as ‘second
object’ is to help limit the introjection of the mother into the child’s self structure in cases where
there is a “pathogenic maternal influence” (p 60). In such instances, the father reflects the child’s
emotional experience of the mother back to the child. If this is done accurately, the child is able to
gain a greater understanding of her own feelings as different from her mother’s and her capacity
to reflect on her relationships grows. This reflective function has been termed ‘mentalisation’
and the father can play an important role in its acquisition (Fonagy and Target 1998, Target and
Fonagy 2002). These authors are not purporting the notion that any father will be able to provide
this valuable function. Fathers who are not able to acknowledge and reflect their child’s authentic
experience will not further the development of mentalisation or a sound self structure.

Distinction between different types of father absence

The increasing recognition by psychoanalytic and child development theorists of the importance of
fathers raises questions about the concomitant effects of father absence. Attempting to address this
question requires a closer examination of the distinction between a father’s psychological unavail-
ability and physical absence. Regarding past literature on father absence, Pruett (2000: 51) states:
“it rarely distinguished between nonresidential, abandoning, ejected, rejected, or even dead fathers.
Both father presence and father absence exist in a continuum.” This quote infers that the specific
circumstances of the ‘absent father’ must be considered when assessing the impact on the child.
Kirshner (1992) studied some of the differences between physically absent and emotionally unavail-
able fathers. One of his findings is that fantasies about present but emotionally unavailable fathers
were less prevalent than those for children with physically absent fathers. In this paper, I focus on
the effects of father physical absence on a girl’s intrapsychic development because the child under
study, Christine, has a father who has been incarcerated since her infancy. Further consideration of
the differences between psychological unavailability and physical absence is an important area to
continue to explore, but beyond the scope of this paper.

Father absence and mother involvement

A child’s response to an absent father is influenced by the child’s age at the inception of the
absence (Jones 2007). When the absence occurs in the first five years of life, children experience
subsequent anxiety around object-loss as well as an anxiety driven wish for closeness (Burgner
1985, Jones 2007). Burgner further states that early loss of the father may contribute to ‘omnipo-
tent thinking’ that perpetuates the fear that the child caused the father’s absence. After separation
from the father, children may live in a constant state of fear that they will lose the other parent. This
anxiety can contribute to difficulties separating from the primary love object (i.e. the mother).
Psychoanalytic literature on father absence postulates that its effects are often intertwined with
the nature of the relationship between mother and child (Seligman 1982; Herzog 1982, Target and
Fonagy 2002). Given the nature of the mother–daughter dyad in the case of Christine, inclusion of
literature on pathological mother–child relationships seems a pertinent area to cover. This existing
body of psychoanalytic literature states that an absent father may lead to an over-involved and
minimally attuned mother who impedes the child’s separation and individuation. Mothers will not
always be over-involved with their children when the father is absent. The past lack of focus on
paternal contributions to child development has perhaps led to mothers being blamed for negative
child outcomes.
Jones (2007) states that the loss of the father in the first year of life can disrupt the mother’s
ability to become immersed with the infant. This disruption “may then lead to impaired develop-
ment of self and object differentiation, reality testing, frustration-tolerance and the capacity for basic
trust and confidence, thereby disrupting the proceeding tasks of separation-individuation” (p 46). In
Herzog’s (1982, 2001) description of ‘father hunger’, he states that often when a father is absent,
Journal of Child and Adolescent Mental Health 2013, 25(2): 119–130 121

maternal libidinal and aggressive impulses and derivatives are directed toward the child and thus
impair the child’s ability to modulate aggression and regulate affect. Seligman (1982) articulates
the ‘absent father syndrome’, which involves a collusion between child and mother, nourishing a
shared illusion of ‘oneness’ from which the developing child cannot separate. Seligman states that
this collusion leaves the child feeling ‘half alive’ because she is never allowed to develop her own
unique and creative thoughts, feelings and wishes. Target and Fonagy (2002) discuss the failure
of ‘triadification’, where a child internalises the primary object into her self structure because of
the absence of one parent and the over-involvement of another. In such instances, the mother
treats the child as a narcissistic extension of herself and is unable to recognise her as a separate
individual. Consistent with Fonagy and Target’s observations, Bishop and Lane (2000) state that
one possible effect of father absence is that the child is treated as a narcissistic object for the
remaining parent’s own gratification. An inflated sense of omnipotence (overvaluation) combined
with the underlying awareness that the parent is not meeting her emotional needs (deprivation)
leads her to develop a sense of entitlement because the child feels she has unjustly experienced
emotional pain and therefore deserves special treatment. While this literature refers to such
maternal qualities as ‘over-involved’, it seems that these parents are more ‘self-involved’ or narcis-
sistic. Such mothers seem to have difficulty with maintaining boundaries and providing an empathic
connection with their children. Paralleling the psychoanalytic view of the mother-child relationship in
the wake of father absence, the nature of the relationship between Christine and her mother, Betty,
is discussed in the case illustration. Although Betty fits the definition of an over-involved mother as
articulated by Seligman, I have chosen to focus on her intrusive and poorly attuned parenting as
opposed to her over-involvement.

