Lessons Learned Lessons Learned from the Circle from the Circle

of Securityof SecurityNeil W. Boris, M.D.Neil W. Boris, M.D.

Tulane University Health Tulane University Health Sciences Center and Institute Sciences Center and Institute for Infant and Early Childhood for Infant and Early Childhood

Mental HealthMental Healthwww.infantinstitute.org

nboris@tulane.edu

Exploration with Exploration with Colleagues!Colleagues!

Glen Cooper, Kent Hoffman, and Bert Powell

Center for Creative Intervention, Spokane, WA

Bob Marvin and Bill Whelan Mary D. Ainsworth Child-Parent Attachment

Clinic, Charlottesville, VA

www.circleofsecurity.org

AcknowledgementsAcknowledgements

My colleagues at Tulane My colleagues at Tulane

especially those at theespecially those at the

Tulane Institute for InfantTulane Institute for Infant

and Early Childhood and Early Childhood

Mental Health…visit us Mental Health…visit us

at www.infantinstitute.orgat www.infantinstitute.org

Exploration with Drug-Exploration with Drug-Abusing MothersAbusing Mothers

A debt of gratitude to Veronica and A debt of gratitude to Veronica and the brave mothers who have come the brave mothers who have come into treatmentinto treatment Perhaps the greatest gift is agreeing to Perhaps the greatest gift is agreeing to

share one’s life story and struggles with share one’s life story and struggles with others…others…

The Circle of Security is a The Circle of Security is a Story of…Story of…

Passion and friendshipPassion and friendship Technology as a tool for connectionTechnology as a tool for connection Leveraging science and creativity to Leveraging science and creativity to

improve clinical practiceimprove clinical practice Finally, an answer to how we can Finally, an answer to how we can

seamlessly link careful assessment to seamlessly link careful assessment to intensive intervention!intensive intervention!

The Circle Team set out The Circle Team set out to create an to create an intervention:intervention:

1.1. That is consistent with attachment That is consistent with attachment theory and researchtheory and research

2.2. That focuses on the caregiver as the That focuses on the caregiver as the partner in the dyad with the greater partner in the dyad with the greater degrees of freedom for initiating degrees of freedom for initiating changechange

3.3. That focuses on both the caregiver’s That focuses on both the caregiver’s Internal Working Models of self and Internal Working Models of self and child child andand on his/her caregiving on his/her caregiving behaviorbehavior

4.4. That can be used as either group or That can be used as either group or individual therapy modelsindividual therapy models

Components of Infant-Components of Infant-Parent Relationship Parent Relationship

IBBaby IBParentRBaby RParent

What you seeWhat you

hear

Developing Attachment System

Adapted from Bruschweiler –Stern and Stern, 1989

What set attachment What set attachment apart from other apart from other

developmental theories?developmental theories? Linked to natural selection as driving Linked to natural selection as driving

force:force: Protection of young = protection of genesProtection of young = protection of genes

Based theory on observations; de-Based theory on observations; de-emphasized the role of “meeting oral emphasized the role of “meeting oral needs”needs” Ethology and Harry Harlow’s monkeysEthology and Harry Harlow’s monkeys The concept of “imprinting” as a cross-The concept of “imprinting” as a cross-

species phenomenonspecies phenomenon

Definition of AttachmentDefinition of Attachment

Inborn system— “feedback loop”Inborn system— “feedback loop” Operative throughout lifeOperative throughout life External goal in infancy is to balance External goal in infancy is to balance

exploration and proximity to exploration and proximity to caregiver (“the secure base”)caregiver (“the secure base”)

Internal goal to achieve sense of Internal goal to achieve sense of “felt security” “felt security”

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityCircle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell, 2000

Experience in Experience in Relationships….Relationships….

As our brain has evolved in As our brain has evolved in complexity our dependence at birth complexity our dependence at birth on caregivers has increased.on caregivers has increased.

