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Home arrow Research
Updated April 2014

Research and Results

Please note that earlier names used for the method (The Cornerstone Therapeutic Preschool Method or The Cornerstone Method) are interchangeable with the current name: Reflective Network Therapy.

Reflective Network Therapy has passed some important and scientific study thresholds. These include service feasibility, prospective, consecutive, controlled and comparison treatment research.

Feasibility.  Reflective Network Therapy can be carried out in settings as varied as day care centers, private therapeutic nurseries, mental health clinics, Head Start projects and homeless shelter classrooms and in public school special education classes.

Prospective. Reflective Network Therapy has been studied by forward-looking studies of outcomes, as well as and in contrast to backward-looking studies of archives.

Consecutive. A study of outcome included a series of children with no omissions. 

Controlled. A study included reasonably well matched untreated same age, race and gender children with the same diagnoses in the same school system.

Comparison treatment. Results with RNT-treated children were compared with results with children given other treatments, such as supportive-expressive group therapy, and individual psychotherapy.  

Two other factors we hope to gain support for are random assignment and further verification of cost benefits based on random assignments.  We plan to randomly assign and have independent study of our outcomes versus other methods such as ABA, Floortime, Psychopharmacologic, and regular special education.   

Replicability is another factor necessary in scientifically based therapies. Our replication manual  is a vital tool for further replication.  Also essential for replication are the use of training videos and observation.  Ongoing laboratories for training in the technique --(Ann Martin Center near Oakland, California, Wellspring Family Services in Seattle, at the University City Children's Center of St. Louis, MO and in Cornerstone Argentina in Buenos Aires and an innovative application of Reflective Network Therapy directed by Alexandra Harrison, MD, Assistant Clinical Professor in Psychiatry at Harvard Medical School in Cambridge, MA.)-- supplement archives of training and research videos from our older New York and California projects .

Psychologists will readily recognize the importance of significant gains among RNT-treated children’s IQ scores, as these measures usually change very little over time. After decades of studying Reflective Network Therapy and its feasibility in various settings, we are convinced that extraordinary IQ gains will continue to be produced and this measure will remain robust in other settings as Reflective Network Therapy is more widely used. 

The easily and objectively measured increase in the standardized intelligence quotients of so many RNT-treated children is compelling in its statistical proof of one of the good effects of Reflective Network Therapy. Usually an individual’s IQ test varies by only a few points when it is repeated after a patient is treated by other methods (Siegel 1986). Thus, our results showing IQ growth resulting from treating children with Reflective Network Therapy are generally surprising.  But they are even more surprising sources for therapeutic optimism about children with severe developmental disorders on the autism spectrum. One study discussed in Reflective Network Therapy in the Preschool Classroom (Kliman, G., © 2011) deals with 10 out of 10 such children (an uninterrupted series) all of whom benefited.  Our overall follow-up group of 58 children, including those ten could simply not be predicted to grow this much in their intelligence. 

To support research, training, and therapeutic education scholarships for needy children, click here to make a tax deductible donation.

Graphs and charts concerning our results

In this section, data concerning our evidence-based method is presented with brief explanations.  

Multi-Site Study of REFLECTIVE NETWORK THERAPY Results: Twice-Tested Children

The meta-analysis [statistical assembly of an accumulation of comparable studies] of data collected over a forty year span now leads us to state that Reflective Network Therapy is an evidence-based method.  Thanks are due to Michael Acree, Ph.D., of San Francisco for this meta-analytic statistical analysis.  It shows the results are extremely unlikely to be due to chance.  The statistical significance is better than a P= .001 level. Reflective Network Therapy has passed many scientific evaluation thresholds: manualization, replicability, feasibility in multiple settings (day care, therapeutic nursery, public special education, homeless shelters), use by many teams other than the original team, use by many therapists other than the original therapist, effectiveness in another language in another culture, blind study, controlled and comparison study.  RNT been delivered very effectively to preschool children with Pervasive Developmental Disorders, as well as to other diagnostic categories of serious emotional disturbances. It works in public school special education preschool classes as well as in a mental health agency.

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Prospective Study of Reflective Network Therapy in a Public School 

Objective raters (defined as professionals who were not involved in any of the children’s treatment) found an average IQ increase of one to two standard deviations. 

That translates to an increase of 14 to 28 points on full-scale IQ scores. This IQ rise occurred only among children treated with Reflective Network Therapy (RNT). No IQ rise occurred at all among the children with similar disorders treated with other methods and no IQ rise occurred among the untreated control children. 

