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The Circle of Security project: Attachment-based intervention with caregiver-

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Article in Attachment & Human Development · May 2002

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Journal of Consulting and Clinical Psychology Copyright 2006 by the American Psychological Association
2006, Vol. 74, No. 6, 1017–1026 0022-006X/06/$12.00 DOI: 10.1037/0022-006X.74.6.1017

Changing Toddlers’ and Preschoolers’ Attachment Classifications:

The Circle of Security Intervention

Kent T. Hoffman Robert S. Marvin

Marycliff Institute University of Virginia

Glen Cooper and Bert Powell

Marycliff Institute

The Circle of Security intervention uses a group treatment modality to provide parent education and
psychotherapy that is based on attachment theory. The purpose of this study was to track changes in
children’s attachment classifications pre- and immediately postintervention. Participants were 65
toddler– or preschooler– caregiver dyads recruited from Head Start and Early Head Start programs. As
predicted, there were significant within-subject changes from disorganized to organized attachment
classifications, with a majority changing to the secure classification. In addition, only 1 of the 13
preintervention securely attached children shifted to an insecure classification. Results suggest that the
Circle of Security protocol is a promising intervention for the reduction of disorganized and insecure
attachment in high-risk toddlers and preschoolers.

Keywords: Circle of Security, high-risk children, intervention, preschool attachment, prevention

Over the past several decades, clear evidence has emerged that ton & Munholland, 1999; Britner, Marvin, & Pianta, 2005; Sroufe,
the quality of the relationship between caregiver and child in the Egeland, Carlson, & Collins, 2005; Weinfield, Sroufe, Egeland, &
first years of life is central to a child’s later functioning (e.g., Carlson, 1999). There is converging evidence that attachment
Thompson, 1999, 2001; Zeanah, 2000). Much of this evidence quality has an important influence on the success of a child’s
comes from researchers working within the framework of attach- developmental pathway toward self-reliant adulthood (Carlson &
ment theory who have noted patterns of individual differences in Sroufe, 1995; Kobak, Cassidy, Lyons-Ruth, & Ziv, 2006; Sroufe et
attachment quality that can be identified reliably in both the al., 2005; Thompson, 1999). Insecure attachment patterns are not
behavior and the internal representational models of both parent in themselves typically considered indicators of psychopathology
and child (e.g., Ainsworth, Blehar, Waters, & Wall, 1978; Brether- but are instead viewed as heightening the risk of psychopathology
when occurring in the context of additional risk factors (Green-
berg, 1999; Kobak et al., 2006; Sroufe et al., 2005). Moreover,
Kent T. Hoffman, Glen Cooper, and Bert Powell, Center for Clinical there is increasing evidence that one particular attachment pattern
Intervention, Marycliff Institute. Robert S. Marvin, Child–Parent Attach- during infancy and the preschool years—disorganized attachment
ment Clinic, University of Virginia. (Cassidy & Marvin, 1992; Main & Solomon, 1990)—may be a
All four authors contributed equally to the project. particularly important risk factor for maladaptive outcomes
This project was supported by U.S. Department of Health and Human (Lyons-Ruth & Jacobvitz, 1999; Moss, Cyr, Bureau, Tarabulsy, &
Services University–Head Start Partnership Grants 90YF0018 and Dubois-Comtois, 2005; Sroufe et al., 2005). Given this substantial
90YD0108 and by a grant from the FHL Foundation of Albuquerque, New
body of evidence that insecure attachment (and perhaps particu-
Mexico.
larly insecure/disorganized attachment) is a risk factor for later
We thank Susan McDonough, James Masterson, Ralph Klein, and
David Erb, whose work initially inspired this project. We thank Jude psychopathology, attempts to reduce the risk of insecure and
Cassidy for her wise counsel and hard work over the years. In addition, we disorganized attachment are particularly important (see also Ber-
thank William F. Whelan, Jeffrey A. Olrick, Nancy S. Weinfield, Susan S. lin, Ziv, Amaya-Jackson, & Greenberg, 2005).
Woodhouse, Miranda Filippides, Susan Paris, Lisa J. Berlin, Kathleen L. Because of the importance of reducing the risk of insecure
Whitten, Jonathan J. Mohr, Howard Steele, Miriam Steele, Susan Spieker, attachment, attempts to develop systematic, replicable, effective
Molly Kretchmar-Hendricks, and Kristin Bernard for their invaluable help. approaches to support more adaptive developmental trajectories
We are also grateful to the children, caregivers, and Spokane research for at-risk parent– child relationships have, in the past 2 decades,
affiliates who gave so generously of their time for this research. become the focus of increasing research (e.g., Zeanah, 2000).
Correspondence concerning this article should be addressed to Kent T.
Attachment theory, especially in combination with other compo-
Hoffman, Center for Clinical Intervention, Marycliff Institute, 807 W.
Seventh Avenue, Spokane, WA 99204. E-mail: kenthoffman1422
nents of current developmental theory and research, has inspired a
@comcast.net. Questions regarding data analysis should be addressed to number of intervention programs for infants, toddlers, and their
Robert S. Marvin, the Mary D. Ainsworth Child–Parent Attachment Clinic, parents (see Berlin et al., 2005; Lieberman & Zeanah, 1999; van
University of Virginia, 914 East Jefferson Street, Charlottesville, VA IJzendoorn, Juffer, & Duyvesteyn, 1995). Because attachment is a
22902. E-mail: [email protected] relationship-based construct, most of these programs have deliv-

