The Problem of Diagnosis in Parent Loss Cases1

PARENT LOSS IS A SHORTHAND term describing a population of adult patients who have sustained, during childhood, the loss of a parent by death. This special group of patients has become increasingly visible within the last 20 years because of a combination of clinical observations and theoretical questions that needed answers. These questions have initiated an intensive study of this group of patients. In the beginning, attention was directed toward them because of an unexpected impasse in therapeutic efforts (Fleming, 1963). Attempts to explain this impasse led to insight in diagnostic understanding which led, in turn, to modifications of technique and to new correlations of old concepts. The new formulations in the areas of diagnosis and technique have been found useful in helping patients who come under the rubric "parent loss." These formulations have also contributed to the growing body of knowledge referable to developmental theory, e.g., self—object relationships, reality testing, and the phenomena of transference.

That is a very brief and generalized statement of the outcome in a long and on-going study of the questions raised by this group of patients. What I want to do in the next half hour is to discuss some of these questions as they come up in the diagnostic process and to present some clinical material that demonstrates the need to recognize the importance of certain developmental experiences in understanding the problems which bring an adult into therapy.

The problem of diagnosis in these cases is an interesting one in that it has implications for prevention as well as treatment. It does