Child fantasies about absent fathers

Psychoanalytic literature has suggested that even when a father is not present he can occupy
substantial intrapsychic space and thus influence the trajectory of his child’s development (Freud
and Burlingham 1943, Spieler 1984, Wallerstein 1984). As mentioned above (Kirshner 1992),
children who have physically absent fathers tend to have elaborate fantasies about the missing
paternal figure. Freud and Burlingham (1943) studied children whose fathers were absent due
to World War II and reported that often the father children yearned for bore little resemblance to
their actual father, thus underscoring the rich fantasy life of the child. Spieler (1984) states that
father absent girls create fantasy fathers in the absence of real ones and subsequently suffer “ill
effects which may persist into adulthood” (p 74). Relationships with fantasy fathers may contribute
to a distorted paternal intrapsychic representation where over-idealisation, fear and rage remain
fragmented. Without the presence of a ‘real relationship’, the child may resort to ‘splitting’ as a
defence mechanism that impedes her progress toward whole object relating (Jones 2007). The
child thus experiences herself and others as either idealised or demonised, and such distortions
impair her capacity to form gratifying relationships in the social environment.
But fantasies of absent fathers may not always have negative effects on the child. The fantasy
of the father can serve as an adequate substitute, helping the child to “create an internalisation of
a triangular structure”. (Target and Fonagy 2002: 56). When considering the positive or negative
impact on a child’s psyche, a key variable is how the mother talks to the child about the absent
father (Seligman 1982, Kirshner 1992, Target and Fonagy 2002). If she can both convey to the
child the child’s connection to the absent father as well as allow her to idealise him in her fantasy,
he can serve a positive developmental purpose for the child. Bach (1946) discusses ‘father typing’,
which describes how the child’s fantasies about the father are affected by the mother’s perception
of him. According to Bach, father typing has a large impact on the quality of the fantasies children
have about absent fathers. Variables that may have an impact on the mother’s feelings toward the
father must therefore be considered. This may include the state of the couple relationship or the
reason for his absence. If his absence is perceived as valuable to society (e.g. fighting in a war or
incarceration due to social protest or political struggle), his intrapsychic presence may be consider-
ably different than if there is shame attached to it (e.g. incarceration due to violent crime or sexual
assault).
122 Strauss

Effects of father absence on girls

Prior research has asserted that girls are less affected by father absence than their male counter-
parts. An early study (Hetherington 1972) reports that while the impact of father-absence on
preadolescent sons has been well documented, few effects have been found with daughters.
Herzog (1982) also observes that most individuals who struggle with issues of father absence are
male, and Wallerstein (1987) notes that the quality of the father–child relationship is strongly linked
with the psychological health of boys but not of girls.
Contrary to these assertions, it has been documented more recently that girls with absent fathers
struggle with higher rates of teen pregnancy, earlier onset of sexual activity, decreased self-esteem
and behavioural problems (East, Jackson and O’Brien 2006). East et al. (2006) interviewed adult
women about their childhood experiences growing up with an absent father and found that they
constructed emotional barriers that impeded their ability to form connections with others. They also
found that no matter how angry the daughter was with her father, her desire to have a relation-
ship with him largely remained. Their reports further highlighted that even in situations where the
individual had a surrogate father (e.g. uncle or stepfather), her feelings of pain and emptiness
regarding her absent biological father persisted. Ellis et al. (2003) found that father absence was
strongly associated with elevated risks for early pregnancy and acting out for adolescent girls. Girls
who experienced father loss at earlier ages were at considerably more risk than those who experi-
enced it later. These studies have in fact elucidated how father absence has the potential to have
negative impact on girls’ present and future relationships with males.

