Greenspan Floortime Is Not DIRFloortime

And Why That’s Important

For many years therapists, educators, and parents have been asking us “What is the difference between Greenspan Floortime® and DIR®Floortime?”. While there are many, this article will highlight some of the transformative differences affecting the successful application of Dr. Greenspan’s work. Let me begin by sharing that for over 10 years I studied with and was directly mentored by my late father, Dr. Stanley Greenspan.  Multiple times a week we would discuss his theory and its application across a variety of pediatric diagnoses using specific examples of children and their families.  While other professionals say they “studied” with Dr. Greenspan, most simply attended a lecture series, and none of them went through the same intense educational process I went through. Developing my comprehensive knowledge of his developmental model, the Greenspan/DIR™ Model, and his intervention, The Greenspan Floortime Approach®, took years of studying, practicing, and being mentored, while also working in the related fields of education, movement and sensory processing, and developmental research.  Mastering this holistic understanding of early child development, neuroplasticity, and social-emotional health continues to be an ongoing learning process integrating many fields.  These experiences have provided me with a unique perspective and understanding of my father’s work allowing me to best answer the question: “What is the difference between Greenspan Floortime and DIRFloortime?”.

While co-directing The Floortime Center® with Tim Bleecker since 2004, and helping set up partner organizations internationally and domestically who specialize in the use of Greenspan Floortime®, I have seen the potential of Dr. Greenspan’s framework and how it must be provided/delivered to be effective.  Unfortunately, most professionals try to add ‘floortime’ to their tool belt and use it as one of many therapeutic curricula they have learned.  When you ask them how they decide what ‘tools’ to use and when, they rarely provide a scientific/medical answer.  They say, “ it depends on the child…” or “every child is different”.  The subjective use of techniques and methods will lead to inconsistent results preventing an intervention, like Greenspan Floortime®, from achieving its full potential benefits.  Dr. Greenspan helped children live lives free of the need for ongoing support and therapy while becoming regulated, empathetic, communicative, social, and adaptive individuals. Only The Floortime Center® and their partners have shown clinical outcomes consistent with his results.  In situations like this, the real tragedy is that it is the children and families thinking they are getting Dr. Greenspan’s Floortime from other ‘Floortime’ organizations who are impacted the most. 

When Dr. Greenspan created his framework, he never intended it to simply be an intervention to be used on the side.  He knew that if a child received an entire program based on his work, where OT’s, SLP’s, mental health professionals, educators, and caregivers all provided floortime-based (relating, communicating, and thinking) interactions/supports, that most children could exceed diagnostic expectation. However, using floortime as only part of a child’s program would yield partial results.  After working with thousands of professionals and families on 4 continents over the last 19 years, The Floortime Center® and their many wonderful partner organizations, have shown that there is a best way to learn and apply Floortime.  Correctly applying Greenspan Floortime®, its curriculum and its systematized application, may not always be what’s easiest for the therapist or best for their company, but it is what’s best for the child.  

  • The Greenspan Floortime Approach®, or Greenspan Floortime®, is Dr. Stanley Greenspan’s version of Floortime.  
  • It is the only version of Floortime supported by Stanley Greenspan MD Inc, and is derived from his 40 books, 200 scholarly journal articles, and numerous unpublished manuscripts.  
  • DIR®Floortime is a product of ICDL, and Stanley Greenspan MD Inc. DOES NOT support ICDL or its DIRFloortime®.

Dr. Greenspan founded ICDL in the 1990’s to be a multidisciplinary group of professionals using his psychodynamic framework to help children and their families.  After his passing in 2010, ICDL was eventually taken over by a cognitive behavior trained therapist named Jeff Grunzell.  He has been overseeing the organization and the training curriculum.  Since Dr. Greenspan’s passing, the training curriculum for DIR®Floortime has changed numerous times and no longer represents Dr. Stanley Greenspan’s most important core principles. The Greenspan Floortime Approach® teaches these core principles and focuses on the consistent ‘Greenspan Level’ of application of Greenspan Floortime®.  It’s worth noting that Dr. Greenspan was a psychodynamic therapist and disagreed with cognitive behavior theory, and behavioral interventions like CBT and ABA.  His model and intervention are a psychodynamic framework.  This is a very important difference when we are working on improving social-emotional health vs. learning social skills (Article). These differences have led to changes in terms and concepts other ‘Floortime’ organizations use, which impact the application of their intervention.  

