Treatment Assumptions

The training in all settings is based upon the following assumptions.

1 Learning (including therapeutic change) occurs from within a secure base
relationship.
2 The quality of the parent/child attachment, which is amenable to change,
plays a significant role in the life trajectory of the child.
3 Interventions need to be based on a differential diagnosis that is informed by
research-based theory.
4 Lasting change comes from parents developing specific relationship
capacities rather than learning techniques to manage behaviors. The
capacities needed for a secure relationship include:
◦ Observational skills informed by a coherent model of children’s
developmental needs,
◦ Reflective functioning and the ability to enter into reflective dialogue,
◦ The ability to engage with children in the regulation of their emotions,
◦ Empathy.
Following is a description of these assumptions.
Secure Base Relationship
John Bowlby concluded that the most dangerous event for baby mammals,
including humans, is separation from a protective adult. Conversely, Bowlby
recognized the need for exploration as being essential to survival. His hypothesis
was that when children feel safe and secure, their attachment system terminates,
and their exploratory system engages. This allows for both optimal safety and the
mastery of necessary skills. However, when children feel threatened, exposed,
criticized, or vulnerable to attack, their exploratory system terminates and their
attachment system is activated.
The reciprocal relationship between seeking protection and developing new
capacities presents a challenge for children and adults alike. This dilemma occurs
because there exist a strong evolutionary advantage for seeking protection, when
needed, to override all other systems, thereby becoming the only system active. In
other words, people cannot adequately learn and defend themselves at the same
time. When parents, especially high-risk parents who are often under social and
legal scrutiny, take the risk of placing their caregiving approach under a magnifying
glass their attachment needs (for protection and comfort) are often activated. This
inevitably results in their need to take a defensive posture. Therefore, it is essential
to provide a secure base environment to help terminate their attachment system.
Only then can they be open to developing new capacities. This requires that
parents view the facilitator as a kind, respectful, interested, caring, and concerned
person capable of providing sufficient protection to allow needed safety, thus
allowing them to calm their defenses in order to take in new experiences.
Parent/Child Attachment
Early intervention programs for at-risk parent/infant dyads are using increasingly
refined procedures for defining goals, as well as for developing intervention
protocols and methods for identifying change. There is an increasing emphasis on
developing interventions that are focused on, in the words of Kathryn Barnard, “…
specific challenges in the caregiving environment, and on specific opportunities to
make a positive difference in the development of children and parents.” Barnard
specifically emphasizes that promoting secure attachments between young children
and their parents should be a focus of early intervention.
It is now well established 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, caregiving behavior patterns, and
internal working models. In turn, the quality of infant and preschool child-attachment
status can be used to identify increased risk for future emotion-regulation struggles,
behavior difficulties, and relationship problems as well as future academic
difficulties. This is especially true in high-risk populations.
Recent longitudinal studies (birth to adulthood) at the University of Minnesota have
found that secure attachment has served as a protective factor for children whose
families have experienced high levels of stressful life events. In comparing
competent children with less competent children from highly stressed families,
researchers found that a history of early attachment-related competence proved to
be a major protective factor against the adverse effects of stressful life events. The
“early history of competence” was characterized by a secure attachment at twelve
and eighteen months.
There is increasing evidence that an insecure attachment during infancy, especially
one that is “disorganized,” is an important component of the cumulative risk factors
on a developmental pathway toward maladaptive child outcomes. These outcomes
are related to social competence with peers and teachers, impulse control, conduct
disorders, anxiety, depression, dissociative disorders, and other psychiatric and
legal problems.
Allan Sroufe, concludes that “Overall, longitudinal findings have indicated that the
early attachment relationship provides an important foundation for later
development and that a secure attachment may serve as a protective factor against
the negative impact of various adversities and risk factors. Our findings and those
of other investigators are quite compelling and suggest that efforts aimed at
promoting a secure attachment may prevent various forms of problems among
children in high-risk circumstances.”
Differential Diagnosis
Over the past decade, the procedures and findings from attachment research have
begun to be applied in the context of clinical assessment and intervention with
infant/preschooler-parent dyads at risk. The primary limitation is that the details of
the interventions are not individualized to the specific attachment-caregiving pattern
of each dyad. While it is almost certain that some individualization takes place as
the intervention unfolds, what is needed at this point is an organized, published,
differential system of assessment-treatment protocols. Without a systematic
protocol, the likelihood that a specific intervention could be ineffective (or worse,
counterproductive) is greatly increased.
The following examples of misattuned interventions are common, within the context
of the four basic attachment strategies (Secure/Secure, Dismissing/Avoidant,
Preoccupied/Ambivalent, and Unresolved/Disorganized):
Caregivers with a Dismissing/Avoidant pattern often “over focus” on the child’s
exploration to avoid activation of the child’s attachment behavior (e.g., distress
regarding an impending separation or at the time of reunion). During a video review
session, this parent might view him or herself on videotape distracting the young
child toward exploration in order to discourage distress. If the facilitator mistakenly
further encourages this parent’s support for exploration, an insecure attachment
strategy could become further entrenched. On the other hand, focusing on a
moment when this same parent appears hurt by the child’s avoidance, or when the
parent and child share a moment of delighted, mutual gaze, could present an
opportunity for important discussion and change.
In the case of a Preoccupied parent with a Resistant/Ambivalent child, the moment
to focus on might be just the opposite, (i.e., a moment on the videotape when the
child engages in competent, independent exploration when not distressed.)
In addition, caregivers with an Unresolved/Disorganized pattern often look to the
child to help them regulate their affect. These parents frequently describe
themselves as helpless to protect their children from threats and danger, and their
caregiving often contains themes of inadequacy, helplessness, and/or losing
control. Such a parent will repeatedly describe her/his child as “bossy,” “too much
for me to handle,” or alternately, as a “best friend” and caretaker of the parent (i.e.
“My little man takes care of his mommy.” Sadly, we even see such projections onto
the child in parents of newborns.) This tends to give rise to children who appear
“over-bright” and “competent,” when in fact disorganized children are actually
frightened regarding the lack of structure in the relationship and thus desperately
seeking to provide some measure of order.
Even so, it is common for a therapist, without access to a working differential
diagnosis, to mistakenly consider the child’s exaggerated competence to be a
positive sign (“Oh look at how active he gets in bringing you all of those toys,” or
“Isn’t it nice to see how much he likes to offer you comfort?”). Such an intervention
further encourages the Unresolved/Disorganized parent’s passivity under the guise
of admiring the child’s “capacity.” Hence, a severely insecure attachment strategy
might become more deeply embedded in both parent and child.
However, a clinician or family coordinator, given a working model of the key
indicators regarding disorganization, can consider another kind of intervention.
Hence a therapist’s focus on a moment when this same Unresolved/Disorganized
parent momentarily takes charge, while simultaneously observing how the child
suddenly settles into her/his lap for several seconds, could present a needed
opportunity for important discussion and change (“Did you see, just then, when you
seemed more clear and firm with your voice, your daughter stopped pulling away
and started to cuddle with you?”).
Hence, a working knowledge of differential diagnosis can take much of the
guesswork out of how to approach treatment with each particular caregiving
strategy (see grid on page 6). Rather than having to intuit or guess what might be
useful with a particular parent/child dyad, a well-developed knowledge of differential
diagnosis can provide specificity in the choice of interventions. When confronted
with a troubled caregiver and her/his troubled child and when given only a short
time to impact their family dysfunction, having access to a systematic
understanding of their particular dynamics can be most beneficial.
Thus, what is needed is a system for differentially identifying each child’s
attachment pattern and his or her parent’s caregiving pattern, followed by a specific
treatment protocol assigned to that dyadic pattern. Such a protocol helps eliminate
the potential problems of a “one size fits all” approach to intervention. It is our belief
that a careful elaboration and dissemination of this differential assessment-
intervention protocol would allow more standardization in the training of service
providers and implementation of their services, as well as the replication of the
success we have come to know in our current work. (On the following page, please
find our “Differential Table: Problem Areas/Specific Events and Behaviors Requiring
Intervention.”)
Differential Table: Problem Areas/Specific Events and Behaviors Requiring
Intervention
Dismissing/ Preoccupied/
 Unresolved/
Avoidant Ambivalent Disorganized

