Child Adolesc Soc Work J (2009) 26:333–350
DOI 10.1007/s10560-009-0166-0
‘‘Why Don’t You Just Tell Me How You Feel?’’: A Case
Study of a Young Mother in an Attachment-Based
Group Intervention
Timothy F. Page Æ Daphne S. Cain
Published online: 15 February 2009
Ó Springer Science+Business Media, LLC 2009
Abstract This paper describes an attachment-based parenting intervention, the
Circle of Security, and presents a case study of one participant’s experience as a
member of it. The Circle of Security is a group intervention for parents of young
children ages 1–5 that teaches parents to recognize and respond to their children’s
alternating needs for attachment and exploration. The intervention content in group
sessions relies to a great extent on discussions of videotaped vignettes of each
parent–child dyad. Ultimately, the intervention focuses on strengthening parents’
capacities for empathic responsiveness to their children’s needs for them. In the
second part of the paper, the case study illustrates one mother’s experience in a
Circle of Security group designed for parents involved with the child welfare system
as a result of substantiated maltreatment. Observations of this parent indicate that
her capacity for empathic understanding was greatly strengthened, which appears to
be related to important behavior change.
Keywords
Attachment Á Intervention Á Child maltreatment
This paper presents a case study of a 23 year-old woman who participated in a
6-month group intervention for maltreating parents, the purpose of which was to
strengthen her parenting skills, and specifically to improve her 4 year-old child’s
attachment security with her. The intervention is the Circle of Security (CoS), which
is based in attachment theory (Marvin et al. 2002). A major component of CoS
emphasizes the strengthening of parents’ observational skills of their children’s
needs for them. Experience in working with vulnerable parents has shown that they
often share a common experience of perceiving their children, even very young
T. F. Page (&) Á D. S. Cain
Louisiana State University School of Social Work, 216 H.P. Long Fieldhouse,
Baton Rouge, LA 70803, USA
e-mail: tpage2@lsu.edu
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children, as not needing them and as feeling hostile toward them (Dadds et al. 2003;
Marvin et al. 2002). In the CoS intervention, parents are taught to examine
distortions in their perceptions of their children’s needs for them, and to learn to
identify their children’s specific needs in the forms of expressions of attachment and
exploratory behavior in the context of the ‘‘secure base’’ of the attachment
relationship. This paper begins with a description of the Circle of Security
intervention and illustrates how one young maltreating mother was able to apply the
knowledge she gained in it to favorably alter the course of her relationship with her
preschool-aged son.
The Circle of Security Intervention
The Circle of Security is a group-based intervention for parents, designed to
strengthen parenting skills and, most notably, improve their children’s attachment
security with them. The intervention typically involves between 5 and 8 participants
and consists of approximately 20–26 weekly group sessions (depending on the
number of participants), lasting approximately 70–90 min each. CoS was initially
created by three psychotherapists, Glen Cooper, Kent Hoffman, and Bert Powell, at
the Marycliff Institute, a private clinic in Spokane, Washington, who, in consultation
with some of the leading attachment researchers, most notably Robert Marvin and
Jude Cassidy, further refined it to reflect the current state of knowledge regarding
secure-base behavior (Ainsworth et al. 1978). The intervention is manualized, and the
Marycliff Institute provides training for professionals who wish to learn to conduct it
(see their website for information about training, www.circleofsecurity.org). All
descriptions of the intervention are taken from materials produced by the Marycliff
Institute or found in Marvin et al. (2002).
