Mitigating the impact of intimate partner violence in pregnancy and early childhood: A dyadic approach to psychotherapy

• Published date: 01 January 2024
• Author: Carolyn Ponting,Rachel C. Tomlinson,Ann Chu,Alicia F. Lieberman
• Date: 01 January 2024
• DOI: http://doi.org/10.1111/fcre.12766

SPECIAL ISSUE ARTICLE

Mitigating the impact of intimate partner violence

in pregnancy and early childhood: A dyadic

approach to psychotherapy

Carolyn Ponting | Rachel C. Tomlinson | Ann Chu |

Alicia F. Lieberman

University of California, San Francisco, San

Francisco, California, USA

Correspondence

Carolyn Ponting, University of California,

UCSF Nancy Friend Pritzker Building,

675 18th Street San Francisco, San Francisco,

CA 94113, USA.

Email: carolyn.ponting@ucsf.edu

Abstract

Intimate partner violence (IPV) is often considered an adult

problem despite profound consequences for the children

who are exposed toviolent relational patterns. About a third

of children and adolescents report past exposure to parental

IPV, and a majority were first exposed as infants. Exposure

to IPV during pregnancy through the first 5 years of a child's

life has consequences ranging from adverse birth outcomes

to diagnosable emotional problems and lasting physiological

dysregulation. This article reviews risks and consequences

of IPV in pregnancy and early childhood and discusses a

relational psychotherapeutic treatment approach (Child–

Parent Psychotherapy) applied to both developmental

stages to mitigate the adverse consequences of family vio-

lence on parents and their children. Research evidence for

the effectiveness of Child–Parent Psychotherapy (CPP)

among IPV-exposed families is reviewed as are specific

treatment components which seek to restore relational

safety following familial violence. Additionally, clinical con-

siderations unique to families with histories of or ongoing

exposure to IPV are discussed. Finally, recommendations

are presented to improve the integration between medical

and early childhood behavioral health systems for families

at highest risk for chronic IPV.

DOI: 10.1111/fcre.12766

© 2023 Association of Family and Conciliation Courts.

112 Family Court Rev. 2024;62:112–130.

wileyonlinelibrary.com/journal/fcre

KEYWORDS

dyadic, early childhood, intimate partner violence, pregnancy,

psychotherapy

Key points for the family court community

•Infants and children exposed to IPV are at elevated risk

for later socioemotional difficulties, physiological dys-

regulation and child welfare involvement.

•IPV threatens relational safety; dyadic, relationship-

based psychotherapies are well suited to repair ruptures

in family relationships caused by violence restore psy-

chological health.

•Child Parent Psychotherapy and its perinatal application

are interventions that can improve to child and parental

psychopathology, parenting beliefs and attachment

security.

INTIMATE PARTNER VIOLENCE IN PREGNANCY

About one in four women living in the U.S. will experience intimate partner violence (IPV) in their lifetime (Smith

et al., 2018). Though there is a common perception that particular developmental periods such as pregnancy temper

IPV risk, national data contradict these assumptions. Over 70% of women abused prior to becoming pregnant will

continue to experience IPV throughout their pregnancy (Saltzman et al., 2003; Van Parys et al., 2014). IPV-related

homicide during pregnancy and the early postpartum period is the leading cause of maternal mortality, surpassing

common medical conditions, including hypertensive and placental disorders (Wallace et al., 2021). A recent review of

international IPV prevalence rates finds them to be relatively stable from pregnancy through the postpartum period

(Mojahed et al., 2021), indicating that the birth of a child is not a deterrent for those engaging in violence.

Consequences of IPV in pregnancy

Exposure to IPV in pregnancy has a lasting impact on maternal mental and physical health. Pregnant women encoun-

tering IPV during pregnancy are at an increased risk for a range of mental health problems including perinatal depres-

sion, posttraumatic stress (Paulson, 2022), anxiety (Navarrete et al., 2021), and suicidal ideation (Alhusen

et al., 2015). These mental health challenges often impact parenting. For example, meta-analytic data from longitudi-

nal studies show that women exposed to IPV in the perinatal period have poorer attachment with their children in

their first 5 years of life (McIntosh et al., 2021). Additionally, chronic physical conditions like irritable bowel syn-

drome, fibromyalgia, and chronic pain are common among women who have experienced IPV and may be the result

of chronic stress or injury as a result of physical abuse (Chisholm et al., 2017). Pregnant women exposed to IPV are

about two times more likely to deliver a baby preterm or at low birth weight compared to women without IPV expo-

sure (Donovan et al., 2016). Adverse birth outcomes are explained by health behaviors more common in women

experiencing IPV, such as substance use and inconsistent attendance at prenatal care appointments (Chisholm

et al., 2017), in addition to patterns of physiological upregulation resulting from IPV (Alhusen et al., 2016). Thus, the

mental and physical effects of IPV can extend well beyond pregnancy even if acute violence has ended.

PONTING ET AL.113