The Impact of Father Absence on Child Mental Health: Three Possible Outcomes

  • Andrew BriggsEmail author


This chapter is about absent fathers. Drawing upon clinical material it discusses three mental health outcomes for children and young people when their fathers are absent from their parenting. Focusing on ADHD, self-harm and sexually inappropriate behaviour the chapter highlights how these derive from the relationship the child or young person has with the mother as the single parent. The chapter concerns a particular type of relationship some single mothers have with their children. It is not a chapter about all single mothers.


Fatherhood Mental health ADHD, self-harm Rape 


This chapter is a discussion of three mental health related outcomes for children and young people when their father is absent. These outcomes are: ADHD, self-harm and sexually inappropriate behaviour. By absent father I mean a father who may be physically present within the child’s life but is psycho-emotionally or physically unavailable for his children. Whichever way he absents himself, or is made absent from the family, in itself has an impact upon his children’s development. However, the point of this chapter is to discuss mental health outcomes that specifically derive from the relationship the mother has with their children once the father is absent. This relationship may even be a cause for the absence of the father. The chapter starts with a brief discussion of absent fathers and then moves on to discussing the child and mother relationship. The final section draws on clinical material from my thirty-five years work within English NHS Child and Adolescent Mental Health Services (CAMHS) that helps us understand the importance of a father’s absence on the emotional well-being and mental health of his children. The clinical material comes from psychoanalytic consultations and psychotherapy with mothers and their children. It demonstrates how effective work of this nature within the child/young person–mother relationship can lead to a significant amelioration in the symptoms presented by the child/young person.

Absent Fathers

The positive impact of a present father on the development of their children is well documented in the research literature of neuropsychology, psychobiology, and various disciplines within psychology. I have no space here to present or discuss this, so will simply mention several recent examples, representative of the clinical and research concerns of those interested in absent fathers that illustrate the need for fathers being present.

The Need for a Present Father

In a recent article Allan Schore (2017) demonstrates that between eighteen and twenty-four months fathers play a fundamental role in regulating the aggression of their children of both sexes. Rough and tumble play between many fathers and their children especially helps boy toddlers control their testosterone-induced aggression, through imprinting their left brains. This aspect of the role of fathers allows for their children to develop into self-regulated young people in society. In his earlier book Schore (1994), reviewing neurobiological research on mother–infant attachment, saw infants being in a very difficult situation when their mothers are depressed. Because of the unpredictability of her responses the infant’s responses mirror this. The mother then begins to withdraw. Because of the infant’s need for a reliable attachment figure, in order to develop neurobiologically, socially and emotionally, he turns to the father. The absence of the father in this scenario would be near catastrophic. Nicholas Davidson (1990) presented data for preschool adolescent children admitted as psychiatric patients to hospitals in Canada, South Africa, and Finland. Eighty per cent of these came from homes without fathers.

Father and Fatherhood: Towards a Definition

For conceptual and clinical purposes, I am referring to the father as the biological male who was part of the conception of the child. These fathers (biological fathers) may later become absent through death, estrangement from their partners and families, through the children being adopted or taken into care, or through the original plan (implicit or explicit in either father or mother) being to only provide the mother with sperm. Explicitly planned acts as sperm donor include the assisted pregnancy of usually lesbian or transsexual couples, and the surrogate mother for gay couples. I have found it useful to see the biological father as the father, and anyone else taking the role of father as actually being in a paternal role. This makes use of the psychoanalyst and psychiatrist Wilfred Bion’s (1959, 1962, 1965, 1970) differentiation between maternal and paternal functions, which he did not cite as gender specific. Thus, a biological father can offer both a maternal and paternal function to his children, as can an adoptive male or female in the parental role. So too can a foster father or mother, and either partner in same sex or transsexual couples with children.

The Role of the Father

In the psychoanalytic literature the role of the father is as follows:
  • To protectively embrace the mother and baby

  • To provide a buffer for the mother from the potentially overwhelming needs and demands of their baby

  • To enable a necessary developmental separation of baby from mother.

