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News: Cornerstone Service and Research CRISIS RESPONSE FOR THE SICHUAN EARTHQUAKE —The work of Gilbert Kliman M.D. by David Trimble, Ph.D. —Netletter http://netletter.se/node/89 I want to share with you the exciting work that Gilbert Kliman, M.D. has been doing. A child psychoanalyst, he has been very interested in the network approach. He renamed his preventive preschool program, originally called Cornerstone, "reflective network therapy." Reflective network therapy weaves together a network of preschool children, many of them with serious mental health problems, their families, and their teachers, to form a healing community. The therapist, usually a child psychoanalyst, conducts play therapy in the classroom over the course of the school day, with the other children and the teachers observing and sometimes participating. After the therapy session, the analyst and child report on the session to the teacher, again in the middle of regular classroom activity. I enjoy how it uses both networks and reflective functions. His workbook approach to help children cope with traumatic stress of the disaster relies heavily on natural helping networks for its implementation, and the text itself stresses for the child the importance of drawing on network supports. Guided Activity Workbook for Children and Teens Traumatized by Hurricanes My Story About the Hurricane is the latest Guided Activity Workbook developed by The Children’s Psychological Health Center for helping children and teenagers learn and thrive after a disaster. The workbook uses very simple language to create a safe, structured way for children and teenagers to express their memories and fears. Ideas are presented like open ended questions. Children are encouraged to think about positive experiences and identify good memories too. Spaces for creating drawings about specific experiences help children learn to recognize and how to think about their own feelings and to think about how others feel. The workbook is prefaced by a Guide for Parents and Teachers with advice for using the workbook with children of different ages and describes some of the many ways the illustrations in this book may help. This book is written for families whose children need a good tool to help empower children to learn, to cope, and to heal from the trauma of a natural disaster and to grow.The workbook includes special focus on aftermaths such as floods and tornados and includes an updated Mental Health Checklist to help parents, teachers, and caregivers identify children who might need more help. The use of psychoanalytically informed Guided Activity Workbooks shows children that honestly facing the disaster is supported rather than avoided. The child's personal feeling of being in control and sense of personal history are enhanced. The psychological benefits of promoting the child’s understanding of shared experience can be powerful. A guided activity workbook allows adults to use their natural tuning in and empathy, so families and caregivers may provide psychological as well as physical nurture to children in the aftermath of natural disasters. -Gilbert Kliman, MD
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CPHC provides Psychological First Aid to Traumatized Earthquake Survivors in CHINA June-July 2008 Download My Sichuan Earthquake Story in English. Download the Mandarin translation. With the second printing of My Sichuan Earthquake Story in Mandarin, 35,000 copies of CPHC's fast tracked Guided Activity Workbook for children traumatized by the May 12th earthquake and aftermath events have been distributed during the month of June. Griff Samples of Mercy Corps expects the third printing to at least double that amount for distribution. Mercy Corps reported to CPHC that 592 volunteers have received training in China to work with children using CPHC’s culturally vetted Guided Activity Workbook as of July 30, 2008. With the conservative estimate that each trained participant works with 30 children, at least 17,760 children benefit immediately from training in this Cornerstone-derivative method provided to volunteers and professionals. We expect this number will increase as training is shared, more trainees are identified and distribution continues to expand.  Two agencies entered into a remarkable collaboration with The Children’s Psychological Health Center to translate and distribute tens of thousands of copies of a psychoanalytically informed guided activity workbook for traumatized children who survived the May 12th earthquake and aftermath events in China. China American Psychoanalytic Alliance (www,capachina.org) guided by CAPA President, Elise Snyder, MD, working with our medical director, Gilbert Kliman, MD, galvanized translators and artists to provide a culturally vetted adaptation of an earlier version of “My Earthquake Story” which Dr. Kliman greatly expanded and modified to fit the special needs and issues identified. Mercy Corps (www.mercycorps.org) under the guidance of Griffen Samples, Senior Technical Advisor, Comfort for Kids entered into an agreement with CPHC to spearhead distribution. A Coincidence Leads to Collaboration On May 3, 2008 Gilbert Kliman M.D. had the honor of addressing the first joint meeting of The American College of Psychoanalysts and The American Academy of Psychoanalysis and Psychodynamic Psychiatry, in Washington D.C. Elise Snyder MD, President of the ACP heard Dr. Kliman present a Unifying New Theory of Posttraumatic Stress Disorder, which drew on his experience with thousands of traumatized children over a 55 year period of his child psychiatric practice, individual trauma and mass psychological first aid