Implementing complex attachment-based interventions: Perspectives on the circle of security-Virginia family intervention

• The Circle of Security developers have made a complex attachment theory tangible for both therapists and parents. • There is a threat of parents developing a pseudo-language, without integrating the new skills in their daily behavior. • It a weakness that the intervention does not include more sessions with children as this can threaten therapists’ ability to ensure the welfare of the children. • Therapists recommended making home-visits and additional videos of parent–child interaction as a part of the intervention. There are many promising attachment-based interventions that are accumulating an evidence-base, one of which is Circle of Security (COS). The COS-Virginia Family (COS-VF) model is one of several versions of COS. The aim of the study was to evaluate strengths and weaknesses of COS-VF from therapists’ viewpoint. Furthermore, we wanted to examine opportunities to further develop the intervention, to make it more efficient for therapists and families. There were 25 therapists in this study (5 males and 20 females). Participants took part in a semi-structured interview and online questionnaire. Results indicated that therapists had positive perceptions about the effectiveness of COS-VF, though the lack of effectiveness studies on the intervention was perceived as a weakness. They praised the graphic illustrations designed for COS. Furthermore, therapists stated that the assessment tools used for COS-VF gave in-depth information that enabled them to efficiently get to the root of the families’ problems. Therapists argued that teaching parents the COS-language facilitated communication and alliance between therapists and parents. However, therapists also mentioned the danger of parents developing a pseudo-language without internalizing the behavior. As such, it was considered a weakness that they only see the children at the beginning and end of treatment, which also threatens their ability to assure children’s welfare. Thus, they recommended including home-visits as part of COS-VF. There is a need for evaluating the effectiveness of COS-VF and assessment tools that have previously not been validated, to assure families get the help they need and ensure children safety.