Each of us, as caregivers, have Each of us, as caregivers, have “working models” in our minds--“working models” in our minds--expectations and emotions about expectations and emotions about relationships derived from relationships derived from experience.experience.

Attachment-- The Attachment-- The “Internal Working “Internal Working

Model”Model”Story of the Relationship

Attachment-- The Attachment-- The “Internal Working “Internal Working

Model”Model” Relationship template (‘structure of Relationship template (‘structure of

the mind’)the mind’) Formed by experience (influenced by Formed by experience (influenced by

temperamenttemperament genes?)genes?) Accessible in adults by interviewAccessible in adults by interview Predicts later patterns of behavior in Predicts later patterns of behavior in

relationships (stable though relationships (stable though malleable)malleable)

Neural PlasticityNeural Plasticity

EXPERIENCE MOLDS THE BRAIN (and vice versa)

Schore, 1999

Peck, S. D. (2003) Measuring sensitivity moment-by-moment: A microanalytic look at the transmission of attachment. Attachment and Human Development, 5, 38-63.

Why All The Fuss?Why All The Fuss?1. Selection of neuronal

pathways

2. Emotions—development and regulation

3. Shaping of Internal Working Models/Representations

Basics of COS ProtocolBasics of COS Protocol

Pre-intervention videotaped, structured Pre-intervention videotaped, structured assessment to inform treatment goalsassessment to inform treatment goals

Group-based parent education and Group-based parent education and psychotherapy lasting ~20-weeks using psychotherapy lasting ~20-weeks using videotaped interventionvideotaped intervention

Goals of video review are to:Goals of video review are to: increase sensitivity to the child’s cuesincrease sensitivity to the child’s cues increase self-other reflective capacity increase self-other reflective capacity explore new representations and interaction explore new representations and interaction

patternspatterns

AssessmentAssessment

Strange Situation ProcedureStrange Situation Procedure Augmented with a cleanup of toys, a reading Augmented with a cleanup of toys, a reading

session and blowing bubbles!session and blowing bubbles! Narrative Interview-Circle of Security Narrative Interview-Circle of Security

InterviewInterview Parent perception about their child’s needs, Parent perception about their child’s needs,

their relationship with the child and childhood their relationship with the child and childhood relationship with their own caregivers relationship with their own caregivers

Other narrative interviews (e.g., the Working Other narrative interviews (e.g., the Working Model of the Child Interview, Insightfulness Model of the Child Interview, Insightfulness Assessment) are equally usefulAssessment) are equally useful

Platforms for COS Platforms for COS Intervention-IIntervention-I

Susan McDonough’s Interaction Susan McDonough’s Interaction GuidanceGuidance One of the earliest parent-infant One of the earliest parent-infant

therapies that used videotape to build therapies that used videotape to build relationshiprelationship

Therapy focused Therapy focused relentlesslyrelentlessly on positive on positive moments of connection in order to moments of connection in order to engage caregiversengage caregivers

Attachment ResearchAttachment Research Both study of interactive behavior using Both study of interactive behavior using

the Strange Situation Procedure, and…the Strange Situation Procedure, and… Study of the importance of Study of the importance of

representations in shaping parental representations in shaping parental behavior, and…behavior, and…

Study of the importance of reflective Study of the importance of reflective capacity in reshaping representations.capacity in reshaping representations.