research. Dr. Snyder noted the very high enthusiasm of the audience, and invited Dr. Kliman to participate in her activities with the China America Psychoanalytic Alliance (CAPA). CAPA is a non-profit organization of about 100 American psychoanalysts and psychotherapists dedicated to providing psychoanalyses, psychotherapies, supervision and training to mental health professionals in the Peoples' Republic of China. Fast Track Process Provides Disaster Relief Nine days later when the Sichuan earthquake struck, Gilbert Kliman responded to a request by Elise Snyder for help in this enormous disaster. He began preparing a mental health resource for translation into Mandarin by CAPA. He formed it as a workbook using his China-congenial emphasis on social networks to help children heal, and his Columbia University Department of Child Psychiatry creation of a manualized workbook for traumatized children entering foster homes. He also used his San Francisco earthquake experience and his prior collaboration with Mercy Corps in storm disasters. Dr. Snyder was meanwhile working on training large numbers of mental health workers to respond to the disaster. Dr. Kliman then suggested the three organizations -- The Children's Psychological Health Center, Inc., China America Psychoanalytic Alliance, and Mercy Corps all offer to collaborate with the People's Republic Government and help all children possible with a practical form of psychological first aid. Griffen Samples of Mercy Corps had already successfully led a response to disastrously huge storms, collaborating with Dr. Kliman and the Children's Psychological Health Center in 2005 and 2006. The Sichuan Earthquake response thus took on a previously successful form, which had been tested by Tulane’s Dept. of Psychiatry. The workbook needed extensive revision for the cultural, linguistic and disaster circumstances. |  |
The participants labored and communicated on the internet with little sleep until May 30th, through over twelve drafts, when a mutually accepted version was created. Speed of creation, translation and distribution was important for delivering rapid first aid, when many psychological wounds could still be kept from becoming long term disorder. It was hoped that Chinese love and thoughtfulness for children, and emphasis on the healing power of social networks would make this supportive and reflective network activity particularly valuable for Sichuan children in their historically immense time of psychological need. Mercy Corps Helps Ensure Support for CPHC’s Guided Activity Workbook in China Mercy Corps was instrumental in obtaining a foreword for the Mandarin edition written by Zhang Kan, Dean of the Research Institute of Psychology, Chinese Academy of Sciences, Counselor of the Chinese Psychology Association. This foreword states, in part: “The Sichuan Earthquake in China in May 12, 2008 has caused great loss to the affiliated areas, and has brought with it tremendous trauma to the local residents physically, materially and psychologically… Now the large scale of life-saving has entered its closure, and this campaign against earthquake and alleviating its aftermath has entered a new stage of reconstruction after the catastrophe. It doesn't take long for people to realize that the work of reconstruction bears an even harder task and still sees a long way ahead. The experience gained from the past effort against earthquake has shown that of all the reconstruction works, psychological reconstruction is the most difficult, and in particular, psychological reconstruction among the children. This is because children are still in the process of psychological development and are more vulnerable to psychological traumas. Meanwhile, we are lacking a certain coping mechanism. It is shown from psychological researches that it is a great difficulty to scientifically and effectively communicate with affected children. The book is particularly aimed at the psychological reconstruction among the children, and has seen its efficacy in helping the psychological reconstruction of people after earthquakes in the U.S. It is my belief that the publication and use of this book can provide a scientific and convenient tool for the Chinese psychological experts, teachers and parents to help the children rebuild their psychology. This is more than a blessing to us." Zhang Kan, 6/6/2008 from Beijing Summary of Training for mental health professionals, teachers and volunteers now using the Mandarin translation of our guided activity workbook (Cornerstone derivative method) with children and families in China (trainings completed as of July 30, 2008):
Donate to support scholarships for Cornerstone treatment of children in need, to support research and training and to help underwrite disaster relief efforts such as these. Special Honor for CPHC Medical Director at an Historic Meeting Washington DC 
