The patient was an 18-year-old girl with a 2-year history of incapacitating Obsessive–compulsive avoidance behaviour for a severe germ phobia. Previous in-patient admissions had failed to produce any improvement. There were no staff in the hospital where she was admitted with any expertise in behaviour therapy so the author was called in as an outside consultant to advise on possible treatment.

A full assessment was made of the patient and the basic behavioural ideas of “modelling”, “flooding” and “avoidance behaviours” were introduced to the entire ward staff. It was decided to employ the ward sisters as the main therapists who were to act as “models”. Target behaviours for change were selected with the patient and baselines obtained before active treatment commenced. Target behaviours were handwashing, time spent in toilet, amount of toilet paper used, rituals before, during, and after showering. In addition, a “germ contamination” hierarchy was constructed. By the 18th week of in-patient treatment, all target behaviours, except going to the toilet to defecate, were under control. This latter behaviour eventually responded well several months later when she was no longer an in-patient. At 2-year follow-up, this girl was entirely free of all “germ” phobias and the associated obsessional avoidance and decontamination rituals.

Marks's paper covers a wide range of different theoretical, clinical and methodological issues in the behavioral approach to the conceptualization and treatment of neurotic disorders. Accordingly, in response to the Editor's request to comment briefly on the paper, I shall necessarily be selective in the points I make, referring the reader to more extended discussions of these issues in other sources. Specifically, I address the following points: the applicability of behavior therapy; the nature and function of its theoretical underpinnings; research strategies; and recommendations for service delivery and training.

Recently a number of studies have reported successfully reducing seizure frequency by interrupting preseizure behaviour and by manipulating the consequences of a seizure. A small research project was set up to overcome some of the methodological problems of earlier studies and to evaluate such a treatment approach with four children. Treatment involved helping the children to develop means of controlling their seizures, and included a system of rewards for seizure-free periods so as to motivate the children to use their method of control. The results indicated that the treatment was successful in two out of four children. On the basis of these results some suggestions as to the mechanisms involved and the place of such an approach in the management of epilepsy are offered.

Six patients suffering from obsessional ruminations were treated with prolonged exposure in imagination. Two variants were compared in a cross-over design: (1) relevant exposure, consisting of exposure to the obsessions and (2) irrelevant exposure, consisting of exposure to ordinary frightening experiences. Relevant exposure proved to be significantly superior to irrelevant exposure. The data of this study suggest that habituation training by means of prolonged exposure to obsessions is a valuable treatment but not the panacea for the treatment of obsessional ruminations.

A 1-year training programme carried out in a group home for mentally handicapped adults is described. A system of goal-planning was used, so that individual goals could be regularly set for clients and their progress monitored. Choice of goals was governed by an attempt to encourage clients to become more independent and more involved with the local community. The success of the training programme is described and the usefulness of the goal-planning procedure is discussed. Implications for residential care services are also briefly considered.

A therapeutic method (behavioural casework) based upon behaviour modification and self-help principles, is described with regard to incontinence and conduct problems, both being categories of social problems which loom large in the consciousness of clinical psychologists, psychiatrists and social workers. Procedures as used in the clinical agency, but more particularly in the natural home setting, are detailed and the results (which are very encouraging) tabulated.

The effects of instructions and reinforcement on the handwriting of a 13-year-old boy in special education were studied. Both variables were found to be effective. A simple scoring method was used. It was found that the scoring system was easily learned by the child, and was sufficiently reliable to merit continued use under certain circumstances.

A survey of 982 betting slips collected within a U.K. bookmaker's office concluded that the vast majority of bets were placed just before the start, or off, of a race. Further analysis revealed that the shorter the race the nearer the majority of bets were placed to the off. Three types of bet were identified: the single bet that involved the backing of one runner in one race (type 1), the multiple bet that involved the backing of more than one runner in a single race (type 2), and the accumulator bet that involved the backing of one runner in each race but over a succession of races (type 3). It was concluded that for horse racing the majority of late bets were type 1, whereas in dog racing most late bets were of the type 2 variety. These results are discussed with reference to a number of theoretical interpretations.

This project was undertaken in an attempt to reduce one of the many problems faced by a man with a severe memory deficit following a left temporal tumour. He was taught to remember the names of 10 people he regularly came into contact with by using rehearsal and visual imagery strategies. Rehearsal alone was ineffective, but within a few weeks he could remember all 10 names once a visual image had been introduced. The findings suggest that this procedure may be used to teach other people with severe memory deficits facts which are useful in their everyday lives. The major difference between this project and most of the others using visual imagery is that the present one is of some practical value for the subject. Most of the others simply demonstrate the ability of the neurologically damaged to use visual imagery.

The effectiveness of instructional training and response cost procedures in reducing the frequency of performance of a range of inappropriate behaviours in a group of nine long-term schizophrenic patients was examined in three distinct settings. Instructional training was found to be generally effective in controlling inappropriate behaviour. The effects of a combined instructional training and response cost procedure in further reducing the level of performance of inappropriate behaviour were confined to a small sub-group of patients and were only demonstrated in one specific setting.

Issues relating to the systematic nature of the instructional training procedure, to maintenance of change and to the role of response cost are discussed.

Kiernan and Riddick's programme for training operant techniques was employed to teach behaviour modification to a variety of staff in a children's mental handicap hospital. The aim was to evaluate the course in relation to a carefully defined group of profoundly retarded multiply handicapped children. Evaluation of the course is described and significant improvement in trainees' skills with respect to the use of physical prompting and reinforcement noted. Some problems of staff in implementing the learnt technique are considered. Finally, the relation between the applicability of behavioural techniques and the characteristics of profoundly retarded multiply handicapped children is considered in the light of more detailed studies of their learning characteristics.

The lack of a suitable technique and inadequate data from previous studies presents problems for the practitioner attempting to evaluate parent mediated intervention. Parent-training schemes tend to be either research oriented or service based. The evaluation of a long-term service presents difficulties while research work has limited application to studies of child change or parent–child interaction and attitude change. Teaching parents behavioural methods usually leads to positive child change therefore emphasis must now move to evaluating the teaching skills parents develop by being trained. Difficulties inherent in the use of multiple-success criteria and various modes of measurement are noted. Observational analysis, using V.T.R., is the most useful technique since it provides a direct record of the skills parents acquire. A practical system for evaluating parent behavioural training is suggested which can be adopted by the practitioner.