In order to deliver a service you have got to have customers. You have got to have permission to provide the service, and you have got to have the competence to provide the service. I want to suggest that social workers do have the clients, are gradually getting the permission, and are suitable candidates for further training in order to become competent.

Behavioural psychotherapists have contributed an enormous amount of research to the problem of smoking; The attraction of smoking as a research field is fairly easy to see. Smokers constitute a high proportion of the adult population of most industrialised countries. A large, reasonably homogeneous subject pool is therefore readily available for research, and since so many smokers claim a desire to stop smoking (McKennell and Thomas 1967), they are ideal for clinical research. In addition the behaviour itself is easy to measure and it is fairly easy to demonstrate behaviour change as a result of therapeutic intervention. Smoking lends itself readily to analysis using the concepts of behavioural psychology, and because such large populations of smokers are always available for therapeutic research, the application of traditional experimental methodology (based upon controlled group comparisons with random allocation of subjects to groups) is quite easy. Despite these apparently favourable conditions, relatively little progress has been made in terms of therapeutic success rates (Bernstein 1969, Bernstein and McAlister 1975). The purpose of this paper is to suggest some reasons for this, and to suggest that behavioural psychotherapists still have a very important role to play in the smoking withdrawal field.

How patients perceive behavioural psychotherapy and what they consider to be the important components and processes involved remain largely a matter for speculation and clinical impression. This is unfortunate since subjective reports constitute a unique source of information and their investigation might yield some valuable insights into the therapeutic process. For example, it could help clarify the role of ‘non-specific’ factors in treatment (Gelder et al., 1973), it might also shed some light on the importance of attributions in behaviour change (Davison and Valins, 1969). With these considerations in mind we decided to ask a group of patients who had improved following a course of behavioural psychotherapy a few simple questions about why they thought this change had occurred.

Self-control is a difficult concept for behaviourists. The implication that we are exercising control over ourselves, rather than being controlled by our environment, appears to run counter to strict behaviourist doctrine. The spectre of mind-body dualism with homunculi sitting inside our head looms large on the horizon. The concept of the self as initiator and controller of our behaviour appears to break all the rules in the behaviourist book. Self-control, in this sense, is not only ‘mentalistic’ and ‘inferential’, it is also in danger of becoming ‘explanatory fiction’. Like the man who gives up smoking because of willpower, we can only infer his willpower from the behaviour it is designed to explain. Skinner (1953) has pointed out the dangers of using inferential concepts such as willpower and self-control. He and many other ‘radical behaviourists’ have strongly argued that there is no place for these concepts in scientific psychology.

The most important role of theoretical models available in psychiatry and psychology is to enable the therapist to “understand” the patient and take therapeutic action on the basis of this understanding. These models determine the nature of the interview, collection of data, conceptualisation of the data and therapeutic strategies to achieve specific goals. The types of knowledge provided by these models can be categorised along a continuum ranging from very subjective to that fulfilling scientific requirements.

Some difficulties in measuring obsessional illness are described. Measurement techniques used in previous behavioural or drug treatment trials are reviewed.

A group of medical students were randomly selected from a larger group to carry out behaviour therapy under supervision. Ten patients with phobic disorders and two with obsessive-compulsive neurosis were treated, and the results, assessed by ratings of proved reliability, compared favourably with other studies in which psychiatrists or nurses acted as therapists. A questionnaire survey showed that students involved in therapy had a more favourable opinion about this kind of treatment than those receiving only theoretical instruction. The results suggested not only that medical students make good behavioural psychotherapists but also that the subject is a worthwhile training experience which warrants inclusion in the curriculum.

Cognitive behaviour modification incorporates procedures aimed at changing clients feelings and actions by modifying what they say to themselves, or think. It is assumed that such self-statements determine, to some extent, emotion and behaviour. The experiments reported sought to examine this assumption in depression, i.e., to what extent do patients feel depressed because they think depressing thoughts? Beck's cognitive theory of depression suggests disordered thinking is the primary cause of depression.

This paper will describe a program whose framework is based on our research of the general characteristics of rapists, and on the results of individual behavioral analyses of over thirty five such individuals. Treatment is aimed at:

(1)reducing the incidence of habitual patterns of unacceptable sexual behavior using aversive therapy and covert sensitization where these two procedures attempt to modify the attractiveness of deviant fantasies.

(2)increasing the incidence of appropriate sexual behavior using various techniques such as: (a) orgasmic reconditioning to enhance the attractiveness of appropriate fantasies; desensitization to reduce heterosexual fearj social skill training involving modeling, videotaped role rehersal, and cue discrimination to reduce aggressiveness and inappropriate assertiveness; thought stopping to eliminate hostile thoughts; converant control to enhance self-esteemj and sex education. The specific content of each program is tailored to the individual's particular problems as revealed by a thorough analysis.