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Home arrow The Method arrow IQ Gains/History
Updated July 2014

About the Name of the Method  / Cognitive Gains – IQ Results  /  Origins and History of the Method 

A brief history of the evolution from “The Cornerstone Therapeutic Preschool Method” (The Cornerstone Method) to the more precise term: Reflective Network Therapy

 

Reflective Network Therapy has been widely practiced in therapeutic preschools by Kliman and his colleagues for more than four decades with over 1500 children treated by over 22 teams. Originally developed by Kliman in New York at The Center for Preventive Psychiatry, the method was first dubbed "The Cornerstone Therapeutic Preschool Method". The name “Cornerstone” was originally used to convey “building” the foundations of personality. The first publication using the term "Cornerstone Method" was Kliman, G. (1968) Psychological Emergencies of Childhood, Grune and Stratton, NY. Over the years, it has often been referred to as “The Cornerstone Method” or simply “Cornerstone” by practitioners and in earlier published scientific papers. Dr. Kliman devised the method and began using it with teachers in White Plains New York in 1965, giving emotional support and preventive guidance to parent-bereaved families with very young children and another kind of orphan: foster children.   

 

The phenomenon of children getting intellectually brighter as well as mentally healthier with an in-classroom combination of education and psychotherapy proved to have psychometrically measurable beneficial effects. As the method was applied to children with psychiatric disorders and severe cognitive delays, it soon became clear that traumatized children and children with developmental disorders similarly benefited rapidly.

 

After the method’s forty-four years of evolution and its increasing emphasis on how a network of others cares about, reflects on and responds to each child’s thoughts and emotions, with that child and with each other in the child’s presence, the name "Reflective Network Therapy" became preferred by our newer therapeutic teams. 

 

The name change also avoids confusion with numerous religious schools which have since sprung up, calling themselves "Cornerstone Schools." Thus, for several reasons, we have transitioned to the more precise term: Reflective Network Therapy.

Throughout this website, any instances of the use of the earlier terms: “Cornerstone” and The Cornerstone Therapeutic Preschool Method”  should be considered interchangeable with Reflective Network Therapy. Applied in multiple classroom settings by over twenty teams of teachers and therapists around the country, the essential techniques of the method were ultimately manualized. 

Cognitive Gains – IQ Results

Reflective Network Therapy in the Preschool Classroom, Kliman, G. © 2011 − Excerpt

The phenomenon of children getting intellectually brighter as well as mentally healthier with an in-classroom combination of education and psychotherapy began to emerge into my awareness when working in Cornerstone classrooms, around 1965.  At first it did not occur to me that there was a psychometrically measurable effect.  Christopher Heinicke (1966), working with child in Los Angeles, had published an anecdotal report of  an IQ effect a year earlier among four young children treated four times a week, but did not give a description of a replicable methodology or a quantitative account of the IQ gains. Headstart programs had shown IQ gains (summarized by Zigler 1979)  The Lovaas method’s important findings of IQ rises among autistic children had not yet come along (Lovaas 1987). (See chapter 9 of Reflective Network Therapy In the Preschool Classroom, G. Kliman, 2011 for cost-benefit detail and other advantages of Cornerstone over Lovaas treatment.) It was to be decades before The Wisconsin Early Autism Project (2006), demonstrated that thousands of hours with the Lovaas method over a period of four years produces IQ gains similar to those of much briefer Cornerstone in classroom psychotherapy treatment. Cornerstone treatment regularly produces such results in as little as 8 months, using 15-20 minutes therapy sessions.  We have found some therapists were effective using two long sessions a week, but most had to work three to five times a week. In contrast, a much larger number of professional hours is needed using Behavioral Modification methods to obtain similar IQ effects. In that regard, the Wisconsin Lovaas’ method data is summarized in the following abstract:

Twenty-four children with autism were randomly assigned to a clinic-directed group, replicating the parameters of the early intensive behavioral treatment developed at UCLA, or to a parent-directed group that received intensive hours but less supervision by equally well-trained supervisors. Outcome after 4 years of treatment, including cognitive, language, adaptive, social, and academic measures, was similar for both groups. After combining groups, we found that 48% of all children showed rapid learning, achieved average post-treatment scores, and at age 7, were succeeding in regular education classrooms. Treatment outcome was best predicted by pretreatment imitation, language, and social responsiveness. These results are consistent with those reported by Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993).

Twenty years after the method’s invention  in 1965 and following initial publications about Cornerstone treatment (Kliman, 1968, 1970), Stanley Greenspan’s excellent “floortime” method of bringing resistant children into affectionate emotional contact came along (Greenspan 1992). When floortime did come into wider use, it was not considering rises of IQ as one of the outcomes.  In fact, that is not surprising.  It is quite possible that “floortime” is producing effects which it is not measuring, (as may be the case with other interpersonal therapies.  The Cornerstone Method’s effect on growth of intelligence, which my psychological colleagues measure by Stanford Binet and Wechsler Preschool Scale of Intelligence IQ tests, started in our Cornerstone nursery school without our noticing the regularity of this result.  It happened right under our eyes, almost immediately after we founded the first school in White Plains, New York. In the first class, a mute three year old boy with autism began to speak.  Others just seemed smarter, but we didn’t start measuring them with IQ tests for another year or two.  The regularity of IQ growth as formally measured by psychologists using Stanford Binet and Wechsler Preschool Scale of Intelligence tests was clear enough by 1970 that I assigned psychology interns the task of giving IQ tests regularly to Cornerstone children. In 1974 I began presenting preliminary reports on the IQs of the first 12 twice-tested children.  They all showed significant IQ growth. In 1976 I designed and in 1978 I implemented a generously funded NIMH study at the same Center, including in the design and actual project the IQ testing and retesting of the majority of 104 consecutive foster children.  They are now included as a comparison group in statistical consideration of outcomes with the Cornerstone twice tested children.

