In selected adult neurotics, nurse-therapists have a significant contribution to make in giving behavioural psychotherapy to patients who were formerly denied it for lack of trained personnel (Marks et al. 1977). Perhaps 10% of all adult psychiatric outpatients can benefit from behavioural psychotherapy as the main approach for those categories of problem where established behavioural methods have been found to be superior to contrasting treatments (Marks, 1976).

Traditionally, behavioural psychotherapists have underplayed the significance of purely verbal means of effecting behaviour change. Verbal therapies have always been regarded with some suspicion and considerable doubts cast about their efficacy (Eysenck 1952; 1960). Even when writers have acknowledged that some change occurs from verbal interventions, their effects are generally seen as weak when compared to more active therapies (e.g. Bandura 1977). In reviews of evaluative research claims are made for the superiority of the behavioural approaches (Rachman 1971) and, even where no such claims are made, there is still the tendency to draw a distinction between behaviour therapy on the one hand, and the verbal or insight therapies on the other (e.g. Smith & Glass, 1977). It is my contention that this distinction is an artificial one; it ignores the fact that behavioural psychotherapists draw heavily on words in their treatments, and, indeed, that many verbal psychotherapists are often very active or behavioural in their work. In this paper I want to illustrate the power of words within behavioural psychotherapy by referring to what therapists actually do in practice. To make this explicit I shall describe a particular case in order to illustrate the way one behaviour therapist uses words for effect. More generally, I shall argue that verbal methods are already a highly significant feature of behavioural psychotherapy, that words, far from being weak in their effects, can be both powerful and efficient and that it is quite appropriate to use verbal methods of analysis and treatment without undermining the basic principles of a behavioural orientation.

People who take heroin, morphine, and other drugs of this type — the opioids — present difficult problems to the therapist. One London drug clinic psychiatrist described them as, “feckless and irresponsible” and even “chronic and untreatable” (Bewley, 1973). The results of treatments summarised below may seem to support these gloomy views, but alternative explanations for drug takers' behaviour in terms of pharmacological and social reinforcement contingencies are possible (e.g. Solomon and Marshall, 1973). The issue is clearly more than academic. If we regard them as untreatable, why treat them? Many people do consider them treatable, and in this paper conventional and behavioural treatments are briefly discussed. It is suggested that although recent behavioural approaches have improved on other treatments they still leave some central questions unanswered.

There can be little doubt that ward-based operant programmes have achieved considerable success in relieving the handicaps of many chronic schizophrenic patients (Atthowe and Krasner, 1965; Ayllon and Azrin, 1968; Kazdin, 1977). In addition, there are now several comparative studies of the token economy (T.E.) and the more traditional therapeutic approaches. Osborne and Adams (1970), found improvements in certain target areas when a reinforcement programme was compared with the traditional form of institutional control in a school for the deaf. Further evidence for the superiority of operant methods over social therapy techniques is provided by Stoffelmayr, Faulkner and Mitchell (1973). The T.E. programme which they implemented, differed from the two social therapy regimes with which it was compared, primarily in that the programmes were devised, specifying the behaviours which were to be encouraged and in that these behaviours when they occurred, were systematically reinforced. The results showed that when the two forms of treatment were compared using direct observation and rating scale techniques, the T.E. regime was superior to social therapy in promoting the following changes: an increase in social interaction, a decrease in apathy (operationally defined), and an increase in self help skills.

Phobias have been defined as excessive fear reactions which are both persistent and unadaptive (Rachman 1974) and have been successfully treated by techniques such as systematic desensitisation (Wolpe 1958) and flooding (Malleson, 1959). Rudestam and Bedrosian (1977) have shown their relative effectiveness to depend upon the type of phobia. Although the client constructs a similar fear hierarchy graded flooding differs from systematic desensitisation in that he is not permitted to “escape” from an item on the hierarchy by returning to an earlier, less threatening one when he experiences fear. Instead, he is required to maintain the activity which has been specified until it no longer evokes anxiety. In the studies described below frequent verbal encouragement was used to elicit and maintain the target behaviours.

Recent articles in this journal have argued for and against the admission of cognitive concepts in discussion of behavioural therapies. The intention of this article is to clarify some of the issues and hence to try and reduce some of the confusion.

Much of the confusion stems from a misunderstanding of behaviourism, particularly of the approach variously called radical, analytical, or systematic behaviourism. This approach, associated with Skinner in particular, must be clearly demarcated from methodological behaviourism which simply distinguishes between the public and the private, and then studies only the former, thus maintaining a dualist ontology between the physical and the mental. Analytical behaviourism, on the other hand, only accepts the existence of the physical, but also distinguishes between the public and the private (Skinner, 1945, 1953, 1964).