Transference and psychoanalytic treatment with children

One manifestation of father absence is evident in the transference relationship. Analysis of the
transference is considered a cornerstone of psychoanalytically oriented treatment. Melanie Klein
(1952) was one of the first psychoanalysts to discuss the importance of transference in psycho-
therapy with children. According to Klein (1952), a patient’s earliest object relations to both internal
and external objects manifest in the transference to the therapist. By containing aggression and
interpreting the transference, the patient gains an increased capacity to decipher between their
actual and phantastic experience. The more a child’s view of others is distorted by his or her
internal object world, the more dysfunctional the child will be. In an application of Klein’s views
on transference, Lush (1978) discussed the specific transferential manifestations in once-weekly
individual treatment with a 10-year-old girl. Lush demonstrated how her preadolescent patient’s
reactions and fantasies reflected her experiences with her primary objects. This is of interest
when considering the similarities between Lush’s patient and Christine. Their respective age, the
frequency of individual sessions, and the experience of an absent fathers are similar in both cases.
Klein’s (1957) concept of ‘working through’ occurs when the client re-experiences emotions and
anxieties in the transference with the analyst. This gives the therapist the opportunity to alter the
phantastic nature of the individual’s internal object world by containing her aggression. Winnicott
(1969) elaborated on the importance of containing aggression when he discussed how a child gains
the capacity to ‘use’ an object. According to Winnicott (1969), this milestone occurs when a parental
figure demonstrates that she can survive the child’s aggression by not retaliating against her when
it emerges. This facilitates the developmental process of relating to others as separate others as
opposed to externalised parts of the child’s internal object world. This applies to the treatment
situation when the therapist is able to contain the client’s raw emotions experienced in the transfer-
ence, and reflect them back to her in a more manageable form.
Fonagy and Target (1998) deviated from the more classical notions of transference, but still
described working in the transference as central to the therapeutic process with children. According
to these theorists: “The analyst uses her relationship with the child as a vehicle…helping him to
find…a way of thinking, understanding and coping with feelings; of recognising the connections and
differences between oneself and somebody else; and of being with another person” (Fonagy and
Target 1998: 108). This approach to transference views the child’s actions toward the therapist as
an attempt to cope with the relational closeness that transpires in the therapeutic relationship.
Journal of Child and Adolescent Mental Health 2013, 25(2): 119–130 123

Father absence has an impact on the transference within a therapeutic relationship. Kirshner
(1992: 1117) states that the “absent father returns in the transference, where the analyst is reexpe-
rienced as useless and absent and as a threat to the specialness of the dyad”. Burgner (1985)
states that some children with absent fathers expect the analyst to fix them ‘magically’”. They
express rage and disappointment when the analyst cannot achieve this result instantly. Seligman
(1982) offers an alternative notion by stating that father-absent individuals seek a ‘merger transfer-
ence’ with the therapist, thus recapitulating the fusion-like state between the mother and father
absent child. The merger transference is preceded by an intense ambivalence to trust the therapist
because of the extent of the child’s dependency needs. According to Seligman (1982), through
timely transference interpretations, the therapist helps the patient relinquish the sense of ‘oneness’
in favour of a sense of ‘twoness’ between self and other.
Given the gender specificity of father absence, the gender of the patient and therapist may affect
the therapeutic relationship. Tyson (1980) discussed how the gender of the therapist influenced
both transference and counter-transference reactions with prelatency children; gender becomes
important when it has a particular meaning to the patient (e.g. a child feels all men are unreliable).
Tyson (1980) further states that the therapist’s gender can serve a developmental need for the
child that was inadequately filled in the past. While Tyson is specifically referring to how a cross-
gender therapeutic relationship may help the child with oedipal strivings, this may also be of value
when considering how a male therapist may be able to fill some of the emotional void created by an
absent father.
Okamoto (2002) documents three transferential stages that transpire between male clinicians
and female at-risk adolescents. These three stages (termed ‘transference’, ‘rage’ and ‘therapeutic
work’), are the process by which the adolescent patients in this study worked through past
traumatic relationships with important males (e.g. absent fathers), and learned that it was possible
to engage in healthy relationships with men. Strauss (2011) discussed some of the opportuni-
ties and obstacles that emerge between male therapists and girls in group therapy. The transfer-
ence to the therapist was influenced by the gender difference between the therapist and the group
members and facilitated the expression of feelings the girls experienced toward their absent and
abusive fathers. While the Strauss (2011) article focuses on the transference in group therapy, this
article deals with the transference that occurs in the dyadic therapeutic relationship.

