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Childhood maltreatment is associated with disruptions in narrative coherence about close relationships. The current pilot study introduced a brief new measure of narrative coherence about romantic partners, and tested whether post-traumatic stress disorder (PTSD) symptoms mediated the link between childhood maltreatment and narrative coherence about romantic partners during pregnancy. Participants were 101 low-income, ethnically diverse pregnant women (62% living below the poverty line; 37% Latina, 22% Black, 20% White, 22% other), with high rates of childhood maltreatment. They completed the Five-Minute Speech Sample about their romantic partner (i.e., the baby's father) during pregnancy, which independent pairs of raters coded for prenatal narrative coherence and prenatal expressed emotion (including negative and warm affect) about partners. Participants also completed standardized self-report instruments assessing childhood maltreatment, romantic partner support, and prenatal PTSD and depression symptoms. Narrative coherence about partners from the Five-Minute Speech Sample showed convergent validity with romantic partner support and expressed emotion about partners. PTSD symptoms (but not depression symptoms) mediated the link between childhood maltreatment and prenatal narrative coherence about partners. The Five-Minute Speech Sample offers a brief and valid strategy to assess NC about romantic partners. PTSD symptoms and narrative coherence about partners are both potential intervention targets to promote healthy psychological and relational functioning during pregnancy., Author(s): Laura M. River [sup.1] , Angela J. Narayan [sup.1] [sup.2] , Miriam L. Castillo [sup.1] , Efrat Sher-Censor [sup.3] , Alicia F. Lieberman [sup.2] Author Affiliations: (1) grid.266239.a, 0000 [...]

During pregnancy, low-income women are at high risk for depression and posttraumatic stress disorder (PTSD), but they are unlikely to receive mental health services. As a follow-up to Narayan et al. (2017), we provide a detailed picture of pregnant women's mental health service (MHS) need versus utilization. Results suggested that the majority of women with very elevated depression and PTSD symptoms received MHSs during pregnancy. However, few women with lower-grade depression received MHSs, despite meeting prenatal depression criteria recommended by the American Academy of Pediatrics. Pregnant women of color were also especially unlikely to receive MHSs. Inefficient transportation and lack of child care were primary issues interfering with service utilization. Detailed recommendations for how to improve MHS access are discussed.

There is an urgent imperative to scale up access to effective, family‐focused mental health services for trauma‐exposed infants, toddlers, and preschoolers, who represent the most vulnerable and most underserved sector of the clinical child population. This article describes the process of scaling child–parent psychotherapy, an evidence‐based treatment currently used in 39 U.S. states and six countries, as an example of the promise and challenge of large‐scale implementation of relationship‐based treatments [ABSTRACT FROM AUTHOR]

Objectives This study examined maternal pregnancy wantedness and perceptions of paternal wantedness, and their associations with maternal perinatal mental health symptoms and relationship dynamics. Methods Low-income, ethnically-diverse pregnant women (N = 101, M.sub.age = 29.10 years, SD.sub.age = 6.56, range.sub.age = 18-44; 37% Latina, 22% African-American, 20% White, 21% biracial/multiracial/other) completed semi-structured interviews of pregnancy wantedness coded by trained raters, and standardized instruments of depression and PTSD symptoms during pregnancy and at 3-4-months postpartum. Results While maternal pregnancy wantedness (rated from 0-Predominately Ambivalent, 1-Mixed, and 2-Predominately Positive) showed no significant associations, a couple-level scale that combined maternal wantedness and her perceptions of paternal wantedness (Equally Positive Wantedness, Mom Wants More, Dad Wants More and Equally Ambivalent) showed several significant associations. Compared to women in the Equally Positive group, women in the Mom Wants More group had significantly higher prenatal and postnatal depression symptoms, prenatal PTSD symptoms, and prenatal and postnatal relationship conflict; and lower prenatal and postnatal relationship support. Women in the Mom Wants More group also had significantly higher prenatal and postnatal depression symptoms and prenatal conflict; and lower prenatal support than women in the Dad Wants More group. Conclusions for Practice Women who perceive themselves as wanting the pregnancy more than their baby's father are at higher risk for mental health and relationship problems than women who perceive themselves and their partners as equally ambivalent. Providers should ask women about their perceptions of partners' pregnancy wantedness to inform delivery of targeted mental health and relationship-based intervention during pregnancy., Author(s): Victoria M. Atzl [sup.1] , Angela J. Narayan [sup.1] [sup.2] , Alexandra Ballinger [sup.3] , William W. Harris [sup.4] , Alicia F. Lieberman [sup.2] Author Affiliations: (1) grid.266239.a, 0000 [...]

