For those who are interested in the welfare and development of young children, it was sad to hear of the death last week of the eminent child psychiatrist Dr. Stanley Greenspan (Washington Post obituary at here.) Dr. Greenspan was much loved by colleagues, students, and the parents who consulted him, and his relatively early death is mourned by many.
Stanley Greenspan's early work involved an attempt to integrate the ideas of Sigmund Freud and of Jean Piaget, the Swiss psychologist whose studies of early mental development are the foundation of much of our present work on children's and adolescents' cognitive abilities. Both of these thinkers began their work with the idea of a predictable sequence of development determined by the biological nature of human beings. They considered early development to proceed through a series of stages and milestones that were necessary for later progress. They also assumed that children's characteristics were determined not just by their biological nature but by their experiences with the environment, especially with other people. Greenspan integrated all these ideas into his own work, but went on to elaborate on Freud's ideas by postulating early stages that Freud had not considered. He also built on the Piagetian framework, but added important concepts about the role of emotional development as a foundation for cognition.
In the 1970s and 1980s, Dr. Greenspan developed techniques and ideas that are useful to parents and teachers of young children. His 1986 PBS program "Life's First Feelings" gave a remarkable view of early stages of emotional development; this program is still available as a video, and some readers may recall seeing it as part of a developmental psychology course. (I used to use it regularly in teaching and learned something new from it every time I showed it.) His book "First Feelings" gave a clear and engaging description of events in early emotional and cognitive development.
Greenspan's "Floortime" method, presented in courses for teachers and parents, and demonstrated in a video of the same name, provided a practical technique for working with children's daily emotional difficulties. The name "Floortime" refers to the practice of sitting on the floor with a child, following his lead, and helping to support him in his thinking about disturbing events.
For example, in the "Floortime" video, an experienced teacher is sitting with a preschool girl who begins to play with dolls and to act out parts of a distressing experience. The child makes a doll fall backward off a block and hit his head. "Take to the doctor! He dead!", the child exclaims in a tense, forced voice--- but she laughs in a "phony" way too. Many adults would respond to this by declaring that the doll is not dead, suggesting a "nicer" way to play, or in some way disengaging from the child's concerns. The "Floortime"-trained teacher is able to help the child focus on her story; she suggests "calling the doctor" on a toy telephone. Gradually,the child's tension and anxiety subside, and she sits leaning against her teacher, not happy, but more content and less brittle than she was at the beginning of the sequence. Greenspan suggested that the "Floortime" technique was useful not only for children dealing with serious events, but every day as a special time for parents and children, especially beneficial when a child had been at day care and a parent at work all day.
Stanley Greenspan also developed a more complex form of this technique for use with disturbed children, focusing particularly on autism. His treatment method is known as DIR, for Developmental, Individual-difference, Relationship-based therapy. He suggested that treatment needs to begin with an assessment of a child's developmental level in terms of both emotional and intellectual growth. In addition, it was necessary to consider biological challenges giving rise to individual differences such as sensory or motor dysfunctions that could interfere with social interactions. DIR treatment occurs in the context of relationships with adults involving transactional processes rather than concentration on "fixing" the child. Using DIR, Greenspan was sometimes able to help children interact with others when they had previously seemed almost completely unresponsive. Videos of his work show infinite patience and the ability to take infinitesimal steps as he assessed what the child could tolerate.
Perhaps each of us is somewhere on a continuum from open-mindedness to being "from Missouri" and demanding evidence for every point. Each of these extremes has its advantages and disadvantages. I would say that Dr. Greenspan was at the open-minded end of the continuum. The advantage of this position was that he was interested and enthusiastic about every fact or idea that might be of help in his work, and drew in to work with him a wide variety of practitioners, occupational therapists, physical therapists, speech pathologists, and so on. He was also willing to give opportunities to "complementary and alternative" treatments, some of which remain without any evidence basis. Perhaps because of this open-minded approach, serious research on Greenspan's work was slow to get started and remains sparse but hopeful.
I recall attending one of Dr. Greenspan's day-long workshops in the ‘80s. Eight hours passed, and the attendees were exhausted, but Dr. Greenspan appeared as fresh as at the beginning. He poured out his energies freely for the benefit of young children. May he rest well from his labors.