Platforms for COS Platforms for COS Intervention-IIIntervention-II

Parent-Child Psychotherapy, for Parent-Child Psychotherapy, for which goals include:which goals include: Gaining an understanding of how parents Gaining an understanding of how parents

experiences are impacting perceptions, experiences are impacting perceptions, feelings, and behaviors toward infant feelings, and behaviors toward infant

Changes are sought at 3 levels:Changes are sought at 3 levels: representation of the childrepresentation of the child representation of the self as parentrepresentation of the self as parent representation of the self as adult representation of the self as adult

individualindividual

Platforms for COS Platforms for COS Intervention-IIIIntervention-III

Leveraging Group Leveraging Group ProcessProcess

Insights of peers can be incredibly Insights of peers can be incredibly helpfulhelpful Distancing from the “expert” (who may not Distancing from the “expert” (who may not

be trusted)be trusted) Sense of shared challenge in parenting is a Sense of shared challenge in parenting is a

huge benefithuge benefit Welcome to the ClubWelcome to the Club

Seeing the struggles (and successes) of Seeing the struggles (and successes) of others is highly motivating and can also others is highly motivating and can also externalize painful patterns so that they can externalize painful patterns so that they can be ‘seen’be ‘seen’

Welcome to the ClubWelcome to the Club

Being a parent may just be the most difficult job on the planet. Everyday, parents – the world over – want the best for their children. And everyday, parents – the world over – fail to meet some of the needs of their children. “Help me” moments go unseen. “Watch over me” moments get interrupted. “Comfort me” and “Organize my feelings” moments end up being pushed away, or lost in the rush and stress of everyday life.

Welcome to the club.Of course, it’s hard to know that we make mistakes.

The good news is that as parents, we all have an inner wisdom that helps us work with these mistakes.

Excerpt from a reading that is part of the group

Let’s Meet Veronica Woman in her late 30’s; mother of 5 Woman in her late 30’s; mother of 5

children, 4 of whom are in custody of children, 4 of whom are in custody of the Statethe State

15-month old named Dalton is with her 15-month old named Dalton is with her in a residential treatment programin a residential treatment program

Participates in a weekly open-ended Participates in a weekly open-ended Circle of Security group which is held Circle of Security group which is held on site at the treatment programon site at the treatment program

3 year history of cocaine dependence, 3 year history of cocaine dependence, major depression and chronic painmajor depression and chronic pain

COSI

Confident and

Worthy

I can read his signals

and respond

He needsme and

will signal me

Old Working Model

New Working Model

Reflective Dialogue

SelfProtectionHurt,

Ashamed and Empty

I am a failure as a mother

Veronica’s Representational WorldVeronica’s Representational World

“He doesn’t

need me”

What About Interactive What About Interactive Behavior?Behavior?

Veronica will need to see how her Veronica will need to see how her wish to have her son “fill her void” is wish to have her son “fill her void” is influencing her behaviorinfluencing her behavior She is very intrusiveShe is very intrusive He is very avoidant He is very avoidant She experiences his avoidance as not She experiences his avoidance as not

“needing her” and, with the weight of “needing her” and, with the weight of having lost her other children, pushes having lost her other children, pushes harder for connectionharder for connection

R2 Clip

Circle of Limited SecurityCircle of Limited SecurityChild Anxious about the Parent’s Needs

I NEED YOU TO

WELCOME MY

COMING TO YOU BUT…

First Things FirstFirst Things First

1.1. Establish a “Holding Environment” for Establish a “Holding Environment” for the Parentthe Parent

2.2. Provide Parent a User-friendly Map of Provide Parent a User-friendly Map of Secure Secure Parent-Child Parent-Child Interaction……….Interaction……….

Technology as a Tool for Technology as a Tool for ConnectionConnection

Current editing software allow for Current editing software allow for extremely creative approaches to extremely creative approaches to engagementengagement Adobe Premiere Elements is available Adobe Premiere Elements is available

at reasonable cost with incredible ease-at reasonable cost with incredible ease-of-use even for non-geeks like me!of-use even for non-geeks like me!

Beauty Tape!

COS Protocol SequenceCOS Protocol Sequence

1.1. Establish a “Holding Environment” for Establish a “Holding Environment” for the Parentthe Parent

2.2. Provide Parent a User-friendly Map of Provide Parent a User-friendly Map of Secure Secure Parent-Child Parent-Child Interaction……….Interaction……….

