Clinical applications of the attachment framework: Relational treatment of complex trauma

The self and attachment difficulties associated with chronic childhood abuse and other forms of pervasive trauma must be understood and addressed in the context of the therapeutic relationship for healing to extend beyond resolution of traditional psychiatric symptoms and skill deficits. The authors integrate contemporary research and theory about attachment and complex developmental trauma, including dissociation, and apply it to psychotherapy of complex trauma, especially as this research and theory inform the therapeutic relationship. Relevant literature on complex trauma and attachment is integrated with contemporary trauma theory as the background for discussing relational issues that commonly arise in this treatment, highlighting common challenges such as forming a therapeutic alliance, managing frame and boundaries, and working with dissociation and reenactments.     

Why now? Timing and circumstances of hastened deaths

We interviewed 35 families to understand the timing and circumstances of hastened deaths. We estimated life expectancy for the 26 patients who hastened their deaths and used content analysis to identify patterns in their decisions. On average, patients had lived with their illness for 2.5 years and had actively planned their deaths for 3 months. Those with less than a week to live (n = 10) were 'dying and done,' having experienced a final functional loss that signaled the end. Those with <1 month (n = 8) were 'dying, but not fast enough.' Those with 1-6 months (n = 5) saw a 'looming crisis' on their horizon that would prohibit following through with their plans. The 3 patients with >6 months were 'not recognized by others as dying, but suffering just the same.' Clinicians should regularly assess where patients perceive they are in the dying process and ask about their comfort with the pace of dying to identify opportunities for intervention.     

Total knee replacement in a patient with unsuspected tabes dorsalis

Rapid and progressive ligamentous laxity following an initially successful total knee replacement is unique in the authors' experience. One case is reported due to previously unsuspected tabes dorsalis.     

Williams–Beuren syndrome: novel risk alleles in transmitting parents

Copy number variation at the 7q11.23 segmental duplications is a susceptibility factor for the Williams–Beuren syndrome deletion
Cuscó et al. (2008)
Genome Research 18 (5): 683–694. Epub 21 February 2008