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The How-To-Do-It Manual The Reflective Network Therapy replication manual is a thoroughly practical guide for training. Highly detailed, it includes specifics regarding all essential aspects of running a therapeutic preschool based on the method and provides examples of intersubjective classroom processes. Downloads: Reflective Network Therapy: The How-To-Do-It Manual for Therapists, Teachers and Parents The complete replication manual is included in Reflective Network Therapy In The Preschool Classroom, (Kliman, G., © 2010) Excerpts from the replication manual
Reflective Network Therapy is an inclusive method, deliberately keeping disturbed children within their classroom special education groups rather than pulling them out of class for behavioral modification or psychotherapy. It does not segregate or isolate children socially from inclusion within a group by having an adult aide constantly at a child’s side. Reflective Network Therapy within the educational setting gives a child gradual transitional preparation for entry and inclusion in the larger, real world. It cushions children, limiting their actions and serving as a stimulating but protective half-way house en route to the more demanding larger community. It is a holding environment, in Winnicott’s (1965) sense, which gives children opportunities for soothing, impulse-containing and expression-supporting relationships, thus not only allowing growth but also correcting for developmental difficulties (Alpert, 1941, 1953). Children are contained by the thoughtful, understanding presence of teachers and a therapist who understand each child’s developmental status, needs and individual impulse control limitations, and who encourage the evolution of his or her expressive skills. … ………………………………… Standards and Structure There is a range between certain ideal and minimum standards for practicing Reflective Network Therapy. Deliberately being repetitive, we will emphasize throughout the manual that some guidelines and aspects are considered essential, such as: - There must be at least three and no more than twelve children in a group, Children are between ages two and seven.
- One child therapist is assigned to each classroom of up to twelve children
- Each psychotherapy session occurs only in the classroom.
- If more than three children are present, two preschool educators are needed, to conduct educational activities while one child is treated at a time within the classroom.
- Educational activities can occur daily for full classroom days which occur five days a week. They must occur at least two hours a day, at least two or three days a week, totaling at least six hours a week if there are eight patients.
- In-classroom psychotherapy sessions must occur with each child at least two and preferably five separate days a week.
- Each session should be preceded and followed by a “briefing” or “debriefing”
- Methodical insistence is required on a child’s individual therapy taking place not only in the classroom but in the presence of other children and teachers rather than being in any way hidden from them.
- Weekly parent sessions must occur with a staff member, sharing what has happened in class and home.
- Weekly staff conferences are needed, sharing what has been going on with the treatment
- Parental permission should be secured so videotaping can be regularly used to assist at staff conferences, and for objective follow ups.
The method is based on a network of intersubjective influences, not just a therapist’s, teacher’s or aide’s influence. In order to be sure that a Reflective Network Therapy service is well set up, all the component pieces must be present and interconnected. If a certain piece of a network influence is lacking, a network’s communication processes might go down. We aren’t sure why this is so, but it may be analogous to an internet server’s disconnect causing a widespread e-mail outage or a broken wire causing lights to go out in a larger but highly connected electrical grid. … ………………………………… Essential In-Classroom Procedures Include: - In-Classroom Briefing
- In-Classroom psychotherapy sessions for each child, multiple times a week.
- In-Classroom Debriefing
- In-Classroom educational activities
- Team Conferences weekly
Briefings are structured times of communication among two adults (teacher and therapist) and the child. These communications involve the teacher and child jointly narrating a summary to the child’s therapist about the child’s day so far. The summary is given in the classroom immediately before a child’s in-classroom psychotherapy session begins. Pre-Session Briefing This briefing serves several functions for the particular child who is about to have a psychotherapy session. The briefing gives the child practice in experiencing being thought about by two important adults (teacher and therapist) at the same time. He processes the emotional expressions as well as words of the two adults who are collaborating about him. He develops a theory of multiple minds. He has a chance to practice learning how two to a dozen people can have caring and detailed knowledge of his behavior and shared but individually varied theories about his mind. During the next fifteen or twenty minutes, his psychotherapy session is necessarily influenced by his knowledge that he is being thought about and his expectation that this experience will occur every time he is in the RNT classroom.
The Pre-Session Briefing is followed by Play Therapy. Fifteen to twenty minutes of in-classroom psychotherapy is provided to each child for as many days a week as the class meets. All of the play therapy sessions take place in the classroom so that the real-life behavioral confrontations and insights developed with the child are shared and verbalized immediately with him or her and the teachers, in the presence of other children and some parents. It is critical that this is done regularly and right on the spot, before meaning is lost to the child’s immature memory and limited attention span or buried by such defenses as avoidance, denial, repression, isolation, dissociation or projection.