Protect me Comfort me Delight in me Organize my feelings

Circle of SecurityCircle of SecurityParent Attending to the Child’s Needs

I need you to

Support My Exploration

Welcome My Coming To You

I need you to

Watch over me Help me Enjoy with me Delight in me

I need you to

I need you to

© Cooper, Hoffman, Marvin and Powell, 2000

COS Protocol SequenceCOS Protocol Sequence

1.1. Establish a “Holding Environment” for the Establish a “Holding Environment” for the ParentParent

2.2. Provide Parent a User-friendly Map of Provide Parent a User-friendly Map of Secure Secure Parent-Child InteractionParent-Child Interaction

----Then, through video review of her child and Then, through video review of her child and herselfherself——

3.3. Develop the Parent’s Observational SkillsDevelop the Parent’s Observational Skills4.4. Increase Parental Reflective FunctioningIncrease Parental Reflective Functioning5.5. Facilitate an Empathic Shift in the Parent Facilitate an Empathic Shift in the Parent

Toward the ChildToward the Child

• To enhance the parents’ feeling of being understood, valued and supported while reducing their anxiety regarding criticism and humiliation

• To engage the parents in reflective dialogue (“Reflective Capacity”)

• To increase the parents’ ability to have empathy for their children even when their children’s needs make the parent uncomfortable

• To help the parents develop a sense of themselves as successful in responding to their children’s needs

Specific Goals of the Videotape ReviewsSpecific Goals of the Videotape Reviews

Support and Reflect with Support and Reflect with VeronicaVeronica

Need to help Veronica see that her need Need to help Veronica see that her need to make up for losing her other kids by to make up for losing her other kids by pushing Dalton to “bond” is not going to pushing Dalton to “bond” is not going to workwork Can she understand the link between Can she understand the link between

intrusiveness and avoidance?intrusiveness and avoidance? Can she tone down the pressure she feels and Can she tone down the pressure she feels and

respond to his cues not her own fear?respond to his cues not her own fear? Can she understand what it has been like for Can she understand what it has been like for

him to live through her depression and drug him to live through her depression and drug abuse?abuse?

Going DeeperGoing Deeper

There are moments in our interactions There are moments in our interactions with others during which the needs of the with others during which the needs of the other set off a reaction other set off a reaction Perhaps fear, withdrawal, dread, anger etcPerhaps fear, withdrawal, dread, anger etc

These moments are EXPLICITLY These moments are EXPLICITLY recognized using the theme song from the recognized using the theme song from the Movie “Jaws”Movie “Jaws” Parents learn half-way through the group Parents learn half-way through the group

about “shark music”—the idea that each of us about “shark music”—the idea that each of us has moments in which we hear the Jaws themehas moments in which we hear the Jaws theme

Mutual regulation:Regulated with the

help of the caregiver

Self-regulation

of behavior

and emotions

Behavior and Emotion Behavior and Emotion Regulation Across Regulation Across

DevelopmentDevelopment

 

Trauma May Impair Both Mutual and Self-Regulation

Shark MusicShark Music

This concept becomes a central focus This concept becomes a central focus of the Tape Review for each parentof the Tape Review for each parent

Moments of struggle, of missed Moments of struggle, of missed opportunity are reviewed and the opportunity are reviewed and the parent is asked to think about their parent is asked to think about their response and why it occurred.response and why it occurred.

These are key moments in the These are key moments in the reflective dialogue and it is here that reflective dialogue and it is here that the “empathic shift” is soughtthe “empathic shift” is sought

Tape Review 2

Circle of Limited SecurityCircle of Limited SecurityChild Anxious about the Parent’s Needs

I NEED YOU TO

WELCOME MY

COMING TO YOU BUT…

Circle of Limited SecurityCircle of Limited SecurityChild Anxious about the Parent’s Needs

I NEED YOU TO

WELCOME MY

COMING TO YOU BUT…

STEPPING OFF THE CIRCLE…..