Caregiver Affect Caregiver Affect Caregiver Affect

Tendancy to be either flat Immature/babyish quality Passive affect
or over bright Dramatic facial/vocal Tendency toward abrupt
Smooth affect only during expression affect change in a way that
child’s exploration and Seeks to convince/plead is unpredictable or
play with child when negative frightening to the child
Dismissing of child’s affect emerges Seem inability to
requests for affection acknowledge affective
Dismission of child’s requests from child
negative affect
Gaze Gaze Gaze
Little gaze Direct and long Fearful
Brief looks Avert, eye-roll, or sharp Abrupt shifts:
glance disinterested/harsh
Exploration & Play Exploration & Play Exploration & Play
Competency (rather than Caregiver seeks to keep Passive role
enjoyment) becomes child focused upon Allows child to organize
theme proximity both play and caregiver
Play sessions become Willingness to accept/ Intermittent aggression on
quiz sessions normalize misbehavior part of caregiver
Departures Departures Departures
Leaves quickly, with little Premature focus on Uncertain, timid during
or no explanation departures leave taking
Dismissing of child’s Drawn-out, conflicted Insensitive departure
concerns and feelings leave taking Confusing/double
No preparation Lies or bribes messages given
No affection Phony affect concerning departure
Child’s Dilemma Child’s Dilemma Child’s Dilemma
“To get close is to be “To be close is to feel “The source of my support
rejected; to truly separate smothered; to separate is is also the source of my
(in areas beyond to feel abandoned.” danger.”
performance) is to be
rejected.”
 Working Alliance Working Alliance Working Alliance
Centers Upon Centers Upon Centers Upon
Therapist’s commitment to Therapist’s commitment to Therapist’s commitment to
empathy, understanding caregiver’s competence caregiver’s well-being via
and willingness to build a and consistency with child building structure,
relationship with caregiver providing predictable
interest and availability,
clear communication and
willingness to support
resolution
Treatment Themes Treatment Themes Treatment Themes
Support attunement and Support hierarchy and Support structure building,
positive experience of competence of caretaker consistency, availability
need between caregiver with child (e.g. willingness and attunement between
and child, (e.g. mutual to take charge, focus on caregiver and child, (e.g.
gaze, sincerity of affect, tasks, clarity and firmness attending to child’s
attending to child’s of purpose, interest in feelings, smooth shift in
feelings, turn-taking, child’s exploration and parent’s affect, recognition
willingness to negotiate, separate experience, of child’s tempo, focus on
matching of child’s temp, frankness, clarity and tasks and their completion,
clarity of speech, etc.) directness of speech, etc.) etc.)

