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Childhood trauma, attachment style, and a couple's experience of terminal cancer: Case study

Published online by Cambridge University Press:  23 March 2010

Linda M. McLean  and
Sarah Hales
Linda M. McLean*
Affiliation:
University Health Network, Princess Margaret Hospital, Department of Psychosocial Oncology and Palliative Care, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Sarah Hales
Affiliation:
University Health Network, Princess Margaret Hospital, Department of Psychosocial Oncology and Palliative Care, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
*
Address correspondence and reprint requests to: Linda M. McLean, University Health Network, Princess Margaret Hospital, Psychosocial Oncology and Palliative Care 16-755, 610 University Avenue, Toronto, Ontario, Canada, M5G 2M9. E-mail: lmmclean@rogers.com
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Abstract

Objective:

The primary objective of this article is to elucidate the significance of psychosocial distress and risk in a sub-population of end-stage cancer patients and their spouse caregivers who present with an especially challenging attachment style and histories of childhood trauma. The case study presented highlights the need to both identify and offer an empirically validated couple–based intervention, along with a multi-disciplinary team approach over the trajectory of the illness and at end of life.

Method:

A validated marital protocol (emotionally focused couple therapy [EFT]) is modified for this population and conducted by an EFT-trained psychologist as part of a pilot investigation as to the feasibility and effectiveness of EFT for the terminal cancer population. Measures of marital distress, depression, hopelessness, and attachment security are completed at baseline and subsequent intervals, as reported in another publication. Attachment insecurity and the exquisitely intimate relationship with caregiving and care receiving are underscored, given the couple's traumatic childhood history.

Results:

The couple described herein, followed from diagnosis of metastatic disease to end of life illuminates the potential effectiveness of a modified EFT protocol, and underscores the need to both identify and intervene with a population potentially at significantly high risk for marital distress, suicidality, depression, and hopelessness.

Significance of Results:

The benefits of a multidisciplinary team is evident as the patient's symptoms of physical distress increased toward end of life and she returned to earlier behaviors, namely suicidal ideation and an attempt to alleviate her experience of suffering. The strength of the marital bond, possibly as a result of the intervention, and the efforts of the multidisciplinary team approach, demonstrate potential to mitigate a catastrophic end of life and a complicated spousal bereavement. This case study adds to the current empirical literature in an area that is currently under-studied and under-reported.

Keywords

Terminal cancerChildhood traumaCouple interventionPalliative careGood dying and death
Type
Case Reports
Information
Palliative & Supportive Care , Volume 8 , Issue 2 , June 2010 , pp. 227 - 233
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