Clinical psychology training for research-oriented scientist-practitioners tends to have a gap in research training during the predoctoral internship year. In 1982, the Clinical Psychology Training Program (CPTP) at the University of California, San Francisco (UCSF) began a 2-year clinical and clinical research training program combining an American Psychology Association (APA)-accredited internship and a postdoctoral fellowship. The goal of the program is to prepare graduates for leadership roles as principal investigators who are licensed clinicians able to function as independent practitioners. This article conveys the philosophy behind the program, its structure, and the results of the program over the last 31 years. The CPTP accepted 142 trainees, of whom 46 (32%) were minorities and 78 (55%) were women. CPTP fellows have published over 250 articles, chapters, and books with their mentors and have contributed to submitting research grants with them. The vast majority continued research and academic activities after graduation. The most recent self-study for APA accreditation reported that of 43 trainees admitted in the 10 years between 1999 and 2008, 41 (95%) went on to academic positions, research, or clinical positions in academic settings or research positions in other settings; 1 obtained a clinical position; and 1 provided no information. The program serves as a model for clinical psychology nationally, allowing for uninterrupted clinical research training during the internship and postdoctoral years, nurturing clinical psychologists committed to clinical research careers, and contributing substantially to the clinical research productivity of the host department.

This article describes the impact on young children of sudden and extended separation from a primary attachment figure. It recommends clinical intervention when the child's development and family functioning are negatively affected by the severity of the child's symptoms, and it highlights key treatment modalities derived from Child-Parent Psychotherapy, including the importance of "speaking the unspeakable," defined as affirming reality by giving words to the separation and its sequelae and the importance of offering a safe space for the child's expression of sadness, anger, and fear in the supportive presence of the caregiver. Two clinical examples illustrate treatment while the separation is ongoing and after reunion takes place.

The prenatal period represents an opportunity to buffer the intergenerational transmission of adversity through integrated, comprehensive perinatal health services for women experiencing high levels of adversity and clinical symptoms. This article presents preliminary descriptive data, drawn from an ongoing clinical research study, on prenatal clinical symptomatology and service usage and needs in 101 pregnant women who have experienced lifetime adversity. The women gave birth at a university-affiliated county hospital that serves low-income, ethnically diverse, medically uninsured families. Results highlight the need for improved identification of unmet mental health service needs during pregnancy. The authors provide recommendations for strategies to more comprehensively understand how to support low-income pregnant women via tailored, trauma-informed services for maternal health and infant well-being.

Caregivers' ability to identify infant cues plays a crucial role in child development, enabling attuned and responsive caregiving that serves as the basis for secure attachment. At the same time, exposure to interpersonal violence (IPV) could alter mothers' interpretations of social stimuli and interfere with normative parent-child interactional processes. The current study examined four interrelated hypotheses. The first two hypotheses test whether IPV-exposed mothers show bias toward fear or anger in interpreting infants' facial expressions, and whether this bias is related to child symptoms. Our second set of hypotheses examines whether bias can be changed by Child-Parent Psychotherapy (CPP) and whether this change mediates treatment gains. 113 IPV-exposed mothers of 2 to 6 year old children completed the I FEEL picture task at baseline and again twelve months later. In the interim, 33 mothers were randomized into a treatment comparison group and the remainder received CPP. Analyses revealed that IPV-exposed mothers exhibit a perceptual bias toward fear, but not anger. Bias toward fear was linked to greater child internalizing symptoms while bias toward anger was linked to greater child externalizing symptoms. Participation in CPP resulted in decreased bias toward fearful faces. The treatment-related changes in mothers' perceptions of children's facial expression did not emerge as the mechanism by which CPP reduces children's symptoms. These results suggest that exposure to IPV alters mothers' ability to interpret infant facial expressions and that CPP is effective in reducing such biases., Author(s): Rosemary E. Bernstein [sup.1] , Adela C. Timmons [sup.1] [sup.2] , Alicia F. Lieberman [sup.1] Author Affiliations: (Aff1) 0000 0001 2297 6811, grid.266102.1, Department of Psychiatry, Child Trauma Research [...]