The Individual Psychotherapy Session must be followed by a Debriefing. The debriefing is an interpersonal event lasting a few minutes. It contains a structured effort to communicate and provides opportunities to view, mirror and identify with others’ feelings and behavior. The child and therapist endeavor together to speak to the teacher about the nature of their session to the teacher. When the child cannot or will not verbally narrate his or her own experience of the session, the therapist fills in the teacher, while in the child’s presence. There is a deliberate recursiveness to this process, as each player has important input into the others’ communications and other interactions and receives input about those which didn’t directly include him or her. Other children in the classroom may be part of and listen to the index patient’s psychotherapy and may hear and participate in the debriefing. ………………………………… ………………………………… Control and Participation The index child is the child who is therapist’s primary focus during a therapy session. Other children will have their turns. They should be allowed to help the current index patient, to the extent they do not interfere with that child’s play and allow that child to have his way in temporarily controlling and the expressive process. Teachers and therapists unhesitatingly remove a disruptive child from the vicinity of the index child’s play session. In practice, most children are initially jealous of the classroom therapy time their peers receive but usually become collaborative in a few days or weeks. Soon they value the sessions so much that most RNT-treated children become altruistic, helping each other to have sessions, and supporting each other’s efforts to talk during the classroom sessions. Videos show that the children often help each other work at their highest abilities, and nurture each other, each respecting the rhythms of the others and identifying with the helpfulness of the classroom adults. Their empathy and altruism is readily commented on by the adults. Such commentary provides a behavioral reward for intrapsychic and interpersonal growth. The network effect is enhanced on a peer level by allowing children to hear one another’s sessions, and to help the index patient play in whatever fashion the index child chooses. As jealous or mean interference by peers tends to be remarkably infrequent once children settle into a new group and join Reflective Network Therapy's culture of kindness, outsiders viewing our videos are often surprised by the altruism the children show. Because children learn to be reciprocally considerate of each other, collaborative and enriching behavior becomes self-sustaining. … ………………………………… Weekly Parent Guidance Sessions Weekly parent guidance sessions, 45 to 60 minutes in duration, are conducted mainly by the head teacher. Once a month, the parent guidance session with the teacher is replaced by an hour with the classroom therapist. Sessions usually occur in a private office within the school, but have often been effectively carried out in a corner of the classroom during classroom activities. Weekly parent guidance sessions start soon after the child’s acceptance into the classroom, and the parent must be prepared to invest an hour a week with the teacher. Routine home or telephone visits for some home-bound parents can replace a session in an office. Resistance to attending parent guidance is often not only the parent’s problem but a product of teacher’s unfamiliarity with relating so intimately to an adult rather than a child. Thus, a therapist can useful supervise the parent guidance, during staff meetings. … ………………………………… The Role of Parents in the Classroom Parents are valued team members, participants who are absolutely essential to the network process that heals children in Reflective Network Therapy classrooms. In addition, parents are fortified themselves in the process, bolstered to continue their challenging parenting roles even more fully. Parents should always feel welcome in the classroom. Parents are encouraged to stay for many days at the beginning of a child’s experience in Reflective Network Therapy. Later, they may just drop the child off. The daily parent-teacher briefing which occurs when a parent drops off a child often takes just a minute but is an important structured opportunity for the parent and child to be impacted by witnessing reflective network therapy time and again. In addition, the content of those parent and teacher briefings are often used to accelerate the child’s recovery. For instance, Oscar’s mother (in the case described above) provided critical information about specific family violence which immediately enhanced the therapist’s ability to interpret the child’s social difficulties and violent, frenetic behavior. During parent guidance sessions as well as in class, this contributed much information about Oscar’s anxieties concerning body integrity in the face of family violence. Over time, she was also rewarded by the child’s growing social abilities and ability to express tenderness. … ………………………………… Parent Guidance Conferences Once a child has been evaluated, there is an ongoing parent guidance process in which both the teacher and therapist have roles. The staff finds it easier and easier, with experience, to be respectful of each parent’s burdens and knowledge concerning their child. Parent-blaming and adultophobic attitudes, which were common at one time in psychotherapeutic and educational professions, are lost with training and experience. Staff becomes increasingly sensitive to parents’ attitudes toward living with a difficult and changing child, fluctuating mutual dependency needs, and often sudden shifts in aggressivity and affection. Staff develops a heightened awareness of the parent’s ability to make critical contributions to the child’s recovery. The staff-parent meetings require sympathetic listening, sharing observations, helping parents to carry insights gained in the classroom into the home environment, supporting parental capacities and responsibilities. Since this method depends on a network influence, the teacher must model communication skills during these meetings, conveying to parents much about how she thinks and feels about the child. Helping parents accept their child’s perceptiveness about home adversities and changes is routine and helping the child mentalize those experiences in child appropriate doses and with parental support is essential. Conversely the teacher can convey information about the child’s intersubjective life in the classroom, making a bridge between home and school, verbalizing and placing the child’s functions in a developmental framework that a parent would usually find more difficult than a teacher to conceptualize. The therapeutic nursery teacher's weekly parent conferences have four main functions: - Receiving information from the parent about current family events,
- Sharing information with the parent about the child’s classroom experience
- Giving educationally oriented developmental guidance, and
- Giving support to the parents or parent surrogates.