Clinical illustration

In my experience working in an agency in an impoverished urban community, child patients often

have minimal contact with their fathers. The absence of fathers in the lives of these children seems
to dramatically affect the fabric of their self structure. This absence, combined with an often tenuous
mother–child relationship manifest in poor self object differentiation, low self-esteem, poor social
functioning, dysregulation of affect and explosive aggression. These symptoms are consistent with
what observational studies have noted when trying to measure the effects of father absence on
children’s emotional, cognitive, and social development (Jones 2008). Below is a case illustration
that focuses on the effects of father absence on Christine. Informed consent was obtained from the
mother of the child.

Christine and father absence

Christine is a 10-year-old girl of Afro-Caribbean decent. I met with her twice weekly (once in
individual/family therapy and once in group therapy) for approximately two years. She first came
for treatment after a violent episode where she engaged in a physical altercation with a classmate
during lunch time. Christine’s teachers could not calm her down and they took her to the psychiatric
emergency room. Christine is obese and her weight has been a source of considerable teasing by
her peers at school. Just before her first birthday, her father Michael was incarcerated for commit-
ting a violent crime and remains imprisoned. Before his incarceration, Michael and Betty shared the
same residence, but he was not a consistent caretaker of Christine. Christine has only visited her
father twice in her lifetime, yet frequently talks about how much she misses him.
124 Strauss

While Betty struggles with validating many of her daughter’s feelings and appears to discourage
her autonomous strivings, Christine suffers from many symptoms that appear to be linked to father
absence. Among her symptoms are intensified abandonment and engulfment anxiety (Jones 2007),
difficulty modulating aggression (Herzog 1982, 2001), and an overdependence on her mother
(Seligman 1982). Christine often verbalises her fears of losing her mother, and has an intense
need to be around Betty at all times. She frequently expresses her fears that ‘something bad’ might
happen to Betty, or that perhaps Betty will leave her. This fear of object loss is consistent with how
children react when they lose their father within the first five years of life (Burgner 1985, Jones 2007).
One of the potential consequences of father absence is the mother’s struggle with achieving
appropriate distance and empathy in her relationship with her children (Seligman 1982, Bishop and
Lane 2000, Target and Fonagy 2002). This problem appears to have manifested in the relation-
ship between Betty and Christine in multiple ways. One pertinent issue is that Christine sleeps in
the same bed as her mother, and has done so frequently since birth. While Betty often attributes
this behaviour to her daughter’s dependency needs, she also admits that she feels lonely when
she sleeps alone and then invites Christine to sleep with her. At times Christine expresses the
wish to sleep alone, and even does spend some nights sleeping in her own bed. This, however,
is followed by the return to her mother’s bed. The oscillation between her bed and her mother’s
perhaps reflects the ambivalence that both Christine and Betty feel about separation.
Christine’s ambivalence regarding her sleeping situation seems to have had direct manifestations
in the treatment. She went through periods where she openly expressed her conflicting emotions
regarding whether to have Betty join the session. At times Christine insisted that Betty come into
the office. When her mother was included, Christine’s anger escalated and she exclaimed that she
wanted her mother to leave the session. Betty displayed minimal empathy regarding Christine’s
distress about Betty dating men other than her father. In one session with both Christine and Betty,
Christine expressed her wish for Betty not to date other men. Betty responded to Christine by
saying: “Well, you don’t help me when I ask you, what am I supposed to do?” Statements such
as this underscore Target and Fonagy’s (2002) point about the importance of the parent acknowl-
edging and reflecting the child’s authentic experience if she is going to develop a sound self
structure. In this instance, it appears that Christine was looking for an empathic response from
her mother that acknowledges how difficult it is for her to think about the dissolution of her family.
Betty responded by commenting how she felt her daughter did not meet her own needs, ignoring
any reflection or containment of her daughter’s experience. These examples also illustrate Bishop
and Lane’s (2000) discussion of the overvaluation and deprivation that can occur in mother–child
dyads when the father is absent. It is possible that Betty uses Christine for her own gratification by
encouraging her to sleep in Betty’s bed (i.e. overvaluation) and is unavailable to validate Christine’s
experience about her dating (i.e. deprivation).
Christine’s obesity may reflect some of the emotional deprivation she has experienced. Her
parents have not been able to soothe her (i.e. absent father, narcissistic and unattuned mother),
so she turns to food for regulation. Christine’s insatiable hunger may also reflect how the timing
of her father’s incarceration has had an impact on the mother–daughter dyad. Early father loss
can impair the quality of the symbiotic connection between mother and daughter (Jones 2007).
Christine seems to constantly want ‘more’ from her mother. It is as though she is trying to receive
the emotional nourishment and connection that she was denied as a young child.
The early psychoanalytic literature suggests that in cases of father absence, much of the father–
daughter relationship exists in fantasy (Freud and Burlingham 1943, Spieler 1984). Christine’s
father has been incarcerated since she was an infant, and she has only seen him twice when she
visited him in jail. Yet, when I first started meeting with her she talked about her father as if she
saw him regularly. She frequently expressed her deep wish to be reunited with him. In her mind,
he seemed to be the answer to all of her problems. Absent fathers are often idealised, and children
struggle with expressing aggression toward them (Bach 1946, Jones 2007). This causes develop-
mental problems because one way idealisation is achieved is through splitting, which results in
problematic object relations and affect dysregulation (Kernberg 1976, Jones 2007). Christine’s
explosiveness and volatility is evident in the way that she interacts with her social environment. She
Journal of Child and Adolescent Mental Health 2013, 25(2): 119–130 125