When the relationship of the mother and infant is troubled the role of the father—as protector of both mother and infant, and as enabling some separation of them—is critical to the infant’s development. Indeed, a father who is emotionally available to the infant and mother, and can hold the infant in mind, can provide the physical and emotional holding of the infant normally associated with an emotionally available mother. However, this is rarely the case for the children and families that are the focus of this chapter. Often the mother is emotionally available enough but has such a poor view of fathers that she does not know (or would not allow herself) to rely upon her partner, whether or not he is emotionally available. This is a double negative as far as the infant’s development is concerned. For those infants where the father is physically absent this double negative also applies. Before discussing the three outcomes of an absent father I want to spend a few moments thinking about what the emotional availability of the father means in terms of development.

Father’s Presence

As the infant begins to recognise that its mother has a relationship with someone other than him the father begins to become important in development in a different way. This is often termed triangulation but in psychoanalytic theory and practice this term has a different meaning from that used by family therapists and others.

In order to begin moving towards establishing an individual identity, and then physical and emotional independence, the human infant begins by seeing the father in him or herself. This person is seen as different to him/her and to the mother, not least because he is a physically different entity and cares for the infant differently than the mother. The infant then recognises that he has a relationship with mother and with this other one (father). He has two relationships. He then notices that father has a relationship with mother. This he recognises as a relationship he is excluded from. Soon he can put together that these two have a relationship that he is excluded from, but has a relationship with both individually that excludes one of them at the time. This is one way psychoanalysts see the birth of learning for humans. Whilst they may have laid the foundations of a mind through the initial realization that their need for sustenance can be met through a cry, and the arrival of a nipple on the end of a breast or bottle, it is the recognition of difference and exclusion that begins the process of taking in information from sources outside of oneself and the mother–infant dyad. This is triangulation.

Fathers therefore have a critical part to play in the development of their children. Partly it is the protection of the mother–infant dyad, partly it involves the protection and maintenance of the nuclear family as a unit (thus the other children in the family are included), and partly it is about providing early experiences of difference and healthy exclusion for the infant, and maintaining this as the infant develops through adolescence. As with their role as providers of rough and tumble (see above), fathers are there to help their children repress those emotions and impulses that are too dangerously anti-social, and to help them learn to self-regulate other emotions. It is all this and more that is not present when fathers are absent.

Children with Absent Fathers: Their Relationship with Their Mothers

During my time in CAMHS I saw several thousand families, over half of which had no father present during the work. This is for several reasons. Firstly, clinic opening hours are not favourable to fathers attending if they are the major breadwinner. Secondly, even if the opening hours did allow attendance, many men do not see their family’s emotional and mental life as a concern for them. Thirdly, lack of attendance is the result of society poorly addressing men as emotional beings with the same susceptibility to mental ill-health as children and mothers. Fourthly, mental health practitioners’ training predicates their thinking about families around mother-centric dependency models. At worst this means they have no, and at best they have a limited, place for fathers in their “meta” and practical bodies of knowledge. Fifthly, through their own experiences of their own fathers, many women actively ensure that their children’s fathers do not attend CAMHS. Sixthly, for many children their biological father does not live at home. For some children this has always been the case and of these some have never met their fathers. For other children the exit of the father was witnessed as acrimonious, leaving them damaged by the trauma of witnessing arguing parents. For many there is no new partner of their mother, so nobody offering a paternal function as a male or female. It is the fifth and sixth groups of mothers and children that this chapter will be concerned with.

Three Mental Health Outcomes

The three mental health outcomes for children discussed here are based upon the context of a father’s absence from his child’s life coupled with that child’s emotional and mental development becoming based upon the mother’s “parasitic” relationship with the child. The term “parasitic” conceptualises what happens when the infant meets the mother’s needs. These needs can be for someone to depend upon her, to carry some of her projections and feelings about the infant’s father and eventually (as child and adolescent) to share and promote her views about the father and fatherhood. For Bion this relationship is doomed to be destructive.

Parasitic Relationship

Bion (1959, 1962, 1965, 1970) based his concept of the parasitic relationship on his formulation of the mother–infant relationship as the prototype for a containing relationship. The mother’s role is to contain her infant’s anxieties through accurately perceiving and transforming the infant’s signals of a particular anxiety. For example, the apprehension and understanding that a particular cry means hunger and so need for a feed. The infant recognises that he has been understood when the bottle or nipple arrives in his mouth. Here the mother as container is containing the infant as the now contained. A parasitic relationship is a corruption of the container-contained relationship. This corruption may be at the start in the form, for example, of a wilful neglect of the infant’s needs or may creep with time. It is based upon the child no longer being seen as the contained but as the container for the mother. In this it is a reversal within the container-contained. Bion (1970, pp. 95–96) sees such a reversal as mentally destructive for the development of the infant into childhood and onwards. In the early stages, being caught in such a relationship ensures that the experience of separateness and difference cannot be established. From a psychoanalytic stance, experiencing separateness and difference is absolutely fundamental to healthy identity development, discernment and the capacity to reflect upon and learn from experiences. Without the presence of the father within the infant–mother relationship therefore, ADHD, self-harm and inappropriate sexual behaviour represent just three possible outcomes of such a parasitical relationship.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a diagnostic label for children and adults presenting with significant problems with the following:
  • Attention

  • Impulsiveness

  • Excessive activity

Diagnostic criteria for ADHD have tended to focus upon inattention and hyperactivity but have not included the emotional dysregulation many practitioners recognise in their patients. The DSM V is a clear example of this. However, Russell Barkley (2015) sees emotional dysregulation as a core component of ADHD. Barkley points to the neglect of the emotional aspect and more especially the lack of control of emotions in people with ADHD. He discusses the “effortful inhibition” and the “top-down self-control of emotions …. particularly those pertaining to the self-regulation of frustration, impatience and anger” as being missing (or largely missing) in those with ADHD. Other authors (e.g. Rapport et al. 2013) focus on how training young patients to develop and use this inhibition within themselves strengthens what workers in the field of ADHD term ‘executive functioning’.

The link between an absent father and a patient with ADHD is through boundary and role. Along with the promotion of the recognition of separateness and difference (and thus the beginnings of the use of the mind to find out, learn and think) the father is an embodiment of a boundary.
  • The father is different to the mother—there is a boundary between them.

  • The father is different to the infant—there is a boundary there.

  • The father has a relationship with the mother from which the infant is largely excluded—that’s another boundary.

Recognising boundaries allows the infant/child/adolescent to see where he stops and the father begins. Internalising boundaries allows for emotional regulation. Internalising a father allows for emotions to be held in check that might otherwise run riot. At a very early stage in the infant’s development, and this gets remembered through the other life stages, the experience of difference can be felt as very painful such that there is an acquiescent identification with something so different (bigger than the infant, has different things to say to the infant than the mother and physically holds the infant differently). This identification is the basis of the executive functioning that developmental psychologists and others discuss in terms of what is missing for ADHD patients. This is what is missing when fathers are absent and, in some cases, it can open the way for the now exclusive relationship with the mother to become parasitical.


Jimmy was referred to CAMHS aged 8 by Community Paediatrics who had already made a diagnosis of ADHD. The referral listed symptoms conducive to ADHD: an inability to concentrate in class, distracting his fellow pupils, finding it difficult to remember simple instructions and refusing to allow adults to help him by repeating things to him and trying to help him follow what he was supposed to do. Recently Jimmy had been disrupting fellow pupils at school and in a separate incident had been restrained by teachers after starting a fight with a boy who had made an offensive remark about his mother.

Jimmy attended the first session with his mother. His older siblings (sisters) were at school and his father was living in another county with a new family. Almost immediately Jimmy’s mother told me that Jimmy “is just like his Dad,” by which she meant “he is all over the place … can’t keep still … drives me mad … won’t do what he is told.” For the first ten minutes of the session Jimmy seemed invisible as his mother told me how difficult he was to manage, and just how like his father he was that she was worried “he’d be the same.” Every so often she would look at Jimmy and say “Don’t worry mate. We’ll be through here soon and you can have your McDonalds on the way back to school.” Far from sounding like a carrot to keep Jimmy calm for his session, this seemed more like a communication between equals; equals who were not taking a CAMHS assessment seriously. I observed Jimmy to be quietly getting on with drawing whilst his mother talked about his similarities to his father. When I asked her what she hoped from a CAMHS intervention she said “that he can just concentrate at school more.” When I pointed out all the similarities with his father that she seemed concerned about she replied “You’ll never sort that out (and to Jimmy) will he mate? You’re just like your Dad and always will be.” To the same question Jimmy told me that he wanted to be like other boys in his class. He was hesitant when I suggested this might be so as to concentrate and get on. It was clear he wanted to speak with me on my own. His mother returned to the waiting room.