The first joint scientific meeting of the American College of Psychoanalysts and the American Academy of Psychoanalysis and Psychodynamic Psychiatry was held May 3, 2008 at the JW Marriot in Washington DC. The first speaker selected to address this historic meeting was our own agency's Medical Director, Gilbert Kliman, MD. Kliman's lecture to over 200 colleagues was entitled "A UNIFYING THEORY OF PTSD – VIDEOTAPED PHENOMENOLOGIC AND INTERVENTION EVIDENCE." The enthusiastic response of Dr. Kliman's peers regarding the clinical and theoretical value of his original insights was very gratifying to the Children’s Psychological Health Center. We are particularly pleased because we have worked so hard to support the services to children and accumulate the information about trauma on which he based his talk. Below is a sample of the comments we received. Discussant Clarice Kestenbaum, MD, Professor of Psychiatry, Columbia University College of hysicians and Surgeons, Department of Child Psychiatry, a highly published child psychiatrist and psychoanalyst with several decades practice and teaching experience: “This is a remarkable, original, important as well as immense body of work on psychological trauma. In preparing to lead this discussion, I had the privilege and advantage of reading Kliman’s theory in essay form, and read it over three times. I did so because of its extraordinary exercise Kliman conducted in comprising a field of great complexity, ranging through evolutionary, neuroscience, and even chaos theory, as well as his review of a huge relevant psychological and psychoanalytic literature. The essay contains an enormous amount of thinking which time did not permit Dr. Kliman to cover today, such as his very important original research observations on memory changes with trauma and the hundreds of other scientific projects which he has considered and summarized. I especially appreciated the exquisite detail in his video interviews, further examples of which I had the privilege of seeing in greater fullness than he could present today. He further showed you a very carefully conducted treatment work based on his theory. His emphasis on the detailed use of reflective networks in the Cornerstone method and narrative therapy, as in his guided activity workbooks, in overcoming behavioral traumatic memory is very important. I have known his work in such narrative therapies since he sent me his 9/11 workbook, “My Personal Story about the Attack on America”. There is so much of value in this essay that I hope he will now turn it into a book.” David Mintz, MD: “Learning about Kliman’s truly profound New Theory of PTSD, I felt a sudden change in myself and my thinking about psychiatry. It was a Copernican moment, comparable to hearing Copernicus say the earth revolves around the sun rather than conversely. Kliman’s view that this set of danger reactions is evolutionarily produced and has value to the gene pool turned my thinking around with a flash of clinically relevant insight. Here the species is benefiting from the burdens of an individual. It makes me think of applications to other disorders, and wonder whether he is considering other disorders in an evolutionary light as well.” Course: Psychological Trauma in Childhood – Gilbert Kliman, MD More than a dozen advanced child psychotherapy students attended this course at the Child Development Program of the San Francisco Center for Psychoanalysis. They were Doctors of Psychology, Doctoral students, Marriage and Family Therapists and Social Workers. Attendees gave “outstanding” reviews of the course on childhood trauma taught by our Medical Director, Gilbert Kliman, MD at the San Francisco Center for Psychoanalysis in San Francisco on March 12 and March 19, 2008. Much of the material presented is available to professionally qualified viewers of this site. Discussion was based on videotaped diagnostic interviews of highly traumatized children and videotaped treatment archives. The latter were from The Cornerstone Method of Reflected Network Therapy. Videos from CPHC archives illustrated the phenomenon of iconic memory, where traumatized children symbolically re-enact devastating trauma. A DVD of treatment sessions demonstrated not only well understood cognitive and emotional problems associated with Post-Traumatic Stress Syndrome, but also demonstrated Cornerstone techniques which reduce PTSD symptoms. Materials used in this course included a paper recently selected for presentation by Dr. Kliman in Washington DC on May 3, 2008 at the 39th annual meeting of The American College of Psychoanalysts. This will be the first joint meeting of two psychoanalytic societies: The American College of Psychoanalysts and The American Association for Medical Psychoanalysts. Interested mental health professionals may obtain a CD containing a draft of this study, “Toward a Unifying New Theory of Posttraumatic Stress Disorder” by sending an email request from the Contacts page of our website. DVDs used in this course will be made available to qualified professionals who make request by submitting a binding Confidentiality Agreement. The agreement can be downloaded by clicking on this link: To view and print the Confidentiality Agreement now, click here. Please specify the course materials by name: DVDs: Iconic Memory and Treatment by The Cornerstone Method. The signed confidentiality agreement may either be faxed to 415 749-2802 or mailed to The Children’s Psychological Health Center. News from Oklahoma Another Long Term Ermergence from Apparently Deep Autism: Sustained IQ Rise and Achievement Reported in Long-Term Follow Up Fran Morris, M.A., Clinical Professor of Psychiatry & Behavioral Sciences, University of Oklahoma Health Sciences Center, has been in touch with Dr. Kliman for many years. Morris conducted a therapeutic preschool equivalent to a Cornerstone Reflective Network Therapy service in Oklahoma City, Oklahoma for several years. Morris recently contacted Dr. Kliman with follow-up notes on a child patient of hers who presented with severe autistic regression and whose initial WISC-R IQ test result was 47. The child began in-classroom treatment in 1978 at age 4 with a very dim prognosis. His treatment was an in-classroom combination of psychotherapy and education. His full scale IQ rose to 91. His most recent full scale IQ was documented as 125, quite respectably above average! Now nearly 30, his prospects have changed dramatically. Morris reports that this young man completed a University education, receiving his