Dr. Greenspan believed there are non-negotiable fundamental elements that must be consistently maintained when applying Floortime.  These non-negotiable fundamentals are what made it so effective with the many children he helped achieve “super star” outcomes.  Dr. Greenspan believed that Floortime is more than just an affect-based approach, which is nonetheless a big part of it.  He felt that its most important principle, and the one missing from other current versions of Floortime, is that it is a Thinking-Based Approach (Article).  This non-negotiable principle is the operative component that makes Greenspan Floortime® so effective.  This term is not a core component of ICDL’s curriculum. Some other versions of floortime are using the term ‘cognitive’ instead of ‘thinking’. While some people think these terms have a similar definition, they carry very different meanings within the therapy world.  Dr. Greenspan deliberately avoided the use of the term ‘cognitive’ because of its connection with Cognitive Behavioral Therapy and outcome-based interventions. When understanding Dr. Greenspan’s definition of ‘Thinking’ and how it is infused within his social-emotional framework, one can see that the ability to be a creative adaptive higher level ‘thinker’ cannot be taught through behavioral means or an adult-led fashion (Listen to Dr. Greenspan explain why).     

Other Floortime organizations have come up with their own definitions for the fundamental Floortime techniques, and even leave one out of their curriculum. 

Another seemingly small, but important, difference is that ICDL only uses the term Capacities referring to Dr. Greenspan’s revolutionary Functional Emotional Developmental Levels/Stages/Milestones/Capacities.  This difference affects how therapists understand how the social-emotional milestones/capacities are all part of the same system and function together (Article). They have chosen to exclude the use of other terms he used; stages, levels, and milestones.  Greenspan Floortime® uses two terms, Capacities and Milestones. This may seem like a difference of opinion but the two terms have different conceptual meanings in reference to Dr. Greenspan’s integrated framework.  To fully understand his theory, one must understand the purpose of each term, how they relate, and how they are different. 

Therapists trained in other ‘Floortimes’ will often (incorrectly) tell families that they are currently targeting their child’s capacity of Regulation or Engagement, but you CANNOT work on those capacities in isolation. You always work on Shared Attention, Engagement, and Intentional Two-Way Communication at the same time, and it’s impossible to work on Regulation outside of an interaction (Listen to Dr. Greenspan discuss working on Milestones 1, 2, and 3 together).   These differences, and more, lead to significant variations in application, affecting the effectiveness and the consistency of Floortime. Other ‘Floortime’ curricula focus primarily on teaching Dr. Greenspan’s theory and want therapist’s to “run with” the application of their version of Floortime.  This lack of consistency in its application leaves it open to interpretation by each therapist.  Once certified, there is no mandatory ongoing oversight provided.  Greenspan Floortime® focuses on both the theory and the specific rules for Floortime’s application that Dr. Greenspan used.  (Listen to Dr. Greenspan discussing the importance of Challenging a child to be purposeful). 

The difference in application of Dr. Greenspan’s Greenspan Floortime® and ICDL’s DIRFloortime is the most significant and troubling inconsistency.   Remember, all forms of Floortime are child-centered, meaning to do it correctly we have to analyze and interpret what the child is doing.  Clinically, Greenspan Floortime® makes sure that every child, starting with their first session, is sharing their attention, engaging, and at a minimum establishing reciprocal communication with the adult.  When learning Greenspan Floortime, professionals and parents are taught techniques for different types of play and for children with different developmental profiles. However, techniques are irrelevant if the child is not responding in a positive, engaged, and interactive manner.  Floortime is only Floortime if the child is Relating, Communicating and Thinking.  

Teaching the effective application of Dr. Greenspan’s framework must account for the child’s response to the techniques being used.  To make sure professionals and parents are thinking about and adapting the techniques they are using while simultaneously interpreting and analyzing the child’s response, The Greenspan Floortime Approach® developed a Fidelity Self- Analysis Questionnaire that takes both into account.  Other Floortime ‘fidelity measures’ only measure what the therapist is doing and do not take into consideration how the child is responding to them.  How can you have a child-centered intervention if your fidelity measure doesn’t include assessing the child’s responses to what you are doing?  With every child being so different, having different needs and abilities, if your application is not dependent on the child’s responses to the intervention, then you are not providing an effective child-centered intervention.

Greenspan Floortime® training focuses on helping each professional learn to apply Floortime with a variety of children with different regulatory and communication profiles.  The theory is used to develop an understanding of each child’s unique profile, but most importantly trainees learn how to adapt its application and determine the best environment and techniques for each child. We focus on teaching people how to apply Greenspan Floortime® through 3 specific types of play; Sensory Play, Object-based Play, and Symbolic Play. The training also uses the final version of the Greenspan/DIR™ Model called The Learning Tree, which we use to understand a child’s individual profile and set goals.  To do this, we use the same system Dr. Greenspan trained us with, analyzing and providing feedback on many sessions with different children.   For the initial level of certification, which focuses on the application of Greenspan Floortime®, trainees

  1. Watch lectures on their own schedule or attend a 2 Day in person training covering, 
  • Identifying a child’s Individual Profile
  • Understanding a child’s Individual Profile
  • The non-negotiable elements of Greenspan Floortime®
  • Videos showing principles relevant for Greenspan Floortime® integration into Speech Therapy, OT, Education, and Mental Health
  • Different types of Developmental Play
  • How to ‘stage’ different rooms/environments for different children and different types of play
  1. Submit 7 videos (ideally 1 per week), and
  2. Complete a Reflective Self Analysis Form for each video submission
  • After each submission, they wait for feedback from a Greenspan Floortime Master Level Trainer before integrating the feedback and filming another session.  
  • Professionals have access to a growing library of short articles detailing specific principles and evidence from related fields. 
  • Additional video submissions with feedback are available for additional mentoring, and are required 2 times a year to maintain a certificate.   
  • No expensive mentoring sessions with other therapists are required.  

Other versions of Floortime combine DIR and Floortime into one term and set of ideas, even though they are 2 separate  but related things; a model for evaluation and an intervention for application.  The initial training for other Floortimes includes attending lectures on theory and only requires the submission of 2 videos,  with no ongoing or follow-up training required.  After you pay their initial training fee, if you want to keep moving forward, you’re expected to sign up for ‘mentoring’ from a certificate holding therapist and pay them their hourly rate ranging from $150-$250 per hour.  

The unfortunate truth is, even when Dr. Greenspan was alive, he saw people taking his work and modifying it to fit their needs within their field of focus.  When I would bring this up and ask his thoughts and feelings about it, he would say, “ I wish people would take what I made and make it better, not take bits and pieces or change what has been established to be effective.”  One of his final wishes was for his work to survive, to be used in its most effective form to help children and families, and for it to be expanded upon and made better.  

Stanley Greenspan MD Inc., through The Greenspan Floortime Approach®, has made sure not to change the effective core components defining his model and his intervention, while still expanding on it and making it better.  With the help of The Floortime Center®, we have identified 

  • the most effective delivery methods for floortime and floortime-based services, 
  • the best environments and types of play for different types of children, and 
  • the best way to train professionals and parents for effective application.

Unfortunately, other floortime groups have changed definitions, taken terms and concepts out of its canon, and primarily focus on teaching theory while encouraging professionals to ‘run with’ its application in an effort to maintain the scalability of their organization.    

Some people will claim this level of differentiation and separating Greenspan Floortime® from other versions of ‘floortime’ is unnecessary.  However, I hope everyone considers the impact of confusing professionals and parents about what therapy they are learning and/or receiving.  Families have the right to full transparency over what they are exposing their children to.  Professionals have the right to choose the type of education and resulting implementation they strive to attain.  After being asked for the last 10 years about the differences between the various types of floortime, I hope this answers the question: “What is the difference between Greenspan Floortime and DIRFloortime?”, and highlights some of Dr. Greenspan’s beliefs, techniques, adn principles missing from other versions of floortime claiming to be his work.

Thank You, 

Jake Greenspan

Greenspan Floortime® Master Trainer