Jimmy told me that the other pupil’s comment about his mother had hurt him very much, but not as much as his mother repeatedly referring to him as if he were his father. He spoke to me calmly, thoughtfully and with certain desperation. With his mother back in the consulting room I offered to see them together for sessions aimed at understanding their relationship, and what part in Jimmy’s difficulties an absent father played.

The work, weekly sessions, lasted six months. The material of some sessions demanded that I then saw one or other individually for a while, before resuming with them both together. Jimmy immediately responded well to me, and by the end we were able to see that he had benefitted from my being a male. His mother was initially very hostile to suggestions that her relationship with Jimmy’s absent father had any bearing on Jimmy’s diagnosis of ADHD. However, by the end she was able to say “I had such problems with my own father I couldn’t bear living with Jimmy’s. I was deliberately difficult, so he had to give up and leave. Then I stopped him seeing Jimmy.” Jimmy’s father had left when Jimmy was three months old. Through our work Jimmy’s mother was able to see that she had “slipped Jimmy into the space in my mind where his dad had been.” This space was not simply the one formerly occupied by a partner who did not do as he was told and was all over the place, and did not concentrate and get on with his life. It was a space marked companion. For all her complaints about his father, Jimmy’s mother came to recognise that his father had been her companion, and that she could not bear having such a companion because this stirred up feelings from her relationship with her own father. She was caught in a circle, with Jimmy slotting in where his father had been pushed out. Jimmy told me just how difficult he felt about having to hear about everything that went on in his mother’s life, and the feeling that she wanted him as a grown up not as a child. Our work together, with his mother present, linked this to his concentration problems at school and home. He told me that he felt his head was too full up and could not take in new things that were said in class and elsewhere. He could not discriminate what to remember and what to forget. He could not see school as different to home whilst his head was so full of his mother’s agenda and concerns. What both of them acknowledged they got from me was a very real sense of difference to both of them, with both individually able to say they had some relationship with me. Such triangulation helped dispense with the parasitical aspect of mother’s relationship with Jimmy.

The presence of me the psychotherapist, as the third corner in the triangle replacing the absence of Jimmy’s father, had a significant effect on his development in CAMHS. Jimmy’s mind was full of his mother and yet he was able to use a male psychotherapist in much the way he might have used a father’s presence. I was the different person in the room—male and adult. My being different and separate actually allowed both he and his mother, individually and together, to use me as an object for processing their experiences and emotions. The outcome was that school reported to me that Jimmy was now more able to concentrate in class and that his learning was showing signs of improvement. They had therefore decided to seek a re-assessment by the paediatrician, something that I wrote in support of.


There are as many reasons for self-harm as there are people who do self-harm. Self-harm, amongst other things, helps people to regulate emotional states that are felt otherwise to be too overwhelming. Here I want to focus on one of the two main methods of self-harm described in the NICE guidelines1—cutting.


Rachel, an only child, was seventeen when she was referred to me following an admission to a paediatric ward via A&E. She had cut her wrist very deeply with a kitchen knife, which required stitches. This had not been her first trip to the hospital. She had been self-harming since the age of 11, often requiring her to attend A&E. She had been known to social services since her first ward admission. However, social services appeared to not judge her as high risk because in their assessment her mother was attentive and concerned about her.

Mother and Rachel attended the first session. Rachel sat looking vacantly at the floor as her immediately distraught mother explained that she had always done what she could for Rachel, and therefore could not understand why she kept cutting herself (thighs, upper arms to start with, then forearms and now her wrist). Whilst one might easily have said mother’s presentation was indicative of trying to absolve herself of blame, it was also the case that she appeared genuinely frightened that Rachel might one day kill herself. As I listened, this fright seemed to be about the fear of such a loss, and that such a loss would be the loss of something more than a daughter. As this came to mind Rachel, some twenty minutes into the session, suddenly sat up and told her mother to “Shut-up being so self-pitying. You want to know why I do it. I’ll tell you. I am sick to death of your leaning on me.” Rachel made sense of something for me in this moment. That she could be so strident and cutting into her mother’s oration suggested that she was robust, was prepared to push back at her mother, and to cut into her mother as she did herself (physically). This preferred method of self-harm was therefore a choice that both conveyed and was based upon the desperate need to experience separation and difference. This spoke to the absence of a father who could offer boundary reinforcement, triangulation for experiencing and developing difference and who also could open up a space for thinking about emotional life. By the end of this assessment I had offered to see Rachel on her own weekly for ten sessions, in order to explore her reasons for cutting her body, and to help her understand her feelings about her mother. In the absence of a colleague to provide a space apart for the mother from this arrangement, I also saw her fortnightly in between Rachel’s scheduled sessions.

