Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy.

This paper introduces the concept of "dissociative collusion" as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well-documented "couple collusion," describes relational unconscious dynamics where split-off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self-other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.

Este artículo presenta el concepto de "colusión disociativa" como herramienta teórica y clínica útil para comprender y trabajar con pacientes con antecedentes de trauma en la terapia de pareja. El artículo describe maneras de diagnosticar y tratar la colusión disociativa basándose en la integración de un enfoque de la relación de objeto, un enfoque relacional y un enfoque narrativo. La colusión disociativa, una versión única de la bien documentada "colusión de pareja", describe una dinámica relacional inconsciente donde los aspectos de la separación de uno o ambos integrantes de la pareja están disociados mutuamente de una manera complementaria que se vuelve parte del inconsciente compartido y se restablece de maneras destructivas. El concepto de colusión disociativa es especialmente relevante para los terapeutas de pareja que trabajan con pacientes con antecedentes de trauma, quienes con frecuencia usan la disociación como mecanismo de defensa principal. Sugerimos que el desafío y el objetivo para la terapia de pareja con esta población es ayudarlos a reconectarse y a oscilar mejor entre configuraciones disociadas del otro yo. Se presenta un caso de terapia de pareja de una esposa que había sido víctima de abuso sexual en la infancia y su esposo que demostró el uso frecuente de defensas disociativas.

Galectin-3, a marker for vacuole lysis by invasive pathogens.

Shigella bacteria invade macrophages and epithelial cells and following internalization lyse the phagosome and escape to the cytoplasm. Galectin-3, an abundant protein in macrophages and epithelial cells, belongs to a family of beta-galactoside-binding proteins, the galectins, with many proposed functions in immune response, development, differentiation, cancer and infection. Galectins are synthesized as cytosolic proteins and following non-classical secretion bind extracellular beta-galactosides. Here we analysed the localization of galectin-3 following entry of Shigella into the cytosol and detected a striking phenomenon. Very shortly after bacterial invasion, intracellular galectin-3 accumulated in structures in vicinity to internalized bacteria. By using immuno-electron microscopy analysis we identified galectin-3 in membranes localized in the phagosome and in tubules and vesicles that derive from the endocytic pathway. We also demonstrated that the binding of galectin-3 to host N-acetyllactosamine-containing glycans, was required for forming the structures. Accumulation of the structures was a type three secretion system-dependent process. More specifically, existence of structures was strictly dependent upon lysis of the phagocytic vacuole and could be shown also by Gram-positive Listeria and Salmonella sifA mutant. We suggest that galectin-3-containing structures may serve as a potential novel tool to spot vacuole lysis.

Shigella phagocytic vacuolar membrane remnants participate in the cellular response to pathogen invasion and are regulated by autophagy.

Intracellular pathogens like Shigella flexneri enter host cells by phagocytosis. Once inside, the pathogen breaks the vacuolar membrane for cytosolic access. The fate and function of the vacuolar membrane remnants are not clear. Examining Shigella-infected nonmyeloid cells, we observed that proteins associated with vacuolar membrane remnants are polyubiquinated, recruit the autophagy marker LC3 and adaptor p62, and are targeted to autophagic degradation. Further, inflammasome components and caspase-1 were localized to these membranes and correlated with dampened inflammatory response and necrotic cell death. In Atg4B mutant cells in which autophagosome maturation is blocked, polyubiquitinated proteins and P62 accumulated on membrane remnants, and as in autophagy-deficient Atg5(-/-) cells, the early inflammatory and cytokine response was exacerbated. Our results suggest that host membranes, after rupture by an invading cytoplasm-targeted bacterium, contribute to the cellular responses to infection by acting as a signaling node, with autophagy playing a central role in regulating these responses.