1017
1018 HOFFMAN, MARVIN, COOPER, AND POWELL

ered the interventions to caregivers. The usual goal of the pro- In developing the protocol, one working assumption was that,
grams has been to improve the caregivers’ sensitivity to infant when taught to caregivers in a user-friendly manner, attachment
attachment and exploratory signals, with the assumption that this theory can be understood and will prove useful to caregivers when
will, in turn, increase the likelihood that the infant or toddler will interacting with their children. In formulating this approach to
develop a secure attachment to that caregiver. teaching attachment theory, we reduced the formal theory and
Although there is evidence from individual laboratories of suc- classification system to a small number of core concepts. These
cessful outcomes of particular interventions (e.g., Anisfeld, core components include how the parent serves as a secure base
Casper, Nozyce, & Cunningham, 1990; Lieberman, Weston, & from which the child can explore and as a safe haven to which the
Pawl, 1991; Lyons-Ruth, Connell, & Grunebaum, 1990; van den child can return in times of trouble; how secure children typically
Boom, 1988, 1994), there is currently disagreement among attach- signal wishes for attachment and exploration directly, whereas
ment researchers about the efficacy of these relatively few existing insecure children typically send misleading messages (miscues)
intervention models. Some researchers provide a summary assess- regarding those wishes; how these misleading messages are part of
ment of the success of previous attempts as “marginally success- an insecure child’s (nonconscious) strategic attempt to maintain
ful” (i.e., Egeland, Weinfield, Bosquet, & Cheng, 2000), whereas connection with the caregiver; and how, because a child thrives
others view these as “rather successful” (i.e., van IJzendoorn, when the caregiver is relatively responsive to both attachment and
Bakermans-Kranenburg, & Juffer, 2005; see also Bakermans- exploratory behavior, it is important that the caregiver consider
Kranenburg, van IJzendoorn, & Juffer, 2003). What is clear, how- what may hinder sensitive responsiveness to particular aspects of
ever, is that there continues to be a need for researchers to examine the child’s behavior.
the effectiveness of interventions designed to reduce the risk of The COS protocol differs from previous intervention ap-
insecure attachment. proaches in several ways. First, COS uses each child’s attachment
Although many intervention programs discussed in the afore- classification coded from the Strange Situation, along with the
mentioned studies have been significantly influenced by attach- mother’s attachment-related behaviors and representations, as the
ment theory and research, none has contained a systematic treat- basis for formulating an individualized approach for each dyad.
ment protocol that is itself based not only on caregiver patterns of Second, our approach focuses on both caregiver behavior and
caregiver mental representations (see Berlin et al., 2005, for dis-
behavior and caregiver representations but also on an analysis of
cussion of the narrower foci of most previous interventions).
the attachment classifications developed in attachment research
Third, we give caregivers a graphic image titled “The Circle of
(secure, insecure, and disorganized). Given the significant role that
Security” (see Figure 1) that contains clear representations of a
the specific patterns of attachment play in the developmental
child’s core needs for exploration and attachment. Fourth, we give
trajectory of children, and the promise that enhancing early attach-
caregivers language to understand defensive processes (which we
ment patterns holds for more positive developmental outcomes, we
call “shark music”), thus inviting caregivers to become partners in
propose that protocols are needed that individualize treatment on
reflecting on how certain behaviors in themselves and their chil-
the basis of the diagnostics inherent within attachment theory. In
dren are triggered by (nonconscious) anxiety. Fifth, COS has a
other words, we believe that much can be gained from the use of
standardized, video-based group model designed to deliver a sys-
individualized intervention plans that are informed by each child’s
tematic, week-by-week protocol to participants (Marvin et al.,
attachment classification. By understanding a child’s classifica- 2002).
tion, we can better understand what that child has learned about To begin evaluating this intervention, we recruited a sample of
being in a relationship with his or her caregiver and, thus, better at-risk toddlers and preschoolers and each child’s primary care-
understand the specific caregiver– child affective and behavioral giver from Head Start and Early Head Start programs. Because
patterns that need to be the focus of intervention. funding limitations precluded the use of a randomized trial with a
The present study was designed to assess the effectiveness of a control group, we used a pretest–posttest longitudinal design to
new group-based intervention protocol, the Circle of Security examine shifts in child attachment classification. The goal of the
(COS), which was developed by drawing on the dynamics of research project was to examine whether the COS intervention
secure and insecure attachment patterns. The intervention contains would prove effective in reducing attachment disorganization and
both educational and therapeutic components (Marvin, Cooper, insecurity. Specifically, we had two hypotheses: After interven-
Hoffman, & Powell, 2002). Five key goals of the protocol are to tion, there would be (a) a significant decrease in disorganized
(a) establish the therapist and the group as a secure base from attachment classifications and (b) a significant decrease in insecure
which the caregiver can explore his or her relationship with the attachment classifications.
child; (b) increase caregiver sensitivity and appropriate respon-
siveness by providing caregivers a map of children’s basic attach- Method
ment needs; (c) increase caregivers’ capacity to recognize and
understand both the obvious and more subtle verbal and nonverbal Participants
cues that children use to signal their internal states and needs when
Participants were toddlers and preschool children and each child’s
using the caregiver as a secure base for exploration and as a haven
primary caregiver recruited from Head Start and Early Head Start programs
of safety; (d) increase caregiver empathy by supporting reflection
in a medium-size city in Washington state. Recruitment took place at five
about both the caregiver’s and the child’s behaviors, thoughts, and sites, after each site had received inservice education about the develop-
feelings regarding attachment-oriented interactions; and (e) in- ment of parent– child relationships from the project staff. Because this was
crease caregiver reflection about how his or her own developmen- a protocol-development study rather than a formal efficacy study, caregiv-
tal history affects current caregiving behavior. ers were recruited. The primary criteria were parent availability to partic-
 SPECIAL SECTION: TODDLERS’ AND PRESCHOOLERS’ ATTACHMENT 1019

Figure 1. Graphic representation of the Circle of Security. Reprinted with permission of the copyright holders.
Copyright 2000 by Glen Cooper, Kent T. Hoffman, Robert S. Marvin, and Bert Powell.

ipate in the group and a history of regularity in bringing the child to the Detailed information on other variables regarding level of family risk
center or having the child available for services if the Head Start Family that would be of interest to this project was not available to the project
Service coordinator came to the home. From that sample, which comprised team. From discussions with the caregivers over the 6-month intervention,
approximately 25% of the Head Start families, teachers were asked to rank however, it was clear that this was a significantly high-risk sample. The
the families from lowest to highest functioning. Families that fell in the majority of caregivers reported that they were living in violent neighbor-
middle third of that group were invited to participate. With few exceptions, hoods and that they had themselves experienced some maltreatment or
invited families agreed to participate. The project and procedures were other trauma during their own childhoods. A minority of caregivers had at
thoroughly explained to potential participants, and informed written con- some point maltreated their own children. One parent did not complete the
sent was obtained separately for the intervention and for each assessment. study because she lost custody of her child during the 6-month intervention
Eighty-seven dyads met these initial criteria and were originally re- period.
cruited and participated in the preintervention assessment. Eleven of the
recruited caregivers made the decision not to participate beyond the as-
sessment. One dyad was excluded because, on interview with the clinician, Procedure
the parent displayed virtually no ability to reflect about her child or herself
A preintervention–postintervention design was used to examine inter-
and displayed much ambivalence about participating. Thus, 75 (86%) of
vention effectiveness, with child attachment as the outcome measure.
the originally recruited dyads began the intervention phase. Sixty-five
Before the intervention began, participants were seen in a laboratory
dyads (87% of those who began the intervention; 75% of those originally
session that lasted approximately 90 min. Data gathered during this session
recruited) completed the intervention and postintervention assessment.
served two functions. First, these data were used to create each partici-
In all cases, the caregiver completing the intervention was the same
pant’s individualized treatment plan, and second, the Strange Situation
caregiver who participated in the pre- and postintervention assessments.
procedure was used as the preintervention assessment of the child’s attach-
The caregivers ranged in age from 16 to 55 years (M ! 23.8 years, SD !
ment security. Approximately 6 – 8 weeks later, the intervention began and
6.8). Thirty-five (54%) of the 65 children were girls, and the mean age of
continued for 20 weekly sessions. Within 10 days after the final interven-
these children at the time of the preintervention assessment was 32 months
tion session, participants were again seen in a 90-min laboratory session
(SD ! 12.6; range ! 11–58 months, with 12 [18%] children younger than
during which the postintervention assessment of child attachment security
18 months of age at that time). Thirty caregivers (46%) were single, 18
was obtained.
(28%) were married, and 17 (26%) had partners to whom they were not
married. The 65 caregivers in the final sample included mothers (86%),
fathers (6%), foster parents (6%), and 1 grandmother (2%). Consistent with COS Intervention
the community in which the intervention was conducted, 86% of partici-
pants were White/Caucasian. All of the families were living below the As noted earlier, the intervention is based on an individualized treatment
federal poverty line. plan for each dyad. In this section, we first describe the creation of the
1020 HOFFMAN, MARVIN, COOPER, AND POWELL