Rachel’s Absent Father

Father had left home when Rachel was nine years old. Mother had been distraught but also was determined not to work towards any reconciliation. Night after night she had cried through dinner and beyond, leaving her daughter very worried about her emotional well-being. Six months after the father’s departure, mother had a breakdown and Rachel had to prepare all meals and take on all the domestic chores. Mother increasingly used her as a confidant. Rachel felt uncomfortable being with her friends, as she was aware that her mother was at home in such a state. When she began self-harming at 11 she was unaware why she did so. By the age of 17 she was aware that she did so because she wanted to distract herself from, as she said, “the incessant feeling, like a plague of locusts, chasing me around my head so I don’t have anywhere to go.” This chasing plague was, of course, her mother and her mother’s unspoken insistence that Rachel devote herself to being her container. What Rachel actually needed was a father, both actually outside her and also inside as an internalised other by whom she could feel contained.

Mother’s Absent Partner

Rachel’s mother began her own sessions by fiercely denying the existence of Rachel’s father, to the extent that it took a mild comment from me about an “immaculate conception” to bring her begrudgingly to “accept he must have been around for that part.” With this early acceptance of his, apparently somewhat short-lived, presence we began to discuss her feelings about him—“Yes, he had been around for nine years, and yes that was significant…. But it isn’t now and wasn’t much then. Rachel was always a mummy’s girl. She always was with me. She didn’t want him or him her.” Acknowledging what she had just said, I moved into asking her why Rachel might now, apparently, be saying that Mummy is Rachel’s girl? Mother became furious. She yelled “Have you any idea what it is to live with someone who lies about what he spends his income on? Who lies about how much he drinks? Who lies about why he is late home from work?” Several sessions later, once the anger about this and other admonishments had abated, I asked whether he had always lied. It appeared not and slowly she told me of how she had always watched her husband “like a hawk,” and not wanted him near her or Rachel. Agreeing that this might not have been helpful to any of the three of them, she went on to say that she watched him because she had never trusted men. Men either left her or they abused her. She told me she was abused by her own father from the age of 9 to 16. Her own mother had denied the possibility on the numerous occasions when she confided to her, often saying that she was making up stories to get her father into trouble.

Rachel’s mother had also had a need for a containing and boundaried mother, and an impulse-regulating and non-abusive father. She had needed an emotionally aware and present parental couple to help her, but she did not have these. When Rachel was 9 years old, her much mother-watched father eventually left the home. This had been reported to me as the same age that Rachel’s mother had reported experiencing her first abuse by her own father. I pointed out this coincidence, asking—“Could it be that at that age Rachel’s mother had felt at her most vulnerable? If so, could it be that, without a professional intervention to help her, she had held onto the pain of that first experience of reporting abuse to her mother? Could it be that when Rachel became 9 her mother was triggered into projecting the pain into both her husband and daughter, forcing the one to leave and the other to self-harm?” These were very fundamental questions pointing to a very sensitive area within mother’s psyche. We agreed to extend the work for another ten weeks, increasing the frequency to weekly. Rachel was also offered and agreed the same temporal extension for her individual work with me.

Mother’s Present Psychotherapist

After a first session of what can be best described as self-righteous explanations for why she had every right to use her daughter as “a prop and confidant,” Rachel’s mother began to accept that she was using her daughter in the absence of a containing mother, partner and psychotherapist. I pointed out that her own mother had dismissed her concerns about something so painful that had negated her as a child and made her into an adult before she was ready. She agreed and said that this comment was “really helpful. Really … it holds me.” She then began to show deep remorse for how she had treated Rachel’s father. She said she had always kept him “at arm’s length” and had become suspicious when “he tried to understand me, get to know me, said he wanted to be there for me.” She told me that she had always been very “controlling of men,” seeing them as “something to be used and ended with, not to be valued otherwise.” Clearly these positions were held because of her relationship with her parents, both of whom had made it near impossible to have faith in intimacy, containment, and containment through intimacy with a partner. By the end of our work, Rachel’s mother recognised that she had made Rachel an adult prematurely, mirroring one outcome of the abuse by her own father. This helped her to begin to position herself more appropriately as an emotional container for Rachel.