B.A. and that he is currently in graduate school earning an M.A. The findings she reports verify that in-classroom reflective network psychotherapy led to a marked and sustained rise of Wechsler Full Scale IQ, and a great deal of clinical improvement. Both IQ and clinical status continued to increase for many years. Though not a full cure, this case resembles a 37 year follow-up of a fully cured patient similarly treated and reported by Kliman. This was of a severely autistic and seemingly retarded three year old. Miriam Siegel, Ph.D found that the child’s IQ was too low for testing. But over several years of in-classroom psychotherapy her IQ rose to a full scale WPPSI score of 80. Ultimately she had no symptoms of autism and her full scale IQ when re-tested at age eight was 120, then at age twelve was 149. (Further details and her autobiography are in Psychotherapy in the Preschool Classroom, Kliman, G. 2007) News from New Orleans Help for Children with Post Traumatic Stress Disorders
Tulane Department of Medicine Researchers led by Jan Johnson, MD studied a derivative of The Cornerstone Method, called “The Personal Life History Book Method,” which has resulted in a series of reflective network therapy applications for children who survive large scale disasters. Applied to children who were displaced by hurricanes Katrina and Rita, this derivative of Cornerstone is producing highly significant reductions of the children’s posttraumatic stress disorder scores. Together with Mercy Corps, The Children’s Psychological Health Center produced a guided activity workbook for New Orleans children, called “My Personal Story About Hurricanes Katrina and Rita.” Over 12,000 copies were used by school children and their families.The Tulane study is published on our website. Kliman Quoted Regarding Impacts of Trauma (ABC News) Since the assassination of President Kennedy, Kliman has written extensively regarding potentially long lasting numbing effects of traumatic events, including mass disasters. He is often called upon by public media (e.g., Barbara Walters Show, 20/20, Channel 2 News, New York Times Magazine) to explain the significance of children’s reactions. Here is a section from his latest book regarding trauma (see news item below) which he drew upon when invited for public media discussion of the Virginia Tech incident on April 20th, 2007. Dr. Kliman was widely quoted regarding the Virginia Tech Massacre on (US) ABC News and (more surprisingly) in the English Language Al Jazeera TV from Jakarta, Indonesia. Traumatized individuals have impoverished ability to think about the future and at the same time, have a tendency to translate experience into malignant omens and prophecies that enter dreams and daily mental life. They experience numbing of interpersonal relationships. Often children traumatized by specific events will exhibit iconic memories of their trauma by repeating behaviors that signify or symbolize that trauma. That is, they may remember their trauma through behavioral enactments… Trauma is a biological as well as a psychological insult. Sustained release of cortisol and long lasting levels of adrenalin produced by response to trauma kill brain cells. Three areas of the brain that produce emotion are affected (limbic, thalamic and prefrontal) as shown by MRI and psychometric data. There is evidence that there is a hereditary component to vulnerability to post traumatic stress syndrome; studies show that 25% of Vietnam veterans and 33% of Iraq veterans develop PTSD. So we might expect that a certain percentage of any population (such as at Virginia Tech) might be more predisposed to the worst effects of traumatizing events. In all cases, the therapeutic objective is … healthy adaptive expression, conversion of a mental state that has been, to some degree, biologically numbed by trauma. (Psychotherapy in the Preschool Classroom, Kliman, G. 2008) Following the horrific events at Virginia Tech, Dr. Kliman was quoted by Dan Childs of the ABC News Medical Unit as follows. Impacts of shootings can last long after shots are silenced. Mental health experts suggest that in traumatic events such as these, even those who escape physically unscathed may have long-lasting psychological wounds. "It's an extremely disorganizing and traumatizing experience," said Dr. Gilbert Kliman of the Children’s Psychological Health Center in San Francisco, California. CPHC Treatment Video Archives Developed Further for Training and Scientific Study Supported by a grant from the Windholz Memorial Fund, Elissa Burian, an experienced Cornerstone supervisor, has begun annotating videotapes of Cornerstone treatments from our agency’s extensive video archives. Detailed annotation will assist independent researchers and make the videos much more practical for training purposes by minimizing or eliminating the need for personal psychoanalytic explication by individual Cornerstone therapist supervisors. New Book Offers New Hope Early Childhood Psychotherapy In the Classroom: The Cornerstone Method of Reflective Network Therapy © 2009 by Gilbert Kliman, MD Parents of severely disturbed preschoolers will be encouraged by this new book’s emphasis on valuing their input and feedback and providing regular guidance and support to families. It is good news that this method is also cost effective for early childhood intervention within public school systems. Dr. Kliman's new book offers practical hope to families and communities struggling to meet the special needs of children who have lost or damaged capacity to care about and learn from others. A dynamic psychological and psychosocial network method, Reflective Network Therapy enables most emotionally disturbed or cognitively