individualized treatment plan, and then describe the intervention. We end the caregiver and the target child, and information regarding the caregiver’s
this section with a discussion of intervention fidelity. internal working models (including discourse patterns and defensive strat-
egies) of close family relationships.
Creation of the linchpin issue. On the basis of information gathered in
Individualized Treatment Plan both the observational procedure (child attachment classification and care-
giver classification) and the COSI, the linchpin issue for each dyad was
Development of the individualized treatment plan consisted of a number defined as the single, most problematic pattern of attachment– caregiving
of steps: (a) identification of caregiver– child interaction patterns, including interaction and caregiver internal working model that, if successfully
child attachment classification; (b) identification of caregiver developmen- changed, was expected to have the greatest positive impact on the child’s
tal history and internal working models of self and child; and (c) identifi- attachment pattern. This linchpin issue was carefully formulated in terms of
cation of a key (“linchpin”) issue that would be the focus of therapeutic both caregiver– child interaction and caregiver defense against his or her
work. own painful feelings regarding that problematic interaction pattern (for
Identification of child attachment and caregiving interaction patterns. additional details, see Cooper, Hoffman, Powell, & Marvin, 2005; Powell,
Identification of these interaction patterns was based on behavioral obser- Cooper, Hoffman, & Marvin, in press). The specific video segments used
vations of the caregiver and child that took place in the laboratory and for review with a caregiver, along with the individualized strategy selected
lasted approximately 30 min. The first procedure, depending on the age of to increase the caregiver’s capacity to reflect on his or her caregiving
the child, was either the Ainsworth Strange Situation (Ainsworth et al., behavior, were chosen to address this specific linchpin issue. For example,
1978) or the MacArthur Preschool Strange Situation (Cassidy & Marvin, the linchpin issue for one caregiver was her fear of assuming the parental
1992). Both versions of the Strange Situation are approximately 21-min role, made obvious in her consistent choice to “give in” to her 4-year-old
procedures involving a free-play episode, the entrance of a friendly adult child’s punitive, controlling behavior on reunion in the Strange Situation.
stranger, and two separations and reunions between child and caregiver,
with the stranger present in some but not all of those episodes. The
Preschool Strange Situation procedure has only minor changes from the Intervention Protocol
infant–toddler version: The parent is less constrained in his or her behavior The 20-week intervention took place in groups of five to six caregivers;
during free play, separation, and reunion; the caregiver is allowed to each weekly group meeting lasted 75 min. This intervention was imple-
negotiate with the child on separation; and the parent is not specifically mented by three experienced psychotherapists (Glen Cooper, Kent T.
asked to pick up the child at the beginning of the second reunion. These Hoffman, Bert Powell), each responsible for five separate groups over 3
minor changes were made to fit the more advanced locomotor, social– years. The initial 2 weeks of the intervention protocol used an educational
cognitive, communicative, and emotion-regulation skills of these older approach to offer caregivers an explanation of attachment theory via video
children (see Cassidy & Marvin, 1992). Each child’s pattern of attachment examples of their children expressing basic attachment and exploration
was classified from the videotapes of the Strange Situation according to needs that were identified on the COS graphic. Across the next 18 weeks,
coding criteria for Ainsworth’s infant system (Ainsworth et al., 1978) or group meetings focused on individual caregivers, with each caregiver being
Cassidy and Marvin’s (1992) preschool system; caregiver interaction pat- the focus of three sessions. During these sessions, the therapist followed a
terns in the Strange Situation were assessed using the Caregiver Behavior detailed, manualized protocol and used edited video clips of that caregiver
System (Britner et al., 2005; Marvin & Britner, 1995). Immediately fol- and child as a springboard to discuss the relationship. The specific se-
lowing the completion of the Strange Situation procedure, the experimenter quence of activities and goals can be summarized as follows:
entered the room, gave the caregiver a few age-appropriate children’s
books, and said, “Here are some books that the two of you can read 1. Through a series of activities, including review of videos of
together for a few minutes.” The experimenter then left the room, and the interactions between each caregiver and the child, the therapist
caregiver and child were videotaped for 5 min. Then, at a preset signal and group members were established as a secure base for each
from behind the one-way window, the caregiver attempted to get the child caregiver to explore his or her relationship with the child.
to clean up and return the toys to the toy box. This sequence too was
videotaped for 5 min. (All videotaped procedures were used not only to 2. As noted, during the first 2 weeks, caregivers were introduced to
create the intervention treatment plan but also to provide the clinical team the COS graphic and learned a user-friendly version of attach-
with edited video clips to use during the intervention. The child attachment ment theory, focusing on secure patterns of attachment. For
assessment— but no other interaction measures—was also used to assess example, the group watched a videotape in which one of the
intervention effectiveness.) caregivers and his 3-year-old son entered the playroom for the
Identification of caregiver developmental history and models of self and first time. The child ran across the room, picked up a toy, looked
child. The Circle of Security Interview (COSI), conducted following around at the new setting, and then ran back to his father with
completion of the behavioral observations, was used to assess caregiver whom he shared the toy. The father, referencing the COS
developmental history and working models. This 60-min videotaped inter- graphic, learned that, as his son goes out into the room to explore,
view was designed to elicit episodic memories of the parent’s past and there is a point at which the child realizes that he is in an
present parent– child interactions and relationships and to elicit the parent’s unfamiliar setting and chooses to come back to his father to feel
reflections on those interactions and relationships. The interview consists more secure, thus “completing the circle.”
of 5 questions about the Strange Situation experience that the caregiver and
child had just completed, 20 questions about the parent’s perceptions of the 3. Through detailed and repeated review of edited video clips, the
child and the relationship between them (adapted from the Parent Devel- therapist attempted to help each caregiver improve his or her
opment Interview; Aber, Slade, Berger, Bresgi, & Kaplan, 1985), and 6 capacity to read and respond to the child’s cues and miscues
questions about the parent’s relationships with his or her own parents regarding attachment and exploration. For example, in one video
during childhood (adapted from the Adult Attachment Interview; George, review, a 4-year-old boy miscued his mother during reunion by
Kaplan, & Main, 1985). This interview was used to design the individu- turning away from her and demanding to be alone. She inter-
alized intervention goals for each dyad by providing at least three types of preted his distance as his not needing her, even though she had
information: historical information about the caregiver’s relationships with watched videotape of his suspending play and standing by the
his or her own parents and about the caregiver’s relationship with the target door glumly during her entire 3-min absence. The mother learned
child, information about the attachment– caregiving relationship between that when her son is upset he manages his distress by pouting and
 SPECIAL SECTION: TODDLERS’ AND PRESCHOOLERS’ ATTACHMENT 1021