Rachel’s Present Psychotherapist

Rachel was very keen to tell me all she experienced and felt in life, and especially in relation to her mother. In life she had very limited experiences, largely because of being driven to attend to her mother’s needs. She gave examples of feeling “chased back from school by the feeling I couldn’t delay by talking with friends.” She talked of being “constantly hounded by feeling claustrophobic. I couldn’t escape unless I found a place to cut myself. The first time was such a relief. It was being naughty that was the relief. The sharp blade felt like nothing. The relief was more powerful.” Soon the sequence of finding somewhere secret, cutting and feeling relief became established as a form of unthinking escape. Rachel said that after the first few times, she knew the moment had been lost in which she could feel and think about what it was she was escaping from. That moment, the tiny moment in which thought might have been possible, was extinguished and with it the opportunity to self-regulate her feelings through thinking about them and giving herself a protective boundary to fend off more self-harm. Throughout the time of our work together Rachel did not self-harm. She said that talking with me about her experiences at times when she had cut helped her to “reflect”. Alongside this we had been talking about her cutting into her mother during the assessment session. She began speaking about how used she felt by her mother and that change was necessary so that her mother could support her. During the penultimate session she said “You know. Talking to you like this makes me think of my dad. I haven’t seen him since he left. I miss him, but I don’t have enough memory of him to know what I miss about him.” I suggested that our sessions had been a space away from her mother and that maybe this is what she needed from a father. Someone who is different but a person who can be relied upon to help her think about things, rather than act on them in the absence of having anyone to help her. Rachel began crying deeply for the remainder of the session.

After finishing the scheduled individual sessions, as is my practice, we met for a review. On this occasion mother and daughter spoke of starting to understand each other better as people with needs. Mother apologised for “loading myself onto..” Rachel. Both agreed that it would be a good idea if mother approached her ex-husband about meeting again. She had much to say to him and she knew Rachel did too.

The effect of the absent father on Jimmy and Rachel was essentially the same. Both had been left with mothers unable to offer anything other than a parasitical relationship with them, which acted as a vehicle for their transmitting their feelings about their ex-partner (the children’s father) into them. This had dire consequences for their development behaviorally, emotionally and in terms of their mental health.

The final mental health outcome I want to discuss here is sexually inappropriate behaviour. The case I will now present is one where an older adolescent was accused of rape.

Sexually Inappropriate Behaviour

Most types of sexually inappropriate behaviour in children and adolescents that present to CAMHS derive from these young people having themselves been exposed to sexually inappropriate behaviour at some point prior to their coming to the attention of concerned adults. Some have been exposed to video or online porn. Others have been exposed to live sexual activity involving adults and/or other children. Invariably there is an adult somewhere in the story who has started off a chain of abuse via the abuse of a child or young person. There are, however, some children (especially boys) whose behaviour is the result of an overly-indulgent mother and an absent father. My previous comments about self-harm’s prevalence and meaning also hold true for this behaviour.


Rob was referred to me at the age of 17 after being sent to trial for the rape of a fellow college student whom he had been close to. The trial had not gone through because the victim retracted her allegation. Despite not consenting to the sexual act, the victim had come to believe that Rob himself did genuinely believe she had given consent. He had been very remorseful at the time showing this frequently during his interrogation. Rob had been open to our services for many years, being under psychiatry for his ADHD. My consultant colleague took the view that his mother (who we will call “Daphne”) was the context for Rob’s difficulties. She was concerned that Daphne was resistant to any consideration of family-based psychotherapy for her and Rob (her only child). Daphne had staunchly argued that ADHD is a one-person problem, and that Rob should receive medication and regular reviews for this.

“Daphne and Rob”

I began my involvement by seeing Rob with his mother, and then decided to see Daphne for several sessions before seeing Rob for his own sessions. My initial session with them both had revealed something very insular about both. Daphne skillfully dissected everything put to her. It made her impervious. One could not offer the most innocuous idea to her without feeling that she had detected it leaving my mind. Before it reached my tongue, she had decided upon the way she would question it. I was surprised at how hesitant Rob was to allow himself to have an idea, let alone articulate it to me. He did not seem to have an idea of a containing parent who was open to containing him. He certainly did not know how to deal with me as a male interested in offering him support.


