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Lessons 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. www.infantinstitute.org nboris@tulane.edu. Exploration with Colleagues!. Glen Cooper, Kent Hoffman, and Bert Powell

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Lessons Learned from the Circle of Security


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    1. Lessons 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 www.infantinstitute.org nboris@tulane.edu

    2. Exploration with 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

    3. Acknowledgements • My colleagues at Tulane especially those at the Tulane Institute for Infant and Early Childhood Mental Health…visit us at www.infantinstitute.org

    4. Exploration with Drug-Abusing Mothers • A debt of gratitude to Veronica and the brave mothers who have come into treatment • Perhaps the greatest gift is agreeing to share one’s life story and struggles with others…

    5. The Circle of Security is a Story of… • Passion and friendship • Technology as a tool for connection • Leveraging science and creativity to improve clinical practice • Finally, an answer to how we can seamlessly link careful assessment to intensive intervention!

    6. The Circle Team set out to create an intervention: • That is consistent with attachment theory and research • That focuses on the caregiver as the partner in the dyad with the greater degrees of freedom for initiating change • That focuses on both the caregiver’s Internal Working Models of self and child and on his/her caregiving behavior • That can be used as either group or individual therapy models

    7. Components of Infant-Parent Relationship Developing Attachment System IBParent RParent RBaby IBBaby What you hear What you see Adapted from Bruschweiler –Stern and Stern, 1989

    8. What set attachment apart from other developmental theories? • Linked to natural selection as driving force: • Protection of young = protection of genes • Based theory on observations; de-emphasized the role of “meeting oral needs” • Ethology and Harry Harlow’s monkeys • The concept of “imprinting” as a cross-species phenomenon

    9. Definition of Attachment • Inborn system— “feedback loop” • Operative throughout life • External goal in infancy is to balance exploration and proximity to caregiver (“the secure base”) • Internal goal to achieve sense of “felt security”

    10. SECURE BASE SAFE HAVEN Circle of Security Parent Attending to the Child’s Needs I need you to I need you to • Watch over me • Help me • Enjoy with me • Delight in me Support My Exploration I need you to I need you to Welcome My Coming To You • Protect me • Comfort me • Delight in me • Organize my feelings © Cooper, Hoffman, Marvin and Powell, 2000

    11. Experience 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.

    12. Attachment-- The “Internal Working Model” Story of the Relationship

    13. Attachment-- The “Internal Working Model” • Relationship template (‘structure of the mind’) • Formed by experience (influenced by temperament genes?) • Accessible in adults by interview • Predicts later patterns of behavior in relationships (stable though malleable)

    14. Neural 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.

    15. Why All The Fuss? • Selection of neuronal pathways • Emotions—development and regulation • Shaping of Internal Working Models/Representations

    16. Basics of COS Protocol • Pre-intervention videotaped, structured assessment to inform treatment goals • Group-based parent education and psychotherapy lasting ~20-weeks using videotaped intervention • Goals of video review are to: • increase sensitivity to the child’s cues • increase self-other reflective capacity • explore new representations and interaction patterns

    17. Assessment • Strange Situation Procedure • Augmented with a cleanup of toys, a reading session and blowing bubbles! • Narrative Interview-Circle of Security Interview • Parent perception about their child’s needs, their relationship with the child and childhood relationship with their own caregivers • Other narrative interviews (e.g., the Working Model of the Child Interview, Insightfulness Assessment) are equally useful

    18. Platforms for COS Intervention-I • Susan McDonough’s Interaction Guidance • One of the earliest parent-infant therapies that used videotape to build relationship • Therapy focused relentlessly on positive moments of connection in order to engage caregivers

    19. Platforms for COS Intervention-II • Attachment Research • Both 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.

    20. Platforms 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 infant • Changes are sought at 3 levels: • representation of the child • representation of the self as parent • representation of the self as adult individual

    21. Leveraging Group Process • Insights of peers can be incredibly helpful • Distancing from the “expert” (who may not be trusted) • Sense of shared challenge in parenting is a huge benefit • Welcome to the Club • Seeing the struggles (and successes) of others is highly motivating and can also externalize painful patterns so that they can be ‘seen’

    22. Welcome 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

    23. Let’s Meet Veronica • Woman in her late 30’s; mother of 5 children, 4 of whom are in custody of the State • 15-month old named Dalton is with her in a residential treatment program • Participates in a weekly open-ended Circle of Security group which is held on site at the treatment program • 3 year history of cocaine dependence, major depression and chronic pain COSI