pulling away (miscue) rather than by directly showing her his and debriefing meetings were held after each group session. This procedure
need for comfort. assisted in keeping the work focused and consistent with the curriculum
across therapists. In addition, implementation and documentation of each
4. Through focusing on videos illustrating each caregiver’s specific tape review session were guided by a written “tape review sheet” com-
linchpin issue, the therapist developed a nonjudgmental dialogue pleted by the therapist.
with the caregiver that supported self-reflection about these Several steps were taken to ensure that participants received the full
linchpin struggles in attachment– caregiving interactions. This intervention protocol. First, during the early parent-education phase of the
process is viewed as the central dynamic for change (Fonagy, work, care was taken to ensure that any parent who missed an educational
Steele, & Steele, 1991). For example, a young mother intrusively session received this material in a “catch-up” session. Second, during the
pursued her son as he sought a toy during play, which precipi- later psychotherapeutic phase of the work in which caregivers took turns (1
tated his pulling away as he attempted to explore; the son’s each session) reviewing their own videotaped interactions with their child,
refusal to play with the mother triggered her chilly withdrawal. schedules were adjusted as necessary so that all caregivers had several
On seeing this interaction in video review, and through reflective opportunities to participate in such individualized sessions. Finally, a plan
dialogue with the therapist, the mother recognized that she was established to discontinue a caregiver’s participation if he or she
viewed her son’s independent exploration as confirming her missed more than 4 of the 20 sessions. Two caregivers were dropped from
belief (negative attribution) that he does not want to be with her. the study for this reason. Thus, all participants attended at least 85% of the
In addition, she began to recognize that she typically manages the sessions.
pain of his perceived rejection by withdrawing her support and
creating distance. Further dialogue with the therapist led to her
realization that her son needs her regardless of his activities and Assessment of Intervention Effectiveness: Child
that when she supports his exploration he naturally comes back Attachment
to her for connection when he is ready.
Assessment of intervention effectiveness was based on measuring child
5. When initiated by the caregiver, the therapist supported reflec- attachment at 6 – 8 weeks prior to intervention and again approximately 10
tion about how that particular caregiver’s own developmental days following the completion of the 20-week intervention.
history may have influenced his or her current caregiving behav- Following receipt of informed consent (IRB approval was obtained
ior. Because the COS protocol normalizes and gives a name through the University of Virginia), each child– caregiver dyad was vid-
(“shark music”) to previously nonconscious anxiety about spe- eotaped in the Ainsworth Strange Situation (Ainsworth et al., 1978) if the
cific needs on the circle, some caregivers spontaneously report child was younger than 24 months of age. For children between 24 and 60
memories of how these same needs were not met in their own months, the dyad participated in the MacArthur Preschool Strange Situa-
childhood. For example, a mother viewing how she encouraged tion (Cassidy & Marvin, 1992). For children younger than 18 months of
her 3-year-old daughter’s overtly childish behavior suddenly age, the Ainsworth (Ainsworth et al., 1978) coding system was used to
remembered how her own mother had often asked her to “never classify the toddler as secure (B), insecure/avoidant (A), or insecure/
grow up.” This led to specific memories of not feeling permis- resistant–ambivalent (C). Each videotape was also coded for disorganiza-
sion to explore her own autonomous experience throughout her tion (D) using the system developed by Main and Solomon (1990). For
childhood. Feeling the pain of this limitation, she decided to not children 30 months of age and older, the Cassidy–Marvin (Cassidy &
repeat it with her daughter. Marvin, 1992) preschool coding system was used to classify the child as
secure (B), insecure–avoidant (A), insecure/resistant–ambivalent (C), dis-
6. With further video review, discussion, and practice, the therapist organized or role-reversed controlling (D), or insecure– other (I-O). For
supported the caregiver’s ability to see the child’s needs with children between 18 and 30 months, coders (all of whom were reliable on
greater empathy (“empathic shift”; Cooper et al., 2005). This both systems) used the generally accepted method of extrapolating between
empathy consists of an increasing recognition that the child’s the infant and preschool systems.
miscues, and much of his or her difficult behavior, reflect valid To avoid confusion, a note about terminology is important at this point.
attachment and exploratory wishes rather than a negative char- During infancy and the toddler period, disorganized attachment patterns
acteristic of the child (e.g., disliking the caregiver, wanting to consist of complex behavioral displays that appear to be in slow motion,
hurt the caregiver; for a similar perspective, see Fonagy, Gergely, contradictory, incomplete, and/or apprehensive, and do not appear “orga-
Jurist, & Target, 2002, on reflective functioning). For example, nized” with respect to gaining or maintaining proximity or contact when
once the mother of the boy (described above) who was pouting the child is distressed (Main & Solomon, 1990). During the preschool
on his mother’s return was able to view his turning away from period, some children still appear disorganized and relatively incoherent
her as a miscue, she was able to experience empathy for his (classified “insecure– other”), and other children are role-reversed control-
struggle in showing a direct request for closeness. This led her to ling. In this study, both of these groups (“role-reversed controlling” and
consider a new choice to comfort him when he is upset and “insecure– other”) were considered to be subsets of a larger “disorganized”
distant rather than to punish him. group. Likewise, the three patterns (secure, avoidant, and resistant–
ambivalent) originally identified by Ainsworth (1978) were considered to
7. The intervention ended with a structured celebration of the be subsets of a larger “organized” group. The reader should be careful not
caregivers’ increased sensitivity in caring for the child. to equate these labels with the words organized and disorganized as used
in colloquial speech.
Intervention Fidelity All coders providing the classifications used for data analysis were blind
to pre- versus postintervention status (i.e., Robert S. Marvin, who coded the
Fidelity was maintained by following a detailed, written manual con- preintervention assessments as part of planning the individualized treat-
sisting of specific goals, plans for achieving those goals, and activities for ment plans, was not one of these coders). The following procedure was
each group session. Plans for each session were reviewed prior to that used to ensure coder blindness: After all postintervention assessments had
session, and video excerpts to be reviewed during that session were been completed, each Strange Situation was assigned a randomly generated
determined by following the plan in the manual. Each session was thus identifying code, and all identifying information regarding name and time
organized around the prepared video edits. All sessions were videotaped, of assessment was deleted from each tape. All 130 Strange Situation
1022 HOFFMAN, MARVIN, COOPER, AND POWELL

