Reflective Network Therapy In The Preschool Classroom

396 Pages·2011·3.116 MB·English

by  Gilbert Kliman

Reflective Network
Therapy in the
Preschool Classroom
Gilbert Kliman
Contributing editor Elissa Burian
UNIVERSITY PRESS OF AMERICA,® INC.
Lanham · Boulder · New York · Toronto · Plymouth, UK
http://avaxhome.ws/blogs/ChrisRedfield
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Copyright © 2011 by
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Printed in the United States of America
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Library of Congress Control Number: 2011929795
ISBN: 978-0-7618-5470-8 (paperback : alk. paper)
eISBN: 978-0-7618-5469-2
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Dedication
This book is written with love, to each of my own five children—Becky,
Amy, David, Steven and Jodie—who, during their childhoods, shared thou-
sands of reflective hours of often delicious and variously difficult conversa-
tions in the small social network of our family. My wife, Harriet Wolfe MD
and youngest daughter Becky have valiantly supported my labors on this task
for a decade. During that time, Dr. Wolfe took time from her psychoana-
lytic practice and administrative duties, giving her energies not only to the
Presidency of the San Francisco Psychoanalytic Institute, but also generously
contributing many hours of fruitful discussion about the reflective network
phenomena. She brought her considerable insight to her review of my writ-
ings and treatment videos. She helped found and served on the Board of
Directors of The Children’s Psychological Health Center, a nonprofit agency
which has supported Reflective Network Therapy activities. Jodie Kliman,
PhD, my oldest child, grew up with the Cornerstone preschool and its reflec-
tive network as if it were a sibling. Then, as an accomplished network and
family therapist herself, she helped edit this book.
Reflective Network Therapy has two forms. One is school based, and
this book harvests knowledge gained from RNT treatment of over 1500
preschoolers. The second form uses psychoanalytically informed guided ac-
tivity workbooks, including the manualized Personal Life History Book. In
the guided activity workbook form, the reflective network is community and
family based for children of all ages.
The present book only touches on knowledge gained while using the
simple derivative method which over the years has served more than 60,000
stressed or traumatized children of all ages, especially during natural disas-
ters. This book is about RNT’s daily school based work, in which children are
treated in the classroom by networks of parents, peers, therapists and teach-
ers. It is an introduction and guide for caring parents, educators and mental
health professionals, hoping they will take this knowledge and use it in real
life spaces. In-classroom use of Reflective Network Therapy can enhance
their own best efforts to heal and educate children.
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Contents
Tables and Figures vii
Preface ix
Acknowledgments xiii
Introduction xvii
Alexandra Harrison, MD
Part 1: Reflective Network Therapy: The Children It Helps
and How It Helps Them
1 New Hope for Children with Psychiatric and
Developmental Disorders 3
2 Welcome to a Reflective Network Therapy Classroom 34
3 Reflective Network Therapy: How-To-Do-It Manual for
Therapists, Teachers, and Parents 56
Gilbert Kliman, MD and Elissa Burian, MA
4 How I Recovered from Autism 115
Dorian Tenore-Bartilucci, Introduction and
Afterword by Gilbert Kliman, MD
5 An Aggressive, Cruel Boy Becomes an Empathic,
Socialized Learner 131
6 A Traumatized Child Emerges from Chaos 162
Thomas Lopez, PhD and Gilbert Kliman, MD
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vi Contents
7 Helping a Child with a Serious Emotional Disorder (SED) and
a Serious Physical Disorder 190
8 Bereaved Preschoolers with Serious Emotional
Disorders (SED) 209
Part 2: Benefits and Cost-Benefit Comparisons to
Other Methods: Theory of What Happens in
Reflective Network Therapy
9 Benefits and Cost Benefit Comparisons to Other Methods:
The RNT Advantage for Special Needs Preschoolers and the
People Who Care About Them 231
10 Theory of What Happens in Reflective Network Therapy 281
References and Suggested Readings 315
Appendix A Resources for Therapists, Teachers, Researchers,
Parents, Schools, and Mental Health Agencies 351
Appendix B Reflective Network Therapy Training and Certification 355
Appendix C Professional Participants 363