Parents receive the deep emotional sustenance required to set up a constructive nurturing cycle of reciprocal love and caring with their children. The failure of a child’s reciprocity is depressing to and depletes many parents. Reflective Network Therapy assumes that each parent in a Reflective Network Therapy group needs and deserves such support. Parents need emotional nourishment in order to care for very troubled children. Many children referred to Reflective Network Therapy do not readily reciprocally nurture their parents, in that they do not return their parents’ love in wholesome ways. In such families, each parent has the burden of living with a child whose emotional life is difficult to support, and whose relationships are layered with resistances and problematic neurobiological complexities. The child’s special assets and deficits, as well as their communications, are often puzzling and quite different from what other families experience. Most RNT parents have been frustrated, disappointed and discouraged –and sometimes immobilized-- in major aspects of their relationship with their children, no matter how much they love them. Parent guidance sessions go a long way to mitigate the resulting pain and confusion. Strengthening the child’s primary support system in turn strengthens the possibilities for the child’s home environment becoming as nurturing as possible throughout treatment. Parent conferences are conducted on an individual basis. The teacher sees the parents (mother and father, if possible) or primary caregivers weekly; the therapist sees them once a month. Current information, current events, and earlier events of importance are reported on this weekly basis to the teacher and are transmitted to the therapist for use in his or her daily work with the child and in the therapist’s monthly sessions with the parents. The child knows that Mommy or Daddy, or whoever sees the teacher, sees the teacher regularly and that the teacher and therapist share information directly with the parents or caregivers. The teacher helps the parents understand the needs of the child, especially how to cope with the child's developmental process. Some parents must be helped to know the difference between what constitutes normal development and what is peculiar to their child. The parent is empowered to cope with the child's difficulties as well as changes on a day-to-day basis and acknowledged for doing so. … ………………………………… The Reflective Network Therapy Teacher: Clarification of Roles and Responsibilities The roles of the RNT teacher in the classroom are many. She has roles as a reality oriented educator, as communicator between the patient and the therapist, as a stimulator, receptor and observer of communications and behavior, and as an observer of responses to interpretations when those responses occur after the therapist has left the classroom. There is a synergistic division of roles in the practice of Reflective Network Therapy. Therapists are not educators in the formal sense. Therapists use a broad repertoire of psychotherapy techniques individualized to a particular child. Cognitive restructuring, dynamic interpretations, and transferential interpretations are feasible within RNT. (Kliman, 1970) It is essential to Reflective Network Therapy that the respective roles of the teacher and the therapist are made clear to the children. The children learn the therapist is there to talk about, interact with, interpret and clarify the child's behavior and thoughts. The teacher is there for educational tasks, in the broadest sense, as well as for discipline management. One child showed his clear understanding of teacher and therapists’ different roles as he finished a block building and said to the teacher, "It's my turn to be with Dr. K." He pulled a rocking chair over to Dr. Kliman, who was sitting nearby and said to him, "let's work," and then began to talk about his dream of the previous night.” (Kliman and Ronald, 1970) The teacher is responsible for developing and implementing the curriculum and educational plan appropriate to each child’s abilities and for supporting the expectation of progress in socialization. The teacher advances curriculum implementation by constantly adjusting to children’s responses and performance. For example, most children are expected to and do sit in circles and “dress the weather man” with weather-appropriate clothing each morning. If they can’t do it, the children are still given the expectation of accomplishing this group activity. The teacher prepares the children to adapt to transitions without emotional upset.For example, children are helped to learn about the calendar and time, and to anticipate the rhythms of weekends, vacations, and each other’s absences. The teacher helps build ego strengths related to handling transitions involving gratification delay. For example, she may help a child learn how to wait or how to share. The therapist will not teach but will interpret a difficulty in sharing or waiting, the more so as the child becomes increasingly aware of the functions of sharing and waiting. The teacher models good reality testing and good communication about realities. There is much value in teachers talking to children in small groups the about the unavoidable upsets that inevitably occur, such as a teacher’s illness, a pet’s death, a birth in a family, or the hospitalization of a parent or grandparent. Such discussion psychologically immunizes children against being overwhelmed in the event of any future, more destabilizing events (Kliman, 1968). The educational program additionally consists of helping the child to explore the real world around him, with all the ramifications of learning to develop logic, order and problem solving ability as related to his world. (Kliman & Ronald, 1970) The therapeutic teacher is responsible for providing a program designed to promote the social, emotional, physical and cognitive development of each child. In this setting the therapeutic teacher also assumes the traditional educator’s role of providing a socializing influence by managing children’s disruptive or aggressive behavior, freeing the therapist to do his or her interpretive work without the complication of such responsibilities. The teacher’s opportunity to work daily in such tandem with the therapist in a preschool setting is a core part of this method. … To read additional material excerpted from chapters of Early Childhood Psychotherapy In The Classroom, please click on the graphic in the Books/Papers section (Published Books and Papers by Gilbert Kliman, MD).
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