seems to sustain positive interactions with peers, and then yell at them for any perceived slight. I
witnessed this tendency during many group sessions. In addition, the first transferential example
below (in the “You don’t do nothing for me!” section) demonstrates how difficult it is for her to
regulate affect in the context of the therapeutic relationship.
Based on the assertions of Bach (1946) and Target and Fonagy (2002), how Betty talked about
Michael to Christine would have a large impact on her fantasies about her father. Betty refers
to Michael in an inconsistent and confusing manner. At times Betty tells Christine that she and
Michael are still in a relationship, and then talks about dating other men. Betty also refers to
Michael as a great dad, and then blames him for the family’s financial trouble and her own feelings
of loneliness. These messages have understandably been confusing for Christine, and perhaps
made it difficult for Christine to utilise fantasies about her father in a constructive manner.
Even if Michael had been more present in Christine’s life, it seems doubtful that he would have
been able to be a source of support and comfort for her. Betty and Michael were not married, and
although they were together when he was imprisoned, both have a volatile relationship history.
This, combined with Michael’s criminal history, suggests that he would not have been capable of
providing the parental functions articulated byTarget and Fonagy (2002).

Working in the transference with Christine

Themes of father absence and mother over-involvement are a large part of how Christine related to
me in the therapeutic relationship. Four forms of transference manifested in my work with Christine.
They are chronologically ordered marking her progression during the course of treatment. The
clinical instances below are short examples that reflect transferential phenomena experienced by
Christine toward me. I present my interpretation of these interactions with Christine. Therefore, they
are subjective accounts and should not be considered as objective data.

“You don’t do nothing for me!”

From the first time Christine comes into my office, she openly states I am not able to help her.
She is willing to engage in play, and we play together for many sessions with minimal discussion.
She seems to enjoy building with Lego bricks. Christine builds, and I assist by finding pieces she
needs. This mutual construction appears to help forge a positive rapport. She then seems to relate
to me as the ineffectual and incompetent parent. During one session, she enters my office and
begins singing loudly in the corner chair. I recognise this behaviour as one of her ways of coping
with distressing affect. She eventually picks up a puppet and starts to play with it. Following up on
this potential therapeutic opportunity, I pick up a puppet and begin to interact with her puppet. My
puppet openly wonders to her puppet if she feels mad or sad about something. Christine’s puppet
nods and then tells me that her baby cousin, who has been staying with her, recently left. I attempt
to empathise with her and reflect how difficult it can be when someone you care about leaves.
Throwing her puppet down, she suddenly becomes outraged and exclaims, “You don’t do nothing
for me! You just sit there and say nothing!” I ask what she would like me to say to her, and her rage
escalates. She continues to yell and I feel completely incapable of calming her down. It feels like
anything I say is met with anger and defiance. I then attempt to just ‘be’ with her by sitting quietly
while she rages. This seems to fuel her anger and she winds up storming out of my office and
slamming the door behind her.
Christine’s reaction in this example may reflect some of the anger she feels toward both her
father and mother for not parenting her appropriately. Consistent with Klein’s (1957) view on
transference, Christine appears to be re-experiencing emotions and anxieties that she has felt
toward her primary objects with the therapist. This reaction also appears to be similar to the
transference articulated by Burgner (1985), who states that father absent children may expect the
therapist to ‘fix’ them and experience rage when he cannot magically take their pain away. Fonagy
and Target (1998) describe transference as a reaction to intimacy between patient and therapist.
Christine and I had shared positive interactions such as the one articulated above involving
Lego bricks. It is possible that she was beginning to feel she could rely on me in ways that were
unfamiliar and foreign to her. The strength of Christine’s affect in this example could therefore be
126 Strauss

