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Circle of Security in the Community

Investing in Early Relational Health

COSP in Mexico City

The National Institute of Psychiatry "Ramon de la Fuente Muniz," a highly specialized facility in Mexico City, serves a population with scarce socioeconomic resources. Our institute has been integrating Circle of Security Parenting (COSP) in two different, but complementary ways: 1) the treatment of the complex families we serve; and 2) the training and supervision of mental health professionals who rotate through our clinic and learn alongside our clinical team.

COSP Groups

A joint collaboration by our Perinatal Psychiatry Clinic, our Borderline Personality Disorder Clinic, and Circle of Security International has offered COSP to 74 people since 2019. We conducted 8 face-to-face groups, switching to online groups when the COVID pandemic began. It is our understanding that attachment security is a variable that contributes to cooperation and autonomous interdependence and that it is in the context of early relationships that this trajectory is scaffolded, which has oriented the collaboration between the Perinatal Clinic and Borderline Personality Disorder Clinic. It is our conviction that early interventions such as COSP provide parents, even in high risk populations, with relational lenses that help their children and themselves.

Initially, our groups were formed for parents with some mental illness (psychotic, mood, personality or substance abuse disorder) who were also being treated at the Institute for their various conditions. Deciding when to offer COSP to our clients starts with considering each client’s current capacity to enter the relational-affective and reflective process of COSP. We also find that having clients grouped by child age is helpful. Our general understanding is that COSP can be implemented in such context as an integral process of being with parents focusing on the necessity to consider all the possible supports that these families require.

Thus far, no patient participating in COSP has required any additional interventions during or after their group as a result of their participation in the parenting group due to worsening of their diagnosis. It also has to be said that all participants are pharmacologically monitored by their corresponding psychiatrists and some of them are in DBT emotion regulation skills groups either before, during or after COSP. Our intention was not only to offer another way of parenting but also to put the model into the mind and experience of the institution.

In our Perinatal Psychiatry Clinic we use the circle in follow-up consultations where the relationship of mothers and fathers with their children is valued. We see this as implementing preventive strategies.

Ivan Arango, MD discusses how he and his team use the COSP as a clinical tool in his clinic's work with caregivers diagnosed with personality disorders.

Integrating COSP into the Training of Mental Health Professionals

In addition we have offered the program to fellow psychiatrists who are also parents.The Circle of Security model allows us to look at caring relationships with others, especially at interactions that can remain hidden without one noticing.

A fundamental experience in the implementation of COSP has been the fidelity coaching process offered by Carlos Guerrero from Circle of Security International. In the Coaching sessions, we have been able to connect with the shark music that can happen when one facilitates a group. Having the opportunity to look at the relationship, trying to help build secure attachment, and remaining hopeful that it can occur has been a very deep experience. This has allowed us not only to understand the painful stories of others, but also of our own. Fidelity coaching has been a continuous fascinating process to experience the coherence of the model. It is through living what it means to be held, received and supported that “being with” the group of participants is possible. Alongside of the universality of the “circle” phenomena, Fidelity Coaching in Spanish provides the linguistic and cultural nuances that colour our colective and individual stories in our relationships.

Real connection, being with in the circle, being with in fidelity coaching, and being the hands of the hands requires loving kindness, intrinsically human, which in these times in not so easy to find. When one is trained in psychiatry the emphasis is placed above all on neurobiology, particularly on the fascinating and fundamental neuronal minutiae. We find it supremely refreshing and beautiful to find evidence, not only in the literature, but also in our experience, of the power of resonance and accompaniment with another. Human beings are made to connect, and it is in the relationships between individuals and within the group that connection occurs.

We also offer the program to psychiatry residents when they rotate through the Borderline Personality Disorder clinic. While most are not parents, they are invited to take the program keeping in mind a significant person with whom they have a caring relationship.

