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Updated April 2014
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The Method


Reflective Network Therapy (RNT) works well as an enrichment added to an ongoing special education service. It can also be a separate classroom service as has been done in San Mateo and San Francisco Unified School District (evidence-based results cited in Research/Results section). The method can work in a part-day or full-day preschool, daycare or serve as its own full-time preschool. Inclusion of a Reflective Network Therapy service for children into a larger public school special education class, Head Start, daycare center or similar agency is valuable in achieving a full mainstreaming of the patients the next year. Inclusion in a larger public school is a means for encouraging social growth of the RNT patients within the larger community. It helps de-stigmatize the psychiatric problems of young patients.

 

The method relies upon a reflective network and structured reflective processes.

  • Each child gets a short psychotherapy session in the classroom every day of class.
  • Individual therapy occurs in the midst of other child patients and classroom educational activity.
  • The child hears and sees others reflecting back what she or he is thinking, doing and feeling.
  • All comments about the child are made in the child's presence during network briefings and debriefings.
  • All children in the classroom can benefit from being witnesses to each other's therapy.
  • Children become calmer and more receptive to learning.

Reflective Network Therapy is a deliberately synergistic combination of in-classroom psychological treatment and education. Its techniques include individualized in-classroom psychodynamic psychotherapy for each child, briefings, debriefings, and parent guidance – all of which takes place within an early childhood educational process.

Early Childhood Intervention

Reflective Network Therapy is intended to be initiated early, during preschool and kindergarten, before the children start first grade, and before they may have been chronically ill for several years. Appropriate settings for  Reflective Network Therapy are any therapeutic preschool or public special education classroom, day care or a Head Start program which includes disturbed or developmentally disordered young children. The process can be continued for as long as it helps, but a typical useful time is one or two school years. Groups of RNT parents and children who started earlier have continued to find the method positive and productive in after-school groups well beyond preschool.

The children served are two to seven years old, in classrooms with small populations. Six to twelve children work best, usually with two teachers and a therapist for each six or eight children. The adults include one head teacher and one teacher’s aide as well as one therapist. Parents are often in the classroom and are welcome for however long the parent’s presence promotes the child’s use of the process.

One Child At A Time

Emphasis is on how we reflect on one child at a time with multiple participants thinking, feeling and speaking about the child’s inner and outer world within a flexible framework which is easily individualized to each child’s needs. Each child hears directly from the network of helping adults what they think and understand about what is happening in his behavior and play. The child is encouraged to participate in these conversations which are structured around the natural events of the classroom in specific ways, including joint adult-child briefings and debriefings on a daily basis. Intersubjective reflections organize and semantically encode each participant’s theory of the child's own mind and to some extent of the minds of all the others in the classroom. The child’s classroom peers are a part of this network. Everything happens in the real life space of the classroom, and takes advantage of what comes up between and among the children both as educational and therapeutic opportunities for growth.

Each child is a pupil as well as a diagnosed patient, treated with parental permission and with the cooperation of his public or private school or day care center. He or she has a psychotherapy session every day of school, usually at least three times a week, right in the classroom, for 15-20 minutes. The brief psychotherapy sessions go on within the classroom in the midst of classroom educational activities of all kinds. Psychotherapy sessions are witnessed, shared and inwardly or outwardly reflected on by everyone in the classroom, right in the real life space of the classroom using the material and behavior which arises naturally in this setting.

Briefings and Debriefings

Before a child has a session in which he is the therapist’s focus (or index patient) the teacher and child brief the therapist about what the child and family have been doing. The child is encouraged to be an active participant and his or her parents participate when they are present. They might speak about any new events in the child’s life and any current behaviors or immediate expressions that the child may have just made. The adults might comment on an interaction just observed between the child and other children in the class. After the 15-20 minutes of individual therapy, the child and therapist close the session by a debriefing, telling the teacher together about the contents of the session. If other children show interest, they can participate in all aspects of an index child's session, provided they allow that child to lead the play and talk.

In a reflective network, information (about behavior, expressed fantasies, perceived feelings, significant events and therapeutic themes) is all communicated among all adult and child persons in the classroom as well as shared with the child. Thus, each person can view the child through a rich set of social lenses and mirrors of other persons’ views. The child can come to perceive him or herself as richly understood in an empathic fashion by teachers, parents and therapist, and importantly, by other children.

Everyone in the network shares reflections. The child becomes a member of the reflective team on his own behalf. The team’s reflections are produced on the spot during Reflective Network Therapy's structured and unstructured educational activities, during individual therapy sessions, and during hundreds of briefings and debriefings about what has been going on with the child to which the child is not only privy but in which the child also participates. A complex network of therapeutic interactions is followed throughout the classroom day. These interactions exercise the child’s emotional and underlying brain processes, leading to mental health improvements and cognitive development.

Parents and Teachers

Parents are especially encouraged to be in the classroom during the early weeks of a child’s treatment. Parents regularly receive a 45 minute guidance session in private with the head or assistant teacher each week. This guidance conference includes the opportunity to give and get feedback about the child’s current behaviors and preoccupations. Parents also benefit greatly from the support of at least one monthly guidance session with the therapist.

The teachers and therapists meet as a group for 90 minutes each week, often viewing a recent videotape of their work, and always sharing the teachers' many hours of classroom behavioral observation. The teachers greatly amplify the knowledge the therapist gains in the daily therapy sessions. Similarly, the constant daily briefings before in-classroom individual therapy sessions immediately augment the therapist’s access to important themes and behaviors based on the teachers’ observations. The content of the therapy sessions varies as greatly as the individual children vary. Content may include a full range of psychoanalytically useful material such as talk, play, fantasies, dreams, interpersonal dramas, art work, interpretations and responses. The content may be quite simple and barren at first, among children who are primitive in their development at the time therapy starts.

Please use the red links at the top of this page (subsections of The Method section)                                                          for more information about how the method works.

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