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Updated July 2014

What is Our Mission?

 

The Children’s Psychological Health Center (CPHC) is dedicated to healing the hearts and minds of children suffering from autism spectrum disorders, developmental disorders and serious emotional disturbances. We do this through a leading edge treatment called Reflective Network Therapy (RNT) −a social network therapy that enlists those closest to the children, including family members, teachers, and therapists as allies in the treatment process. Children are treated in classroom environments and in communities stricken by natural disasters. Children treated by RNT achieve improved mental health, greater empathic capacity, improved social skills and cognitive gains and are helped to fulfill their human potential.

 

What is Reflective Network Therapy?

Reflective Network Therapy is an evidence-based psychological treatment method for harnessing the power of small social networks in real life spaces such as schools and shelters. It is individualized to help traumatized young children as well as those with mild to moderate psychiatric and autism spectrum disorders.
 
 
Reflective Network Therapy (RNT) depends on a structured sequence of reflection and empathy developing activities carried out by a therapist, teachers, children’s peers and available family members who assemble on behalf of a child. The reflective and empathic activities are focused on one child at a time. The method enables individual troubled children to become the treatment focus of a small social group of peers and adults for brief periods. The group tries to nurture, think about, understand, attune with, engage, communicate with, heal and develop the child.  RNT has one child patient after another as a therapist’s or caregiver’s focus for periods of 15 to 30 minutes at a time, often in an actual classroom in which educational activities are also conducted. This treatment can be done daily when orchestrated by a therapist in a classroom group. It often is performed in a therapeutic preschool where the class is filled with pupils and their teachers, who meet daily. The method helps children deal with a variety of psychiatric problems – and is measurably helpful not only to traumatized patients but also to many youngsters who are on the autism spectrum.

Reflective Network Therapy – Basic Practices

 
Reflective Network Therapy is practiced with a variety of patients in a preschool or special education day class. RNT is usually aimed at treating children’s existing disorders.  From three to twelve patients can be in the treatment classroom group, each receiving that reflective focus in sequence for about a quarter of an hour at a time.  Each child is usually each focused on in turn as the index patient.  Most interpretations and interventions are made to the individual child, but the educational and sometimes the psychodynamic activities often include group interventions within the classroom.  As the patients are usually very young children, parents are present for the first few days or weeks and also have guidance sessions. The group is led by a psychotherapist. Others help, and teachers conduct regular classroom activities. Peers observe and with the index patient’s permission, can participate collaboratively in the index child’s work.  The psychotherapist tries to engage, attune with and interpret the communications of each patient, but almost entirely one child at a time. The method can be practiced with very young children in their real life spaces, such as with their preschool teachers, peers and parents. Before each child’s session the teacher briefs the child and therapist right in the classroom about what has been going on in the child’s life and classroom work. After each session the psychotherapist and child in turn debrief  the teacher concerning the contents of their work.  For detailed information about how the method works, including excerpts from the Reflective Network Therapy manual, see The Method section and its subsections.

Synergy between In-Classroom Psychological Treatment and Preschool Education   

 
When used in a therapeutic preschool classroom, Reflective Network Therapy creates a powerful synergy between in-classroom psychological treatment and inclusive preschool education. It has been widely applied, with measurable success, for seriously emotionally disturbed and/or pervasively developmentally disordered young children, two to seven years old. It is usually practiced in a classroom, right in the midst of preschool educational classroom activities. There a psychodynamically trained therapist intensely focuses on and attunes to each child in turn. During that attunement, the therapist tactfully verbalizes his or her reflections about the child’s feelings and behavior, especially the therapist’s thoughts about what the child is doing and thinking in the here and now of the classroom.

Overcoming Resistance to Learning and Socialization

Children’s resistances to education, refusal of affection, and inhibited or inappropriate socialization are interpreted on the spot. Teachers, parents and the therapist touch base during daily short briefings with and about each child in the classroom.  Parents are given weekly conferences in private, where they get support and share insights. The network on which the method depends is comprised of a classroom team of parents, child pupils who are patients, their classroom teachers and a classroom therapist. The interactive and reflective network is dynamically engaged with each child, one at a time in the classroom, every day the class meets. Parents have guidance and information sharing sessions in an office near the classroom, usually with a teacher who works with their child. Once a month, parents meet with the psychotherapist.