Akechi, T., Okuyama, T., Sugawara, Y., et al. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: Associated and predictive factors. Journal of Clinical Oncology, 22, 1957–1965.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (4th ed., text revision). Washington, DC: American Psychiatric Association.Google Scholar
Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7, 147–178.CrossRefGoogle Scholar
Bartholomew, K. & Horowitz, L.M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.CrossRefGoogle ScholarPubMed
Beck, A.T., Steer, R.A. & Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.Google Scholar
Beck, A.T., Weissman, A., Lester, D., et al. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861–865.CrossRefGoogle ScholarPubMed
Bowlby, J. (1969). Attachment and Loss, Vol 1: Attachment. New York: Basic Books.Google Scholar
Bowlby, J. (1973). Attachment and Loss, Vol 2: Separation: Anxiety and Anger. New York: Basic Books.Google Scholar
Bowlby, J. (1979). The Making and Breaking of Affectional Bonds. London: TavistockGoogle Scholar
Bowlby, J. (1980). Attachment and Loss, Vol 3: Loss: Sadness and Depression. New York: Basic Books.Google Scholar
Bowlby, J. (1988). A Secure Base. New York: Basic Books.Google Scholar
Braun, M., Mikulincer, M., Rydall, A. et al. (2007). Hidden morbidity in cancer: Spouse caregivers. Journal of Clinical Oncology, 25, 4829–4834.CrossRefGoogle ScholarPubMed
Brennan, K., Clark, C. & Shaver, P. (1998). Self-report measurement of adult romantic attachment: An integrative overview. In Attachment Theory and Close Relationships, Simpson, J.A. & Rholes, W.S. (eds.), pp. 46–76. New York: Guilford Press.Google Scholar
Burman, B. & Margolin, G. (1992). Analyses of the association between marital relationships and health problems: An interactional perspective. Psychological Bulletin, 112, 39–63.CrossRefGoogle Scholar
Busby, D.H., Crane, D.R. & Christensen, C. (1995). A revision of the Dyadic Adjustment Scale for use with distressed and non-distressed couples: Construct hierarchy and multidimensional scales. Journal of Marital & Family Therapy, 21, 289–308.CrossRefGoogle Scholar
Carlson, L.E., Bultz, B.D., Speca, M., et al. (2000). Partners of cancer patients: Part 1. Impact, adjustment, and coping across the illness trajectory. Journal of Psychosocial Oncology, 18, 39–57.CrossRefGoogle Scholar
Cohen, S.T. & Block, S. (2004). Issues in psychotherapy with terminally ill patients. Palliative & Supportive Care, 2, 181–189.CrossRefGoogle ScholarPubMed
Douglas, L.G. (1997). Reciprocal support in the context of cancer: Perspectives of the patient and the spouse. Oncology Nursing Forum, 24, 1529–1536.Google Scholar
Eton, D.T., Lepore, S.J. & Helgeson, V.S. (2005). Psychological distress in spouses of men treated for early-stage prostate carcinoma. Cancer, 103, 2412–2418.CrossRefGoogle ScholarPubMed
Fonagy, P. (1998). An attachment theory approach to treatment of the difficult patient. Bulletin of the Menninger Clinic, 62, 147–69.Google ScholarPubMed
Green, B.L., Rowland, J.H, Krupnick, J.L., et al. (1998). Prevalence of posttraumatic stress disorder in women with breast cancer. Psychosomatics, 39, 102–111.CrossRefGoogle ScholarPubMed
Gurevich, M., Devins, G.M., Rodin, G.M., et al. (2002). Stress response syndromes and cancer: Conceptual and assessment issues. Psychosomatics, 43, 259–281.CrossRefGoogle ScholarPubMed
Hales, S., Zimmermann, C., & Rodin, G. (2008). The quality of dying and death. Archives of Internal Medicine, 168, 1–7.CrossRefGoogle ScholarPubMed
Hunter, J. & Maunder, R. (2001). Using attachment theory to understand illness behavior. General Hospital Psychiatry, 23, 177–82.CrossRefGoogle ScholarPubMed
Hunter, M.J., Davis, P.J. & Tunstall, J.R. (2006). The influence of attachment and emotional support in end-stage cancer. Psycho-Oncology, 15, 431–444.CrossRefGoogle ScholarPubMed
Johnson, S.M. (2002). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds. New York: Guilford Press.Google Scholar
Johnson, S.M. (2004). The Practice of Emotionally Focused Couple Therapy: Creating Connection. New York: Brunner-Routledge.Google Scholar
Johnson, S.M. & Greenberg, L.S. (1985). Emotionally focused couples therapy: An outcome study. Journal of Marital & Family Therapy, 11, 313–317.CrossRefGoogle Scholar
Kissane, D.W., Blocj, S., Burns, W.I., et al. (1994a). Psychological morbidity in the families of partners with cancer. Psycho-Oncology, 3, 47–56.CrossRefGoogle Scholar
Kissane, D.W., Blocj, S., Burns, W.I., et al. (1994b). Perceptions of family functioning and cancer. Psycho-Oncology, 3, 650–658.CrossRefGoogle Scholar
Kissane, D.W., Bloch, S., Dowe, D.L., et al. (1996a). The Melbourne family grief study, I: Perceptions of family functioning in bereavement. American Journal of Psychiatry, 153, 650–658.Google Scholar
Kissane, D.W., Bloch, S., Onghena, P., et al. (1996b). The Melbourne family grief study, II: Psychosocial morbidity and grief in bereaved families. American Journal of Psychiatry, 153, 659–666.Google ScholarPubMed
Kuhl, D. (2003). What Dying People Want: Practical Wisdom for the End-of-Life. Toronto: Anchor Canada.Google Scholar
Lyons-Ruth, K. & Block, D. (1996). The disturbed caregiving system: Relations amongst childhood trauma, maternal caregiving, and infant affect, and attachment. Infant Mental Health Journal, 17, 257–275.3.0.CO;2-L>CrossRefGoogle Scholar
MacCormack, T., Simonian, J., et al. (2001). “Someone who cares”: A qualitative investigation of cancer patients'experiences of psychotherapy. Psycho-Oncology, 10, 52–65.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
McLean, L.M. & Gallop, R. (2003). Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder. American Journal of Psychiatry, 160, 369–371.CrossRefGoogle ScholarPubMed
McLean, L.M. & Jones, J.M. (2007). A review of distress and its management in couples facing end-of-life cancer. Psycho-Oncology, 16, 603–616.CrossRefGoogle ScholarPubMed
McLean, L.M. & Nissim, R. (2007). Marital therapy for couples facing advanced cancer: Case review. Palliative and Supportive Care, 5, 303–313.CrossRefGoogle ScholarPubMed
McLean, L.M., Jones, J.M., Rydall, A.C., et al. (2008). A couple's intervention for patients facing advanced cancer and their spouse caregivers: Outcomes of a pilot study. Psycho-Oncology, 17, 1152–1156.CrossRefGoogle ScholarPubMed
Mikulincer, M., Florian, V., & Weller, A. (1993). Attachment styles, coping strategies, and post-traumatic psychological stress. Journal of Personality and Social Psychology, 64, 817–826.CrossRefGoogle Scholar
Minuchin, S. & Fishman, H.C. (1981). Family Therapy Techniques. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar
Northouse, L.L., Dorris, G., & Charron-Moore, C. (1995). Factors affecting couples' adjustment to recurrent breast cancer. Social Science and Medicine, 41, 69–76.CrossRefGoogle ScholarPubMed
Northouse, L.L., Templin, T., Mood, D., et al. (1998). Couples' adjustment to breast cancer and benign breast disease: A longitudinal analysis. Psycho-Oncology, 7, 37–48.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Rogers, C. (1951). Client-Centered Therapy. Boston: Houghton-Miffin.Google Scholar
Tan, A., Zimmermann, C. & Rodin, G. (2005). Interpersonal processes in palliative care: An attachment perspective on the patient-clinician relationship. Palliative Medicine, 19,143–150.CrossRefGoogle ScholarPubMed
Weihs, K. & Reiss, D. (2000). Family reorganization in response to cancer: A developmental perspective. In Cancer and the Family, Baider, L., Cooper, C.L., & Kaplan De-Nour, A. (eds.), pp. 17–39. Chichester, England: John Wiley.Google Scholar
Weitzner, M.A., McMillan, S.C. & Jacobson, P.B. (1999). Family caregiver quality of life: Differences between curative and palliative cancer treatment settings. Journal of Pain & Symptom Management, 17, 418–28.CrossRefGoogle ScholarPubMed
Ybema, J.B., Kuijer, R.G., Buunk, B.P., et al. (2001). Depression and perceptions of inequity among couples facing cancer. Personality and Social Psychology Bulletin, 27, 3–13.CrossRefGoogle Scholar