impaired children to become healthier and receptive to learning. This method helps developmentally challenged young children develop empathy, relate to family and peers, and grow intellectually. Twice-tested child patients regularly show statistically highly significant IQ gains which are sustained over time. Children become emotionally healthier and smarter, gaining new interpersonal and cognitive skills. Surprisingly positive outcomes have been measured in varied psychosocial contexts: inclusive public special education classes, day care centers, Head Start programs, public and private therapeutic preschools. It is good news that this method is also cost effective for early childhood intervention within public school systems. Reflective Network Therapy appears to be a major advance in the effort to meet the emotional and developmental special needs of young children. The book includes a replication Manual for the benefit of therapists, teachers, parents and researchers. The author strikes a balance between making complex material accessible to the general reader and keeping to the rigors of scientific presentation. Real life classroom narratives and discussion of more formal case studies enhance the reader’s understanding and help personalize theoretical explication. New research, some being planned in collaboration with Harvard Medical School, may ultimately help explain why this method works. The method is evidence-based and time-tested by clinical, comparative, and controlled psychometric studies. The author describes his own experience and that of many colleagues with 1000 children treated by over 20 teams of using the Cornerstone method of Reflective Network Therapy. Case studies are enriched with the author’s psychoanalytic commentary which illuminates scientific studies and findings and points out aspects of the method which will benefit from future multi-site studies. Projects and Funding Windholz Foundation Grant
CPHC was awarded a Windholz Foundation grant from the San Francisco Psychoanalytic Institute and Society of $11,300 (July 2007). The award will be used to purchase video conferencing equipment to further enhance ongoing supervision of the Ann Martin Center Cornerstone service site, and to support the services of an experienced Cornerstone supervisor (Elissa Burian, MA) who will begin annotating some of our treatment tapes from our archives. A major goal is to begin indexing and deepening the training value of our video archives. Detailed annotation will assist independent researchers as well as potential Reflective Network Therapy practitioners. Continued development of heightened training tools for training, supervision, replication and research study of Reflective Network Therapy’s value for existing and new child patients is the primary goal of this project. Funds are requested for basic video-conferencing regarding child patients Ann Martin Center, for equipment and supplies to continue video documentation of in-classroom treatments at this service site, and for indexing of 150 hours of Ann Martin Cornerstone DVD archives of treatment selections for collation into training videos by Elissa Burian, MA, a co-founder of the method in collaboration with Gilbert Kliman, MD, whose services are donated. Requested funds will also cover the costs of an independent videographer’s services to attach indexed treatment notes to training videos. Update: The Windholz Foundation donated $11,300 for this effort.
Verbatim transcription and scientific notation of 100 existing archived video records of actual treatment sessions selected for their value regarding children with Autism Spectrum Disorders, Attention Deficit Disorder and Posttraumatic Stress Disorder. Transcripts will be a contribution to the best didactic use and application range of existing DVD’s as an educational and training tool. It makes the details of this applied analytic treatment method more accessible (DVD menu findable) for further objective study of non-verbal aspects of psychotherapy and education. Psychoanalytically informed annotation of transcripts will augment written case reports and studies of Reflective Network Therapy for preschoolers and enhance the cost-effectiveness of video archives as a foundation for training new therapists. Such transcripts will be an important new tool to promote independent verification of clinical, cognitive and linguistic results and to support ongoing and future research. Study of the phenomena of statistically significant psychometric improvements will be facilitated. For example, videotapes of children with IQ and CGAS gains could be studied by a Q-Sort method to compare with non-responders or children treated by other methods. Transcripts will assist Reflective Network Therapy supervisors in the training of therapists, teachers and parents for future independent trials of the method in new sites for comparison studies. The Harvard Medical School project we plan is one which would immediately benefit from transcripts. Donations for Service and Research In 2007, CPHC received $75,983 in private donations targeted for the continued support of the Ann Martin project and Cornerstone Argentina Children’s Psychological Health Center Board Members have given contributions to the Harvard Medical School Cornerstone Project totaling $35,250. The International Psychoanalytic Association’s Cornerstone Service and Research Fellowship recently received $27,850 from CPHC. The Ann Martin Center in Piedmont, California, received a CPHC $13,250 grant installment for its Cornerstone Service. CLICK HERE TO DONATE. PLEASE SUPPORT SCHOLARSHIPS FOR NEEDY CHILDREN, RESEARCH AND TRAINING.
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