When Fantasy Meets Diagnosis: Parental Denial around a diagnose

In my practice, the psychological process might includes the formulation of a diagnosis, which can evoke strong emotions as parents move between partial acknowledgment and denial. This article examines the clinical tension between the child as held in parental fantasy and the child as encountered in reality following a psychological or developmental diagnosis. From a psychoanalytic and psychodynamic perspective, parental denial is understood not simply as resistance, but as a defensive response to narcissistic injury and to a form of parental mourning that frequently goes unrecognized. These issues are explored with particular attention to attachment, developmental timing, and reflective functioning.

Parental Representations and the Fantasmatic Child in Development

From a child psychologist’s perspective, parenting is organized through internal representations of the child that precede and accompany development. Even before birth, parents hold an emotionally charged internal image, the fantasmatic child, which integrates unconscious wishes, attachment histories, and hopes for continuity and repair. This internal representation shapes parental sensitivity, expectations, and the capacity to respond to the child’s emotional signals.

The fantasmatic child is an emotionally charged internal figure shaped by the parent’s attachment history, unconscious wishes, and hopes for continuity and repair. It plays a central role in regulating parental sensitivity, expectations, and caregiving behavior. It reflects who the parent hopes the child will be and who the parent hopes to become through the child. As such, it plays a critical role in the regulation of parental affect and in the emergence of caregiving patterns that support or hinder secure attachment.

In typical development, the relationship between the fantasmatic child and the real child undergoes gradual transformation. Parents encounter the child’s temperament, rhythms, and limitations, and revise their internal representations accordingly. This ongoing adaptation supports reflective functioning and enables the parent to experience the child as a separate subject with an inner world, laying the groundwork for secure attachment.

Diagnosis as a Disruption of Parental Attachment Organization

A psychological or developmental diagnosis can profoundly disrupt this adaptive process. From a developmental standpoint, diagnosis is not experienced by parents as neutral information but as an event that destabilizes the internal representations through which parenting has been organized. The diagnosis often sharply exposes the gap between the imagined child and the real child, overwhelming the parent’s capacity to integrate fantasy and reality.

This disruption frequently activates attachment-related anxieties. Parents may experience threats to their sense of competence, emotional availability, and continuity as caregivers. Feelings of shame, guilt, and helplessness are common, even when unspoken. From this perspective, parental denial emerges not as a lack of concern for the child, but as a defensive attempt to preserve emotional regulation and caregiving capacity when the attachment system is under strain.

Denial may therefore function as a temporary stabilizing strategy, allowing parents to remain engaged with their child when full acknowledgment of the diagnosis would lead to emotional collapse or withdrawal. The different manifestations of denial that exist, denial of difficulty, denial of diagnosis, or denial of future implications, will make the process long.

Parental Mourning, Reflective Functioning, and Developmental Timing

Alongside attachment disruption, diagnosis often initiates a form of parental mourning that remains largely unrecognized. Parents grieve not only the imagined child but also their image of themselves as effective, protective caregivers. This mourning process is complex and non-linear, frequently unfolding without social validation or ritual containment.

When mourning is insufficiently processed, parents may experience a temporary reduction in reflective functioning. The ability to think about the child’s mind, intentions, and emotions may be compromised, increasing the risk of mis attunement. Parents may oscillate between moments of partial acknowledgment and renewed denial as they attempt to regulate overwhelming affect. These fluctuations are developmentally meaningful. They reflect an effort to maintain attachment availability under conditions of emotional threat.

Integrating the Fantasmatic and the Real Child: A Developmental Process

From a developmental and attachment perspective, the goal of parents is not to eliminate parental fantasy but to accept its transformation. Acceptance occurs when parents can hold both loss and reality, allowing the fantasmatic child to evolve rather than dominate the internal landscape.

Early in this process, the child may be experienced primarily through the lens of diagnosis, with behaviors interpreted as signs of deficit or loss. Over time, as parental regulation improves, parents may begin to perceive the child’s individuality, agency, and emotional expressions. The diagnosis gradually becomes one lens among others rather than a defining identity.

This integration supports the reorganization of parental hope, from hopes rooted in normalization and repair to hopes grounded in relationship, adaptation, and developmental progress. Such hope fosters sustained parental engagement and supports the child’s emotional security, keeping parents emotionally available and aimed to protect the parent–child attachment relationship.

In other words, parental hope shifts from ideals of repair and normalization to hopes grounded in relationship, adaptation, and developmental progress, supporting sustained engagement and child well-being.