Curiously, the reasons for the intern’s testings and my presentations themselves, as well as the IQ testing of most of the 104 foster children in the project supported by the NIMH grant on foster care all were largely forgotten by the White Plains staff during a traumatic time.  This was when I became disabled by a severe physical illness and about the same time our Educational Director (Doris Gorin) developed a fatal carcinoma.  The staff was psychologically devastated  But my associates, Arthur Zelman, Shirley Samuels and David Abrams continued working on aspects of the Cornerstone project and rediscovered the 12 cases on which I reported and 40 more twice-tested children at the same Center (Zelman 1996, 1999). They renewed and extended my research with deep considerations of variables related to IQ rise.  Fortunately, remarkable intellectual growth of Cornerstone children seen in New York is still happening regularly among our child patients in California and Argentina. Every one of the children in Cornerstone’s twice-tested follow up series has shown the IQ rise effect.  There have been no exceptions so far, although we are sure there will be.  The shortest testing follow ups are eight months and the longest has been nine years.  Clinical follow-ups of earlier Cornerstone work sometimes span as long as 30 and 37 years.  In IQ follow up studies, over sixty children who were treated at the same Cornerstone sites, often by the same staffs, and six children in an untreated public special education control group showed no IQ rise.  Unlike the Cornerstone children, some children in the comparison group had declines of IQ.

We originally created the Cornerstone therapeutic preschool as a way to help children who had experienced the death of a parent.  The idea was to create an educational and therapeutic service dedicated to giving emotional support and preventive guidance to bereaved families with very young children. We also began working with another kind of orphan --foster children (the subject of a whole chapter in this book). Soon many other children with differing neurotic and behavioral problems, stressful or traumatizing life experiences and family troubles came as well. 

We were often impressed with how rapidly and measurably some of the children grew, both emotionally and intellectually, in Cornerstone’s early years. Responding to an early publication of mine (Kliman, 1970), Anna Freud (1969) made an editorial comment that the child described in my paper had an unusually adult way of expressing himself (Newman 1969).  She was so skeptical about the accuracy with which we quoted the child’s vocabulary that were particularly pleased with an event which occurred shortly thereafter.  The child’s grateful grandfather donated a video recorder so that we could begin highly objective documentation.  In retrospect, I think Anna Freud was noticing in my account (Kliman 1970) the unlikely (but nonetheless actual) growth of a particular child’s intelligence and development.  After a few more years, similarly striking growth would become regularly and objectively noted in series of children (Zelman et al 1996, 1999, Diaz Hope 1999, Kliman 2006). as described in later chapters.

Ultimately, instead of retrospectively using The Center for Preventive Psychiatry’s archives, a deliberately prospective (forward-looking) study was designed by Miquela Diaz Hope (1999), who did so in a California public school special education setting and found very strong rise of Wechsler Preschool Scale of Intelligence IQ among ten consecutive Cornerstone treated children, but not among 9 control and comparison children. Similar effects are continuing to be observed at the Ann Martin Center in Piedmont, California and at Cornerstone Argentina in Buenos Aires.

Origins and History of the Method

Dr. Kliman devised the Cornerstone Method and first began using it with teachers Doris Gorin Ronald and Florence Herzog in a suburb of New York in 1965.  His interests were in combining physiological and interpersonal psychiatry, for the benefit of children. He already had an interest in neurophysiology, had published on stress hormones (Kliman 1953), and made some presentations about an autistic child to Margaret Mahler, while a trainee in child psychiatry.  Marianne Kris was then his supervisor in child analysis, as he was a student himself, at The New York Psychoanalytic Institute.  She was very encouraging, and voluntarily contributed two hundred supervisory hours to the project between 1965 and 1967, particularly helping him tell her about and receive her feedback about his first discovery (Kliman 1970) – that a real psychodynamic and psychoanalytic process was occurring, in a very unusual setting – the children’s real life school.  She, together with Peter Neubauer, Mary O’Neal Hawkins, and Al Solnit, formed a Foundation for Research in Preventive Psychiatry, of which they were trustees.  They helped start a flow of funding, resulting in over 50 grants which have supported the projects. Soon a nonprofit agency was formed, which was supported in part by contracts with The Westchester County Community Mental Health Board and the Dept. of Mental Hygiene of New York State.

Over the ensuing forty years more than 1,400 children of diverse ethnic and socioeconomic communities have been treated and educated using the Cornerstone Method. Research colleagues and Dr. Kliman have begun to systematically follow up the results and now have twice-tested over 56 of those children for IQ They have performed IQ follow ups on a larger number of control (completely untreated) and comparison (otherwise treated) children; [Zelman, 1996, Diaz Hope 1999, Kliman 2006].  The research data provide a strong confirmation of the favorable experiences of therapists, educators, and parents in multiple Cornerstone projects and sites. The data includes not only many emotionally disturbed children but also children with developmental disorders – especially mild to moderate autism spectrum disorders. In Dr. Kliman’s career of practicing psychotherapy and psychoanalysis with individual children and their families over more than four decades, Cornerstone has been an outstandingly successful method. His best outcomes in several diagnostic categories have been among young Cornerstone patients. There have been some failures, especially among children who were so totally emotionally unrelated and nonverbal that they could not play at all.  But for those children who are related enough to ultimately take IQ tests and who remain available for follow-up assessments, lasting and remarkable successes have been documented. These successes include preschoolers with the very difficult problems of severe anxiety due to trauma, and the interpersonally avoidant children who suffer from autism spectrum disorders.

Cornerstone’s outcome studies should give some cheer and encouragement to the hundreds of thousands of families, teachers, and therapists trying to help very young children in need of mental health services. 

 
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