On Saturday and Sunday, June 2 and 3, The Cambridge Ellis School hosted a training on treating autistic spectrum and other children with serious dysregulation syndromes in the preschool classrooms. The training was led by Dr. Gil Kliman, the recipient of many awards, including an International Prize for “World’s best book concerning the well-being and nurture of children”. Dr. Kliman has worked intensively with preschool children for over forty years and has developed a method for treating seriously troubled children in their own world – their preschool classroom. It is called, “The Cornerstone Method”, or “Reflective Network Therapy”. I was honored to assist him in this important training.
Those attending the conference included the Director of the preschool, Jenifer Dempko, many teachers from the school, several fellows from the U Mass Boston Parent-Infant Mental Health Certificate Program, a psychoanalyst and a preschool teacher from New Jersey, a psychoanalyst from Michigan, and a group of day care providers and some supervisors from Catholic Charities from the Boston area.
Reflective Network Therapy (RNT), carried out in the classroom by a collaboration of individual therapist, preschool teacher, peers, and parents, is I think the treatment of choice for psychologically troubled preschoolers. The therapy occurs in multiple short (15-20 minute) sessions, four or five times a week, and these sessions are optimally designed to help the children make sense of their otherwise chaotic and frightening worlds “on the spot”, making it an essentially practical therapeutic modality.
In addition, Kliman has done something very unusual in the field of child mental health: he has conducted scientific studies to test the efficacy of the method. In addition to the anecdotal evidence that child mental health practitioners usually put forth to support their methodologies, Kliman has data to demonstrate its effectiveness, including improvement in IQ scores, an unintended but very welcome result of the study. The method is shown to be a remarkable “cost-effective” treatment for young children with severe mental conditions – autistic spectrum disorders, pervasive developmental disorders, trauma, behavior disorder, and other serious emotional disorders. I would add disorganized attachment to the list, in keeping with Kliman’s in-classman work with a series of thirty foster children and his studies of guided activity workbooks for children in disaster areas.
In the RNT work that I have done, I have aimed to help the child understand his world through a particular use of play and language. The play is based on psychoanalytic play therapy and attempts to improve both the developmental competency of pretend play, and also the capacity to make meaning through elaborating potential symbolic themes (such as “good guys” and “bad guys” representing what the child perceives as the “good” and the “bad” parts of himself and of his parents). The language makes links between the child’s inner world of intentions, thoughts, and feelings and his own behavior, plus the outside world of other people. The RNT method uses repetition to keep the elements of meaning in awareness long enough to allow the child to attend to them and to begin to reflect on them. For this aspect of the method, the presence of others in the child’s environment is crucial. The collaboration of peers, teachers, and parents, is a critical piece of the work.
In my work with children in the classroom, I as the therapist make use of the group of peers and the teachers to elaborate a simple narrative linking behaviors to inner affective experience. This vital communication begins with the “briefing” of the parents to the teacher at the beginning of the school day to fill her in on what has happened to the child since she last saw him. Then there is the briefing of the therapist by the teacher when the therapist comes for her session with the child. Finally, there is the de-briefing of the teacher by the therapist at the end of the therapy session and a de-briefing of the parent by the teacher at the end of the day. This chance for multiple iterations of the communication, displaced slightly to other listeners away from the target child, allows the child to consider the message (multiple times) while minimizing the stress of social engagement and without having to shut down his emerging reflective capacity. Often the peers contribute variations of meaning in their own words as part of a growing meaning about something that happened.
One time a little girl on the autistic spectrum I was treating took a bucket that a group of boys were playing with on the playground, seemingly oblivious to anything but her own compelling desire for the bucket. When the boys loudly objected, she was stunned. I had begun to tell the story to the teacher, when one little boy said, “Maybe she didn’t know it had a treasure in it.” A second boy said, “Yeah, maybe she thought it was just a bucket.” A third boy chimed in, “Maybe she didn’t know we were using it.” As I watched the little girl take in these various communications from her classmates – simple, short verbalizations from her peers – I began to see in her face a dawning of awareness about what she had done and what had been going on. In the acceptance and tolerance generated by the children and scaffolded by the adult caregivers, the little girl found the safety to consider what she had done, and why she had done it, and even what she might have done towards a better result, all without fear and shame.
In the first day of the training, Dr. Kliman showed us many videos. In one of them a little boy, Lonny, had withdrawn in anger after another boy had “wrecked” his tea party. After the essential briefing by the teacher, Dr. Kliman approached the boy. Getting down to his level where was hiding under the table, Dr. Kliman began to sing a song about a ruined tea party, with many verses about what had happened and how the party had been spoiled by the uninvited intrusion of the other boy. Lonny, an autistic spectrum disorder (ASD) child who was prone to aggressive outbursts, began to calm. By the end of the play, the offending child was welcomed into the tea party.
The day was filled with fascinating videos of children in treatment in the classroom. Another child was very agitated because of having witnessed domestic violence at home, including having seen his father throw a cup of scalding coffee in his mother’s face that morning. Despite his dysreguation, he was engaged by the therapist, with his teacher’s help, and finally began to build towers that seemed to represent houses that were “unsafe”, kept falling down. After a while of continuing to build structures with the therapist and a peer, the structures became increasingly solid, representing the safety the child could experience when he felt acknowledged and understood.
The training was designed as the first step in creating a school within a school at Cambridge Ellis (CES), a therapeutic learning experience for children who need special help, within the already enriched preschool environment. Next year we will begin a pilot program in which I will treat several children who have been identified as needing special help, using the Cornerstone Method. I am excited to be able to treat children who are struggling in what I consider the optimal setting – their own natural world, in the company of their wonderful peers and their talented teachers, with many chances to bring their parents into the process.
I would like to emphasize as well that a program such as this benefits the entire school. All the children will learn more about emotions and how they influence behavior. They will all refine their capacity for reciprocity, for compassion, and for self-reflection. These critical developmental competencies will be practiced more often in a RNT classroom.
In addition, I am counting on the fact that the contributions of a child psychoanalyst who has spent her career learning about the inner life of children and helping them make sense of themselves and their worlds using that knowledge, can be supportive and vitalizing to teachers who have learned so much about children from another perspective and who are so good at communication with them. It seems to me to be a natural match. And if we bring parents more closely and respectfully into the mix and provide for them ways of better understanding their own children, we will be providing the best possible environment for young learning.
Gilbert Kliman, Contributing Editor Elissa Burian, Reflective Network Therapy int he Preschool Classroom, University Lanham, MD, Press of America, 2011.
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