The circle of security parenting and parental conflict: a single case study

Introducing Norwegian parents to the Circle of Security Parenting program during the postpartum period: A qualitative descriptive study

OBJECTIVE

Public health nurses in Norway provide a range of health promotion and primary prevention services to families in the postpartum period. The study objectives were to describe parents' experiences of: 1) being introduced to the Circle of Security Parenting program during a home visit and 2) participating in a parent group meeting.

DESIGN

Qualitative descriptive study.

SAMPLE

A purposeful sample of 24 caregivers (n = 15 mothers, n = 9 fathers) parenting an infant.

MEASURES

In-depth, semi-structured interviews were conducted to document participants experiences. Content analysis was used to code and categorize the data.

FINDINGS

Three main categories with seven subcategories reflected the parents' experiences: 1) Confidence-building home visit, 2) Awareness-raising parental group, 3) Dissemination of knowledge.

CONCLUSIONS

The parents experienced the home visit as being on their family's terms and reassuring. The parental group session started a reflection process which made them aware of the importance of being present for their child, how to modify their communication and have a common understanding of childrearing. The parents thought the group was a great way to introduce the Circle of Security Parenting program and experienced it as a continuation of the information presented at the home visit. The introduction provided them with new knowledge.

The Circle of Security Parenting Program (COS-P): A Randomized Controlled Trial of a Low Intensity, Individualized Attachment-Based Program With at-Risk Caregivers

The Circle of Security-Parenting Intervention (COS-P; Cooper et al., 2009) is a psychoeducational program for caregivers of young children that has been widely disseminated. The program is founded in attachment theory and relies on computer-delivered content and parent reflection and discussion to teach concepts of safety and security to promote better caregiver-child relationships and child wellbeing. The present study is a randomized controlled trial of COS-P, individually delivered to 85 Australian caregivers (51 COS-P, 34 waitlist control) who reported parenting distress and child disruptive behaviors. Caregivers completed a baseline assessment and repeated the assessment after completion of COS-P or 8 weeks on the waitlist. Caregivers completed surveys to report child symptoms, and parenting stress, anxious and avoidant attachment, reflective functioning, parenting practices, and depressive symptoms. No differences in COS-P vs. waitlist participants were found at baseline. Analyses of complete data (35 COS-P, 25-26 waitlist) revealed a greater decline in caregivers' attachment anxiety and negative parenting relative to waitlist, but only attachment anxiety in intent-to-treat analyses. Other improvements were found, but these extended to both the COS-P and waitlist conditions and did not differ between conditions. Overall, effects of COS-P were small and rarely significant, suggesting the need to consider alternative programs that have evidence of effectiveness when providing services to at-risk families.

Addressing the Evidence Gap: Protocol for an Effectiveness Study of Circle of Security Parenting, an Attachment-Based Intervention

Background: Parenting interventions informed by attachment theory are an increasingly popular choice for clinical services that work with parents of babies and young children. Circle of Security Parenting (COS-P) is one such intervention, which has had extraordinary uptake internationally. Evidence for COS-P is very limited, however; there are few published studies, most with very small samples, and findings are mixed. This paper describes a multi-site evaluation of COS-P, designed to help address this evidence gap.

Methods/Design: This is a non-randomized controlled effectiveness study of COS-P in four community child and family health settings. Participants are caregivers of children aged 6 years and under, who present to study sites with parenting challenges in the early parenting period. Participants are recruited through these sites, and allocated to either treatment or waitlist control condition based on their capacity to attend the next available COS-P group. Outcomes (changes in caregiving attitudes and capacities linked to child social and emotional development, and caregiver depression symptoms) are assessed at baseline and post-treatment/waitlist using self-report questionnaires (all participants), and a narrative interview and 5-min parent-child interaction (a sub-sample of participants). Additionally, potential moderators of the intervention (demographic, symptom severity) will be tested.

Discussion: This is one of the first controlled evaluations of COS-P, and the first in Australia where COS-P dissemination has been particularly widespread. Results from this study will provide valuable information about the effectiveness of COS-P for caregivers with early parenting challenges, and will increase understanding of what works for whom.

Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD

Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.

Adding "Circle of Security - Parenting" to treatment as usual in three Swedish infant mental health clinics. Effects on parents' internal representations and quality of parent-infant interaction

This study presents effects of adding Circle of Security-Parenting (COS-P) to an already established comprehensive therapeutic model for early parent-child intervention in three Swedish infant mental health (IMH) clinics. Parents' internal representations and quality of parent-infant interaction were studied in a clinical sample comprised of 52 parent-infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU) supplemented with COS-P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS-P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA), significantly increased over time in the COS-P group. Improvements in the TAU-group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS-P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS-P in IMH treatment.

