The intimate interconnections linking biological, psychological, and social processes often are most apparent under conditions of environmental adversity, when the risk factors are so salient that their impact on personality functioning can be readily measured. In this case study, we present the treatment of a young pregnant woman whose childhood history of chronic and severe trauma, deprivation, and abuse was enacted in the present through violent and self-destructive behavior that endangered her well-being and her unborn child's healthy development. The treatment aimed at increasing the mother's safety, preventing abuse after the baby's birth, and interrupting the intergenerational transmission of psychopathology, which is well documented in the clinical and research literature (Fraiberg, Adelson, & Shapiro, 1975; Doumas, Margolin, & John, 1994).
Pregnancy is a time of profound transformation for women physically, psychologically, and interpersonally. The impending birth of the baby may be anticipated as the fulfillment of a cherished wish, but it may also elicit fear of body damage, resentment about loss of autonomy, and anxiety about the capacity to fulfill the new role expectations. For some women, the resulting stresses can result in anxiety, depression, and increased risk of domestic violence and child abuse (Gazmararian et al., 1996; O'Hara, 1995). At the same time, this developmental transition offers an opportunity for the improvement of long-standing maladaptive patterns (Benedek, 1959; Bibring, 1959).