Case-Based Trainings on Promoting Security in Caregiver-Child Relationships
Our team at COS-International is excited that the COS-Intensive model is now more accessible to providers and, therefore, to families. The new pathway to endorsement as a COS-Intensive provider is depicted in the figure below. The pathway begins with training in the COSP program. Learning the COSP program means learning the basics of attachment theory and science and how that theory and science is applied in a relationship-based intervention. However, we’ve learned from COSP providers around the world that working with caregivers who have a history of trauma, mental health issues or a combination of risk factors means encountering dyads for whom individualized, extended intervention is indicated.
Details of the COS-Intensive Training Pathway
1. COSP Training
Step 1 on the pathway to becoming a COS-Intensive provider is completing the COSP training. Practitioners may complete this training online or in person and the cost is $1000 USD per person (though group discounts are available). Most practitioners want to become Registered COSP Facilitators, but those not interested in facilitating the COSP program can choose to audit this course for $700 USD; auditors do not get the COSP program manual and video, do not sign the Facilitator contract allowing use of these materials with caregivers and don't have access to our member's side of the website following training. Register for the COSP Training here.
2. COS-Intensive Assessment Training
Step 2 on the pathway is the COS-Intensive Assessment Training. This training focuses on the individualized assessment at the heart of the COS-Intensive model. Providers learn how to conduct and analyze the Strange Situation Procedure (SSP) and the Circle of Security-Interview (COSI’s) which are the core assessment tools used for the COS-Intensive model. A primary focus of this training is on identifying the key attachment issue impacting a caregiver-child dyad (called the “Linchpin Issue”) as revealed by this systematic assessment. A secondary focus of the training is on identifying the caregiver’s core sensitivity, which helps guide the clinician in conducting the treatment model. [Note: for interested clinicians, there are other learning opportunities to learn more about the core sensitivities (see below under the Optional Trainings heading)]. Providers are given the COS-Intensive Assessment manual at this training, which will allow them to conduct the comprehensive assessments in their practice settings. Register for this training here.3. Intensive Case Review
4. Intro to Treatment Course
Step 4 on the pathway begins the part of the training that is for clinicians who conduct psychotherapy with high-risk clients (see below). This next course focuses on key principles of the COS-Intensive Treatment. It is here that eligible providers are first exposed to the Treatment phase of the model, including the Treatment manual. This course starts with an overview of the COS-Intensive protocols, which can be delivered with individual clients, couples or with groups of caregivers. The next section of the course focuses on the concept of Being With as applied to the therapist: client relationship. Participants will explore how the therapeutic stance is connected to the concept of Being With. In the next module, the key steps of the intervention process are presented through an analysis of a case from one of the very first groups conducted by Bert Powell. Bert’s guided review of key moments in the treatment of one participant in the group brings alive the intervention phases. The next module focuses on a different case and involves active learning wherein participants are asked to review an SSP and select intervention clips they might use with the caregiver. By picking apart a Strange Situation Procedure, and watching an expert do the same, the learner will experience first hand how to put together a treatment plan. The final module of the course is an introduction to Supervision, the final step on the training pathway.
5. Case-Based Consultation with Certified COS-Intensive Supervison
Step 5 on the pathway is case-based consultation. This is the final step on the path to endorsement and will be conducted via secure sharing of video assessments gathered by the trainee and regular online meetings reviewing video of the clinician’s COS-Intensive intervention cases. Small group case consultation is recommended and is less costly than individual case consultation.
Who is Eligible for COS-Intensive Provider Training?
While the COS-Intensive training was created primarily for clinicians with experience as psychotherapists, we allow any provider to take Steps 1, 2 and 3 on the training pathway. We have found that the COS-Intensive Assessment training and the Online COS-Intensive Case Review training provide an excellent organizational framework to enhance facilitation of COSP and increase the ‘seeing and guessing skills’ at the heart of all the COS intervention models.
However, only providers who already do psychotherapy with at-risk clients can move on to Steps 4 and 5 on the pathway as these steps are focused on Treatment instead of Assessment. We are aware that, in many parts of the world, definitions of which providers are eligible to conduct psychotherapeutic intervention vary.
Working With a Team
While we have worked hard to make the COS-Intensive protocol and this training pathway more accessible to individual practitioners, including those in private practice, we have learned that most practitioners prefer both learning and implementing COS-Intensive as part of a team. Reflecting with a close colleague as you learn COS-Intensive is also very helpful. Furthermore, providers often tell us that working alone with this model is difficult. Having a colleague to share circle stories with is not just helpful, it prevents isolation and burnout.
We certainly allow individual practitioners to train in the COS-Intensive model, but we do recommend learning alongside peers and encourage individual learners to ‘buddy-up’ with 1-2 other providers for both the Case Review course and Case-Based Consultation/Supervision.
Comparing the COSP™ Program with the COS-Intensive Protocol
We're often asked by various providers about the Circle of Security-Intensive model. While the Circle of Security Parenting program can be conducted by anyone who has completed the COSP™ training (either in person or online), only clinicians with experience as psychotherapists are able to be trained in the Circle of Security-Intensive model. The Figure below summarizes the differences between the COSP program and COS-Intensive model.
In many ways, Circle of Security Parenting is built on the same "platform" as the Circle of Security Intensive model. Both use video to introduce to parents what the science of attachment has shown professionals: namely, that the elements of secure attachment can be understood by anyone. Our goal is to engage each parent's wisdom by introducing the map of attachment (the Circle of Security Diagram) and by reviewing interactions between caregivers that illustrate how attachment needs are expressed (or sometimes hidden) by young children.
We've found that the key to engaging caregivers' wisdom is to get them reflecting on both the meaning of what they see on screen and how what they see on screen makes them feel. Each moment of caregiver-child interaction is packed with information about attachment. At the same time, how caregivers think about attachment is often connected to their own relationship history. We might wonder about the mother in this cartoon: what's her story? How did it come to be that she sees her son's plea for connection to be about "wanting attention?"
One key difference between the Circle of Security Parenting program and the Circle of Security-Intensive intervention has to do with intensity: COSP is generally an 8-10 week program in which parents reflect on video of other caregivers. COS-Intensive uses a comprehensive individualized assessment to feed into a longer intervention that focused directly on each caregiver’s video with their child. The assessment and personalization of the COS-Intensive model, in the hands of an experienced psychotherapist, means that parents can "go deeper" into their histories. For some parents or caregivers COSP is enough to promote security in their relationships; for others–particularly those with histories of trauma and/or other stressful conditions– a more intensive therapy model is required.
