Presentation on theme: "Lessons Learned from the Circle of Security"— Presentation transcript:
1Lessons Learned from the Circle of Security Neil W. Boris, M.D.Tulane University Health Sciences Center and Institute for Infant and Early Childhood Mental Health
2Exploration with Colleagues! Glen Cooper, Kent Hoffman, and Bert PowellCenter for Creative Intervention, Spokane, WABob Marvin and Bill WhelanMary D. Ainsworth Child-Parent Attachment Clinic, Charlottesville, VA
3Acknowledgements My colleagues at Tulane especially those at the Tulane Institute for Infantand Early ChildhoodMental Health…visit usat
4Exploration with Drug-Abusing Mothers A debt of gratitude to Veronica and the brave mothers who have come into treatmentPerhaps the greatest gift is agreeing to share one’s life story and struggles with others…
5The Circle of Security is a Story of… Passion and friendshipTechnology as a tool for connectionLeveraging science and creativity to improve clinical practiceFinally, an answer to how we can seamlessly link careful assessment to intensive intervention!
6The Circle Team set out to create an intervention: That is consistent with attachment theory and researchThat focuses on the caregiver as the partner in the dyad with the greater degrees of freedom for initiating changeThat focuses on both the caregiver’s Internal Working Models of self and child and on his/her caregiving behaviorThat can be used as either group or individual therapy models
7Components of Infant-Parent Relationship Developing Attachment SystemIBParentRParentRBabyIBBabyWhat youhearWhat you seeAdapted from Bruschweiler –Stern and Stern, 1989
8I love to shop this slide because it illustrates how infants as young as a few weeks of age can detect and imitate the emotional tone of the environment, and especially, the emotions and the affect of his primary caretaker.This 6 week old infant is already capable of imitating joy, sadness, and surprise as is maniifested by his caretaker’s expression.Infants are exquisitely sensitive to their caregiver’s affecy, and in turn can even internalize the caregivers’ affective states.IN face to face interactions of maternal negativity and withdrawal have been shown to elicit reposnse of anger, decreased activity, dysphoria, and social withdrawal from infants.Prolonged exposure to such interactiuons has been linked to the development of depressive behavioral styles observed outside of mother –infant interactions.Thus, a mom who is depressed can lead to a baby becoming depressed.Which brings us to out next topic of discussion: the effects of maternal depression on infant behavior and development
9What set attachment apart from other developmental theories? Linked to natural selection as driving force:Protection of young = protection of genesBased theory on observations; de-emphasized the role of “meeting oral needs”Ethology and Harry Harlow’s monkeysThe concept of “imprinting” as a cross-species phenomenon
10Definition of Attachment Inborn system— “feedback loop”Operative throughout lifeExternal goal in infancy is to balance exploration and proximity to caregiver (“the secure base”)Internal goal to achieve sense of “felt security”don’t want to spend much time with this audience, but term attachment is used in many ways-- we think of attachment as....READ SLIDE
12Experience in Relationships…. As our brain has evolved in complexity our dependence at birth on caregivers has increased.Each of us, as caregivers, have “working models” in our minds--expectations and emotions about relationships derived from experience.
13Attachment-- The “Internal Working Model” Story of the Relationship
14Attachment-- The “Internal Working Model” Relationship template (‘structure of the mind’)Formed by experience (influenced by temperament genes?)Accessible in adults by interviewPredicts later patterns of behavior in relationships (stable though malleable)
15Neural Plasticity EXPERIENCE MOLDS THE BRAIN (and vice versa) Schore, 1999Peck, S. D. (2003) Measuring sensitivity moment-by-moment: A microanalytic look at the transmission of attachment. Attachment and Human Development, 5,
16Why All The Fuss? Selection of neuronal pathways Emotions—development and regulationShaping of Internal Working Models/Representations
17Basics of COS ProtocolPre-intervention videotaped, structured assessment to inform treatment goalsGroup-based parent education and psychotherapy lasting ~20-weeks using videotaped interventionGoals of video review are to:increase sensitivity to the child’s cuesincrease self-other reflective capacityexplore new representations and interaction patterns
18Assessment Strange Situation Procedure Augmented with a cleanup of toys, a reading session and blowing bubbles!Narrative Interview-Circle of Security InterviewParent perception about their child’s needs, their relationship with the child and childhood relationship with their own caregiversOther narrative interviews (e.g., the Working Model of the Child Interview, Insightfulness Assessment) are equally useful
19Platforms for COS Intervention-I Susan McDonough’s Interaction GuidanceOne of the earliest parent-infant therapies that used videotape to build relationshipTherapy focused relentlessly on positive moments of connection in order to engage caregivers
20Platforms for COS Intervention-II Attachment ResearchBoth study of interactive behavior using the Strange Situation Procedure, and…Study of the importance of representations in shaping parental behavior, and…Study of the importance of reflective capacity in reshaping representations.