All of the RNT-treated children with Pervasive Developmental Disorder whose IQ’s were tested twice showed show an IQ rise upon retesting. At this writing, only one of the entire population of 63 twice-tested children, no matter what the diagnosis, failed to show an IQ rise upon retesting. 
 

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IQ RISES IN CHILDREN WITH PERVASIVE DEVELOPMENTAL DISORDERS

The IQ rise benefits of Reflective Network Therapy are particularly significant in light of a large literature showing the stability of IQ. It is not generally found in psychological studies of intelligence that children’s IQ’s change much over time. A recent study of 41 preschool children with PDD including childhood autism shows that when treated with “eclectic” means such as medication, behavioral management, and speech therapy, their IQ is stable, and developmental quotient also does not rise (Jonsdottir et al 2006). This contrasts with Reflective Network Therapy outcomes and provides a robust comparison group. 
 
Reflective Network Therapy's IQ gains have been sustained over decades as shown in anecdotal follow-ups. See Dorian Tenore-Bartilucci's personal account of recovery from autism in this book for an example of this phenomenon documented by periodic testing and follow up over thirty years: Reflective Network Therapy In the Preschool Classroom, Chapter 4, Kliman, G. © 2011.

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IQ Gain Correlates with Number of Reflective Network Therapy Sessions

The graph below shows the IQ gains over time from twice-tested children and points out the direct correlation between the number of Reflective Network Therapy sessions and rises in IQ, highlighting the RNT advantage in this regard. 
 
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Financial Feasibility OF REFLECTIVE NETWORK THERAPY in a Public School in terms of Staff Time

The table below includes start up costs for implementing Reflective Network Therapy in public schools, including training.

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Cost Effectiveness OF REFLECTIVE NETWORK THERAPY as Special Education Enhancement

Reflective Network Therapy has been successfully tested in more highly varied educational and community based group settings than has the Lovaas method using one-on-one behavioral aides: public school special education classrooms, preschools, mental health clinics, private therapeutic preschools, homeless shelters, day care centers, Head Starts and has been successful in another culture. Reflective Network Therapy is successful for children on the autism spectrum as well as for children having a full range of emotional and developmental disorders, while Lovaas is primarily viewed as a therapeutic response to ASD. Mental health and cognitive gains are produced faster by the RNT method which reduces the treatment timeline and therefore the extension of all costs.

Reflective Network Therapy eliminates the necessity for one on one aides in the classroom who have been previously assigned, and accordingly lowers the associated costs. Additional reduction of expenses for staff: (a) The RNT method eliminates the costs of pull-out therapy; (b) Reflective network therapy achieves results using only 15-20 minutes per classroom day of professional psychoanalytic therapist time with each child; and, the cost of individual psychoanalytic in-classroom therapy is included in the calculated cost savings. The chart includes start up costs for implementing Reflective Network Therapy in public schools, including training. 
 
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TWO YEAR REPORT FROM CORNERSTONE ARGENTINA: AN APPLICATION OF PSYCHOANALYSIS IN PRESCHOOL EDUCATION
 
By ALICIA MALLO ASMAN, MD, Psychoanalyst, Infant and Adolescent Psychiatrist, Full Member of the IPA

Since April 2004 I have been managing the Cornerstone Argentina interdisciplinary program along lines designed in the United States by Gilbert Kliman, MD, using the method of Reflective Network Therapy.

This experience takes place inside a regular school building in Buenos Aires, Argentina. The Cornerstone Argentina project in Buenos Aires is a model application of psychoanalysis responding to a community need: the treatment of severely disturbed preschoolers by an analytically orchestrated network.  The treatment includes a synergistic combination of in-classroom analytic psychotherapy, classroom education, and analytically informed parent guidance and family psychotherapy. 

Highly disturbed or developmentally delayed preschoolers are generally not adequately treated by education or therapy alone, especially in public educational settings. This project aims to help preschoolers from 2 to 6 years old suffering from severe psychopathologies. The interventions are based on appropriate psychoanalytically informed knowledge of every child, the group and their families. Our objective is to help the children recognize themselves as individuals within a group and to integrate them into the regular education system. The children from this program join children from other classrooms and share activities such as: cooking, music, self-expression through movement, outdoor play and artistic activities.

The interdisciplinary project requires the intervention of a team that consists of: a head teacher, an assistant teacher, a psychoanalyst, a family psychotherapist and the participations of consultants such as a pediatrician, child neurologist, an educational psychologist, a social worker, a speech therapist and other related specialists. Video-documentation is a regular occurrence. I have been training more than ten Argentine therapists in the method. Argentine newspapers and magazines such as Elle are following the project, which has also received television attention.