On December 19th last year, the BABP sponsored a well-attended symposium on Social Skills Training. The size of the audience attests to the interest in this area, but the level of discussion was less sophisticated than they had the right to expect. The publicity posters posed two questions: “Who, if anyone, really benefits? How, if at all, should it be done?”. This implied that a critical look would be taken at the voluminous literature and that healthy scepticism was the keynote of the evening.

Following the setting-up of the token economy programme (T.E.P.) in St. Brendan's Hospital, Dublin in 1968 (Fingleton and Mccutchan, 1969) and completion of the first series of studies (Fernandez, 1972, a) this author was awarded a Travelling Fellowship by the World Health Organization, Geneva; which enabled him to visit a number of T.E. Programmes in the United States. Following the above visit, a Final Report was submitted to the funding agency (Fernandez, 1972, c). This paper will concern itself with a summary of all observations made in the above Report, and where relevant, these observations have been up-dated in the light of recent research developments and with other informal observations not mentioned in the Final Report.

Chelfham Mill School, Barnstaple, Devon, is a residential school designed on behavioural principles. (Burland, 1976). It is an independent residential school for 46 maladjusted boys aged 7–12 years with I.Q. range 70–95. The boys are referred through child guidance clinics and maintained by local education authorities. The staff consists of an educational psychologist, headteacher, deputy headteacher, social worker, 5 assistant teachers and 9 residential therapists. They have all been trained to use behaviour modification techniques and many of the staff have built up considerable practical expertise since the school was established in 1966.

The following discussion relates our experience of teaching behavioural techniques of child management to single-parent mothers. We found that these mothers were able to conceptualize the theories of child behaviour and apply them successfully to their own children through the use of behavioural programmes.

In teaching behavioural techniques to parents we had the following aims in mind:

1. To initiate behavioural change

2. To maintain behavioural change

3. To foster the group members' ability to anticipate future problems and to deal with these with the minimum of professional advice. Firmer control of their children would result in greater feelings of self confidence for the mothers.

Several experiments were reported in order to show that there are good reasons for suspecting disturbed interhemispheric relationships in some schizophrenics. It was argued that interhemispheric transfer deficits might underlie some of the classical symptoms of schizophrenia and might be related to auditory hallucinations, in particular. The latter suggestion was supported by experimental and clinical observations. Finally, the possibility of introducing neuropsychological methods into behavioural treatment was discussed.

A Report on the NATO International Conference “Experimental and Behavioural Approaches to Alcholism” held in Bergen, Norway (August 1977).

Behaviour therapists everywhere should rejoice that such a conference received the support of the major military powers of the Western World. This unlikely teaming up with NATO is apparently just one example of the noble organisation's efforts to promote international goodwill. Possibly the ultimate achievement of the conference, however, was the promotion of inter-disciplinary goodwill by successfully gathering together 150 participants from the fields of behavioural psychology, anthropology, sociology, animal research and neuropsychology. The subject matter was wide-ranging, including symposia on the assessment of cognitive functioning in alcoholics, alcohol and crime, cross-cultural studies as well as on the behavioural treatment and analysis of excessive drinking.

The recognition that psychological theories, and methods of behaviour change derived from them, are value laden seems to be relatively recent. Vine (1977) has commented on the fact that ethical questions receive the least attention of any topic area in psychology examination questions. He believes that psychologists “are evidently impervious to all those many critics of psychology who object to our irresponsible methodologies, to our philosophical ignorance in recognising that data are theory-laden, and to our frequent and unrecognised prostitution of our discipline” (Vine, 1977, p.377). In view of attempts at restriction of behaviour modification practice already made in the United States and in Britain, it becomes a professional necessity, not a mere armchair luxury, to assess the ethical status of behaviour modification procedures.

We have been engaged in running token economies at St. Crispin Hospital for four years; the initial impetus coming from a Research Grant from Oxford Regional Health Authority at the instigation of the Principal Psychologist here. The patient group we have concentrated on, is the severely chronic long stay male, averaging 25 to 30 years in the institution. In consequence, the goals of such schemes have so far been towards rehabilitation within the institution, by increasing the level of activities of chronically withdrawn patients and by restoring some of the most personal responsibilities for themselves, through the use of structured activities.

A guide to a highly selected list of books written by “experts” for the layman. The selection reflects the authors' own bias for experts whose approach relied primarily on sound scientific bases such as large scale and representative surveys, systematic or controlled observations.