    24. Hurt, Ashamed and Empty Self Protection “He doesn’t need me” I am a failure as a mother Reflective Dialogue Veronica’s Representational World Confident and Worthy He needs me and will signal me I can read his signals and respond Old Working Model New Working Model

    25. What About Interactive Behavior? • Veronica will need to see how her wish to have her son “fill her void” is influencing her behavior • She is very intrusive • He is very avoidant • She experiences his avoidance as not “needing her” and, with the weight of having lost her other children, pushes harder for connection R2 Clip

    26. Circle of Limited Security Child Anxious about the Parent’s Needs SECURE BASE SAFE HAVEN THAT MAKES US UNCOMFORTABLE SO... I NEED YOU TO WELCOME MY COMING TO YOU BUT… ACTING LIKE I NEED TO EXPLORE OR BE DISTANT I MISCUE YOU ABOUT MY NEED BY...

    27. First Things First • Establish a “Holding Environment” for the Parent • Provide Parent a User-friendly Map of Secure Parent-Child Interaction……….

    28. Technology as a Tool for Connection • Current editing software allow for extremely creative approaches to engagement • Adobe Premiere Elements is available at reasonable cost with incredible ease-of-use even for non-geeks like me! Beauty Tape!

    29. COS Protocol Sequence • Establish a “Holding Environment” for the Parent • Provide Parent a User-friendly Map of Secure Parent-Child Interaction……….

    30. SECURE BASE SAFE HAVEN Circle of Security Parent Attending to the Child’s Needs I need you to I need you to • Watch over me • Help me • Enjoy with me • Delight in me Support My Exploration I need you to I need you to Welcome My Coming To You • Protect me • Comfort me • Delight in me • Organize my feelings © Cooper, Hoffman, Marvin and Powell, 2000

    31. COS 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 Skills • Increase Parental Reflective Functioning • Facilitate an Empathic Shift in the Parent Toward the Child

    32. Specific Goals of the Videotape Reviews • 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

    33. Support 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 work • Can 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?

    34. Going Deeper • There are moments in our interactions with others during which the needs of the other set off a reaction • Perhaps fear, withdrawal, dread, anger etc • These 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

    35. Behavior and Emotion Regulation Across Development Mutual regulation: Regulated with the help of the caregiver Self- regulation of behavior and emotions Trauma May Impair Both Mutual and Self-Regulation

    36. Shark Music • This concept becomes a central focus of the Tape Review for each parent • Moments 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 sought Tape Review 2

    37. Circle of Limited Security Child Anxious about the Parent’s Needs SECURE BASE I NEED YOU TO WELCOME MY COMING TO YOU BUT… SAFE HAVEN THAT MAKES US UNCOMFORTABLE SO... ACTING LIKE I NEED TO EXPLORE OR BE DISTANT I MISCUE YOU ABOUT MY NEED BY...

    38. YOU GET OVERWHELMED AND CHECK OUT Circle of Limited Security Child Anxious about the Parent’s Needs STEPPING OFF THE CIRCLE….. SECURE BASE I NEED YOU TO WELCOME MY COMING TO YOU BUT… SAFE HAVEN ACTING DISTANT OR LIKE I NEED TO EXPLORE I MISCUE YOU ABOUT MY NEED BY...

    39. Celebrating Change • Goal is to highlight shifts in behavior and to create a “living memory” of progress • One effective method is a music video of key moments… F/U reunion and Song

    40. Attachment-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 follow • The use of video ‘externalizes’ the struggles and allows the therapist to face the caregiver’s struggles with them

    41. Applications of the COS-I • Open-ended groups • Well-suited to certain situations including substance-abuse programs • Requires more of the therapist in that there is constant “catching up” of new group members and need for recreating the holding environment serially

    42. Applications of the COS-II • Model being used in individual or couples’ therapy • Allows for wider latitude to explore related themes • Ability to focus on issues like abdication of hands on the circle and role reversal • Loses the “punch” of group input • Can add in parenting partners more easily than with groups

    43. Applications of the COS-III • Focus on different child age groups • Infants using the Still Face procedure as key to interactive assessment • School-aged children using Story Stems as key to interactive assessment • Adolescents using “Relational Play” procedures or shared narratives

    44. 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... Monitor me (texting!) · Support My Delight in me · Exploration See cues for help but ask before helping · Enjoy with me · 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. © 2000 Cooper, Hoffman, Marvin & Powell

    45. 安全感の輪 子どもの要求に目を向けよう こういう ことをして 欲しいな みててね 手伝ってね 緒に楽しんでね 緒に喜ぼうよ いろんなことを するからみててね こういう ことをして 欲しいな • 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 今行くから おいでよって 待っててね 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。

    46. Bibliography on The Circle of Security • www.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