Implementation of attachment-based interventions in mental health and social welfare services: Therapist’s experiences from the Circle of Security-Virginia Family intervention

•Continued supervision or professional fellowships was imperative for implementation.•Lack of time and resources impeded therapist’s ability to perform COS-VF as intended.•It was important for implementation that COS-VF was valued within the organization.•Implementation was facilitated by having more than one therapist in a workplace. Closing the gap between attachment theory and clinical practice can be challenging. However, the developers of the original Circle of Security intervention have tried to do this as they developed their intervention. The Circle of Security-Virginia Family model is one version of Circle of Security that has been implemented across Norway. The aim of this study was to investigate the implementation of the Circle of Security-Virginia Family model intervention in mental health- and social welfare services. A mixed method approach was used to gain an in-depth understanding of the specific implementation factors that facilitate and/or inhibit the use of the intervention from the therapist’s perspective. There were 25 participants (5 male and 20 female), 3 of whom were also supervisors. Participants answered an online Implementation Component Questionnaire and took part in a semi-structured interview. The results suggested an overall impression that the intervention is demanding, but effective. The factors that inhibit the implementation of the intervention appear to be mostly out of the therapist’s hands because of political, organizational and administrative issues. These include therapists not being allocated enough time to do the work as intended, not receiving supervision and evaluations after ending the Circle of Security training, pressures to meet the system’s demands and lack of decision support systems. Factors that facilitated the implementation were, for instance, more than one Circle of Security-Virginia Family model therapist within the organization, sufficient time with the families in and between sessions, and the presence of some form of supervision and/or professional networks.