procedures (65 preinterventions and 65 postinterventions) were coded by between a child’s preintervention and postintervention classifica-
one of three different coders who was reliable on both the infant and tions if for no other reason than that the same child was being
preschool system and who was blind to preintervention versus postinter- assessed at both time points. Our hypotheses were concerned,
vention condition. however, with differences, rather than relations, between pre- and
Eighty-five (65%) of the 130 tapes were randomly selected and double-
postintervention proportions of classification; thus, we used the
coded for reliability, with disagreements being conferenced to agreement.
McNemar test.
For the two combined classification systems and all major attachment
groups (i.e., A, B, C, D– controlling, and I-O), the five-way exact agree- Because the McNemar test is relatively not well known, we
ment was 80% (" ! .74, p ! .000). provide an explanation of this approach. If the intervention had no
effect whatsoever, we would expect that shifts from “positive” to
Results “negative” groups (e.g., as in Hypothesis 1, from organized to
disorganized) would be equally likely as shifts from “negative” to
Pre- and Postintervention Distributions of Major “positive” groups (e.g., from disorganized to organized). Even if
Classifications the intervention had no effect, we would expect some random
fluctuation between groups. That random fluctuation would result
Table 1 presents the descriptive statistics for all five major in shifts between groups being equally likely in either direction.
attachment classifications pre- and postintervention. Sixty percent The formula for the McNemar test statistic is as follows (Ott,
of children were classified into one of the two highest risk groups Larson, Rexroat, & Mendenhall, 1992):
(disorganized– controlling and insecure-other) before intervention,
whereas 25% of children were classified into one of these groups 2
$M ! (N1 % N4)2
following intervention. Twenty percent of children were secure
before intervention, and 54% were secure following intervention. ______,

Hypothesis Testing N1 & N4

As stated earlier, we hypothesized that after intervention there where N1 is equal to the number of cases in the cell that reflects a
would be (a) a significant decrease in disorganized attachment shift from a negative preintervention classification (e.g., disorga-
classifications and (b) a significant decrease in insecure attachment nized or insecure) to a positive postintervention outcome (e.g.,
classifications. We tested each of these hypotheses using the organized or secure), whereas N4 is equal to the number of cases
McNemar test, which is used to assess whether there is a signifi- in the cell that reflects a shift from a positive preintervention
cant difference between two correlated proportions. The preinter- classification (e.g., organized or secure) to a negative postinter-
vention and postintervention proportions in the current study were vention outcome (e.g., disorganized or insecure).
correlated because the preintervention and postintervention pro- The McNemar test, then, allows for assessment of whether this
portions were based on the same sample of subjects at two differ- null hypothesis (that shifts between groups are equally likely)
ent time points. should be accepted or rejected through comparison of the McNe-
2
Although the McNemar test is superficially similar to a test of mar test statistic ($M ) with critical chi-square values (df ! 1). If
independence (i.e., a 2 # 2 chi-square test), it is quite different in the null hypothesis is accepted, then the intervention is thought to
terms of the question it answers. The chi-square test allows one to have no effect. If the null hypothesis is rejected, then the inter-
determine whether there is a significant relation between variables, vention can be said to have an effect. Furthermore, this procedure
such that if the null hypothesis is rejected, one can conclude that allows for assessment of whether shifts are more likely from the
there is a statistically significant relation between the variables. “positive” to the “negative” group or from the “negative” to the
Naturally, we expected that there might be some degree of relation “positive” group. In the current study, the two hypotheses were of

Table 1
Attachment Classifications Pre- and Posttreatment for Five Categories

Posttreatment classification

Disorganized– Insecure–
Avoidant Secure Resistant controlling other
Pretreatment Pretreatment
classification n % n % n % n % n % total

Avoidant 3 27.3 5 45.5 0 0.0 1 9.1 2 18.2 11

Secure 0 0.0 12 92.3 0 0.0 1 7.7 0 0.0 13
Resistant 1 50.0 1 50.0 0 0.0 0 0.0 0 0.0 2
Disorganized–controlling 2 10.5 8 42.1 5 26.3 0 0.0 4 21.1 19
Insecure–other 1 5.0 9 45.0 2 10.0 1 5.0 7 35.0 20
Posttreatment total 7 35 7 3 13 65

Note. Percentages provided reflect the percentage of children classified in each attachment group at Time 1 (listed in rows) who were then classified in
each attachment group (listed in the columns) at Time 2.
 SPECIAL SECTION: TODDLERS’ AND PRESCHOOLERS’ ATTACHMENT 1023

interest: one involving a shift from disorganized attachment and Table 3

one a shift from insecure attachment. If such shifts were found, Pre- and Postintervention Secure Versus Insecure Groups
then the McNemar test would allow us to determine that there was
a significant reduction in the occurrence of disorganized and Posttreatment classification
insecure classifications postintervention. Secure Insecure
Pretreatment Pretreatment
Hypothesis 1 classification n % n % total

