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Fraiberg and her colleagues (1975) introduced the metaphor "ghosts in the nursery" to describe the ways in which parents, by reenacting with their small children scenes from the parents' own unremembered early relational experiences of helplessness and fear, transmit child maltreatment from one generation to the next. In this article we propose that angels in the nursery-care-receiving experiences characterized by intense shared affect between parent and child in which the child feels nearly perfectly understood, accepted, and loved-provide the child with a core sense of security and self-worth that can be drawn upon when the child becomes a parent to interrupt the cycle of maltreatment. We argue that uncovering angels as growth-promoting forces in the lives of traumatized parents is as vital to the work of psychotherapy as is the interpretation and exorcizing of ghosts. Using clinical case material, we demonstrate the ways in which early benevolent experiences with caregivers can protect against even overwhelming trauma, and examine the reemergence of these benevolent figures in consciousness as an instrument of therapeutic change. Finally, we examine implications of the concept of "angels in the nursery" for research and clinical intervention.RESUMEN: Fraiberg y sus colegas (1975) introdujeron la metáfora "fantasmas en la habitación" para describir las maneras en que los padres transmiten el maltratamiento infantil de una generación a la otra, por medio de poner en escena, con sus niños pequeños, situaciones de sus propias -si bien no recordadasexperiencias de miedo y falta de ayuda en sus tempranas relaciones en sus tempranas relaciones. En este ensayo, proponemos que "ángeles en la habitación," experiencias del cuidado recibido, caracterizadas por un intenso y compartido afecto entre padre o madre e infante, en las cuales el infante se siente casi perfectamente comprendido, aceptado y amado, proveen a éste con un sentido central de seguridad y autovalor al que se puede recurrir cuando el infante se convierte en padre o madre, con el fin de interrumpir el ciclo de maltratamiento. Sostenemos que dejar al descubierto "ángeles" como una fuerza que promueve el crecimiento en las vidas de padres o madres traumatizados es tan vital para el trabajo de la sicoterapia como la interpretación y el exorcismo de "fantasmas." Por medio del uso de material de casos clínicos, demostramos las maneras por medio de las cuales las tempranas experiencias benevolentes con quienes nos prestaban el cuidado pueden proteger aun contra el trauma abrumador. También examinamos la reaparición de estas imágenes benevolentes en la conciencia como un instrumento de cambio terapéutico.Support for the writing of this article was provided by the Coydog Foundation. Direct correspondence to: Alicia F. Lieberman, San Francisco General Hospital, Building 20, Suite 2100,1001 Potrero Avenue, San Francisco, CA 94110; e-mail: Alicialieberman@sfgh.org. Angels in the NurseryFinalmente, examinamos las implicaciones del concepto de "ángeles en l...

Objective This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the mother-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs). Methods Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child’s exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs). Results For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group. Conclusions The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well. Practice Implications Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the mother as an integral participant in the child’s treatment may be particularly effective in the treatment of young children exposed to multiple risks.

Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children's response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.

This paper describes a conceptual approach to understanding the impact of marital violence on preschoolers, examines the predictors and mediators of child behavioral problems in a clinical sample of multiethnic preschoolers who witnessed their mothers' battering by their father figure, and presents empirical evidence supporting the use of relationship-based therapeutic modalities in treating preschoolers exposed to violence. We find that exposure to violence and maternal life stress are each predictive of child behavior problems, and that the impact of maternal life stress on child behavior problems is mediated by maternal psychopathology and the quality of the mother-child relationship.

The perceived loss of physical abilities and the generation of meaning and purpose in life are important variables that relate to positive adaptation following spinal cord injury. Treatment implications related to factors that increase quality of life following spinal cord injury are discussed.

this pilot study examined the potential impact of a perinatal adaptation to Child-Parent Psychotherapy (CPP), an evidence-based treatment for traumatized mother-child dyads, on maternal functioning 6 months post-partum among women with history of complex trauma and current intimate partner abuse. Pregnant women (n = 64) enrolled during the third trimester of their pregnancy (Mean gestational age = 27.48 weeks, range of 12 to 42) and participated in weekly perinatal CPP sessions until their infant was 6 months old. women completed measures of trauma history, depression, posttraumatic stress symptoms (PtSS), and child-rearing attitudes at pre-and post-treatment. results showed decreases in depression and PtSS from pre-to post-treatment assessments, as well as an increase in positive child-rearing attitudes. as hypothesized, women with low maternal-fetal attachment demonstrated the greatest improvement in depression, PtSS, and child-rearing attitudes compared to women with high maternal-fetal attachment. the current study provides promising results indicating that a perinatal