Celebrating ChangeCelebrating Change

Goal is to highlight shifts in behavior Goal is to highlight shifts in behavior and to create a “living memory” of and to create a “living memory” of progress progress

One effective method is a music One effective method is a music video of key moments…video of key moments…

F/U reunion and Song

Attachment-Based Attachment-Based TherapyTherapy

The Circle of Security model not only The Circle of Security model not only provides a roadmap of attachment that provides a roadmap of attachment that parents can understand and relate to….parents can understand and relate to….

The model ALSO supports the therapist The model ALSO supports the therapist by providing a protocol to followby providing a protocol to follow

The use of video ‘externalizes’ the The use of video ‘externalizes’ the struggles and allows the therapist to face struggles and allows the therapist to face the caregiver’s struggles with themthe caregiver’s struggles with them

Applications of the COS-IApplications of the COS-I

Open-ended groupsOpen-ended groups Well-suited to certain situations Well-suited to certain situations

including substance-abuse programs including substance-abuse programs Requires more of the therapist in that Requires more of the therapist in that

there is constant “catching up” of new there is constant “catching up” of new group members and need for recreating group members and need for recreating the holding environment seriallythe holding environment serially

Model being used in individual or Model being used in individual or couples’ therapycouples’ therapy Allows for wider latitude to explore Allows for wider latitude to explore

related themesrelated themes Ability to focus on issues like abdication of Ability to focus on issues like abdication of

hands on the circle and role reversalhands on the circle and role reversal Loses the “punch” of group inputLoses the “punch” of group input Can add in parenting partners more Can add in parenting partners more

easily than with groupseasily than with groups

Applications of the COS-Applications of the COS-IIII

Focus on different child age groupsFocus on different child age groups Infants using the Still Face procedure Infants using the Still Face procedure

as key to interactive assessmentas key to interactive assessment School-aged children using Story Stems School-aged children using Story Stems

as key to interactive assessmentas key to interactive assessment Adolescents using “Relational Play” Adolescents using “Relational Play”

procedures or shared narrativesprocedures or shared narratives

Applications of the COS-Applications of the COS-IIIIII

Help me protect myself Comfort me Delight in me Organize my feelings

CIRCLE OF SECURITY PARENT ATTENDING TO THE CHILD’S NEEDS

I need you to...

Support My Exploration

Monitor me (texting!)

Delight in me

See cues for help butask before helping

Enjoy with me

© 2000 Cooper, Hoffman, Marvin & Powell

I need you to...

Welcome My Coming To You

Always: be BIGGER, STRONGER, WISER, and KIND. Whenever possible: follow my child’s need.

Whenever necessary: take charge.

みててね 手伝ってね 緒に楽しんでね 緒に喜ぼうよ

こういうことをして欲しいな

こういうことをして欲しいな

安全感の輪 子どもの要求に目を向けよう

いろんなことをするからみててね

いつだって :子どもより大きく、子どもより強く、子どもより賢く、そして優しい存在でいよう。

できるときは :子どもの要求にこたえよう。必要なときは：毅然とふるまおう。

今行くからおいでよって待っててね

まもってね なぐさめてね大好きってうけとめて気持ちを落ち着かせてね

Bibliography on The Circle Bibliography on The Circle of Securityof Security

www.circleofsecurity.orgwww.circleofsecurity.org Cooper, G., Hoffman, K., Powell, B. and Marvin, R.

(2005) The Circle of Security intervention: Differential diagnosis and differential treatment. In Berlin, L.J., Ziv, Y., Amaya-Jackson, L. M., & Greenberg, M. T. (eds.) Enhancing early attachments: Theory, research, intervention, and policy. New York: Guilford Press.

Marvin, R., Cooper, G., Hoffman, K., and Powell, B. (2002) The Circle of Security project: Attachment based therapy with caregiver-pre-school child dyads. Attachment & Human Development 4(1):107–124

nboris@tulane.edu