This type of intervention consists of:

1) Psychotherapeutic, educational, and interdisciplinary intervention in a special classroom of a regular nursery school. The intervention is based on the application of the knowledge of psychoanalysis and educational psychology. Individual sessions are held four times a week. 

2) Gradual child integration within the remaining classrooms, both individually and as a group with an assistant teacher.

3) Weekly parent guidance, monthly parent conferences, and family therapy.

4) Weekly supervision of the team with videotaped material of the children, and interdisciplinary network.

5) Consultation with the Medical Director Gilbert Kliman of the Children's Psychological Health centre in San Francisco, USA.

6) Making of a life history book for individual children.

7) Multi-axial Assessment Scale (CGAS) and educational-psychological follow up with WPPSI and C.A.R.S testing.

Why at school?

A human being becomes human together with another human being. The natural course is that a child grows up surrounded by other children. Providing a healthy environment and the exchange with other children turns out to be therapeutic and tend to the integration of the child with himself and with the others.  Regarding this issue Freud said   "Spending a good deal of time with other children clearly forms part of a child's normal development" in Analysis of a Phobia in a Five-year-old Boy. S. Freud. (1909).

Parents play a leading role in this project, participating in parent guidance sessions and family sessions.  The whole early intervention method is tailored to the individuality of each child and his family.

Most of the children referred have received the diagnosis of Pervasive Developmental Disorders, autistic spectrum disorder, or PDD NOS.  These psychiatric categories are described in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV. The diagnoses are characterized by severe and pervasive impairment in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests and activities.

Ten professionals receiving varying degrees of training in Reflective Network Therapy and two teachers were trained.

I have been delivering lectures about Reflective Network Therapy at several scientific institutions, like the Buenos Aires Psychoanalytical Association, the Argentine Pediatrician Society, the Buenos Aires University (Psychology Department), the Argentine Psychiatric Association and several public Hospitals.  I also lectured at international scientific events including the International Psychoanalytic Congress in Rio de Janeiro and the Mar del Plata International Psychiatric Congress, both in 2005. I made a film showing follow ups of our patients. With the Reflective Network Therapy team we wrote papers about the development of this method in the culture of Buenos Aires, Argentina.  About 450 pages of English publications on Reflective Network Therapy are also being translated into Spanish.

Clinical progress is being documented by CGAS scores and digital video tape recording.  Samples of children before and after periods of treatment are available.  Several reports have already been made, using such videos and written information to Gilbert Kliman, M.D.

The task has been very difficult because the children's disorders are extremely severe.   Thanks to the application of psychoanalysis and Reflective Network Therapy, we have consistently been able to obtain a positive outcome.  In order to carry out this method properly we found it was very important to work closely and thoughtfully parents as well as with an interdisciplinary team.  We supervise the professionals in their classroom and parent guidance work, and confer as a team every week with a deep level of theoretical and clinical discussion. 

ALICIA MALLO ASMAN, MD    

CORNERSTONE ARGENTINA OUTCOME DATA 

Eleven out of twelve children treated at Cornerstone Argentina using Reflective Network Therapy showed significant improvement in emotional health upon retesting.  

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The Childhood Autism Rating Scale is used to test children 2+ years old. Cornerstone Argentina results indicate a consistent reduction of autistic symptoms for children treated using Reflective Network Therapy.

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CORNERSTONE ARGENTINA Mental Health Improvements: Further Results

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RNT-Treated Patients, Cornerstone Argentina - 2008 classroom group: preliminary data

As is the case with the following grouping, a high proportion of the children treated at Cornerstone Argentina are very severely autistic. 

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It is rare to see a child with a subnormal IQ climb into the normal range with any other treatment method we know of. This result is also showing up in Cornerstone Argentina where most of the children treated with Reflective Network Therapy are severely autistic. The chart below shows one child’s IQ scores climbed into the normal range from the retarded range.

MENTAL HEALTH GAINS IN ONE YEAR

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CUMULATIVE DATA:  IQ RISES, MENTAL HEALTH IMRPOVEMENTS, DECREASES OF AUTISM SYMPTOMS

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For more about Cornerstone Argentina as well as several U.S. service sites, see: Affiliated Service Sites

Research REGARDING EFFECTIVENESS OF A  rEFLECTIVE NETWORK THERAPY DERIVATIVE: PSYCHOANALYTICALLY INFORMED GUIDED ACTIVITY WORKBOOKS FOR SPECIAL APPLICATIONS

A series of Guided Activity Workbooks developed by CPHC helps parents, teachers, therapists and disaster relief responders working with children and families traumatized by natural  or man made disasters. These resources are derivatives of Reflective Network Therapy designed to provide psycholotgical first aid.