Relationship Capacities
The Circle of Security™ Project helps develop the following relationship capacities:
Observational Skills and the Circle of Security™
Attachment theory provides a framework to comprehend children’s fundamental
relationship needs. The Circle of Security™ is a user-friendly map that we
developed to teach attachment theory to parents. The following is a summary of our
introduction:
• When children feel safe, their exploratory system or innate curiosity is
activated and they need support (either verbally or non-verbally) for
exploration;
• As they are exploring, sometimes they need their parents to watch over them,
sometimes they need help, and sometimes they need their parents to enjoy
with them;
• When they have explored long enough, (or if they get tired or anxious, or find
themselves in an unsafe situation) they need their parents to welcome them
back. When they return, they need their parents to comfort, protect, delight in,
and/or organize their feelings. We focus on the last piece because for many
of the parents it is a new idea that children need help organizing their internal
experience as well as the external environment.
• When the attachment system is terminated, children are ready to start the
circle again.
Much of our training with parents (and therapists) entails helping them develop the
observational skills to differentiate between exploration and attachment systems; it
also involves differentiating among the specific needs within each system. With a
clear understanding of attachment theory and enhanced observational skills,
parents (and therapists) can sharpen their responses to further promote secure
attachment.
Reflective Functioning
We do not learn from our experience, we learn from standing back and reflecting on
our experience. Our program teaches parents to reflect on their experience by
utilizing video review and reflective dialogue. When we first engage parents in
reflecting on their experience (or the experience of their children) it is not unusual
for them to reply, “No one has every asked me that before.” Because video review
is, by its very nature, reflective, the weekly utilization of increasingly specified
review supports and enhances the parents’ competence for reflective functioning.
As the group continues, we often see a dramatic increase in their capacity for
reflection. Current attachment research shows a direct correlation between a
caregiver’s capacity for reflective functioning and the security of her/his children.
Emotional Regulation
Many theorists are currently focusing on the essential role of emotional regulation in
the health of individuals and relationships. Much of psychotherapy and
psychopharmacology are designed to help patients contain emotional experience
within a manageable range. Regulation of affect is not an innate capacity, but rather
a capacity learned in infancy through a relationship with a primary caregiver. For
many parents the idea that children need help learning to regulate their experience
is new information. Through the course of the group, parents learn to identify,
acknowledge, and bring language to their children’s emotional experience. This
process teaches children that emotions are a useful source of information rather
than something they need to hide or be punished for feeling. Through this process
of working with their children’s emotional experience, parents in the group increase
their own capacity for emotion regulation.
Empathy
Our experience is that as parents gain experience utilizing the Circle of Security™
as a map, improve their observational skills, enter into reflective dialogue, contain
their own affect as they attend to their children’s need for affect regulation, we see a
shift from defensive process to more empathy for their children. Typically, this
“empathic shift,” is a movement away from focusing on children’s behavior to
focusing on: 1) the relationship in general and 2) specific emotional needs. Our
repeated experience shows that when parents attend to relational/emotional needs,
the necessary changes in behavior follow. To be sure, a healthy relationship
requires parents to be “bigger and stronger” (set limits, take a position of hierarchy,
and have high standards and expectations of children’s behavior [see p 41]) as well
as be “wiser and kind.” However, behavior is like a finger pointing to the moon. If
parents focus primarily on the finger (conduct), they will miss the moon (the
centrality of the underlying relationship). When parents stabilize the relationship by
responding with wisdom, appropriate hierarchy, and empathy, their children are
then free to engage in a satisfying relationship and act appropriately.
© Cooper, Hoffman, Marvin, & Powell – 2000