Circle of Security – Intensive™

In-home Parent Skill-Based Does Not Currently Meet Criteria

Circle of Security – Intensive™ (COS-Intensive™) is a caregiver training and psychoeducation intervention that aims to improve caregiver-child relationships and enhance secure attachment. It is delivered by certified therapists and features individualized recordings of participating caregivers to demonstrate content related to the caregiver-child relationship. COS-Intensive uses a visual map of attachment referred to as the “circle of security.” This map emphasizes the caregiver’s role in providing a secure base from which their child can explore the world and a safe haven where their child can return for comfort.

 

Therapists begin by assessing caregiver-child attachment using the Strange Situation Procedure and the Circle of Security Interview, both of which are video-taped. During the COS-Intensive intervention, therapists conduct three phases of tape review in which edited clips from these assessments are used to demonstrate program content and prompt caregiver reflection on caregiver and child behavior, feelings, and needs. These phases of tape review alternate with sessions that introduce and reinforce program content such as the dyadic connection, the benefits of secure relating, children’s needs signaling, emotional availability, and shark music (i.e., experiences that can trigger a heightened sense of alertness in caregivers and may lead to avoidance behaviors or psychological discomfort). The final session prompts caregivers to reflect on the process of change and provide feedback on the therapeutic process. In some cases, the therapist may schedule a follow-up session 2 to 3 months later in which they touch base with the caregiver(s) and consolidate learning from the program.


COS-Intensive does not currently meet criteria to receive a rating because no studies of the program that achieved a rating of moderate or high on design and execution demonstrated a favorable effect on a target outcome.


Date Research Evidence Last Reviewed: Oct 2021


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: the program or service manual and the program or service developer’s website.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

COS-Intensive is designed for caregivers seeking to improve the attachment relationship with their child.

Dosage

COS-Intensive is typically delivered in 12 to 20 weekly sessions over 3 to 5 months. It can be delivered individually or in groups of up to six caregivers. The number of sessions varies depending on the number of participating caregivers. As the number of caregivers increases, the number of sessions increase to allow for additional tape review. Each session lasts about 90 minutes.

Location/Delivery Setting
Recommended Locations/Delivery Settings

COS-Intensive is primarily delivered in clinical settings or community-based agencies/centers. It can also be delivered in participants’ homes.

Education, Certifications and Training

COS-Intensive therapists must have at least a master’s degree and be licensed psychotherapists. Therapists must first complete the 24-hour Circle of Security – Parenting (COSP) training (in-person or as a blended online training). The training teaches therapists how to use the video-based manualized program, as well as how to identify secure and problematic caregiver-child interactions. Graduates of the COSP training become Registered Circle of Security Facilitators® and can pursue COS-Intensive training. COS-Intensive training is delivered in-person over 10 days. The training teaches therapists about core program concepts and foundational theories, as well as how to conduct key program activities. After completing both the COSP and COS-Intensive trainings, therapists must pass a written exam including two case presentations and obtain weekly supervision by a certified COS-Intensive Supervisor while leading their first two COS-Intensive therapies. After successful completion of all steps, therapists are eligible to be Certified COS-Intensive providers.

Registered Circle of Security Facilitators have the option to receive Fidelity Coaching, a form of reflective supervision, by a Certified Fidelity Coach. Licensed psychotherapists have the option of becoming a Certified Fidelity Coach.

Program or Service Documentation
Book/Manual/Available documentation used for review

Coyne, J., & Anderson, E. (Eds.). (2021). Circle of Security Intensive™ protocol. Circle of Security International.

Available languages

The COS-Intensive manual is available in English and Norwegian.