DOWNLOAD:

1. Papers by Gilbert Kliman, MD and Independent Findings

2. Psychosocial Support to Conflict-Affected Children in Gaza 

   2009 Evaluation, UKaid and Mercy Corps, Queen Margaret University, Edinburgh

3. Helping Children Heal Project: A School Based Mental Health Recovery Effort

Tulane University School of Medicine, Mercy Corps and The Children's Psychological Health Center: A collaboration designed to test reduction of PTSD symptoms among middle school children displaced by hurricanes using a specialized CPHC guided activity workbook: 2006 preliminary results.

HELPING CHILDREN HEAL PROJECT                                                                                                                            by Lawrence L., Viron M., Johnson J..E., Hudkins A., Samples G. and Kliman G.   

TULANE UNIVERSITY SCHOOL OF MEDICINE: Reporting Reduction In Symptoms of Post-Traumatic Stress Disorder in Middle School Children: Displaced Victims of Hurricane Katrina Using Psychoanalytically Informed Guided Activity Workbooks Developed by The Children’s Psychological Health Center

ABSTRACT:  A School-based Mental Health Recovery Effort

OBJECTIVE: On Monday, August 29th, Hurricane Katrina made landfall in New Orleans, causing extensive destruction and widespread flooding. The objective of this study was to decrease Post Traumatic symptoms in 6th – 8th grade children  attending New Orleans West (NOW), School  based in Houston, TX exclusively for children displaced from New Orleans. The student population is 100% African-American, the majority of whom were from impoverished areas of New Orleans; areas that were widely devastated by Katrina.

METHOD: The University of California at Los Angeles Child Post-Traumatic Stress Disorder Reaction Index (PTSD-RI) was administrated to the children prior to beginning work on the Hurricane Workbook and after approximately three months of working with the workbooks. My Personal Story About Hurricanes Katrina and Rita: A Guided Activity Workbook for Children by Gilbert Kliman, et al. was given to each child who worked on it for 30 minutes weekly for approximately three months.

RESULTS: For grades 6-8), post-traumatic stress symptom level scores declined compared with pre-assessment scores. See charts below.

SUMMARY:   My Personal Story About Hurricanes Katrina and Rita appears to have contributed to decreasing  PTSD symptom factors in 6th – 8th graders post-Hurricane Katrina. 

For the entire middle school (6-8), compared with earlier in the year (Nov.-Jan), the post-traumatic symptom level scores declined 18.75%, from a median of 32 to 26. This reduction was statistically significant (p=.0001). The intervention being monitored was the use of the Guided Activity Workbooks developed by The Children’s Psychological Health Center, Hurricane workbooks, but obviously, other factors such as classroom and home environment, counseling groups, individual support from teachers and family, and the passage of time all likely contributed to the reduction in symptom levels. For the entire middle school (6-8), statistically significant reductions were observed in the responses to assessment questions. An increase was noted in the response to the question “Do things make you think it might happen again?” (p=.0349)

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For the 6th grade, compared with earlier in the year (Nov-Jan), post traumatic symptom level scores declined 25% from a medial of 32 to 24. This reduction was statistically significant (p=.0719). The intervention being monitored was the use of the Hurricane workbooks, but obviously, other factors such as classroom and home environment, counseling groups, individual support from teachers and family, and the passage of time all likely contributed to the reduction in symptom levels. For the 6th grade statistically significant reductions were observed in the responses to assessment questions.

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For the 7th grade, compared with earlier in the year (Nov.-Jan.), post traumatic symptom level scores declined 18.75% from a medial of 32 to 26.  This reduction was statistically significant (p=.0719). The intervention being monitored was the use of the Hurricane workbooks, but obviously, other factors such as classroom and home environment, counseling groups, individual support from teachers and family, and the passage of time all likely contributed to the reduction in symptom levels. For the 7th grade statistically significant reductions were observed in the responses to assessment questions.

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For the 8th grade, compared with earlier in the year (Nov.-Jan.), post traumatic symptom level scores declined 18.75% from a medial of 32 to 26.  This reduction was statistically significant (p=.0008). The intervention being monitored was the use of the Hurricane workbooks, but obviously, other factors such as classroom and home environment, counseling groups, individual support from teachers and family, and the passage of time all likely contributed to the reduction in symptom levels.For the 8th grade statistically significant reductions were observed in the responses to  assessment questions.

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Research Forms for Use by Affiliated Service Sites

DOWNLOAD:

1. Monthly Status Report and Statistical Tracking

2. Cumulative / Quarterly Report on IQ, CGAS and CARS Testing

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

 

 
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