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Circle of Security in the Community

Investing in Early Relational Health

Use of Circle of Security Intensive in Borås, Sweden

Emma Liljestad and Karin Simonsson

Emma Liljestad and Karin Simonsson, two child psychologists in Boras, Sweden, began offering Circle of Security Intensive (COS-I) in spring of 2016, realizing that many families they took through Circle of Security Parenting (COSP) needed additional help. They work within a solid support structure both at a national and local level, with all organizations sharing a commitment to promote mental health and prevent mental illness for children 0-5 years of age.

a portrait of Karin Simonsson and Emma Liljestad

Karin Simonsson and Emma Liljestad

Their work takes place at a Primary Health care unit of psychologists within a Maternity and Child Health Care Center. Such centers are part of public health care, and aim to provide all pregnant women and families with children 0-5 years of age with free support. Attendance rate is nearly universal. These centers form a platform supporting the healthy development of children’s attachment to parents. Some parents who need a little more support than offered by the midwives and nurses at the Centers are referred to the Psychology Unit.

Within this unit, a specialized clinic, Samspelsmottagningen (​​Clinic for Parent-Child Interaction), exists with the goal of “early identification and intervention for children 0-5 years at risk of attachment-related problems in their relationship to a parent, to prevent unhealthy mental development.” Today colleagues run 10 regular COSP groups a year through the psychology unit of the Child Health Care Center.

Parents who continue to struggle can be referred to Samspelmottagningen for additional help. Here the clinicians work to deepen parents’ understanding of their children’s emotional needs and begin individual therapeutic work with a focus on the relationship using COS-I.

The team runs 2-3 COS-I groups each semester with 3-6 parents in each group. The length of treatment varies from 14-20 weeks. They have found that the group format itself is helpful, as the group itself serves as a secure base to explore what they do and not yet do to meet the child’s emotional need. The group also provides a safe haven to return to when parents experience difficult feelings connected to parenting struggles. Parents gain insight into each other’s aspirations and share their experiences with each other.

Watch as Emma and Karin talk about the value of the COS-Intensive intervention for families who need more than the 8-session COSP program in Sweden. Despite the challenges of comprehensive individualized assessment, Emma and Karin see great value in the group-based intervention they conduct with higher-risk parents.

As they have become wiser from offering COS-I groups, Karin and Emma have also shifted in how they engage and explore with parents about receiving COS-I. They have found it is very important to not put any pressure on a parent to take COS-I and to help parents understand the level of commitment needed to complete COS-I. It generally takes parents around 40 hours to complete COS-I and requires a lot of energy and effort from the parent. During the group, some parents may also experience and need to address struggles related to their own mental health or their relationship with their partner. As a result of this wiser approach, it is now rare to have a parent dropout from COS-I groups. In turn, this helps prevent the group from being impacted by a parent dropping out.

For more information on Karin and Emma's current intervention clinic, please visit their website: