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Intro

At St. David’s Center, we are proud to serve as a Midwest Regional Greenspan Floortime® Training Center, helping clinicians and families deepen their understanding of this transformative, child-led, play and thinking-based approach. To explore the impact of the unique methodology and its ongoing development, St. David’s Center recently sat down with Jake Greenspan, son of Dr. Stanley Greenspan, the visionary behind the Greenspan/DIR™ Model and The Greenspan Floortime Approach®. We’re excited to share Jake Greenspan’s reflections on what sets Greenspan Floortime®, Dr. Greenspan official version of floortime, apart as it prioritizes emotional engagement and internal motivation to foster development, and integrates emotional, developmental, and relational principles to create a meaningful, individualized approach for each child.

In this Q&A, Jake offers a personal perspective on growing up with his father, insights into the origins of Greenspan Floortime®, and a glimpse into the ongoing efforts to demonstrate the efficacy of the model scientifically. He also shares actionable advice for therapists working with children and families and highlights success stories that demonstrate the profound potential of Greenspan Floortime®. For clinicians dedicated to fostering meaningful connections and holistic development, this conversation sheds light on how Greenspan Floortime’s principles can be woven into daily practice to create lasting change.

St. David’s Center: What was it like to grow up with Stanley Greenspan as your dad?

JG: My dad was, at his core, kind of your old-school New York type. He was the son of two immigrants who came through Ellis Island—a tough, football player with a high intellect. He was incredibly passionate about his work, which meant he wasn’t a big part of our childhoods in the traditional sense. It’s something I’ve only really come to realize as an adult.

To his credit, though, he adapted. When I was a preteen and struggling emotionally—depressed, honestly—he recognized that my needs weren’t being met. He took it upon himself to make changes in our relationship, which had a really positive impact. I can honestly say I wouldn’t be here today, or doing this work, without that connection we built during my adolescence.

It was a unique family. My mom, like my dad, has a high intellect. She co-authored four books with him and later published two biographies, learning quantum physics and German to write them. Ours was a very academic household, which didn’t always come with the highest EQs. But like all of us, my parents did the best they knew how to do, and my sisters and I are figuring it out as we go as well.

St. David’s Center: Do you have a sense of what inspired the development of Dr. Greenspan’s Floortime model? Was it personal, professional, or both?

JG: I actually learned a lot more about my dad after he passed away, once I became a professional in the field and started working with people who knew him back in the 1970s. For example, I was at the University of Texas at Austin, and the head of the UT Child Development Center, a psychiatrist who had known my father shared a story. He remembered hearing my dad lecture in the mid-1970s about how emotions, starting from day one, are the driving force behind all other developmental systems working together. He described emotions as the “conductor of the orchestra” and the glue that integrates everything. He said my dad was the first person he’d ever heard argue that emotions present at birth remain with us and fundamentally shape our development. It was groundbreaking at the time.

My father studied under Skinner at Harvard, so he was exposed to behavioral frameworks early on. Later, during his medical training and subsequent work, he explored approaches like ABA and realized they weren’t addressing the emotional aspects of child development. He wanted something different—something better.

That’s where it all started, even before he wrote his first book, Intelligence and Adaptation. When he was running the Child Study Center at NIMH, he was able to do research that identified Piagetian stages of development. He then aggregated ideas from Skinner’s behavioral theory, Piaget’s developmental stages, and Freud and Erikson’s psychoanalytic perspectives on relationships. That’s how the whole framework came together—a synthesis of emotional, developmental, and relational insights. He saw how, through caregiver-child interactions, children moved through these milestones, with emotions as the driving force. Those observations laid the foundation for the DIR model.

St. David’s Center: In what ways are you working to provide evidence for the efficacy of Floortime as an approach? Is this challenging when it comes to scientific validation, given the difficulty of quantifying emotions and achieving consistency in application of relationship-based models?

JG: One of the challenges in legitimizing Floortime—and, really, any approach that focuses on emotions—is that it’s difficult to quantify emotions in a way that fits traditional scientific methods. And it’s not just about measurement; it’s also about ensuring practitioners are trained well enough to apply the methodology consistently.

Over the last five years, I’ve been working on developing measurement systems to capture both quantitative and qualitative outcomes. While we can’t easily conduct double-blind, randomized control trials, we’ve explored the use of neuroscientific tools like functional EEG measurements to support our findings. For example, a study at York University collected excellent data on Floortime but ran into political roadblocks that prevented its publication. Politics often play a role in these situations—funding and established practices, like ABA, can complicate efforts to compare methodologies fairly.

To address these challenges, I’ve been breaking down Floortime into its actionable components—like caregiver reciprocity, responsive caregiving, internal motivation, and learning through problem-solving and creativity. Each of these elements is supported by robust neuroscientific research. For instance, we know that internal motivation activates different brain regions than external motivation, and problem-solving engages the brain differently than rote memorization. By isolating and validating these core elements, I’ve woven together hundreds of studies that demonstrate how ahead of his time my father was in his understanding of development.

This integrative, interdisciplinary approach helps us build a stronger scientific foundation for Floortime while addressing the inconsistencies that have emerged due to different versions of the methodology being practiced today. What I hope to do over time is establish a set of highly validated data collection methods—using pre-, mid-, and post-assessment points—across the organizations we work with. Establishing the reputation and legitimacy of a methodology like Floortime is a lengthy process, but it’s definitely achievable.

St. David’s Center: What are some of the principles of the Greenspan Floortime methodology that therapists can emphasize today, even if they are working in other modalities?

JG: One of the most misunderstood and frequently left-out principles of Floortime is its thinking-based approach. Adults, especially professionals, are often trained to follow linear paths with specific goals in mind. Even when a child is leading an activity, it can quickly turn into a more adult-led, behavioral methodology, one focused on eliciting specific outcomes. My father believed this approach wasn’t enough to truly engage children. Instead, Floortime emphasizes broader capacities or milestones, like reciprocity—whether the child initiates or responds—rather than focusing on specific actions like a point, smile, or word. This thinking-based component is one of the most actionable and effective elements of the methodology.

The principle most people associate with Floortime is that it is child-centered and child-directed. This helps ensure the child is internally motivated to participate, since research now shows that internal motivation is essential for triggering neuroplasticity and creating rapid changes in the brain. Unlike adults who can independently choose to engage in therapist-led approaches like CBT, for therapy to be effective, children must actively participate, and in some way choose, to derive any benefit. However, most children don’t choose therapy, which is why a child-centered focus is so critical.

Being child-centered also allows therapists to step back from their own goals and focus on who the child they are working with truly is as an individual. Floortime encourages seeing every child as a full human being, understanding their strengths, needs, and ideal environments—rather than following a one-size-fits-all approach.

St. David’s Center: What challenges do you see in implementing these approaches, beyond consistency?

JG: One of the biggest hurdles is that we’re pushing against a general medical system that’s symptom-based. The DSM is a diagnostic tool focused on symptoms, so treatments are designed to address symptoms rather than core issues, delays, or developmental difficulties. This creates a barrier to implementing approaches like Floortime, which address underlying needs instead of just managing symptoms.

A related challenge is integrating these approaches into systems like insurance and Medicaid. While there is now a Medicaid code for developmental intervention, most insurance companies don’t accept it. This makes it difficult for professionals to deliver these services and be reimbursed, which limits accessibility.

This issue extends to schools, which, despite not relying on insurance, still follow a symptom-based behavioral model. Schools tend to prioritize their own needs—like keeping children in the classroom—over meeting children’s individual developmental needs. After age five or six, children spend so much of their time in school, but if their

social-emotional skills haven’t been fully supported by that point, they’re at risk of falling further behind, which can lead to mental health and behavioral issues.

My father often spoke out against systems that prioritize productivity over family and child development. He was critical of narratives that suggest putting children in daycare at three months is no different than waiting until two years. These systems—rooted in capitalism—undervalue the family structure and perpetuate inequality, making it harder to nurture a child’s health from an early age. While capitalism may be the system in which we live, we need to approach it in a way that is more ethical and supportive of families.

St. David’s Center: What recommendations do you make for families experiencing extreme strain, like single parents working multiple low-paying jobs?

JG: There aren’t, unfortunately, a lot of easy solutions, and many public resources are not ideal. Utilizing the resources that are available can certainly help, but one of the things my father often recommended—and something I also emphasize—is leaning into the community around you. It really does take a village. Accessing that village—whether it’s family, friends, or neighbors—can make a big difference.

For instance, spending time with grandparents can be more beneficial than being in a crowded classroom where a child might only get a few minutes of attention. Even if grandparents can’t be as active as they’d like, that one-on-one time still offers personal feedback and attention. And it doesn’t have to be all day—even partial support, like a grandparent or neighbor picking up a child early from school so they can skip an after-school program, can be meaningful. Finding ways to prioritize one-on-one relationships, even outside of primary caregivers, provides far greater benefits than just having a child “watched.”

Organizations like St. David’s Center are also doing their part to provide supportive services that reduce some of the burdens families face. While there’s no perfect solution right now, these kinds of community connections and supportive services can help families navigate the strain and ensure children get the attention and care they need.

St. David’s Center: Do you have any specific success stories—whether from clinicians or children—that illustrate the impact of Floortime?

JG: We’ve had many successes over the years, both with therapists and children. Some therapists really embrace Floortime, make incredible progress, and even become

leaders in the field, which is always rewarding to see. But the breakthroughs with children are where the impact is most profound.

One case that stands out involved a little girl, about two and a half, diagnosed with level two autism. Her mother asked me what the long-term outlook was, and while I couldn’t make any promises, I told her that if she fully committed to the work, the progress could be remarkable. She did exactly that—followed every recommendation, even through difficult times—and the results were beyond expectations. That little girl no longer has an autism diagnosis. She went from level two to no longer meeting diagnostic criteria. Her mother’s dedication was exceptional, and it was a powerful reminder of what’s possible when the methodology is applied consistently.

There are countless other examples, like a boy in Chile who started crawling for the first time during his first Floortime session, after a year and a half of unsuccessful physical therapy. Or a young man named Brandon, who my father worked with in the late ‘90s. He recently reached out to tell me he’s now an author and public speaker and wanted to include my father in his book. Brandon is a testament to what Floortime can achieve—he has meaningful relationships and a depth of connection with others that surpasses most adults I know.

The goal of Floortime isn’t necessarily to change a diagnosis but to help every child build nurturing relationships, improve communication, and engage meaningfully with the world around them. And that’s something we’ve seen happen time and time again.

Conclusion

Greenspan Floortime® is more than a therapeutic methodology—it’s a framework for fostering connection, understanding, and growth between caregivers and children. As Jake Greenspan emphasizes, the heart of this approach lies in recognizing each child’s individuality and empowering them to thrive, each in their own, unique way.

For clinicians, embracing Greenspan Floortime® means moving beyond symptom-focused interventions to address the deeper emotional and developmental needs of children and their families, and by building authentic, meaningful relationships rooted in trust and mutual regard, and encouraging the child to do the thinking. Whether through small, everyday breakthroughs or life-changing success stories, the impact of this methodology is evident in the lives it touches.

As we continue to expand our understanding of child development in our communities at large, the commitment to relationship-based, individualized care that Greenspan Floortime® embodies remains an inspiration, and a rigorous method. In fact, its results

connect with many of today’s cutting-edge scientific advances in neuroscience and developmental psychology. We are honored to collaborate with Jake Greenspan and the entire Greenspan Floortime® community in sharing this knowledge and supporting clinicians in their work to help children reach their fullest potential.

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