El círculo de seguridad para padres es una estrategia maravillosa que permite a los profesionales conocerse mejor y obtener herramientas para transmitir a los consultantes, facilitando estrategias que permitan establecer relaciones más sanas con otros. El círculo debería ser más conocido en el ámbito de la salud, no solo por profesionales del área de la salud mental o aquellos que deseen obtener la certificación, sino por otros especialistas, para favorecer el establecimiento de vínculos más sanos y amorosos entre padres/ cuidadores y los niños desde la infancia temprana, lo que finalmente repercutirá en la salud mental del individuo y de las familias.

-Dra. Milena García, residente de psiquiatría.

The Circle of Security for Parents is a wonderful strategy that allows professionals to get to know each other better and obtain tools to transmit to consultants, facilitating strategies that allow establishing healthier relationships with others. The circle should be better known in the health field, not only by mental health professionals or those who wish to obtain certification, but also by other specialists, to promote the establishment of healthier and more loving bonds between parents / caregivers. and children from early childhood, ultimately impacting the mental health of individuals and families.

-Dr. Milena García, psychiatry resident

Little by little, through all these efforts, the language of the circle becomes part of the discourse of the Institute. We bet on the relationship, on good enough parenting, on connection and on the construction of “being with” networks. Our networks are not perfect but they are strong enough, wise enough and kind enough.

Ivan Agango, MD discusses why he and his team ask their psychiatry residents to attend COSP groups as part of their training experience.

Four Leaders and a Shared Passion

A group of four psychiatrists, pictured above, brought COSP to the National Institute of Psychiatry in Mexico City. They trained together, planned together and now, after several years, Ivan has pulled together their shared story which makes up this webpage.

Violeta Pérez también quiso compartir aquí su experiencia personal en este proceso:

Para mí hay un antes y un después con Círculo de Seguridad. Antes, como psiquiatra y terapeuta en formación, no había nada que me llenara y motivara más que la teoría del apego y los efectos que puede tener en las personas, desde niños, adultos, madres, familias y cualquier persona en relaciones íntimas. Estudiando el apego es donde encontré ESPERANZA para mis pacientes y sus familias.

La siguiente fase llegó cuando me convertí en madre, ¡la experiencia fue impactante! Llena de amor y miedo; de alegría y frustración. El Círculo de Seguridad nos dio PAZ a mí y a mi familia. Me consuela pensar que ser una madre "lo suficientemente buena" es suficiente, pero el Círculo también me inspira a seguir creciendo como profesional, madre, esposa, hermana, etc.

Compartir COSP con los padres a quienes yo acompaño en terapia, ha sido muy enriquecedor.. Espero que nuestro equipo pueda ayudar a crear generaciones de niños seguros; Estamos descubriendo que cada vez más padres quieren saber más sobre el programa y cómo ponerle un nombre a lo que experimentan con sus hijos. En general, cada grupo que termina en un Capítulo 8 lleno de celebración me hace crecer como profesional y me trae mucha alegría. ¡Agradezco al Círculo de Seguridad Internacional por su apoyo a lo largo de los años!

-Violeta Pérez

Violeta Pérez also wanted to share her more personal journey here:

For me there is a before and after with Circle of Security. Before, as a psychiatrist and therapist-in-training, there was nothing that fulfilled and moved me more than attachment theory and the effects it can have on people from children, adults, mothers, families and anyone in intimate relationships. Studying attachment is where I found HOPE for my patients and their families.

The next phase came when I became a mother – the experience was shocking! Full of love and fear; of joy and frustration. The Circle of Security gave PEACE to me and my family. I find solace in thinking that being a “good enough” parent is enough but the Circle also inspires me to continue growing as a professional, mother, wife, sister, etc.

Sharing COSP with the parents whom I accompany in therapy has been very enriching for me. I hope our team can help create generations of secure children; we’re finding that more parents now want to know more about the program and how to put a name to what they experience with their children. In general, each group that ends in a Chapter 8 full of celebration makes me grow as a professional and brings joy. I thank Circle of Security International for their support over the years!

-Violeta Pérez