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Updated July 2014
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Training for Professionals: Therapists and Teachers

Standards for Certification as Reflective Network Therapy Teachers, Therapists and Senior Therapists/Certified Trainers. General Minimums for Certification. Criteria for Advanced Therapists and Researchers.

Certification in Reflective Network Therapy

Introduction:

CPHC provides onsite training, guidance and supervision for mental health professionals, in including: psychiatrists, psychotherapists, psychologists, social workers MFTs and teachers leading to Certification upon completion of course of study. Additional is often provided remotely using video conferencing. In general, we strive to train the therapist to attune and focus on a child’s interpersonal relationships and communication of here and now play, behavioral and emotional process, and to help the therapist and child mentalize that process. In addition to selected readings, the study of videotapes illustrating a spectrum of Reflective Network Therapy techniques is a unique and essential part of the training. Theses tapes are a valuable archive of briefings, debriefings, and full therapy sessions with individual children in the classroom which illustrate uses of a spectrum of dynamic techniques, children’s immediate responses, therapeutic turning points, and long term changes.

The Reflective Network Therapy Manual:

The replication manual provides a strong working knowledge of basic concepts, processes and procedures. Study of the manual will facilitate the training process and further clarify requirements and expectations for certification. During training, the therapist will be guided regarding his or her responsibility to provide clinical leadership of the classroom team. Candidates are further guided in their work by the Criteria for Judging the Existence of a Psychoanalytic Process.

Data Collection:

Certified Therapists will regularly provide their RNT Supervisors with standardized reports which capture data on child patients. This includes documentation of IQ changes, Mental Health Ratings in the form of CGAS score, and changes on the Child Autism Rating Scale. Tracking the number and frequency of child sessions and parent guidance sessions is also essential.

FAST TRACK FOR SENIOR THERAPIST CERTIFICATION 

How a new Cornerstone Site can be up and running quickly when a child psychoanalyst or Board Certified Child Psychiatrist becomes a local supervisor of in-classroom Reflective Network Therapy

If fast track certification is needed, training can be compressed in some locations –especially those with existing patient populations waiting to be served. Experience with four or more patients who receive a total of one hundred fifteen minute sessions of Reflective Network Therapy can lead an already well trained analyst or psychiatrist to certification as a Reflective Network Therapy supervisor. These quantities are equivalent to a half-time, five week long initial clinical immersion period which can result in immediate provisional certification as a Reflective Network Therapy Clinician/ Supervisor. The supervisor can then take prospective junior and mid-level RNT clinicians into training, multiplying the number of staff and greatly increasing the number of children served.

The rationale for this fast track training is that Reflective Network Therapy is derived from and builds upon both therapeutic education and child psychotherapy.  The most experienced and highly trained psychoanalytic therapists are encouraged to attempt the method and will usually require minimal training to get started doing independent work. After ten sessions of actual work being supervised by a trainer, the work will be self-instructing, with optional but desirable refresher supervision, once or twice a year.  

Thus, in a short time a Certified Senior Reflective Network Therapy clinician can learn the method and then become a supervisor of this form of very intensive psychotherapy. Certified child psychoanalysts and most experienced child psychiatrists have already learned to reliably conduct very intensive insight-oriented psychotherapies with preschoolers.  They have already much experience working with schools, and even more experience working with parents and collaterals.  They understand the technical problems of transference and countertransference, the value of supervision, and how to follow the effects of an interpretation. Therefore they can be expected to acquire skill in reflective psychotherapy methods much more quickly than less fully trained and experienced child therapists, and they can be certified quickly as trainers. 

Senior Reflective Network Therapy practitioners often are previously very experienced supervisors of intensive psychodynamic interpersonal therapy. They can be expected to transmit their understanding of the RNT experience to their own therapist-trainees after a hundred Reflective Network Therapy sessions have been conducted.

The ideal setting:  Those hundred sessions and ten supervisory sessions concerning the work can occur most easily when Reflective Network Therapy occurs in an already existing setting, with preschool patients already enrolled in a school or agency.  In some circumstances one could start out treating four children a day, work up to six or eight a day, average five sessions a day four days a week – or at least 20 brief sessions a week.  By treating children at that pace, perhaps in mornings only, a seasoned child analyst can perform a total of one hundred Reflective Network Therapy treatment sessions (of 15 or more minutes each) in five weeks.  During that five-week timeframe there will also be weekly conferences with teachers and each child’s family should be met with at least once for an hour.