Intervention Structure
The first two sessions in the CoS intervention provide a basic educational
foundation for parents to understand their children’s secure base behavior. Using the
terminology of behavioral systems, parents are shown how children alternate
between a basic need to explore away from the physical presence of their parents, in
circumstances where they experience sustaining support and protective oversight to
do this, and a need to achieve proximity with their parents when they experience
distress or otherwise need the reassurance provided by physical contact. In this way,
children’s alternating expressions of exploratory and attachment behavior are
presented as a continuous ‘‘circle of security’’, where the activation of one of these
behavioral systems involves the deactivation of the other (Bowlby 1982). Parents
are also taught that their sensitive responsiveness to these needs, which depends on
their accurate perception and appraisal of them, is the primary way in which
children learn to consistently rely on their parents for the nurture and support they
need, and that it is through this process that attachment security forms. Furthermore,
specific needs within these two broad dimension are identified: As children activate
and express needs for exploration away from the secure base of physical proximity
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Fig. 1 Circle graphic with formula
with caregivers, they specifically need to be supported, watched over, enjoyed,
delighted in, and helped (when necessary); as children activate and express
attachment needs by increasing physical proximity with caregivers, they specifically
need to be welcomed, comforted, protected, delighted in, and, very importantly, to
have their feelings ‘‘organized’’, i.e., made sense of, interpreted, and accepted. The
entire circle with these broad and specific needs is presented graphically on a poster
board measuring approximately four feet by three, which is used as a visual aid in
every session to cue parents to the specific needs being addressed in the intervention
(see Fig. 1). Additionally, parents are provided with the following succinct
‘‘formula’’ for successful parenting, which encapsulates the construct of sensitive
responsiveness: ‘‘Always be bigger, stronger, wiser, and kind; whenever possible,
follow my child’s need; whenever necessary, take charge’’.
Use of Videotape
One of the important innovations of the CoS is the way in which key attachment
concepts are taught through the combination of didactic material and videotaped
excerpts of actual interactions participants have with their children. McDonough
(2000) was among the first to use videotape to examine parent–child interaction
qualities in therapeutic interventions with individual dyads. The CoS expanded on
McDonough’s work by applying this approach to a group format, reasoning that
participants could benefit from the support and contributions of other parents facing
similar challenges, and learn from the experiences of others. The videotapes used in
the CoS intervention are provided by the pre-test observation of the primary
dependent variable used in its evaluation, the Strange Situation Procedure (SSP)
(Ainsworth et al. 1978; Cassidy and Marvin 1992).
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The SSP is the best known of the attachment measures, against which other
measures of attachment are often evaluated (Solomon and George 1999). It provides
an assessment in controlled conditions, consisting of seven 3-min episodes, of the
ways in which the child uses the caregiver as a secure base in the somewhat stressful
circumstances of an unfamiliar laboratory environment. Among the seven episodes,
the child is invited to play with toys in the presence of his/her parent, when a
‘‘stranger’’ joins them, in the presence of the stranger only, and when the child is
alone. The child’s reactions to separations and reunions with the parent are
particularly relevant to coding attachment quality. There are several advantages of
this method of assessment, for both research and clinical purposes. First, because the
SSP is a standardized measure, the same stimuli are presented to all participants, for
equal amounts of time in the same conditions, which strengthens the validity of the
assessments. Additionally, the use of videotape enables multiple viewing and a
deeper level of analysis, by multiple observers, that also enhances the validity of the
assessment. While the original research with the SSP utilized group-level data
analyses, not individual analyses, recent research with the Circle of Security, and
other attachment-based interventions, has demonstrated that the SSP provides a
sensitive measurement of attachment quality capable of detecting change at the
level of the individual parent–child dyad (Cohen et al. 2002; Marvin et al. 2002).
The uses of the videotapes of the SSP begin in the first session, starting with a
tape compilation known as the ‘‘You Are So Beautiful’’ tape. Early in their
introduction in the first session, the group is shown a video compiled from
participants’ Time 1 SSP observations that consists of at least two short clips of each
participant in interaction with his/her child, arranged to the Joe Cocker song, ‘‘You
Are So Beautiful’’ (Preston and Fisher 1974). The clips are selected for their
expressions of mutual pleasure and especially the child’s display of delight toward
the caregiver. As part of the introduction, parents are told to imagine that their
children are singing this song to them. This early introduction to watching
themselves in interaction with their children on tape also conveys a message to
appreciate the ways in which their children need and value them, as it removes the
sense of harsh judgment with which many parents enter parenting programs. By
seeing this tape on the first day, and through the introductory discussion, parents
receive the message that their strengths will be a major focus for the group
activities, and that their children perceive them as literally the most important thing
in their lives.