Measurable Outcomes of Reflective Network Therapy

Measurable results include substantial gains of IQ, improved relational skills, positive behavioral changes and rise of CGAS (DSM IV Children’s Global Assessment Scale). Learning becomes based in part on intensive exercising of positive self-perceptions experienced through in-classroom and team-guided family relationships. The term network also takes into account respect for the value of an interdisciplinary and multi-generational team. A child’s treatment situation is deliberately designed to support the child with a reflective network of adult helpers. The therapist, teachers and parents provide interactive emotional mirroring reflections for and with the child, right in the real life classroom space. Rather than focusing on whether the child’s behavior is socially acceptable or on task, this method quickly generates social attunements, internal rewards, motivation for social and cognitive tasks and develops skills which are emotionally positively charged by interpersonal transactions. Behavior also improves as a byproduct of this process as the child develops a “theory of the minds of others” from the frequent verbalized reflections about what he is feeling, doing and might be thinking.

Reflective Network Therapy is Different from other Treatment Methods

In other methods, children are treated psychodynamically and individually but in no other manualized method does intensive psychotherapy by a psychodynamically trained psychotherapist take place exclusively within the learning and play activities of their actual school classroom groups. With Reflective Network Therapy, no pull-out therapy is involved. The child is simply not removed from the classroom. The child’s interpersonal relational problems with parents and other children that come up in the moment are seen in the real life space of the classroom. Here and now problems can be addressed therapeutically in the immediacy of the moment.

The Method is Manualized and has a Long History of Success

 
This method is manualized (Kliman and Burian, 2011) and seems to works very well in the hands of a variety of practitioners and in a variety of settings. It has been most documented in therapeutic preschool groups, where it has been systematically practiced since 1965 (Kliman, 1968, 1970). At first it was an experimental application of child analysis in a therapeutic classroom, intended for bereaved children. It turned out to be useful for homeless children, other traumatized children and for many preschoolers on the autism spectrum. About 1,500 children have been treated by over 20 different teams. Five sites are now in operation, in various forms of affiliation with The Children’s Psychological Health Center. Each current site is now collecting outcome data concerning the phenomenon of IQ rise as well as CGAS gains. Among the approximately 40% of preschool patients seen with autism spectrum disorders at the various reporting sites, IQ gains are being found regularly and Childhood Autism Rating Scores are also improving reliably. There is public health significance to this method, since its costs are approximately one sixth that of the most widely used preschool method for treating preschoolers on the autism spectrum – the Applied Behavioral Analysis method (Kliman and Burian, 2011). At present we are considering in-classroom applications of Reflective Network Therapy for disturbed children beyond the preschool level.

Reducing Children’s Psychological Damages after Catastrophic Events

In mass disasters there are special applications of Reflective Network Therapy which reduce children’s psychological damages. During catastrophic events or in their aftermath, Reflective Network Therapy can be done in a shelter, school, family or caring facility for trauma impacted children of any age. In such situations, RNT is done using guided activity workbooks. The workbooks are designed to help a group assembled to support a stressed child’s autobiographical work. The guided activity workbook method of Reflective Network Therapy is often disaster focused or foster placement focused. This method is preventive for childhood post-traumatic stress disorder, rather than an effort to heal and develop a chronically disturbed child with an already existing and diagnosed disorder. Problems of debriefing, which some research shows can be overly trauma-focused, are dealt with by the broad autobiographical focus of our workbooks. They allow for reflection on the child’s entire life, including traumatic events.

Our agency’s numerous guided activity workbooks encourage the healing of traumatized children by recruitment of small social networks to assist the children in filling out their personal histories. As a treatment method, the use of these resources has been manualized, studied and proven to improve important aspects of behavior and mental health. The child’s personal feeling of being in control and sense of personal history are enhanced. Our agency has developed guided activity workbooks as responses to placement in foster care, the 1989 Loma Prieta Earthquake, the 9/11 Attack on America, Hurricanes Katrina and Rita, the Sichuan Earthquake, middle eastern terrorism and wars, the Haiti Earthquake and other natural disasters. Free downloads of our workbooks are in the Guided Activity Workbooks section of this website.

Evolution from “The Cornerstone Therapeutic Preschool Method” to Reflective Network Therapy

To learn about the history and development of Reflective Network Therapy, see IQ Gains/History. Reflective Network Therapy was originally called "The Cornerstone Therapeutic Preschool Method”  and was often referred to simply as the "Cornerstone Method." The more precise and current  name Reflective Network Therapy is interchangeable with any use of earlier terms such as "Cornerstone" that may be found on this website.

Gilbert Kliman, MD, Medical Director,The Children's Psychological Health Center, Inc., Distinguished Life Fellow of the American Psychiatric Association and Board of Psychiatry and Neurology, Life Fellow and Diplomate of the American Academy of Child and Adolescent Psychiatry, Certified Psychoanalyst for Children, Adolescents and Adults, American Psychoanalytic Association
 
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