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TRAINING STEP ONE: Initial training for therapists and teachers

A start-up weekend of training: This training is given by Gilbert Kliman, Linda Hirshfeld, Alicia Mallo, or a combination of senior therapists certified by The Children’s Psychological Health Center Inc. Training is videotape-based until the third day, when demonstrations are given with actual children in the real life setting of the new site. A site’s teacher is chosen to help do briefings and debriefings, and one of the training therapists does a demonstration with several children for a morning.  Discussion is then held in the afternoon, based on videotapes of the morning’s work.

Thereafter, a child analyst or child psychiatrist who has already previously treated at least two preschoolers in an intensive form of individual psychotherapy for more than a year can usually begin using the Reflective Network Therapy method.

TRAINING STEP TWO:  Reviewing actual work of the senior clinician

Ten videotaped sessions of the senior clinician’s own Reflective Network Therapy work should be reviewed during and as part of personal supervision. The review should be done by a therapist already trained in Reflective Network Therapy. That supervisor can certify whether the work is inclusive of and demonstrates reliable use of the basic techniques of Reflective Network Therapy, including successful use of interpretations and collaborative inclusion of material from teacher briefings. Some of the supervisory sessions can be by videoconferencing if videotapes are available in advance for the supervisor’s study.

 

Training Mid-Level or Junior Psychotherapists to Use Reflective Network Therapy

Psychotherapists, who lack certification in psychoanalysis but have had two preschool cases in long term intensive psychotherapy on an individual basis (three to five times a week for a couple of years per child) are often very effective in Reflective Network Therapy.  Some with even less experience have been effective.  Depending on prior levels of training, the junior and mid-level therapists will require more initial supervision than senior therapists such as analysts and Board Certified Child psychiatrists. Ideally they will receive at least 20 rather than ten supervised hours. 

After the weekend initial start-up training, the mid-level or junior therapist is likely to need some help understanding how powerful the intensive process is, how closely one must work with families, and how much teachers have to contribute to understanding of the children. Countertransference processes must be brought into awareness. That is particularly so if certification candidates have not been in an interpersonal treatment themselves, where their own defensive tendencies to avoid or disrupt intimacy has been dealt with.

 

General Minimums for Therapist Certification in Reflective Network Therapy

Quantity of sessions: To be certified a certified psychoanalyst or Board Certified Child Psychiatrist therapist should conduct one hundred individual treatment sessions of 15 or more minutes per child.  Four cases are needed, one of them on the autism spectrum. Others should conduct two hundred individual treatment sessions. At that point a preliminary certification will be issued. A satisfactory planned termination of a case will allow full therapist certification in Reflective Network Therapy when the other minimums are met.

Numbers of children:  At least four children including one child whose treatment is deemed satisfactorily completed case and whose treatment termination has been discussed with a supervisor.

Quantity of videotapings:  Ten satisfactory videotaped sessions should be approved by a supervisor, documenting work with at least four children.  One of the four children should be on the autism spectrum.  At least one child’s case should later be brought to successful planned termination, and the certificate finalized at that point. 

Therapist supervision of teachers:  At least ten hours of teacher-therapist conferences should have occurred and their contents discussed cogently with a supervisor as part of the overall supervision of cases.

Parent guidance sessions:  A therapist must have conducted 10 sessions and supervised teachers in at least 20 sessions. (Teachers are expected to conduct parent guidance sessions with each child’s parents 3 out of 4 weeks on an ongoing basis to make the network effect sufficiently powerful).

Substitution for videotapes:  In the absence of permission to videotape treatment sessions, two detailed case reports and an essay should be submitted for review by the supervisor, who should certify that the products show a grasp of basic features of the method including an understanding of transference and countertransference issues. Scientific reports and publications are encouraged and, at the discretion of a supervisor, may indicate readiness for certification before other standards are met.

 

Teacher Certification in Reflective Network Therapy

Head teachers must be licensed in their state or supervised by a state licensed teacher, and have training appropriate to the age levels of their pupils. Ideally, Special Education Certification is desirable for the head teacher.