Two other tape compilations from the Time 1 SSPs are produced and shown
during the first two introductory sessions, the ‘‘Circle Moments’’ and ‘‘Name the
Need’’ tapes. Both of these tapes are used to illustrate children’s needs for their
parents as represented in the Circle of Security graphic (Fig. 1). Circle Moments is
composed of short vignettes, which, again, depict each parent–child dyad, where
children are shown in the laboratory setting venturing away from their parents to
explore the unfamiliar environment, and back toward their parents to regain contact,
completing a circle. Parents are typically fascinated to see that this apparently
simple process, so easily observed once one’s attention is called to it, represents
essential learning about how to rely on caregivers to negotiate unfamiliar
circumstances, and reflects the history of the ways in which this process has
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occurred in the relationship. The Name the Need tape expands on this to illustrate,
again with each dyad, the specific needs within exploration and attachment systems
that children have for their parents. So, for example, one dyad will serve to illustrate
support for the child’s exploration and another will be used to show the provision of
protection, etc. Through these early videotape compilations parents receive essential
training in information about their children’s emotional development and the
formation of attachment, as they learn to become informed observers of their
children’s needs, and their own responses to these.
Structure of the Individual Videotape Reviews
The nature of the intervention in the CoS, the heart of the experience, consists of
individualized tape review sessions, which begin with session three, following the
introductory educational sessions. Each participant is the focus of three reviews, in
which the major parenting strengths and challenges are illustrated using videotaped
examples of their actual interactions with their children. Each of the first two of the
three reviews lasts an entire group session; the third lasts approximately one-half
session. The structure of the group process, therefore, is unlike most group
interventions in that the bulk of the therapeutic work is heavily individually
focused and relies comparatively little on the process of interactions among group
members.
The selection of vignettes from the SSPs is done on the basis of a clinical
assessment of the parent’s major strengths and challenges in the relationship with her
child. [The pronoun ‘‘her’’ is used in this paper as all caregivers in the study were
female. However, male caregivers have been included in CoS intervention (Marvin
et al. 2002).] The data on which this assessment is made are the SSP and an
attachment-based interview, conducted at the time of the SSP and also videotaped,
that probes the parent’s history of attachment relationships with those who cared for
her as a child as well as her current relationship with her child. Individualized
treatment plans are formulated on the basis of the Circle of Security dynamics.
Parents’ central strengths and challenges are understood as representing the specific
dimensions of exploration and/or attachment. Some parents, for example, are
identified as relatively strong on the exploration, the ‘‘top’’, side of the Circle while
struggling with their children’s needs for intimacy on the attachment, ‘‘bottom’’,
portion of the Circle. For others, the pattern may be the opposite, with strengths in the
attachment dimension and struggles in the exploratory dimension, or, most
complicated, with significant struggles in both major dimensions. Readers familiar
with attachment theory will recognize that the conceptualization of relationship
qualities in terms of the Circle of Security dynamics reflects the dimensions of
attachment security recognized in the literature over the past 30 years as identified by
Ainsworth and, later, Main and Solomon (1990): Attachment security corresponds to
a balanced integration of both major dimensions of exploration and attachment;
insecure-avoidant attachment corresponds to relative strengths in the exploratory
dimension with struggles in the expression of intimate, attachment behavior;
insecure-ambivalent attachment is represented in relative strength in the intimate
dimension and struggle in the exploratory dimension; insecure-disorganized
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attachment, the most vulnerable of the identified attachment categories, is reflected in
struggles in both major dimensions represented on the circle.