Work with Daphne was very difficult. Firstly, she did not see the point of it as Rob “got into a tangle with that student because he has ADHD and, as everyone knows, ADHD is a genetic problem and nothing to do with the environment provided by the parents.” She moved from this to an attempt at analysing what she imagined were my reasons for being a psychotherapist, and one working on “this forensic case.” Daphne was highly articulate. She worked as a barrister helping the police with profiling in very serious forensic cases. Profiling did not seem to be simply the product of her professional training. Her own psyche appeared to attune to everything forensically, making an image of it, and then dissecting the evidence to fit or refute aspects of what she had profiled. Invariably she dissected everything I suggested so that we remained in a mono-dimensional world devoid of spontaneity, creativity or connection. In such a world, she was able to be in control. It soon became apparent that this control was to ensure not simply that emotions had no part in profiling or the profiled, but also that she could not be given things to think about that would challenge her way of thinking.

I don’t usually challenge patients as strongly as I needed to challenge Daphne. I began by suggesting to her that she had given me an idea of her as a hands-off mother who coped with family matters in the way that she coped with work matters—with a mind that was looking to dissect but not link up with what was being communicated. After several weeks of her saying that I didn’t make sense because to dissect something involves some sort of engagement with it, Daphne let me make another observation—that her persistence with getting things right made me wonder about Rob’s early years. Surely babies and young children need some slack? Daphne was more open to thinking about Rob’s early years. She had been completing her training. The pregnancy had come at the wrong time. She was a trainee who had fallen in love when she meant to qualify at the elite level. The two things didn’t go together and from there (she only just qualified) she blamed Rob’s father for coming into her life. She loved Rob as a baby but began to hate the father simply because he had disrupted her life. She kept him away from caring for the baby and then from playing with him as a toddler. By the time Rob was three, the father had left the home angry at not being allowed to parent his son. “Yes,” she said, “I am very controlling. I only just qualified because my tutor wrote in mitigation that I was pregnant.” She kept Rob close for fear of losing him—“I have smothered him and made it so that he probably can’t breathe without thinking of me.”


I offered Rob weekly sessions immediately following on from offering Daphne the same. I saw them both for just over a year. For the first few sessions Rob was very remorseful about raping his fellow student—“despite her saying that I didn’t, I know that she didn’t want to. I did. I didn’t use force but I know she wasn’t up for it. She seemed reluctant and disinterested. That was all.” Rob corrected me when I said it seemed she thought he had not recognised that she did not want to have sex with him. He said “It was rape. I knew what I was doing. She must have thought so, otherwise she wouldn’t have allowed herself to be interviewed by the Police. Call it rape please, even if it’s covered up now.” We discussed how he had got close to her from day one of his course, and that he thought they had formed a friendship. After several weeks we moved from his softer feelings to the ones involved in raping her.

Rob spoke a great deal about the sense of liberation he felt in having control over the girl and “getting rid of something into her.” There was the evacuation of the feeling of being controlled as he controlled the girl and, as he said, “did what I wanted for the first time ever.” We were able to see this freedom as freedom from being controlled by his mother. The rape was an act in which he had a moment of freedom, as certainly this would not be something his mother would want him to have done. However, it was freedom only up to a point. Rob’s chosen form of evacuating his mother from inside him was not an accident. He told me he knew that his mother blamed his father for her pregnancy, and thus for Rob’s birth. Rob was very interested in philosophy and had long had an argument in his mind (only) about causation in human relationships. He did not at first see a valid link between his mother’s pregnancy as a student, and his forced sexual intercourse with a student. Rob had been in touch with his father from whom he understood he had been a planned baby, because at the time his mother thought she could qualify well and also carry a baby. Added to this, she had loved Rob’s father, at least until the baby was born. After her disappointing qualification she blamed Rob’s father for everything. Interestingly, Rob could not understand why initially she was not more condemning of his raping the fellow student. In one session, he became extremely angry as he concluded that her not being condemning was a sign of her being out of touch with reality, and too interested in closing the gap between them. He had felt liberated by this gap but he was aware his mother sought to close it “somehow…anyhow.”