Teacher Training will be conducted by CPHC certified senior staff. Teacher’s Roles and responsibilities are detailed in the Reflective Network Therapy Replication Manual.

Teachers will study of actual treatments by viewing selected RNT training DVDs. Explication and discussion of the content these DVDs will be facilitated by the CPHC certified trainer or supervisor. These DVDs demonstrate many aspects of technique essential for carrying out the method.

Teachers aiming at certification will provide videotapes of their work to their CPHC trainer for review, discussion and guidance. In-classroom video documentation should be made at least weekly.

Ongoing in-staff training includes periodic review of current treatments by the CPHC certified trainer which have been videotaped. The therapist supports and guides teachers to develop or deepen skills, achieve performance expectations and learn method techniques both explicitly and through modeling. Briefings and debriefings and working in tandem in the classroom provide opportunities for teacher training as do the weekly staff meetings.

Practice Required for Teacher Certification

In order to be eligible for Certification, a Teacher must complete at least one semester of supervised practice in a Cornerstone classroom with at least five children, two reaching a planned termination, at least one of the children being female, and at least one autistic or on the Pervasive Developmental Disorder spectrum.

 

A data coding option for advanced therapists and researchers: See Downloads below.

CRITERIA FOR JUDGING THE EXISTENCE OF A PSYCHOANALYTIC PROCESS -Gilbert Kliman, MD

 

The Criteria are divided into three category groupings:

 

   Group A: Criteria of Preparatory Phenomena (1-7 criteria to be considered)

   Group B: Criteria of Deepening Analysis (1-6 criteria to be considered)

   Group C: Criteria of Well Established Analysis (l‑24 criteria to be considered)

 

Please review Criteria Groups A, B and C below to familiarize yourself with the criteria. To facilitate indexing and research, advanced Cornerstone therapists, teachers and researchers should use this set of three criteria tables to record and report evidence-based observations in this Checklist. Routinely capture this information in progress notes or process notes -including relevant notes from parent conferences- and video transcripts by making notes on the source documents for reporting in this Checklist at a later date.

 

Annotate those source documents to show your degree of certainty that a criterion is present and to identify supporting evidence that a criterion is present: If a criterion is present, use the Letter of the Criteria Group (A, B or C) and the Number of the criterion being considered.

 

Examples: “A-3”would represent Group A, criterion 3; “C-17” would represent Criteria Group C, criterion 17. Annotate the material where you, the rater, found the criterion evident.

 

Also make a note of your degree of certainty that a particular criterion is satisfied in the material near supporting evidence found in that material using this shorthand:

0 = no evidence; 1 = slight evidence; 2 = moderate evidence; or 3 = strong evidence.

Finally, be prepared to date and source the material reviewed using the following shorthand:

 

         PN (Progress Note); VT (Video Transcript); T-P Teacher-Parent Conference; or Th-P (Therapist-Parent Conference)

 

Immediately following the three groupings of criteria for judging the existence of a psychanalytic process listed below is a link for downloading the same material in table format with appropriate columns for collecting the data as described above. The first page of the document reiterates these instructions and provides header space for identifications appropriate for this purpose. (Please povide coded IDs for child patients.)

 

GROUP A: CRITERIA OF PREPARATORY PHENOMENA

 

1. Child gives evidence of understanding the analyst's work is to help him with some emo­tional problem with which the child wants help.

 

2. Analyst's observation of child's interper­sonal action, when shared with the child, leads the child to talk with the analyst about his inner life more than earlier in the session, or leads to more communication through sublimative activities.

 

3. Child brings the analyst a fantasy, a dream, or a thought about current or past anxiety, guilt, symptom or problem.

 

4. Presence of transference phenomena; for ex­ample, affective reaction to analyst's arrival or departure, evidence of love or aggression toward the analyst in marked degree, curiosity about intimate details of analyst's life (unless such curiosity is widespread for the particular child under other circumstances also), slips, dreams, fantasies or play activities indicating linkage of analyst’s representation to mental contents regarding a major real life object.

 

5. Confrontation of patient with existence of a conflicted behavior or conflict related mental events leads to alteration of the scrutinized behavior or scrutinized expression of mental events.

 

6. Marked thematic continuity of child’s communi­cation from the previous session in a child whose behavior is not ordinarily stereotyped or thematically constricted.