21Platforms for COS Intervention-III Parent-Child Psychotherapy, for which goals include:Gaining an understanding of how parents experiences are impacting perceptions, feelings, and behaviors toward infantChanges are sought at 3 levels:representation of the childrepresentation of the self as parentrepresentation of the self as adult individual
22Leveraging Group Process Insights of peers can be incredibly helpfulDistancing from the “expert” (who may not be trusted)Sense of shared challenge in parenting is a huge benefitWelcome to the ClubSeeing the struggles (and successes) of others is highly motivating and can also externalize painful patterns so that they can be ‘seen’
23Welcome to the ClubBeing 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
24Let’s Meet VeronicaWoman in her late 30’s; mother of 5 children, 4 of whom are in custody of the State15-month old named Dalton is with her in a residential treatment programParticipates in a weekly open-ended Circle of Security group which is held on site at the treatment program3 year history of cocaine dependence, major depression and chronic painBriefly note that there are several interviews which can be used—we use the Insightfullness Interview from Oppenheim et alWMCI and AAI combinationCOSI
25Veronica’s Representational World Hurt,Ashamed and EmptyI am a failure as a mother“He doesn’t need me”Confident and WorthySelfProtectionHe needsme and will signal meI can read his signals and respondReflective DialogueOld Working ModelNew Working Model
26What About Interactive Behavior? Veronica will need to see how her wish to have her son “fill her void” is influencing her behaviorShe is very intrusiveHe is very avoidantShe experiences his avoidance as not “needing her” and, with the weight of having lost her other children, pushes harder for connectionR2 Clip
27Circle of Limited Security Child Anxious about the Parent’s Needs HAVENSAFESECUREBASEI NEED YOU TO WELCOME MY COMING TO YOU BUT…THAT MAKES USUNCOMFORTABLESO...ACTING LIKEI NEED TOEXPLOREOR BEDISTANTI MISCUE YOU ABOUTMY NEED BY...
28First Things First Establish a “Holding Environment” for the Parent Provide Parent a User-friendly Map of Secure Parent-Child Interaction……….
29Technology as a Tool for Connection Current editing software allow for extremely creative approaches to engagementAdobe Premiere Elements is available at reasonable cost with incredible ease-of-use even for non-geeks like me!Beauty Tape!
30COS Protocol Sequence Establish a “Holding Environment” for the Parent Provide Parent a User-friendly Map of Secure Parent-Child Interaction……….
32COS Protocol Sequence Establish a “Holding Environment” for the Parent Provide Parent a User-friendly Map of Secure Parent-Child Interaction--Then, through video review of her child and herself—Develop the Parent’s Observational SkillsIncrease Parental Reflective FunctioningFacilitate an Empathic Shift in the Parent Toward the Child
33Specific Goals of the Videotape Reviews To enhance the parents’ feeling of being understood, valued and supported while reducing their anxiety regarding criticism and humiliationTo 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 uncomfortableTo help the parents develop a sense of themselves as successful in responding to their children’s needs
34Support and Reflect with Veronica Need to help Veronica see that her need to make up for losing her other kids by pushing Dalton to “bond” is not going to workCan she understand the link between intrusiveness and avoidance?Can she tone down the pressure she feels and respond to his cues not her own fear?Can she understand what it has been like for him to live through her depression and drug abuse?
35Going DeeperThere are moments in our interactions with others during which the needs of the other set off a reactionPerhaps fear, withdrawal, dread, anger etcThese moments are EXPLICITLY recognized using the theme song from the Movie “Jaws”Parents learn half-way through the group about “shark music”—the idea that each of us has moments in which we hear the Jaws theme
36Behavior and Emotion Regulation Across Development Mutual regulation:Regulated with the help of the caregiverSelf-regulationof behavior and emotionsTrauma May Impair Both Mutual and Self-Regulation3636
37Shark MusicThis concept becomes a central focus of the Tape Review for each parentMoments of struggle, of missed opportunity are reviewed and the parent is asked to think about their response and why it occurred.These are key moments in the reflective dialogue and it is here that the “empathic shift” is soughtTape Review 2
38Circle of Limited Security Child Anxious about the Parent’s NeedsSECUREBASEI NEED YOU TO WELCOME MY COMING TO YOU BUT…HAVENSAFETHAT MAKES USUNCOMFORTABLESO...ACTING LIKEI NEED TOEXPLOREOR BEDISTANTI MISCUE YOU ABOUTMY NEED BY...
39Circle of Limited Security Child Anxious about the Parent’s NeedsSTEPPING OFF THE CIRCLE…..SECUREBASEI NEED YOU TO WELCOME MY COMING TO YOU BUT…HAVENSAFEYOU GET OVERWHELMEDAND CHECK OUTACTING DISTANT ORLIKE I NEED TOEXPLOREI MISCUE YOU ABOUTMY NEED BY...
40Celebrating ChangeGoal is to highlight shifts in behavior and to create a “living memory” of progressOne effective method is a music video of key moments…F/U reunion and Song
41Attachment-Based Therapy The Circle of Security model not only provides a roadmap of attachment that parents can understand and relate to….The model ALSO supports the therapist by providing a protocol to followThe use of video ‘externalizes’ the struggles and allows the therapist to face the caregiver’s struggles with them
42Applications of the COS-I Open-ended groupsWell-suited to certain situations including substance-abuse programsRequires more of the therapist in that there is constant “catching up” of new group members and need for recreating the holding environment serially
43Applications of the COS-II Model being used in individual or couples’ therapyAllows for wider latitude to explore related themesAbility to focus on issues like abdication of hands on the circle and role reversalLoses the “punch” of group inputCan add in parenting partners more easily than with groups
44Applications of the COS-III Focus on different child age groupsInfants using the Still Face procedure as key to interactive assessmentSchool-aged children using Story Stems as key to interactive assessmentAdolescents using “Relational Play” procedures or shared narratives
47Bibliography on The Circle of Security 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