viewed as a reaction to past disappointments combined with the closeness she was beginning to
feel in the dyadic interaction.

“Why do I have to come here?!”

At times Christine also seems to view me as the intrusive and dominating mother. She complains
about my insistence that she attend therapy consistently. She states that I am impinging on other
activities and interfering with television shows she wants to watch. She also states that she thinks
I want to meet with her for my own benefit and not hers. These transferential reactions are filled
with anger and intense affect. In moments such as these, Christine seems to experience me as the
suffocating and self-indulgent mother.
During this period in the treatment, Christine enters my office and almost immediately begins to
whine: “Why do I have to come here?!” Statements such as this sound like an angry protest. I attempt
to address and explore Christine’s feelings, but her anger increases. She begins to tantrum, stomping
her feet and yelling. “You’re making me come here!” “You don’t care about me, you just want money!”
I then attempt to empathise with her around the frustration of being forced to do something against
her will. I also remark how difficult it is for her to trust that I care about helping her. This intervention
seems to have a containing function for Christine and she is able to return to a state of calm.
Another potential way of interpreting these behaviours is an attempt to dilute the positive attach-
ment she feels toward me because of the ultimate fear that she might lose me just like she lost her
father. While her mother responds to her by threatening abandonment or inducing shame, I attempt
to empathise and contain these difficult emotions. This therapeutic approach consists of maintaining a
positive and accepting stance toward Christine and my relationship with her. No matter how much she
complains about coming to therapy, my desire to see her remains. This represents Winnicott’s (1965,
1969) concept of resisting retaliation to facilitate her ability for object usage.

“Are you going to leave too?”

Then a different transference begins to emerge in the treatment; Christine appears to view me as
a fragile and abandoning parent. In the midst of play, she remarks: “You look tired.” I then state,
“I wonder what you think it means if I am tired.” She then reveals that she would worry that I
might be sick and something terrible might happen to me. As I continue to explore this with her,
she articulates her concerns that if something terrible happens to me, I would not be there to meet
with her anymore. In this instance, she appears to view me as a fragile parent who may not have
the strength to survive or could disappear at any moment. To more fully understand this transfer-
ential reaction, it is illuminating to further consider the dynamics between Christine and Betty. As
mentioned above, Christine is often preoccupied with her fears of object loss. When reflecting
on her worries about her mother, she makes statements such as, “She’s all I have left.” Such
cognitions result in a state of hyper-vigilance and fear that “something bad” might happen to Betty.
While this is consistent with Burgner’s (1985) assertions about the concerns of father absent
children, it also seems to be a function of how Betty fuels such anxiety in her daughter. During one
family session Christine is able to express her fear that Betty might die or get sick. I then ask Betty
to help assuage her daughter’s worries regarding this issue. Betty responds by stating, “Well, if
you keep giving me a hard time, I don’t know what is going to happen to me.” It seems clear how
statements such as this could perpetuate the concern that her mother is fragile and there is a real
possibility that Christine might destroy her with her aggression.
Another example of this form of transference occurs when I move offices within the clinic. In
our first session in the new office, Christine wants to know what happened to the therapist who
had previously been there. She then articulates a fantasy that he (the prior therapist), has left the
agency, and therefore I am going to leave as well. In moments such as this, I attempt to reflect back
to Christine her understandable concern that I might either leave her or perhaps I am not strong
enough to tolerate all of her feelings. The response to the change in offices represents her fear that
I will leave her the way others have in the past.
These two instances indicate a transferential shift that suggests some movement from the
Kleinian paranoid-schizoid position to the depressive position (Greenberg and Mitchell 1983). In the
Journal of Child and Adolescent Mental Health 2013, 25(2): 119–130 127

previous two forms of transference, Christine appears to experience me as a persecutory object.