To examine whether there was a significant decrease in disor- Secure 12 92.3 1 7.7 13
ganized attachment classification, we created the disorganized and Insecure 23 44.2 29 55.8 52
Posttreatment total 35 30 65
organized categories by collapsing the relevant attachment classi-
fications into their respective groups. Disorganized (infant classi- Note. Percentages provided reflect the percentage of children classified in
fication), disorganized– controlling (preschool classification), and each attachment group at Time 1 (listed in rows) who were then classified
insecure– other (preschool classification) groups were collapsed to in each attachment group (listed in the columns) at Time 2.
form the disorganized group. Secure, avoidant, and resistant were
pooled to form the organized group. We used the McNemar test to
the secure group was more likely than movement from the secure
examine the null hypothesis that shifts from organized to disorga-
to insecure group: Whereas 44% of the preintervention insecure
nized attachment or from disorganized to organized attachment
children shifted to secure, only 8% of the preintervention secure
would be equally likely. As can be seen from Table 2, the null
children changed to insecure. In other words, based on the McNe-
hypothesis was rejected: Shifts from organized to disorganized and
2 mar test, there was a significant decrease in insecurity after the
from disorganized to organized were not equally likely, $M (1, N !
intervention.
65) ! 17.06, p ' .001. Movement from disorganized to organized
classification was more likely than movement from organized to
disorganized classification: Sixty-nine percent of the 39 children in Discussion
the preintervention disorganized group moved to the postinterven- The COS protocol is an attachment theory-driven protocol de-
tion organized group, whereas only 15% of the 26 children in the signed to be used for either prevention or intervention that is
preintervention organized group moved to the postintervention individualized for a particular caregiver– child dyad on the basis of
disorganized group. In other words, based on the McNemar test, the child’s attachment classification and the caregiver’s behavior
there was a significant decrease in disorganization after interven- and working models. Within the limitations of a longitudinal study
tion. lacking a control group, the results suggest that the COS protocol
may have a significant positive impact on the attachment–
Hypothesis 2 caregiving patterns of high-risk toddlers, preschoolers, and their
primary caregivers. The postintervention distribution of attach-
To examine whether there was a significant decrease in insecure
ment classifications is remarkably similar to those found in the
attachment classifications, we created the insecure group by col-
meta-analysis of attachment distributions in nonclinical, low-
lapsing the avoidant, resistant, disorganized, disorganized–
income samples by van IJzendoorn, Schuengel, and Bakermans-
controlling, and insecure– other groups; we compared these chil-
Kranenburg (1999).
dren with those classified secure. We used the McNemar test to
In developing and implementing this protocol, we had expected
examine the null hypothesis that shifts from secure to insecure and
that children classified in the two disorganized groups would tend
from insecure to secure would be equally likely. As can be seen
to shift toward one of the organized groups, and we found that
from Table 3, the null hypothesis was rejected: Shifts from secure
approximately 70% of them did so. This becomes especially mean-
to insecure and from insecure to secure were not equally likely,
2 ingful when one considers that, consistent with attachment theory
$M (1, N ! 65) ! 20.17, p ' .001. Movement from the insecure to
(e.g., Bowlby, 1969/1982, 1973, 1980), rates of stability for these
disorganized classifications in nonclinical, low-income popula-
tions tend to be ! 70% (e.g., Moss et al., 2005; see van IJzendoorn
Table 2
et al., 1999), compared with 30% stability of disorganization
Pre- and Postintervention Organized Versus Disorganized
following the COS intervention. Even in the absence of a control
Groups
group, this difference suggests that the COS intervention may be
Posttreatment classification targeting an important mechanism for change. It is unlikely that
this shift from disorganized to organized attachment is an artifact
Organized Disorganized of the attachment assessments, as might be the case if a large
Pretreatment Pretreatment proportion of the sample was coded with different coding systems
classification n % n % total
at pre- and posttest and the system used at posttest was less likely
Organized 22 84.6 4 15.4 26 to produce a disorganized classification. In this sample, all but nine
Disorganized 27 69.2 12 30.8 39 children were assessed with the same attachment system at both
Posttreatment total 49 16 65 time points, and only one of these nine was in the group that
Note. Percentages provided reflect the percentage of children classified in
shifted from disorganized to organized.
each attachment group at Time 1 (listed in rows) who were then classified Moreover, nearly two thirds of these children who shifted from
in each attachment group (listed in the columns) at Time 2. one of the disorganized groups moved to the secure group rather
1024 HOFFMAN, MARVIN, COOPER, AND POWELL

than to one of the organized yet insecure groups (i.e., the avoidant Limitations and Future Directions
and resistant groups). We suspect that this is attributable to the
caregivers’ new capacity to recognize and reflect on key defensive The study’s greatest limitation is the lack of an experimental
strategies that had previously hindered their ability to respond to control or comparison group with randomized assignment. Repli-
specific needs essential for security in their children. Our assump- cation of this study with a randomized controlled design is essen-
tion is that once caregivers are better able to manage their own tial to verify that the results obtained here reflect the effects of the
defensive strategies in interaction with their children, a secure intervention. In addition, there is need for a larger sample size to
attachment– caregiving pattern is the least complex and most com- examine more closely the differential effects of the intervention
fortable of the five major patterns represented in the literature. across the full range of attachment classifications. Furthermore,
the addition of a greater number of secure children would allow
additional exploration of the issue of “do no harm.” Also, the
Stability of Classifications and the Issue of “Do No addition of a 1-year follow-up assessment would permit examina-
Harm” tion of potential long-term effects. We have collected these
follow-up data and coding should be completed shortly. Finally,
Of the 13 children classified secure before the intervention, only because it is important to demonstrate that others can implement
1 changed to insecure. It is noteworthy that the parent of this child the protocol and obtain effective outcomes, several studies are
experienced a drug-use relapse toward the end of the 20-week currently underway in which we have trained clinicians to serve as
intervention and that this child’s classification changed to group leaders.
disorganized– controlling. This 92% rate of stability for the secure It is also important to note that the caregivers who participated
classification is important for at least two reasons. First, this rate of in this study were selected for their willingness to participate in the
stability appears to be higher than that found in longitudinal, intervention on the basis of the regularity of their participation in
nonintervention studies of attachment (e.g., Moss et al., 2005; Head Start and Early Head Start as well as their interest in
Weinfield, Whaley, & Egeland, 2004). If replicated, this would participating in the program. This strategy of recruiting partici-
underscore the usefulness of the COS intervention as an early pants has implications for the generalizability of the intervention.
preventive intervention for enhancing the stability of secure at- Further research will be needed to examine how to reach caregiv-
tachments. Second, from a health care perspective, one critical ers who may not be highly motivated to participate in such a
question is, Does this intervention “do no harm”? Especially given program for any of a variety of reasons (e.g., life stressors, care-
the potential and reported danger (e.g., O’Connor & Zeanah, 2003) giver personality, low IQ, and even such difficulties as lack of
of some forms of what have been labeled “attachment therapies” reliable transportation).
(e.g., the “rage reduction” and “holding” therapies), it is incumbent An additional direction for further work is related to the “effec-
on us to demonstrate that the COS protocol does no harm. Because tiveness” of the protocol and its dissemination in a form that is
we recruited dyads containing securely attached as well as inse- practical for community-based therapists. In the form described in
curely attached children, we have been able to demonstrate that the this article, the COS intervention requires enough investment in
COS intervention does no harm for securely attached children. space, video equipment, and preparation time to constitute a chal-
From a public health perspective, this issue of assessing the lenge for some therapists, especially those in private practice. We
potential risks of a parent– child intervention is as critical as are currently working on two variations of the protocol. One is a
demonstrating benefits but is too often not examined. This is an parent-education version that will use archived videotapes of
especially timely issue given the number of community-based parent– child interaction rather than “individualized” videos of the
therapists who treat preschool and young school-age children with participating dyads. In addition, this version will not include the
problematic attachments. Although there are a number of attach- actual psychotherapy phase, focusing instead on the earlier edu-
ment research-based interventions for infants and young toddlers cational and supervised practice components of the protocol. A
(see Berlin et al., 2005; Lieberman & Zeanah, 1999), these com- second variation is one in which the intervention is delivered by a
munity therapists have available almost no relatively standardized therapist to one parent (or couple) at a time. This version, although
protocols for preschool and school-age children with problematic lacking some of the advantages of a group model, has more
attachments other than the rage reduction, holding, and other at flexibility in terms of timing and individualizing the protocol to fit
least mildly coercive therapies (e.g., Cline, 1992; Levy, 2000; the needs and characteristics of each client or family.
Thomas, 1997). These nonevidence-based therapies are currently
under intense scrutiny because of their potential for causing either Conclusion
physical injury, death, or psychological injury that stems from
their underlying framework of making negative inferences regard- Increasingly, preschool and early school-age children are being
ing the needs and motivations that lead to the child’s problematic referred for intervention for attachment-related problems, and their
“symptoms” (O’Connor & Zeanah, 2003). The COS protocol is caregivers are being referred to increase or improve their parenting
one of the few promising interventions available to community skills. Although there are several science-based attachment inter-
therapists that can make an evidence-based claim of low risk for ventions for infant– caregiver dyads, the COS is one of the few
negative outcome (however, see also Cohen, Lojkasek, Muir, such protocols with preliminary evidence suggesting that it is
Muir, & Parker, 2002; Juffer, Bakermans-Kranenburg, & van effective in reducing disorganization and increasing security for
IJzendoorn, 2005; and McDonough, 2004, for examples of children in the age range between toddlerhood and the early school
evidence-based interventions that are designed to support security years. Given the fact that insecure attachment and disorganized
in children). attachment can be a risk factor for future psychopathology in the
 SPECIAL SECTION: TODDLERS’ AND PRESCHOOLERS’ ATTACHMENT 1025

