Interventions in Childhood Attachment: The Circle of Security

Our group discussed social interventions through the lense of attachment theory. What follows is a summary of the articles and discussion from the seminar we led. Additionally, we showed a clip from Science Bulletins: Attachment Theory—Understanding the Essential Bond, a video about John Bowlby (the researcher who originated attachment theory) and a modern attachment intervention that utilizes a unique operationalization of security, as well as a TEDtalk entitled,”The Tragedy of Orphanages” in which Georgette Mulheir discusses attachment-related problems in orphanages.

Hoffman et. al (2006)

          Hoffman et. al (2006) created an intervention, the Circle of Security (COS) Intervention, which aims to increase secure attachment of children to their caregivers. It uses a group treatment modality to provide parent education and psychotherapy. They hypothesized that after the COS intervention, there would be a significant decrease in disorganized attachment classifications and a significant decrease in insecure attachment classifications.

          The five key goals of COS intervention are as follows: a) establish the therapist and the group as a secure base from which the caregiver can explore his or her relationship with the child; b) increase caregiver sensitivity and appropriate responsiveness by providing caregivers a map of children’s basic attachment needs; c) increase caregivers’ capacity to recognize and understand both the obvious and more subtle verbal and nonverbal cues that children use to signal their internal states and needs when using the caregiver as a secure base for exploration and as a haven of safety; d) increase caregiver empathy by supporting reflection about both the caregiver’s and the child’s behaviors, thoughts, and feelings regarding attachment-oriented interactions and e) increase caregiver reflection about how his or her own developmental history affects current caregiving behavior. The COS protocol differs from other interventions because the treatment is individualized according to each parent-child dyad.

          Participants were 65 parent-child dyads recruited from Head Start and Early Head Start programs in a medium-sized city in Washington state. All of the families were living below the federal poverty line. After 6-8 weeks of pre intervention, caregivers in groups of five or six attended weekly meetings for 75 minutes for 20 weeks. There was no control group. Approximately 70% of children tended to shift toward one of the organized groups. They found that the COS protocol was effective in reducing disorganization and increasing security for children in the age range between toddlerhood and the early school years.

          One major confound discussed in class was the time between the pretest and posttest. The posttest occurred nearly 30 weeks after the pretest. At this age, normal development can greatly increase in 30 weeks, which could affect the results of the intervention. Because there is no control group, it is difficult to tell if the changes in attachment were a result of the intervention or of normal development. For this reason, additional research must be carried out to measure the effectiveness of the COS intervention.

Juffer et. al (2010)

          Juffer et al (2010) included the results of a meta-study in this chapter of this volume in their positive parenting series. The studies analyzed were those pertaining to early childhood attachment. The authors argued that overall, the most effective variable to target in relation to attachment, specifically decreasing disorganized attachment, was parent (most often the mother’s) sensitivity. The chapter went on to discuss various different types of interventions. The second chapter argued for smaller, shorter-lasting interventions (specifically their video series).

          The points made in the meta-study chapter as well as the information about past studies raised many questions during discussion. We discussed the experimental design of most of the studies. Many did not use a control group. Perhaps these factors that we focus on for our interventions are not in fact related to attachment. We discussed whether it would be possible to have a more IV-focused experiment in which we attempted to understand better the mechanisms behind secure attachment formation. As a class, we agreed that exploring research in this direction would not only be worthwhile, but ethical, as these interventions are directly affecting family mechanisms in pursuit of a goal that we do not fully understand the mechanisms behind. This need for controlled, randomized experiments (with larger sample sizes!) to find out whether these targeted interventions are valid was agreed on, but as a group we had trouble coming up with ideas for future research. We suggested that perhaps we look into designing an experiment more like the baby-carrier experiment.

          In discussion of these studies and their methodology, we also questioned whether this focus on attachment was culturally specific or applied globally and also discussed which segment of the national population to draw our samples from. All in all, a review and discussion of the literature out there on attachment interventions led us as a class to question the existing interventions and to begin to think about possible designs for research that could shed some light onto where and who to direct further research or interventions towards.

Circle of Security Website

Circle of Security International (COSI) is a company that offers treatment, interventions and education to parents and caregivers aimed at increasing attachment security in children. According to the COSI website’s homepage, “The Circle of Security is a relationship based early intervention program designed to enhance attachment security between parents and children,” which they claim enhances empathy, self-esteem, relationships, and emotional maturity.

Many of the training sessions offered by COSI are rather expensive (between $250 and $2200) and are geared toward practitioners- those who work in childcare facilities such as Headstart. One of the biggest issues brought up in our class discussion was that of accessibility. Because the trainings are so expensive and aimed at teachers, not parents, the intervention may not be available to those who need it most, such as parents from low SES backgrounds. Additionally, those parents in greater need of attachment training are probably those who are less likely to seek it, especially given the high cost.

One student in class noted an interesting theoretical discontinuity. While the COSI website claims that during “the period beginning at birth and continuing through the end of the preschool years, the quality of the child’s attachment is related to concrete, definable parental capacities, care giving behavior patterns, and internal working models.” However, Juffer et al. (2010) found that interventions that targeted infants older than 6 months were more effective than those that started before 6 months. It is important to remember, therefore, that COSI and similar groups have a monetary interest in providing services targeted toward as many age-groups as possible, whether research agrees with the timing or not.

The class discussion came back several times to the idea of cross-cultural relevance. COSI provides services to clinicians in several countries, including Japan, Italy, and New Zealand. Given that much of the literature on attachment was conducted in the United States, to what extent are the same interventions applicable and effective in other cultural contexts? In Germany, for example, avoidant attachment is found more often than other styles and is considered normative (Grossman et al., 1981), yet COSI only aims to nurture secure attachments. The COSI website does not address this issue except to say that seminars are offered in translation, which itself brings up many problems such as back-translation issues and semantic inequality.

One of COSI’s selling points is that the program is customizable to each dyad. This is valuable in that no parent-child relationship is the same and each deserves a unique intervention. Customizability complicates research, however. By identifying and treating a “linchpin issue” in each dyad that addresses the area of the relationship in greatest need of change, research findings may be confounded. That is, if each intervention is designed differently, there are fewer controls. This makes the findings less reliable, less generalizable, and less replicable.

While the theoretical underpinnings of the Circle of Security intervention are valuable and important, the intervention in practice is expensive, cross-culturally questionable, and difficult to generalize to a wider population.

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