In Klein’s paranoid-schizoid position, the individual splits off her aggression and projects it outward
(Greenberg and Mitchell 1983). This projection is necessary because the individual experiences her
own aggression as dangerous and destructive. The result is persecutory anxiety, which Christine
exemplifies in the first two forms of transference when she tells me that I am useless and am
forcing her to attend therapy. In the above instances, her fears seem to be less that I am the
‘bad object’, and more that her aggression will destroy me. This is termed ‘depressive anxiety’
(Greenberg and Mitchell 1983), and is more evolved than persecutory anxiety because she is not
experiencing her own aggression as coming from external objects.

“I know you respect me.”

As therapy continues to progress, Christine’s transference continues to evolve, hopefully signalling
a shift in her internal object world and self structure. She begins a session by yelling at me, “Have
some respect!” While this is not an unusual remark (and almost playful), she follows it by saying
“I’m just playing, Dave. I know you respect me.” I was deeply moved by these words. I ask Christine
to elaborate and she responds by saying that she knows that I listen to her, and she likes that I
listen. Later in the session, she shifts to her usual complaints about having to come to therapy. But
she stops herself, saying, “I guess I do have fun here with you.” Both of these statements might
reflect a shift in how Christine experiences our relationship. This vignette highlights the role that
the therapist can play in helping the child achieve the capacity to mentalise (Fonagy and Target
1998). For mentalisation to occur, the child must be able to find herself “in the mind of the analyst
as a thinking and feeling being…” (p 109). Christine’s statements reflect that she has an accurate
understanding of how I view her, and thus can trust that I will treat her with respect. Fonagy and
Target (1998: 92) state that mentalisation allows the child to “read other people’s minds”, and
“make people’s behaviour meaningful and predictable”. Christine’s statements in this session show
that she is developing these skills in the context of our relationship.
The above development is perhaps achieved through many instances of containing aggression and
reflecting Christine’s emotional state. This past year, her father is temporarily transferred to a location
in close proximity to Christine and Betty while he awaits trial. During this period, Christine and Betty
visit Michael. Christine reveals to me in a session for the first time that she does not want to visit her
father in prison. In this moment, I note to myself that this is one of the first times she is not speaking
about her father in an idealising manner. She says she does not even know him, and feels pressure
from her mother to treat him like an important person. In response, I attempt to empathise and reflect
what I think this experience might be like for her. She states that her mother does not understand her
feelings regarding this matter, and this infuriates her. By conveying my understanding of Christine’s
emotional response in this instance, I am providing a paternal function as articulated by Target and
Fonagy (2002). The father (or second object) may limit the extent to which the mother (or first object)
gets internalised into the child’s self structure. Validating responses at this crucial point helped allow
Christine to achieve a representation of her relationship with Betty that is concurrent with her experi-
ence of her mother as intrusive and unempathic.
Christine has experienced me as ineffectual, intrusive, abandoning, and fragile during the course
of our therapeutic relationship. My attempts to contain these negative transference reactions have
perhaps helped her view the world around her in a less distorted manner. Winnicott (1969) states
that a child gains the capacity to ‘use’ an object when the parental figure survives her aggression
by resisting retaliation when it emerges. Containment of the negative transference described above
may have begun to help her to see others in a somewhat modified way; I am becoming David to
her, a different object who is not doomed to disappoint her.

Discussion

The idea for this paper originated out of my experiences working with many children whose fathers
are absent from their lives. It has been my experience that mental health practitioners have a
tendency to neglect the impact of an absent father, especially in inner city clinics where absent
128 Strauss