child if present in conjunction with additional risk factors, the George, C., Kaplan, N., & Main, M. (1985). The Adult Attachment Inter-
reductions in disorganized and insecure attachment have important view. Unpublished manuscript, University of California, Berkeley.
implications for the health of families and children. Greenberg, M. T. (1999). Attachment and psychopathology in childhood.
In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory,
research, and clinical applications (pp. 469 – 496). New York: Guilford
References Press.
Juffer, F., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2005).
Aber, J. L., Slade, A., Berger, B., Bresgi, I., & Kaplan, M. (1985). The The importance of parenting in the development of disorganized attach-
Parent Development Interview. Unpublished manuscript, City Univer- ment: Evidence from a preventive intervention study in adoptive fami-
sity of New York.
lies. Journal of Child Psychology and Psychiatry, 46, 263–274.
Ainsworth, M. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns
Kobak, R., Cassidy, J., Lyons-Ruth, K., & Ziv, Y. (2006). Attachment and
of attachment: A psychological study of the strange situation. Hillsdale,
developmental psychopathology. In D. Cicchetti (Ed.), Developmental
NJ: Erlbaum.
psychopathology (2nd ed.; pp. 333–369). New York: Wiley.
Anisfeld, A., Casper, V., Nozyce, M., & Cunningham, N. (1990). Does
Levy, T. M. (2000). Handbook of attachment interventions. San Diego,
infant carrying promote attachment? An experimental study of the
CA: Academic Press.
effects of increased physical contact on the development of attachment.
Child Development, 61, 1617–1627. Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive
Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2003). intervention and outcome with anxiously attached dyads. Child Devel-
Less is more: Meta-analyses of sensitivity and attachment interventions opment, 62, 199 –209.
in early childhood. Psychological Bulletin, 129, 195–215. Lieberman, A. F., & Zeanah, C. H. (1999). Contributions of attachment
Berlin, L. J., Ziv, Y., Amaya-Jackson, L., & Greenberg, M. T. (Eds.). theory to infant–parent psychotherapy and other interventions with in-
(2005). Enhancing early attachments: Theory, research, intervention, fants and young children. In J. Cassidy & P. Shaver (Eds.), Handbook of
and policy. New York: Guilford Press. attachment: Theory, research, and clinical application (pp. 555–574).
Bowlby, J. (1969/1982). Attachment and loss: Vol. 1. Attachment. New New York: Guilford Press.
York: Basic Books. Lyons-Ruth, K., Connell, D. B., & Grunebaum, H. U. (1990). Infants at
Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation. New York: social risk: Maternal depression and family support services as media-
Basic Books. tors of infant development and security of attachment. Child Develop-
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss. New York: Basic ment, 61, 85–98.
Books. Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization:
Bretherton, I., & Munholland, K. A. (1999). Internal working models in Unresolved loss, relational violence, and lapses in behavioral and atten-
attachment relationships: A construct revisited. In J. Cassidy & P. R. tional strategies. In J. Cassidy & P. R. Shaver (Eds.), Handbook of
Shaver (Eds.), Handbook of attachment: Theory, research, and clinical attachment: Theory, research, and clinical applications (pp. 520 –554).
applications (pp. 89 –111). New York: Guilford Press. New York: Guilford Press.
Britner, P. A., Marvin, R. S., & Pianta, R. C. (2005). Development and Main, M., & Solomon, J. (1990). Procedures for identifying infants as
preliminary validation of the caregiving behavior system: Association disorganized/ disoriented during the Ainsworth Strange Situation. In
with child attachment classification in the preschool Strange Situation. M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment
Attachment & Human Development, 7, 83–102. in the preschool years: Theory, research, and intervention (pp. 121–
Carlson, E. A., & Sroufe, L. A. (1995). Contribution of attachment theory 160). Chicago: The University of Chicago Press.
to developmental psychopathology. In D. Cicchetti & D. J. Cohen Marvin, R. S., & Britner, P. A. (1995). A classification system for parental
(Eds.), Developmental psychopathology: Vol. 1. Theory and methods caregiving behavior patterns in the preschool Strange Situation. Un-
(pp. 581– 617). New York: Wiley. published classification manual, University of Virginia.
Cassidy, J., & Marvin, R. S. (1992). Attachment organization in preschool Marvin, R. S., Cooper, G., Hoffman, K., & Powell, B. (2002). The Circle
children: Procedures and coding manual. Unpublished manual, Univer- of Security project: Attachment-based intervention with caregiver–
sity of Virginia.
preschool child dyads. Attachment & Human Development, 4, 107–124.
Cline, F. (1992). Hope for high risk and rage-filled children. Evergreen,
McDonough, S. C. (2004). Interaction guidance: Promoting and nurturing
CO: EC Publications.
the caregiving relationship. In A. J. Sameroff, S. C. McDonough, &
Cohen, N. J., Lojkasek, M., Muir, E., Muir, R., & Parker, C. J. (2002).
K. L. Rosenblum (Eds.), Treating parent–infant relationship problems:
Six-month follow-up of two mother–infant psychotherapies: Conver-
Strategies for intervention (pp. 79 –96). New York: Guilford Press.
gence of therapeutic outcomes. Infant Mental Health Journal, 4, 361–
Moss, E., Cyr, C., Bureau, J.-F., Tarabulsy, G. M., & Dubois-Comtois, K.
380.
(2005). Stability of attachment during the preschool period. Develop-
Cooper, G., Hoffman, K., Powell, B., & Marvin, R. (2005). The Circle of
Security intervention: Differential diagnosis and differential treatment. mental Psychology, 41, 773–783.
In L. J. Berlin, Y. Ziv, L. M. Amaya-Jackson, & M. T. Greenberg (Eds.), O’Connor, T. G., & Zeanah, C. H. (2003). Attachment disorders: Assess-
Enhancing early attachments: Theory, research, intervention, and policy ment strategies and treatment approaches. Attachment & Human Devel-
(pp. 127–151). New York: Guilford Press. opment, 5, 223–244.
Egeland, B., Weinfield, N. S., Bosquet, M., & Cheng, V. K. (2000). Ott, R. L., Larson, R., Rexroat, C., & Mendenhall, W. (1992). Statistics: A
Remembering, repeating, and working through: Lessons from tool for the social sciences (5th ed). Boston: Wadsworth.
attachment-based interventions. In J. Osofsky & H. E. Fitzgerald (Eds.), Powell, B., Cooper, G., Hoffman, K., & Marvin, R. (in press). The Circle
WAIMH handbook of infant mental health: Vol. 4. Infant mental health of Security project: A case study. In D. Oppenheim & D. Goldsmith
in groups at high risk (pp. 35– 89). New York: Wiley. (Eds.), Clinical application of attachment theory: Bridging the gap
Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, between theory, research, and practice. New York: Guilford Press.
mentalization, and development of the self. New York: Other Press. Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). The
Fonagy, P., Steele, H., & Steele, M. (1991). Maternal representations of development of the person: The Minnesota Study of Risk and Adaptation
attachment during pregnancy predict the organization of infant–mother from birth to adulthood. New York: Guilford Press.
attachment at one year of age. Child Development, 62, 891–905. Thomas, N. L. (1997). When love is not enough: A guide to parenting
1026 HOFFMAN, MARVIN, COOPER, AND POWELL