Other supporting materials

Circle of Security Overview

Training Overview

Comparing COSP and COS-Intensive

Caregiver Resources

For More Information

Website: https://www.circleofsecurityinternational.com/

Phone: (509) 462-2024

Email: info@circleofsecurityinternational.com


Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review Number of Studies Identified and Reviewed for Circle of Security – Intensive™
Identified in Search 8
Eligible for Review 2
Rated High 1
Rated Moderate 0
Rated Low 1
Reviewed Only for Risk of Harm 0

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info 		N of Studies (Findings) N of Participants Summary of Findings
Child well-being: Behavioral and emotional functioning 0.80
28 		1 (1) 24 Favorable: 0
No Effect: 1
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info 		N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured Months after treatment when outcome measured more info
Child well-being: Behavioral and emotional functioning 0.80
28 		1 (1) 24 Favorable: 0
No Effect: 1
Unfavorable: 0
 -
Study 11677 - CoS-Intensive vs. Waitlist Control (Dehghani, 2014)
Attachment Q-Set 0.80
28 		- 24 - 0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated High

Study 11677

Dehghani, A., Malekpour, M., Abedi, A., Amiri S. (2014) The efficacy of Circle of Security on attachment and wellbeing in preschool children. Management Science Letters, 4, 607-612. https://doi.org/10.5267/j.msl.2013.12.031



Studies Rated Low

Study 11684

Ramsauer, B., Lotzin, A., Muhlhan, C., Romer, G., Nolte, T., Fonagy, P., & Powell, B. (2014). A randomized controlled trial comparing Circle of Security Intervention and treatment as usual as interventions to increase attachment security in infants of mentally ill mothers: Study Protocol. BMC Psychiatry, 14, 24. https://doi.org/10.1186/1471-244X-14-24

Ramsauer, B., Muhlhan, C., Lotzin, A., Achtergarde, S., Mueller, J., Krink, S., Tharner, A., Becker-Stoll, F., Nolte, T., & Romer, G. (2019). Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: Maternal unresolved attachment moderates changes in sensitivity. Attachment & Human Development. https://doi.org/10.1080/14616734.2019.1689406

This study received a low rating because it did not meet design confound standards.


Studies Not Eligible for Review

Study 11675

Cassidy, J., Woodhouse, S.S., Sherman, L.J., Stupica, B., & Lejuez, C.W. (2011). Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Journal of Development and Psychopathology, 23, 131-148. https://doi.org/10.1017/S0954579410000696

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 11679

Huber, A., McMahon, C., & Sweller, N. (2015). Improved child behavioural and emotional functioning after Circle of Security 20-week intervention. Attachment & Human Development, 17(6), 547-569. https://doi.org/10.1080/14616734.2015.1086395

Huber, A., McMahon, C., & Sweller, N. (2015). Improved child behavioural and emotional functioning after Circle of Security 20-week intervention. Attachment & Human Development, 17(6), 547-569. https://doi.org/10.1080/14616734.2015.1086395

Huber, A., McMahon, C., & Sweller, N. (2016). Improved parental emotional functioning after Circle of Security 20-week parent–child relationship intervention. Journal of Child and Family Studies, 25(8), 2526-2540.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 11683

Moschner, S. L., Achtergarde, S., & Ramsauer, B. (2018). Treatment satisfaction of mothers with postpartum depression concerning Circle of Security Intervention. Praxis der Kinderpsychologie und Kinderpsychiatrie, 67(4), 351-366. https://doi.org/10.13109/prkk.2018.67.4.351

This study is ineligible for review because it is not available in English (Study Eligibility Criterion 4.1.3).

Study 12726

Cassidy, J., Ziv, Y., Stupica, B., Sherman, L. J., Butler, H., Karfgin, A., ... & Powell, B. (2010). Enhancing attachment security in the infants of women in a jail-diversion program. Attachment & Human Development, 12(4), 333-353.

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 12727

Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers' and preschoolers' attachment classifications: The Circle of Security intervention. Journal of Consulting and Clinical Psychology, 74(6), 1017.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 12729

Huber, A., Hicks, A. M., Ball, M., & McMahon, C. (2020). Postintervention and follow-up changes in caregiving behavior and representations after individually or group delivered hybrid Circle of Security-Intensive intervention with New Zealand caregiver-child dyads. Attachment & Human Development, 1-22.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).