fathers are a common reality. I have articulated four different transferential phases which may
transpire when working with a father absent child. The transferential reactions described above are
specific to the client discussed in this article and another father absent child may relate differently to
the therapist based on a myriad of factors (e.g. reason for father’s absence, intrapsychic presence
of father in child, quality of mother–child relationship, therapist variables etc.). Establishing some
common themes for how father absent children approach the therapeutic relationship is an area
given little attention in past literature. It is therefore important not to generalise these results for the
entire father absent population. In this case, I believe each of the transferential phases stem from
either the child’s experience of the father’s absence, the nature of the mother–child relationship, or
both. Christine seems to first experience the therapist as incompetent and then intrusive (mirroring
her paternal and maternal experiences respectively). This is followed by fears that the therapist
will leave or abandon her. Finally, a more accurate and positive understanding of the therapeutic
relationship evolves where the child gains a sense of trust and recognises the potentiality for
respectful and fulfilling relationships. This occurs as a result of successful containment of negative
projections and consistent empathic attunement.
An important variable that seems to influence this process is time. The child has to ‘work
through’ all of the feelings and concerns she experiences toward the therapist. There seems to
be no formula for this evolution, the therapist must be patient and wait for opportunities to further
the treatment. It seems difficult to predict when the state of the transference will shift, and this
depends on the unique interactions that occur between patient and therapist. Children with absent
fathers have experienced abandonment in some form, and this may require more time for positive
therapeutic change to transpire.
Throughout the course of treatment, my emerging presence in Christine’s intrapsychic world
seemed to contribute to increased autonomous strivings, improved mood, impulse control and
self-esteem. She also began to grasp the potential for understanding relationships with others.
These data would suggest that the therapeutic relationship can provide some of the important
paternal functions articulated by Target and Fonagy (2002), Abelin (1975) and Mahler et al. (1975).
How important was my gender in this process? I assume that the transference to a male therapist
facilitated the opportunity to fill the emotional void created by father absence although Christine
never acknowledged this. My interpretation is that there were both maternal and paternal aspects
to Christine’s transference. Although more reflection and research is necessary, based on this case
illustration it seems that the transference to any therapist will reflect the issues of father absence in
the child’s life. While gender may influence the specific way the transference manifests, a connec-
tion to a consistent and empathic adult can provide some of the paternal functions articulated in the
literature regardless of gender.
One important issue for further exploration is how socio-economic issues have an impact on
father absence in this case and in other urban, low income families. Regarding Christine, the
reason for her father’s absence is incarceration. His race (part African-American, part Latino)
places him at higher risk for incarceration. In the United States, 1 in 4 African-American children
has a parent incarcerated by the time he or she is 14, as opposed to 1 in 25 for their white counter-
parts (Wilderman 2009). While specific traits of Michael as a parent are unknown, it is hypoth-
esised that his parenting skills would be compromised even if he had not been incarcerated.
Betty revealed that he comes from a broken home, and witnessed domestic violence between
his parents. Empirical research suggests that men who have had negative experiences with their
fathers are more inclined to display negative parenting skills (Forste et al. 2009). Therefore, future
explorations into father absence may need to consider the intergenerational transmission of absent
or negative parenting specifically among socio-economically disadvantaged demographics.
Many of the children treated at the clinic where Christine receives psychotherapy are both
impoverished and father absent. Past research has suggested that low income, employment status
and educational attainment detract from father involvement for non-residential fathers (Forste et al.
2009). This may be because impoverished fathers feel more shame and thus withdraw from their
children. Father identity has traditionally been linked to his role as a ‘breadwinner’ and poor fathers
may see themselves as inadequate providers (Lupton and Barclay 1997). Such considerations
Journal of Child and Adolescent Mental Health 2013, 25(2): 119–130 129

should be part of the discourse on father absence and methods for improving father–child dyadic
relationships must consider the specific obstacles low income individuals face.

Conclusion

In this paper I have emphasised the importance of exploring the role that an absent father plays
in the life and development of a child. An internal representation of the father is part of the child’s
intrapsychic life, and therefore influences her development. It colours her experience of herself and
others and influences the kinds of relationships in which she will engage, both in childhood and
adulthood. The father’s absence also has the potential to affect the mother–child relationship. In the
case illustration presented in this paper the quality of the mother–daughter relationship can strongly
influence impairment of the child’s developmental path.
The child’s fantasies about both mother and father will emerge in the transferential relationship.
The case material I have presented suggests that if the therapist can recognise and appropri-
ately contain negative projections as well as reflect elements of the child’s experience, he can help
further her intrapsychic development. In this manner, it seems that the therapist can offset some of
the negative emotional effects of father absence. While this does not take away the pain that a child
experiences when she does not have her father in her life, it may give her a forum to express these
feelings and create the possibility for positive relationships.

Acknowledgment – I thank Marsha Kline Pruett and Dr Susan Sherman for all their help, guidance and support
throughout this process.

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