The first of the three individual tape reviews acquaints parents with the video
review process and emphasizes the strengths of their parenting. Once again, this
approach typically challenges the expectations of harsh judgment with which most
parents enter the intervention, and often eases defensive reactions. For each review,
typically, four or five short vignettes are selected from the participant’s SSP, each
lasting anywhere from 5 to 30 s. Most of these vignettes will typically show
positive capacities, while one will show a key vulnerability in the parent’s
capacities to respond to her child’s needs. The selection of the vignette that
represents the key relationship vulnerability is based on the clinical judgment of
the most important struggle the parent faces in the relationship. This key theme
will be expanded upon, indeed will become the focus of, the second tape review
session. (The second round of tape reviews begins after all participants have
completed the first review). The way in which the participant engages in and
responds to the first tape review, that is, the level of defensiveness especially
toward the discussion of the identified vulnerability, provides valuable information
about how the discussion of this relationship vulnerability will be approached in
the second review.
The second tape review progresses into the areas of tension and conflict in the
relationship by focusing on the theme of vulnerability first addressed in the first
review. Typically, 4–6 vignettes are shown in the second review, of which at least
two represent the central vulnerabilities of the relationship with the child.
Additionally, parents are provided with opportunities to discuss the challenges
they have in their relationships with their children in the context of the type of care
that they received from their own caregivers as children. This important topic is first
introduced in another didactic session that separates the first and second tape
reviews, which has come to be known as the ‘‘shark music’’ session.
In this transitional, didactic session between the first and second tape reviews, we
introduce the topic that the ways in which we perceive and respond to our children’s
needs are colored, and distorted, by what we ourselves learned about close
relationships, in particular the expression of exploratory and attachment needs, as
children in relationship to our own caregivers. The theme of perceptual distortion is
graphically illustrated through the viewing of a videotape of a walk to a beach on a
sunny day. The tape itself shows a brightly lit path through woods, from the
viewpoint of a hand-held camera, until the termination at the seashore. In the
background, soft piano music plays, creating a relaxing and inspiring effect.
Afterwards, participants are asked about the emotions they experience and virtually
all report a calming sense of well-being and enjoyment. Next, this video is
re-shown, exactly as it was the first time, only now the musical background is
changed. Instead of a soft piano, the background music is the same that
accompanied the approach of the killer shark in the movie, Jaws (Williams
1975). The crescendo that signals the immediate threat of attack is reached as the
video concludes with the scene of the seashore. Now, participants are again asked
about their emotional reactions, and almost all report a sense of tension and dread.
The message that participants are asked to apply to their relationships with their
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children is that parents’ perceptions of their children in interaction with them are
colored and distorted by the ‘‘music’’ they carry in their minds, which was formed in
their own early caregiving experiences as children. Pressing this issue further,
participants are asked to examine the specific areas of the dimensions of exploratory
and attachment behavior illustrated in the Circle of Security that they associate most
with threat and vulnerability, their own ‘‘shark music’’. To deepen their
observational skills, participants are asked to examine, outside the group, as they
interact with their children, the moments at which they begin to hear their shark
music, those moments when their children express specific needs of them that
activate anxiety and emotional threat. At these key points, parents are taught that
they can: 1) identify that the anxiety they experience is ‘‘old music’’, not relevant to
the present situation with their children, and two), that they can employ alternative
responses to their children that reflect the real needs that their children have of them.
The new, alternative response is often referred to as the ‘‘new dance’’ that the parent
must learn to be able to escape from the former interactive patterns that have not
worked, and strengthen new interactive patterns that reflect the needs of both child
and parent in the relationship. The concluding videotape vignettes in the second
review are selected to show the parent that the capacities to take this alternative
route, to respond to the child in a way that is free of the old shark music and more
reflective of the child’s real needs, exist now in the parent, even if only in nascent
form. These are conceptualized as the ‘‘underused capacities’’. The important point
is for the parent to see that she is capable of providing the new, positive response
through actual examples, however brief, that this already does occur.