children with RAD—Reactive attachment disorder. Glenwood Spring, the effects of attachment-based interventions on maternal sensitivity and
CO: Families by Design. infant security. Journal of Child Psychology and Psychiatry, 36, 225–
Thompson, R. A. (1999). Early attachment and later development. In J. 248.
Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, re- van IJzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M. J.
search, and clinical applications (pp. 265–286). New York: Guilford (1999). Disorganized attachment in early childhood: Meta-analysis of
Press. precursors, concomitants, and sequelae. Development and Psychopa-
Thompson, R. A. (2001). Development in the first years of life. Future of thology, 11, 225–249.
Children, 11, 21–33. Weinfield, N. S., Sroufe, L. A., Egeland, B., & Carlson, E. A. (1999). The
van den Boom, D. C. (1988). Neonatal irritability and the development of nature of individual differences in infant– caregiver attachment. In J.
attachment: Observation and intervention. Unpublished doctoral disser- Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, re-
tation, Leiden University, Leiden, The Netherlands. search, and clinical applications (pp. 68 – 88). New York: Guilford
van den Boom, D. C. (1994). The influence of temperament and mothering Press.
on attachment and exploration: An experimental manipulation of sensi- Weinfield, N. S., Whaley, G. J. L., & Egeland, B. (2004). Continuity,
tive responsiveness among lower-class mothers with irritable infants. discontinuity, and coherence in attachment from infancy to late adoles-
Child Development, 65, 1457–1477. cence: Sequelae of organization and disorganization. Attachment &
van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Juffer, F. (2005). Human Development, 6, 73–97.
Why less is more: From the dodo bird verdict to evidence-based inter- Zeanah, C. H. (Ed.). (2000). Handbook of infant mental health (2nd ed.).
ventions on sensitivity and early attachments. In L. J. Berlin, Y. Ziv, New York: Guilford Press.
L. M. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early
attachments: Theory, research, intervention, and policy (pp. 297–312).
New York: Guilford Press. Received January 17, 2006
van IJzendoorn, M. H., Juffer, F., & Duyvesteyn, M. G. C. (1995). Revision received July 21, 2006
Breaking the intergenerational cycle of insecure attachment: A review of Accepted July 25, 2006 !

Call for Papers: Special Section on Suicide and Self-Harm Behaviors

The Journal of Consulting and Clinical Psychology is requesting submissions of empirical papers
that focus on suicide and self-harm behaviors, including non-suicidal self-injury. In particular,
submissions are requested that may address one of the following topics; (1) beyond the identifica-
tion of broad biopsychosocial risk factors, what are possible specific mechanisms that promote
self-harm behavior, and might be addressed in prevention/intervention efforts? (2) how might
cross-disciplinary theoretical perspectives (e.g., biological, interpersonal) be integrated to under-
stand or treat self-harm behavior? (3) what are some innovative methodological paradigms for
investigating self-harm behaviors? (4) randomized clinical trial data on preventions/ interventions
designed to reduce self-harm behavior. The papers must present original empirical findings. The
goal of this special section is to have a set of papers that represent the lifespan.
The deadline for submissions of manuscripts is February 1, 2007. Final editorial decisions will
be made by late 2007, with an anticipated publication date of early 2008. All submissions should
be entered through the main submission portal for the journal (www.apa.org/journals/ccp.html).
Authors should indicate in their accompanying cover letter that the paper is to be considered for the
special section on “suicide and self-harm.” All submitted papers must be in APA format and
conform to the all the guidelines for submission for JCCP (see www.apa.org/journals/ccp).
Questions or inquiries regarding the special section should be directed to the section editor, Mitch
Prinstein ([email protected]).

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