Bringing an Attachment Perspective Using CIRCLE OF SECURITY Concepts to Working with Women with Postnatal Depression and Anxiety

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1 Bringing an Attachment Perspective Using CIRCLE OF SECURITY Concepts to Working with Women with Postnatal Depression and Anxiety Mrs Anne Clifford Dr Caroline Zanetti WAPMH Symposium

2 The Raphael Centre SJGHC commissioned market research in 2001 as a result of growing concern about the increase in perinatal mental illness in the community. The Raphael Centre opened at SJOGS in November 2002 followed by other Raphael Centres in other states. This community based Perinatal & Infant Mental Health service is situated adjacent to St John of God Hospital in Subiaco. This service is available to all families with Perinatal and Infant Mental Health issues across the state.

3 Relationships are an essential part of human experience, and for the infant, a crucial aspect

4 Donald Winnicott: the infant s sense of self is built substantially upon having the mother mirror back his experience in a way that also gives him a sense of her experience of him Daniel Stern: mirroring occurs in terms of voice, affect and movement Colwyn Trevarthen: one s sense of self emerges from within an intersubjective experience

5 Attachment Theory Human infants are born with the capacity to identify and attach psychologically and emotionally to those caregivers (usually the parents) who will keep them safe as they learn about the world, and develop the skills that enable the successful negotiation of life s challenges. Attaching to a particular person means that the infant will rely upon him or her to provide a safe haven when discomfort or danger arises, and a secure base for exploration at other times.

6 Attachment Theory The tendency to seek and maintain the support of an attachment figure is fundamental to human infant behaviour. Many things can promote, and interfere, with the caregiver s capacity to provide adequate support for infants and small children.

7 WAPMH Symposium

8 (Almost) Everything I Need to Know About Being a Parent in 25 Words or Less Always: Be BIGGER, STRONGER, WISER & KIND Whenever Possible: Follow your child s need Whenever Necessary: Take charge

9 The Circle of Security graphic and formula appears simple, but there are layers embedded within it: layers involving children s basic psychological and emotional needs, child behaviour, parental capacity, and parental patterns of psychological defence.

10 Circle of Security concepts are woven into the Raphael Centre: we use this model in many aspects of our work.

11 Touching Base Group Follows the Circle of Security Protocol (Cooper, Hoffman, Powell, Marvin). 20 weeks with 6 mothers Utilizes video footage from SSP. Examines how the attachment relationship works at different moments around the COS. Allows parents to reflect on their difficulties with parenting, as well as their strengths, in the context of a non-blaming therapeutic relationship. Original COS Protocol modified to add 4 partners sessions.

12 Pathways to Wellness Group Content has a CBT framework but informed throughout by attachment theory. One session dedicated to discussion of the parent child relationship using the COS as a model for reflection on both current interactions and family of origin relationships. Dads session discusses the men s relationship with their partners & with their children using the COS. Once the COS has been introduced all sessions contain reference to Circle moments, & parents are given opportunities to reflect on what they notice in their children, & in themselves, as different needs present during the day.

13 Baby Massage Group Mothers with infants aged 5 weeks to 5 months. 4 sessions: 1 hour each week. Maximum of 6 mothers & infants. Mothers may have a mood disorder, or may just want to become more relaxed & confident with their babies. Fathers can also attend

14 Being With At the heart of developing a secure attachment is the knowledge that your caregiver is emotionally available to be with in during times of need. Children need their parents support for comfort & protection (and sometimes just to feel lovable). They also need support when they are exploring the world, and mastering new skills.

15 Creating the Circle of Security (Birth to 12 months) Be with me... When I m feeling OK.. Be with me... Delight in me as I fall in love with your face Watch over me as I turn to new sights, sounds, and touches Try to see the world through my eyes and talk to me about it Connect with me by matching my voice, face, and movement Wait for me when I look away to keep from getting too revved up Protect me Help me feel that you get it by matching my emotions with your voice, face and touch Stay with me even when my distress upsets you* Wait for me when I look away, so I can learn to use both you and myself to calm down Organise my feelings by sharing, naming, and accepting them without fear When I m feeling upset Always: be BIGGER, STRONGER, WISER, and KIND. Whenever possible: follow my child s need. Whenever necessary: take charge Cooper, Hoffman, Marvin & Powell

16 Enhancing the mother /infant relationship using baby massage Focus on: Establishing an informal, warm, non-judgemental space for mother & baby - providing the Hands on the Circle. Enhancing sense of self as a mother, and building on the attachment relationship she is establishing with her infant. Observing the non-verbal expressions and responses of the infant, and in particular, the interactions between mother and infant.

17 Baby Massage Group Two key concepts: The quality of parent-infant interaction has a powerful effect on infant development. In particular, moments of intimate connection with the care giver will determine the ultimate design of the baby s brain, and the nature and extent of the baby s secure attachment to the caregiver. The tender touch of baby massage, and gentle playfulness together will enhance the mother s and the infant s experiences of being together in a relationship.

18 Involved Dads group Monthly information and support evening for new & expectant fathers. Facilitated by two male clinical psychologists. Provides an overview of the Circle of Security and encourages fathers to look at parenting from a relationship based perspective.

19 Raphael Centre Crèche An integral part of many of our programmes. Led by an experienced, qualified childcare worker who has attended a Circle of Security workshop. Staffed by volunteers who are given training in Circle of Security concepts through our in-service staff development programme. Minimum ratio of one staff member per 3 children. Children are routinely assigned to the care of one particular caregiver each week.

20 The experience of emotional connection with other human beings remains important for our physical and psychological wellbeing throughout our lives The COS gives us a common language for talking about attachment needs of young children with colleagues and parents.

21 In particular we understand that: All parents struggle. It s hard to give what we weren t given. Many parenting difficulties arise from unconscious attempts to protect from emotionally painful memories. All parents have wisdom. The love between parent and child is a powerful force-one that can motivate parents to deal with their pain in a different way.

22 Thank you WAPMH Symposium