In Britain, social workers are trained on a variety of courses in colleges of further education, polytechnics and universities. Some of these courses are intended primarily for non-graduates and last two-years, others are four year undergraduate courses combining a first degree with professional training, and the remainder are at postgraduate level. Students in the last group may have graduated in any discipline from the humanities or the physical, biological or social sciences, many have degrees which included the study of psychology for one, two or three years, and some of these are honours graduates in this subject. The postgraduate social work courses last one or two years depending on the subjects covered in the students' first degrees.

Research into the problem of elective mutism and functional speech disorders has not been excessive during the past 10 years. Previous to this, however, Black (1966) drew attention to the fact that speech problems have occurred throughout history, and problems of stuttering were recorded in hieroglyphics by the ancient Egyptians.

Pavlov's words presaged a twentieth century development for study of human behavioural disorders: Animal learning models. In essence, animal modeling involves induction of disorders analogous to naturally occurring human psychopathologies in animal subjects. The goal, of course, is illumination of cause, cure, and prevention of human disorders. Historically, although Pavlov's (1941, 1966) discovery of “experimental neurosis” in dogs generated initial enthusiasm for animal modeling, the approach later fell into disrepute probably because the early animal experimentation was rather poor (McKinney, 1974). The experimental analyses of the apparently maladaptive animal behaviours were reasonably thorough, but the claim that they represented and/or analyzed some form of naturally occurring disorder was usually unconvincing. Currently, however, a resurgence of interest in the method of animal modeling coupled with increased concern by investigators to set down ground rules for evaluation of animal models is apparent in the recent compilation of several books on the subject (two still in press): Experimental psychopathology: Recent research and theory, Psychopathology: Experimental models, and Relevance of the Psychopathological animal model to the human.

Cullen and Gathercole's review (B.A.B.P. Bull., 1976, Vol.4) of Mahoney's book, Cognition & Behaviour Modification, Ballinger, 1974, prompts me to take up my pen in defense of Mahoney and attack what I believe to be the unfortunate position that some radical behaviourists find themselves in. My reaction to Mahoney's book was very different from that of Cullen and Gathercole's. Fair enough, perhaps, as we each have our own standpoint on how cognitive behaviour modification is or should be. Nevertheless I feel some necessity to present my own views as I do not believe that Cullen and Gathercole's review did justice to the book as a whole. I found Mahoney's book to be an exciting and welcome departure from the current trend of books on behaviour therapy. It is not a review of existing behavioural techniques; nor an idiosyncratic view about what clinical practice should be. Mahoney has focussed carefully on one important and developing area in behaviour modification and provided a lucid, well-informed, thoughtful and at times amusing analysis of the clinical and experimental work pertinent to that area. Regardless of whether one accepts his conclusions or supports his theoretical position, I think the quality of the book should be recognised. Cullen and Gathercole spend most of their review discussing and rejecting Mahoney's theoretical views about mediational models. This is fair enough as their concern is primarily to demonstrate that such models are of little or no use in experimental or clinical psychology.

My topic is the relationship between patient and therapist that occurs in most types of one-to-one therapy involving behavioural principles, but also including therapy with couples and with co-therapists. I shall not deal with the realtionships involved in therapeutic groups or in the application of behaviour modification principles in institutional settings or classroom.

The British Association for Behavioural Psychotherapy (BABP) is not competent to answer fully every question asked by the D.H.S.S. Committee of Enquiry, and it has consequently restricted its evidence to those areas where behavioural psychotherapy has obvious and relevant contributions to make.

What is behavioural psychotherapy? In the following note I do not intend to give a comprehensive answer to this question but rather to put forward a point of view and to illustrate it using one particular example. It appears that the term ‘behavioural psychotherapy’ has acquired a rather restricted meaning in the relatively short time it has been around. In many senses the term Behavioural has become synonymous with scientific i.e. the sort of knowledge gained by the application of experimental techniques to a problem. This I believe is all well and good. The restrictive aspect comes when we consider what sort of problems have been tackled in the ‘behavioural way’. On the whole it seems that we have concentrated on treatment aspects of psychotherapy and appear to have made substantial inroads into problems of therapy. We have now available a plethora of techniques e.g. systematic desensitisation, flooding, modeling, token economies, which had been demon-stated to be efficient in the past. In addition to this there has been a concerted effort to develop a method which enables a degree of experimental rigour to be introduced into the treatment of the individual case (see Mathews, 1975; Leitenberg, 1973).

The first group project I was involved in which could legitimately be called a token economy started in a long-term psychiatric ward some 4½ yrs. ago and ran for 2½ yrs. I do not intend to go into all the details of the project, as they have been published elsewhere (Presly et al., 1976) and the project was similar to others (e.g. Mumford et al., 1975). I want instead to describe some of the things I learned from running a token economy and also to raise a number of issues which seem to be all too seldom discussed in relation to token economies in particular and to psychologists' involvement with long-term patients in general.

Judging from the interest that has been shown in our research project - the Teacher-Child Interaction Project - and from the number of requests we have had to talk to various groups all over the country, there is a growing awareness of the value of behaviour modification in education. However, the various groups interested in these developments seem isolated from each other, and have no obvious forum to discuss areas of mutual interest. It would seem to us that the B.A.B.P. could provide such a forum.

John Marzillier (BABP last issue) has taken exception to our review of Mahoney's Cognition and Behaviour Modification and it behooves us to add a note in defence or justification. The most cogent way of doing this is to comment in turn on each of the major points made by Marzillier.

Examination of the results of previous treatment trials suggests that although behavioural treatment is effective in reducing agoraphobic symptoms, a large amount of treatment time is required, and patients tend to make no further gains when regular therapy sessions stop. A treatment programme was developed which was designed to provide an on-going alternative within the patient's own environment for the instructions and support normally given by the therapist, with the intention of reducing therapist time requirements and maintaining progress in the absence of contact during follow-up. This was done by incorporating the following features: detailed but easily understood instructions were given in written form as well as in discussion, all practice was carried out from the patients' own home, the patients spouse was actively involved in planning and encouraging practice attempts, and both patient and spouse were asked to take overall responsibility for running the programme themselves. Instructions were given in the form of manuals which contained material covering the nature of agoraphobic symptoms, the selection of targets, graded practice and suggestions for panic management.

Previous research suggests that the main causes of dental fear are a traumatic dental experience and negative expectations from others (Lautch, 1971), (Kleinknacht, 1973).