The third and final tape review typically is shorter than the first two. It is used
primarily to review the key issues of challenge in the relationship and plan for
termination and the future. The vignettes selected for the third review are not taken
from the original SSP; instead, about 2/3 of the way through the group, a new taping
is done in the laboratory with a less structured protocol. The purpose of this taping is
to make observations of the ways in which parents have applied their new learning
to their interactions with their children. Vignettes for the third review are selected
with the focus of the first two reviews in mind. Situations similar to those in the first
SSP taping that were used to represent the core relationship struggles are selected
with an eye for how these may represent progress in providing the new, positive
responses to children’s expressions of need for their parents.
Empirical Support
The Circle of Security has a limited though growing body of research that has
demonstrated a favorable alteration in children’s attachment organization with their
caregivers. Marvin et al. (2002; see also Hoffman et al. 2006) report that among
high risk families involved with an Early Head Start program, attachment
classifications among 75 children significantly shifted from the most insecure,
disorganized, type to the less insecure (anxious-avoidant and anxious-ambivalent)
and secure types following the intervention. As yet, however, the Circle of Security
awaits the first examinations in which true randomized, controlled conditions are
provided.
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Table 1 Characteristics of group participants
Mothers
7 Caucasian, 1 hispanic
Age range: 20–31 years (mean = 25)
50% less than high school education
50% history of serious substance abuse
6 of 8 report yearly family incomes below $15 K
Reasons for referral to protective services/types of maltreatment by mothers:
Inadequate supervision/protection—4
Substance abuse/dependence–3
Domestic violence—3
Physical abuse—2
Children
6 boys, 2 girls
Ages ranged from 16 to 69 months (mean = 48 months)
5 of 8 children in foster/kin placements at some point
Background to the Present Study
The following case study is taken from the first, pilot application of the Circle
of Security to a group of parents involved in a child welfare system as a result of
substantiated child maltreatment. This case will be presented through an analysis of
the second and third tape reviews which presented the core relationship struggles,
with indicators of progress in addressing these for this parent, and post-test
assessments.
This pilot study took place in a semi-rural parish in southeast Louisiana and
involved eight mothers who were referred by the child welfare system as a result of
substantiated maltreatment. All children were between the ages of 1 and 5 at the
start of the group. The group lasted 27 weeks and consisted of weekly meetings of
approximately 90 min each, and was co-led by the authors. The average number of
sessions attended among the eight mothers was 20. LeeAnn, the focus of this case
study, attended 19 of the 27 sessions (70%). We selected LeeAnn for the focus of
this case study because at the outset of the group she appeared to us to be the most
intimidating and potentially frightening of the participants toward their children, yet
at the group’s conclusion, we felt she had made the most dramatic progress.
Characteristics of the group participants are presented in Table 1.
The Case of LeeAnn and Her Son Mike
LeeAnn (age 23) became involved in the child welfare system due to child neglect/
endangerment associated with substance abuse by her and her husband. She resided
with her husband, the father of the children, and their children, ages 4, 3, and 2, in a
mobile home of sub-standard condition, in a rural area. The annual family income
was between $10,000 and $15,000.
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LeeAnn’s son, Mike, the focus for the intervention, was 4 years, 7 months old at
the time of the start of the intervention. Mike resided in a foster home from ages 2 to
3 (a total of 18 months) resulting from the endangerment to him caused by his
parents’ neglectful behavior. Some months after he was returned to the custody of
his parents, LeeAnn relapsed and she was ordered out of the house and not
permitted to return until 2 months later. She finally returned home 5 months prior to
the start of the Circle of Security group intervention. Her SSP assessment, which as
with all mothers provided the basis for the clinical assessment of her relationship
with her son, was conducted only 2 months after she had returned to live in the
home. At the time of the start of the group, Mike’s school reported that he had
serious, aggressive-externalizing behavior pro…
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