When I began psychoanalytic training in the late 1950s, it occurred to me that some of the powerful phenomena being induced in the private dyad of analyst-patient might be harnessed in a public-health setting. Soon, as a candidate in child analysis, then a supervisee of Marianne Kris, I began to receive encouragement to take seriously some of the clinical evidence developing in the therapeutic nursery I had founded—The Cornerstone School.
Disturbed preschool children who had been assembled in a therapeutic nursery classroom with two teachers talked to me regularly about their emotional troubles, told me their dreams, behaviorally and verbally associated to their dreams, played expressively with each other and me, and had marked reactions to my arrival and departure. I spent fifteen or twenty minutes a day with each child, right in the classroom.
As I reported to Kris on the phenomena I observed at The Cornerstone School, it became clear that in response to my daily presence in the classroom five days a week for ninety minutes, most of the half dozen preschool patients were developing useful transferences and analyzable transference neuroses. I was in fact functioning much as a child analyst for each of the patients, and their families, in the therapeutic nursery. First described in 1970 in The Psychoanalytic Study of the Child, the persistent application of psychoanalytic techniques, including transference interpretations, became the backbone of The Cornerstone Therapeutic Nursery that in turn became the backbone of a large, publicly supported mental-health agency specializing in the treatment of young and stressed children — The Center for Preventive Psychiatry, in White Plains, New York. Several hundreds of preschool children have now been treated using the Cornerstone method in New York, Oklahoma, and California.
The Center, which housed the original Cornerstone therapeutic preschool, provided many modalities of treatment for preschoolers — including full-scale psychoanalysis (four or five times a week); individual psychotherapy once-or twice-weekly; and educational psychotherapy, in groups or individually. All methods involved regular parent guidance sessions, usually once a week. But only the Cornerstone children showed IQ gains.
Among eight serially tested preschoolers about whom I reported in 1978 and an overlapping series of fifty-two serially tested children reported on in 1996, the IQ gains averaged 12 points, almost a whole standard deviation rise. These rises occurred only among the 42 of the 52 children who received Cornerstone method treatment. IQ gains correlated in an orderly fashion with the number of sessions as well as the number of parent guidance sessions.
Since founding the method in 1965, I trained nineteen people to carry out the therapeutic work of applying analytic techniques in a busy classroom filled with six to twelve patients and two or more teachers. Many teachers learned to collaborate with analysts, and analysts learned to respect the teachers as great sources of knowledge about the classroom events and home life of each patient. A therapeutic milieu was created by each team, and the teachers became capable of carrying out the bulk of the weekly child guidance sessions, the analyst supervising the guidance once a month with each family.
We have taken the method as an outreach right into several large day-care centers, some containing Head Start programs. However, until 1994 no public school was approached to see if it wanted to interface with our analytically oriented mental-health service.
Then, in 1994, having established a Children's Psychological Trauma Center in San Francisco, my colleague Karita Hummer (of the Chicago Psychoanalytic Institute's Barr Harris Center) and I persuaded a public school to host a Cornerstone therapeutic preschool. As a result there have been Cornerstone treatments going on in public school special-education classrooms at the Office of Education, County of San Mateo, since mid-1995. I was the analyst in the classroom for the first year, during which video documentation was extensive. From the video documentation of my work and that of my two teachers and seven preschool patients and their families, we created some multimedia training materials. A Cornerstone Laboratory School and Training Institute were set up in the San Mateo office of Education, where I supervise the work of four new Cornerstone therapists (including two psychoanalysts — Mary Jane Otte and Mali Mann). A clinical psychologist and a school-salaried school psychologist are also learning the method. Colleagues in other cities are invited to attend the training sessions. A Cornerstone Method videotape and accompanying bibliography are available from the Children's Psychological Trauma Center, 2024 Divisadero Street, San Francisco, CA 94115 ($55, payable by check).
The first forty-two serially studied Cornerstone patients show a marked correlation between clinical gains and IQ gains. In turn, the frequency of sessions in the Cornerstone method distinguished it from nonanalytic techniques. But other therapeutic nurseries with similar frequency of sessions, such as leader-child educational therapy nurseries, did not produce a significant IQ rise.
It is my theory that in addition to the efficacy of interpretative work on each child's intrapsychic problems, much else goes in Cornerstone that explains the IQ rise. The interpretive work often is on-the-spot, right when a child is showing a symptom such as refusal to cooperate or learn in the classroom.
Gilbert Kliman is a certified child psychoanalyst, a life Fellow of The American, and a Fellow of the American Academy of Child and Adolescent Psychiatry. He created the nation's busiest psychoanalytically oriented center for people of all ages in states of psychological trauma, the Center for Preventive Psychiatry in White Plains; he co-wrote “Responsible Parenthood;” and he participated in a controlled assessment of Personal Life History Books, a brief narrative psychotherapy, which he proved reduces transfers among foster homes. Kliman has testified in more than 100 cases of severe psychological trauma throughout the nation, and he is developing a new theory of post-traumatic stress disorder that unifies biological and psychoanalytic findings. He has five children, the youngest age four.
The immediate interpretive intervention often transiently causes suspension of a child's defenses against receptive learning, before the defenses go back into operation and are more slowly worked through. Thus before the analytic process is completed, much learning receptivity occurs. Further, the child is constantly 'learning“ exquisitely from the analyst, moment to moment, how to mentalize and verbalize rather than enact his inner life. Sensorimotor behavior is daily translated by the analyst into semantic form, permitting much higher cognitive processing. Peer group pressure is quite positive, providing an arena in which therapy is competed for rather than avoided, a setting in which the analyst's work is regarded as precious by a whole community. The developmental status of the children is such that the creation of an artificial family — the two teachers, the analyst, and a half-dozen or more peer ”siblings“ — allows a working through of dysfunctions that are often invisible or unnoticed for long periods in the dyad of private child analytic work.
The teachers provide extra eyes, ears, minds, and hearts for the analyst to have for his own understanding of each child and family. In fifteen minutes a day, five times a week, the analyst can work intensively with a child, hear from teachers what he has been doing the rest of the time, and can inform the teachers — right in the classroom — of the salient content of the child's fifteeh-minute session. Much takes place deliberately with the child's collaboration — he is asked to help the teacher brief the analyst his activities that morning, and he is asked at the end of his in-class session with the analyst to help brief the teacher on what has occurred there. Thus the child is given semantic communication models by powerful figures with whom he and his peers identify, constantly transforming behavioral chaos into verbalized thoughts and affects.
Parents are a vital part of the process. They learn from the teacher what their child has done all week, and share with the teacher what has been happening at home. There is a subtle, gentle guidance given by modeling, as the parents are welcome visitors not only at the beginning of the school year and at weekly guidance sessions, but as frequent drop-ins. The entire set of teachers, families, analyst, and peers thus becomes an energetic therapeutic community, a supportive, structured network, effectively promoting the developmental growth of all its members.
Cognitive gains are a small and readily measured part of the growth we see in Cornerstone. We can hardly believe, ourselves, the occasional miracle of mental birth that occurs. Visible in one of our video segments is the remarkable effect of a transference relationship in which an avoidant psychotic child becomes an empathic human being, transformed from hurling furniture and feces in autistic rages to visibly becoming a full participant in subtle social communications, including empathy. Thirty-year follow-ups indicate much to be encouraged about. Some children referred to us mute and with pervasive developmental disabilities are now intelligent, productive adults. Others who were aggressive or neurotic have also made substantial gains.
We feel it is time to take this method into the world of public health and public schools, and welcome the challenging opportunity to test the feasibility of its applicability while showing its effects by continuing objective outcome measures.