 

7. There is a dialogue between analyst and patient about the patient's psychological functioning in any area.

 

GROUP B: CRITERIA OF DEEPENING ANALYSIS (1‑5)

 

1. Work on a dream leads to a day residue or expression of wish, memory, or affect not apparent earlier in the treatment; or leads to shared scrutiny of defenses or shared scrutiny of transference material.

 

2. The child responds to the analyst's interpre­tations with some elaboration on the theme which is contained within the interpretation or develops a new theme which casts light upon and provides further understanding of the psychological area with which the inter­pretation was concerned.

 

3. Interpretation of a resistance leads to freer communication.

 

4. Patient’s associations or play indicate some increased consciousness of relations between his current anxiety and elements o£ his per­sonal history.

 

5. Presence of transference neurotic phenomena.

 

6. A generalizing effect is noted in response to any interpretation. For example, if an in­terpretation about a child's con£1ict in re­gard to waiting to be fed has a beneficial effect on his waiting to be fed but also has a beneficial effect on his waiting in turn at games, tolerance for frustration of requests for non‑food supplies, or reduction of some other tolerance related problems, this would be regarded as evidence of a generalizing effect of an interpretation.

 

GROUP C: CRITERIA OF WELL ESTABLISHED ANALYSIS (l‑24)

 

1. Interpretation of conflict solution by defense of repression or reversal of affect leads to emergence of defended‑against affect.

 

2. Interpretation of conflict in which the de­fense is turning passive into active leads to dealing with the passive wish or memory of some related historical experience in play or verbal communication.

 

3. Interpretation of conflict in which denial is the defense leads to some dealing with the defended against impulse, affect or memory.

 

4. Interpretation of defensive avoidance leads to some dealing with the defended against perception.

 

5. Interpretation of repression leads to some uncovering of memories.

 

6. Interpretation of distortions of memory lead to some correction.

 

7. Interpretation of conflict solution through a regressive phenomenon leads to more age ­appropriate behavior or fantasy.

 

8. Interpretation of a premature progression leads to more age‑appropriate behavior or fantasy.

 

9. Interpretation of reaction‑formation leads to some expression of the defended against im­pulse in derivative or undisguised form.

 

10. Interpretation of projection leads to some recognition of impulse by the patient as his own.

 

11. Interpretation of isolation leads to some appropriate action or affect in regard to the experience or memory under analytic scrutiny.

 

12. Interpretation of undoing leads to some recognition of the original aim in discus­sion or expression of the impulse in a less defended form.

 

13. Interpretation of introjection leads to some reduction of manifestations of the intro­jected object or part object in fantasy, action, or character.

 

14. Interpretation of turning against the self leads to some turning toward the original object of impulse, or toward related objects.

 

15. Interpretation of developmentally inappropriate altruism leads to expression of the defended against impulse.

 

16. Interpretation of any defense leads to use of a less pathological form of defense.

 

17. Use of sublimation of any impulse follows in­terpretative work regarding any other defen­sive process concerning that impulse.

 

18. Interpretation of a conflict leads to some shift in the psychosexual theme of the pati­ent's communications; for example, from urethral theme to genital theme. The shift may be in either direction, progressive or regressive.

 

19. Patient develops understanding of relation be­tween transference and his feelings about major life objects; or interpretative work on transference phenomena leads to more adaptive relationship with a major life object.

 

20. Patient brings material about connection be­tween current object relations problems and past object relations problems.

 

21. Patient's associations or play indicate some increased consciousness of relations between his current anxiety and defense against current impulses.

 

22. Patient develops understanding or increased consciousness of relationship between his symptoms (or behavior problems) and symbolic representation of current or historical conflicts.

 

23. Alterations of character emerge in connection with interpretation and/or working through of insight; especially alterations which are psychosexually progressive and alterations which are in the direction of age‑appropriate­ness.

 

24. Alterations of character emerge in connection with interpretation and/or working through of insight with evidence of improved flexibility and resourcefulness of adaptation to existing social tasks, external frustrations and dis­charge opportunities.

 

Downloads:

 

Criteria for Judging the Existence of a Psychoanalytical Process - Instructions and Tables
 

Monthly Status Report and Statistical Tracking

Cumulative / Quarterly Report on IQ, CGAS and CARS Testing



For more information about Reflective Network Therapy training and certification programs: Contact us


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