“Of all the contributions made by psychologists to the education and training of the mentally retarded in recent years, pride of place must surely be accorded to behaviour modification” (Clarke and Clarke, 1987). This is a significant claim and one that may be disputed by those who work in other areas (as indeed do the Clarkes themselves) but there is little doubt that behavioural methods have made a major contribution to the teaching and management of people with learning difficulties. This paper will divide the, necessarily selective, review of recent research into two main areas: first, that concerned with skill development and second, that concerned with behaviour reduction and the management of what has become known as Challenging Behaviour.

Patients' beliefs about the causes of anxiety problems have received comparatively little attention. In the present study, agoraphobic patients rated the contribution of eight factors in causing their condition. They also selected the major cause of their agoraphobia and evaluated that in relation to the elements of attributional style. The most commonly selected major cause was stress, which also attracted the highest average ratings. This was followed in frequency by disposition (being a naturally nervous person), circumstances (staying home too much) and childhood experiences. Depression was associated with stronger beliefs in the contribution of several of the causal factors and with rating the major cause as more stable and global. Anxiety was associated with a stronger belief in medical illness as a cause, and with a lower sense of controllability of the major causes. These results suggest that agoraphobic patients' views of the causes of their condition vary, and could usefully be evaluated in relation to the provision of treatment in order to modify the way treatment options are presented to the patients.

Self-monitoring, a competing response and response cost were used in the successful treatment of a 49 year old female patient with a 19 year history of trichotillomania. Self-monitoring and a competing response produced significant decreases in hair-pulling, but still continued as the patient found it pleasurable at times of stress. The addition of response cost procedures overcame this.

In England over the last ten years Behaviour Modification has become increasingly more known, accepted and utilised in the education sector; but only in the last half decade or so has Behaviour Modification been utilised with any generality and regularity.

The successful treatment of faeces retention in a 6-year-old boy is discussed in the light of recent findings in the literature which suggest the need to take both family and therapist variables into account when training parents in child management skills. Details are given of the family variables considered relevant to the presenting problem in this case: lack of paternal motivation to co-operate in treatment, maternal depression and social isolation, and problem behaviour in a sibling. The treatment plan designed to take account of these variables is described, as well as the problems (and their resolution) encountered in implementing it. Successful outcome was maintained at three and six month follow-up. It is argued that wider use of this model of an expanded case study would provide useful hypotheses for future research, as well as clinical relevance for other practitioners.

I have subtitled this address An Autobiographic View; it is also anecdotal and subjective. I find it fascinating to realize that my own autobiography coincides with, and indeed is part of, the history of behaviour therapy and, indeed, of much of clinical psychology as a profession in Britain. Clinical psychology scarcely existed before the Second World War. Even in 1945 the British Psychological Society listed it among terms not entirely meaningless, but too ambiguous for use by the Society. Between the Wars, there had been great resistance to lay encroachment upon medical territory, although there had been a little intellectual testing in mental hospitals by interested academic researchers. At the end of the war, Hans Eysenck came to the Maudsley having done his pioneer factor analytic work on dimensions of personality at Mill Hill. He was keen to establish a clinical psychology course, but was appalled by the existing main models along psychoanalytic lines, both in the United States of America and in the Tavistock Clinic in London. His most important initial recruit was Monte Shapiro, who became head of the clinical course of which I was an early student member and a relatively early staff member. The early emphasis was on assessment mainly by objective standardized tests. Indeed, much of our early intellectual effort went into disputations about the lack of validity of projective tests, such as the Rorschach. We had no real involvement in treatment. Aubrey Lewis, who was the Professor of Psychiatry at the Institute and the dominant figure at the Maudsley Hospital was very much against non-medical participation in therapy.

On a cold and dull Autumn Friday in 1972, I was among hordes of Behaviour Changers/Modifiers/Engineers/Therapists (all to become Psychotherapists) making their way from the four corners of Britain to the Middlesex Hospital in London. We were all going to a meeting to discuss the setting up of a National Association for those interested in Behavioural … whatever. When I arrived, I was refused entry unless I paid £3 annual membership fee to the very smartly dressed bouncer on the door who claimed to be the Treasurer. “But I thought the meeting was to decide if we are going to form an Association and, if so, to elect the officers!” My protests were in vain, as would have been my 460 mile day trip if I had not parted with my £3 — I have never really mastered contingency management!

The present study evaluated the effectiveness of a multiple treatment approach to the group treatment of hypnotic and non-hypnotic taking insomniacs. Twenty subjects sequentially assigned into four groups attended weekly group therapy over a period of 11–13 weeks. Pre- and post-treatment comparisons indicated an overall improvement of the total sample on measures of general health, benzodiazepine related symptom reduction, reduction from hypnotic sedative medication as well as on measures of the quality and quantity of sleep. Overall there was a marked similarity between hypnotic and non-hypnotic users on the measures both before and after treatment. Psychological approaches are suggested as an effective alternative to the prescription of sedative-hypnotics to both recent and chronic insomnia sufferers. The implications of the findings are discussed.

Although body image problems are a major prognostic factor in the course of eating disorders, its treatment has received little attention in the research literature. We present two psychophysiologically controlled cases of intensive exposure treatment with conflicting outcomes. Pre-post treatment assessments included measurements of body size estimation, body related avoidant attitudes and body dissatisfaction. In case 1, although dissatisfaction and avoidant attitudes decreased, body size overestimation remained basically unchanged. Case 2 did not improve. Psychophysiological recordings showed a covert avoidance of treatment stimuli. We discuss the pros and the cons of the treatment, and the implications for the use of exposure therapy in body image disorders.