training for Professionals: Therapists and Teachers

Therapist Certification

in Reflective Network Therapy, The Cornerstone Method

CPHC’s certified senior staff provides remote and onsite training, guidance and supervision for training and service in the practice of The Cornerstone Method of Reflective Network Therapy for mental health professionals, in including: psychiatrists, psychotherapists, psychologists, social workers and MFTs leading to Certification upon completion of course of study. Professionals learn to use Reflective Network Therapy with child patients who are also students in their inclusive classrooms which may be public school special education classrooms, public or private preschools or therapeutic preschools or other settings which provide a mental health component in an educational program designed for children between the ages of two and seven. 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, CPHC supports new therapists with the following toold and procedures for training:

A strong working knowledge of basic concepts, processes and procedures as extensively detailed in the Reflective Network Therapy Replication Manual. Study of that manual will facilitate the training process. Requirements and expectations for a Reflective Network Therapist are set forth in the Replication Manual (see it in Early Childhood Psychotherapy In the Preschool Classroom: The Cornerstone Method of Reflective Network Therapy, (Kliman, G., © 2008). 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.

An introductory two-day seminar in Reflective Network Therapy is taught by Cornerstone therapists who have significant successful experience applying the method. A Cornerstone training seminar covers several diagnostic categories of treated children, the work of several different teams, and illustrates adaptation of the method to different physical and administrative types of sites.

Studying training videotapes that illustrate a spectrum of RNT techniques is a unique and essential part of the training. These videotapes are selectively made available only to credentialed mental health and educational professionals and to interns and students who sign a binding Confidentiality Agreement.) 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.

Continuing Supervision and Expectations

Continuing supervision by an RNT therapist for the first year is based on conferences, often using videotapes provided to the supervisor showing at least 10 videotaped hours of actual work performed by the trainee. The therapist will be reviewed and guided to perform periodic assessment and record keeping. Therapists or non-treating consultants who are psychologists will assess children’s progress according to established standards and will contribute to outcome studies, and follow-up studies. These include WPPSI IQ testing, CGAS, Childhood Autism Rating Scale, and other tools.

Minimally, a therapist will keep a problem/symptom checklist and rate changes quarterly. Specimen checklists will be provided by the trainer. A therapist or intake work should make a baseline diagnosis including DSM IV axis 5 rating (Children’s Global Assessment Score) based on parental history and the therapist’s or evaluator’s child behavioral observations. Maximally, an extremely well trained psychodynamic or psychoanalytic therapist may keep a Hampstead Profile, which is a complex description of many psychological functions (A. Freud, 1962; (Nagera 1963) on each child, as well as quarterly clinical summaries containing a problem/symptom checklist with ratings of change, and a consideration of changes in object relations (e.g., from narcissistic to altruistic), ego functions (e.g., degree of reality testing, which defenses are used and which predominate), superego functions, psychosexual theme levels, and transference processes. At the Center for Preventive Psychiatry, abbreviated Hampstead Profiles were designed and used (Kliman, 1972, unpublished, available on request)

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. In addition, routine tracking of the number and frequency of child sessions and Parent Guidance sessions is essential.

Practice Required for Therapist Certification

In order to be eligible for Certification, a Therapist needs 200 hours of supervised practice in the 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.

Teacher Certification in Reflective Network Therapy, The Cornerstone Method

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 facilitating CPHC certified trainer or supervisor. These DVDs demonstrate many aspects of technique essential for carrying out the method.

The trainee 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.

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A data coding option

for advanced therapists and researchers:

CRITERIA FOR JUDGING THE EXISTENCE OF A PSYCHOANALYTIC PROCESS

Gilbert Kliman, M.D.

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.

Click here to download a PDF copy of this data collection form

Contact the CPHC office to request an editable Word copy.