The work with both Daphne and Rob concluded with two months of weekly joint sessions for them. Daphne discussed just how controlling she had been of Rob, and just how she missed his father. At this point Rob broke into deep sobbing, crying out to his fellow student how sorry he was. Mother and son both sobbed together with Daphne saying that she was so sorry for “making Dad go… and just when you … when I needed him most. None of this would have happened.”

Daphne recognised how Rob’s rape of the student was partly an act of liberation from feeling suffocated by an omnipotent mother who constantly thought for him and explained him to him. Further, this was a mother who had used him as a companion now that she lived in a world without his father.

Addendum to the Case

What I have very quickly described is psychotherapeutic work to address a parasitical relationship. It was a complicated case made so not least because of the allegation of rape being redacted. I have seen many other cases where this parasitical relationship often produces a development beginning with stealing, moving to more serious stealing or fire-setting, sometimes leading to sexual excursions that are intrusive and unwanted by those intruded into and ends with a serious sexual offence (including rape). At each stage of this horrendous trajectory there is an opportunity for these developments to be halted. Understanding what the behaviour is trying to draw attention to is critical to such halting. Daphne and Rob worked hard to understand their relationship and how it contributed to the outcome that was acted out by Rob. Daphne had effectively got rid of Rob’s father. She was able to accept in the end, however, that had she not done so, the father’s presence could have supported her parenting of Rob and could have potentially prevented her from inappropriately projecting her own intense feelings and needs into that relationship.

As a footnote, after the end of the work Rob’s father and Daphne sought help from me to bring them closer together as parents. They worked through Daphne’s original rejection of him, and his own feelings of not challenging her sufficiently before leaving the home. They were then able both to be present but not intrusive for Rob, putting their efforts towards giving him space to develop as a late adolescent/young adult. Rob’s father was a man very able to bring his difference as a parent and human being into the mix. He was sufficiently benign to help form a family based on a triad, not a dyad. For my part this second piece of work left me aware that, had Rob’s father been present from the outset of his life, then Rob would have developed a concept of difference. Difference was, presumably, not in mind when he crossed the boundary with his fellow student. This case illustrates one cause of intrusive sexual behaviour and rape. It does not, however, account for a great number of different causes and motives in other cases.

Concluding Comments

I have chosen these three cases because they are representative of the diverse presentations of children, young people and their mothers that nevertheless have a common causality for their mental health outcomes. They are just three of many cases that I have seen over the years where the absence of the father, often instigated by the mother, allows for a parasitical relationship to take hold with disastrous consequences for the emotional development and mental health of the children. The absent father has a very powerful presence, in that the consequences of his absence have such pervasive and damaging results. However, I hope that I have also demonstrated how significant amelioration is possible with correctly focused and emotionally attuned psychotherapeutic interventions.


  1. 1.

    Self-Harm: Longer-Term Management. National Clinical Guidance Number 133.


  1. Barkley, R. A. (2015). Emotional dysregulation is a core component of ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 81–115). New York, NY: Guilford Press.Google Scholar
  2. Bion, W. R. (1959). Attacks on linking. In Second thoughts: Selected papers on psycho-analysis. London: Tavistock.Google Scholar
  3. Bion, W. R. (1962). Learning from experience. London: Tavistock.Google Scholar
  4. Bion, W. R. (1965). Transformations. London: Tavistock.Google Scholar
  5. Bion, W. R. (1970). Attention and interpretation. London: Tavistock.Google Scholar
  6. Davidson, N. (1990). Life without father: America’s greatest social catastrophe. Policy Review, 51, 42.Google Scholar
  7. Rapport, M. D., Orban, S. A., Kofler, M. J., & Friedman, L. M. (2013). Do programs designed to train working memory, other executive functions and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clinical Psychology Review, 33(8), 1237–1252.CrossRefGoogle Scholar
  8. Schore, A. (1994). Affect regulation and the origin of the self. Psychology Press: Hove and New York.Google Scholar
  9. Schore, A. (2017). All our sons: The developmental neurobiology and neuroendocrinology of boys at risk. Infant Mental Health Journal, 38(1), 15–52.CrossRefGoogle Scholar

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© The Author(s) 2019

Authors and Affiliations

  1. 1.Private PracticeLondonUK

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