I’m Uncomfortable, You’re Uncomfortable, We’re Uncomfortable: An Integrative Family Approach to the Treatment of Tourette’s Disorder and Separation Anxiety Disorder in a Young Child

This case study follows a 6-year old Caucasian Hispanic male who presented with symptoms of Tourette’s disorder and separation anxiety disorder. Given the young age of the child, a critical focus was placed on parental involvement and parental mastery of the treatment components within an attachment-focused conceptualization as the foundation for all treatment delivery. To address all issues presented by the family of this young child, a behavioral treatment was utilized to target symptoms of Tourette’s disorder, and components of cognitive-behavioral therapy were used to address symptoms associated with separation anxiety disorder (in the young child). Further, components of an attachment-based parenting program, Circle of Security–Parenting, were inserted throughout treatment to keep this young child’s parents in tune with their relationship with their young child. Following completion of treatment, this young child displayed significant decreases in his symptoms across both disorders. Further, this young child and his parents demonstrated a mastery of treatment concepts and coping skills. The family reported both qualitative and quantitative improvements in the young child’s overall emotional and behavioral functioning. This study displayed the effectiveness of an integrative family-based approach in the treatment of a young child with symptoms of both Tourette’s disorder and separation anxiety disorder.

Perceptions and Experiences of an Attachment-Based Intervention for Parents Troubled by Intimate Partner Violence

It is known that intimate partner violence (IPV) negatively affects both parental capacity and children's well-being, but few studies have focused on the experiences of those taking part in family interventions focused on IPV. In this study, 26 parents (16 mothers and 10 fathers) with a history of IPV participated in focus groups concerning their attachment-based group intervention experience in the program Parenting and Violence. The transcripts, subjected to thematic analysis, showed that participants experienced the intervention as supportive and confirming of their role as parents. Parents described feeling more in control, more self-confident, more skilled in communicating, and more able to provide security for their children. However, they also expressed a need for continuing support to maintain their improved parenting strategies.

Assessing Attachment Representations in Adolescents: Discriminant Validation of the Adult Attachment Projective Picture System

The contribution of attachment to human development and clinical risk is well established for children and adults, yet there is relatively limited knowledge about attachment in adolescence due to the poor availability of construct valid measures. The Adult Attachment Projective Picture System (AAP) is a reliable and valid instrument to assess adult attachment status. This study examines for the first time the discriminant validity of the AAP in adolescents. In our sample of 79 teenagers between 15 and 18 years, 42 % were classified as secure, 34 % as insecure-dismissing, 13 % as insecure-preoccupied and 11 % as unresolved. The results demonstrated discriminant validity for using the AAP in that age group, with no associations between attachment classifications and verbal intelligence, social desirability, story length or sociodemographic variables. These results poise the AAP to be used in clinical intervention and large-scale research investigating normative and atypical developmental correlates and sequelae of attachment, including psychopathology in adolescence.

Analyzing Two-Phase Single-Case Data with Non-overlap and Mean Difference Indices: Illustration, Software Tools, and Alternatives

Two-phase single-case designs, including baseline evaluation followed by an intervention, represent the most clinically straightforward option for combining professional practice and research. However, unless they are part of a multiple-baseline schedule, such designs do not allow demonstrating a causal relation between the intervention and the behavior. Although the statistical options reviewed here cannot help overcoming this methodological limitation, we aim to make practitioners and applied researchers aware of the available appropriate options for extracting maximum information from the data. In the current paper, we suggest that the evaluation of behavioral change should include visual and quantitative analyses, complementing the substantive criteria regarding the practical importance of the behavioral change. Specifically, we emphasize the need to use structured criteria for visual analysis, such as the ones summarized in the What Works Clearinghouse Standards, especially if such criteria are complemented by visual aids, as illustrated here. For quantitative analysis, we focus on the non-overlap of all pairs and the slope and level change procedure, as they offer straightforward information and have shown reasonable performance. An illustration is provided of the use of these three pieces of information: visual, quantitative, and substantive. To make the use of visual and quantitative analysis feasible, open source software is referred to and demonstrated. In order to provide practitioners and applied researchers with a more complete guide, several analytical alternatives are commented on pointing out the situations (aims, data patterns) for which these are potentially useful.

A quantitative exploratory evaluation of the circle of security-parenting program with mothers in residential substance-abuse treatment

Maternal substance abuse is a risk factor for child maltreatment, child attachment insecurity, and maladaptive social information processing. The aim of this study was to conduct a quantitative exploratory evaluation of the effectiveness of an attachment-based parent program, Circle of Security-Parenting (COS-P; G. Cooper, K. Hoffman, & B. Powell, 2009), with a community sample of 15 mothers in residential treatment for substance abuse. Participants attended nine weekly group sessions and were given three measures at pretest and posttest: the Emotion Regulation Questionnaire (J.J. Gross & O.P. John, 2003), the Parent Attribution Test (D. Bugental, ), and the Parenting Scale (D.S. Arnold, S.G. O'Leary, L.S. Wolff, & M.M. Acker, 1993). The results indicate that mothers who attended the majority of group sessions showed greater improvements on all three variables. Participants who attended some of the sessions showed some improvements on the measures, but participants who did not attend the group sessions had no improvements, and on some measures, declined significantly. Further analyses of demographic data indicates that participants with more education, no personal history of child maltreatment, less time in the residential program, and lower social desirability scores demonstrated more positive outcomes. These findings suggest that the COS-P may positively impact parental risk factors associated with child maltreatment and maladaptive social information processing in the context of residential substance-abuse treatment.