Appendix D The Children’s Psychological Health Center, Inc. 367
Index 369
About the Author 373
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Tables and Figures
Figure 1.1. A child’s drawing shows a fragile self-concept 24
Table 1.1. Prospective Study of Reflective Network Therapy in
Public School Special Education Class 31
Figure 2.1. A child’s drawing reflects fear, helplessness and
powerlessness… 52
Figure 2.2. Oscar’s drawings increasingly reflect his interest
in relating 54
Figure 3.1. Diagram of a therapeutic network scenario 64
Figure 3.2. Child tells therapist about his drawing of a
face without eyes: “That’s you!” 72
Figure 3.3. Drawing by a severely traumatized child… 76
Table 3.1. RNT: Typical Staff Time Per Week and Related Costs
for a 45 Week School Year 100
Table 3.2. Comparing Costs of Two Early Intervention Methods:
Staff Time and Salaries for Special
Education Enhancements 101
Table 3.3. Summary of an Autistic Child’s IQ Changes:
Oklahoma Case 107
Table 4.1. History of IQ Changes: Dorian Tenore-Bartilucci 128
Figure 5.1. Drawing: “Fighting rhino with a nose ring”… 150
Figure 7.1. Drawing: “Mickey Mouse with extra parts”… 198
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viii Tables and Figures
Table 9.1. Multi-site Study: IQ and CGAS Changes for RNT
Treated, IQ Testable, and IQ Re-tested children 237
Table 9.2. Multi-site Study: Control and Comparison IQ
Followed Children 238
Table 9.3. Multi-site Study: Summary of Findings 239
Table 9.4. Comparison of Early Intervention Methods:
Features and Benefits 254
Table 9.5. Intervention Comparison: Clinical Versatility 255
Table 9.6. Intervention Comparison: IQ Gains 255
Table 9.7. Intervention Comparison: Manualization
for Replication 256
Table 9.8. Intervention Comparison: Feasibility in a Variety
of Settings 256
Table 9.9. Comparing Costs of Two Early Intervention Methods:
Staff Time and Salaries for Special
Education Enhancements 260
Table 9.10. RNT: Typical Staff Time Per Week and Related
Costs for a 45 Week School Year 261
Table 9.11. IQ Gain Correlates with Total Number of
RNT Sessions 265
Table 9.12. Time and Costs to Achieve IQ and Global Mental
Health Gains 276
Table 9.13. Intervention Comparison: What Is Needed to
Raise IQ 277
Table 9.14. Summary Comparison of Advantageous Factors
among RNT, ABA, DIR/Floortime, TEACCH and
Pull-Out Therapy 278
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Preface
This book describes a remarkably effective school based treatment method
which harnesses small social networks for the good of seriously emotionally
disturbed (SED) preschool children and those with pervasive developmental
disorders (PDD or ASD). It explains the method to parents as well as teachers
and mental health workers who struggle to help disturbed or developmentally
disordered very young children, many of whom seem to have stopped loving
and learning. The contents come from testing the method’s feasibility with
hundreds of patients treated with Reflective Network Therapy in therapeutic
services and projects. The clinical value and testing results of the projects
took many years for me to fully appreciate. This book is not only a legacy of
my own forty five years of treatment work using this method. It is also the
legacy of dozens of colleagues who practiced the method and many hundreds
of parents who experienced its benefits for children treated in sites on two
continents. It is written at a time when few, if any, other methods for treat-
ing young children have shown as much versatility, safety and scientific
evidence of good outcome as has Reflective Network Therapy. If you, as a
professional educator, mental health clinician, or a well-read parent, are an
informed skeptic, you will notice differences between Reflective Network
Therapy and most forms of child psychotherapy. Unlike many interpersonal
psychotherapy methods, the RNT method described throughout this book has
a reasonably substantial evidence base. The method relies on about the same
number of subjects and a larger number of comparison and control cases as
the published IQ results of the most widely used comparable school based
method. It has been well tested for feasibility, replicability, IQ effects, as well
as children’s global mental health results (CGAS), and has been used in many
real life environments, classrooms and other therapeutic settings. It has been
replicated by many people other than its originators. The Reflective Network
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