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.

The BABP was founded in 1972 as an interdisciplinary Association to advance the theory and practice of behavioural psychotherapy in a wide variety of settings. Its membership includes nurses, psychologists, psychiatrists, social workers and teachers.3 The Association has lost no time in getting off the ground. The BABP was responsible for organisation of the successful conference of the European Association of Behaviour Therapy in Heathrow in July, 1974, and for its own annual conference in Leicester in April 1973, including a special national conference which it sponsored on The Psychiatric Nurse as Therapist; proceedings of the latter were published as a Special Supplement to the Nursing Times in 1973 and were distributed to members. The BABP has also sponsored many workshops and meetings round the county, and its members have been represented to the Department of Health and Social Security on two issues of major importance viz. the possible registation of psychotherapists (a questionnaire and agenda of a meeting are enclosed with this newsletter) and the ethics of behavioural treatments.

Behaviour modification or therapy is taken to refer to procedures having the explicit aim of effecting a therapeutic change in the observable behaviour of an individual or group, which is in the long-term interests of the well-being or health of that individual or group, as far as these do not conflict with the interests of society as a whole.

Clinicians faced with the problem of finding the most effective treatment of individual patients often express disappointment and frustration when turning to the research literature for guidance. Treatments and measures reported are often standardised, may be carried out for a fixed period irrespective of response, and use atypical - even ‘analogue’ populations, while variables of most clinical interest - such as individual differences - are symbolically relegated to the error term of the ANOVA. One reaction to this is to dismiss the experimental method as irrelevant to clinical problems, usually in favour of intuition in one guise or another, as a more satisfying and creative activity. It is unfortunately true that rigorous experiment is no guarantee of rapid success in generating valid theory or successful application in the clinic - however it is the only available route to cumulative progress. To utilise it most effectively requires both awareness of relevant clinical questions by the research worker, and willingness to utilise experimental or ‘quasi-experimental’ (Campbell & Stanley, 1966) methods on the part of the clinician, rather than to retreat to the non-experimental and untestable position of the pre-scientific psychotherapists.

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.

One aspect of behaviour therapy research that has been surprisingly slow to develop is the prediction of outcome from individual differences. In most other ways (the formulation of treatment methods precisely enough for them to be replicable, the controlled evaluation of treatment efficacy, the investigation of procedural variations which are of theoretical importance etc.) behaviour therapy research is relatively advanced. But curiously, the prediction outcome is much less well investigated than it is in some other treatment fields such as rehabilitation, which are in other ways at a lower level of scientific development than behaviour therapy.

About 10 years ago, experimental psychology seemed to have little to offer for the analysis and solution of mental health problems. We all remember the joke about the psychologist searching under the lamp-post where the light was strongest. It is not repeated as often nowadays - and with good reason. Concepts from experimental psychology have come to play an increasingly central role in psychiatry. The following is an analysis of the percentage of articles in the British Journal of Psychiatry which were not concerned with psychiatric diagnosis, psychoanalysis, dynamic psychotherapy, physical therapies, neurology, epidemiology, genetics, prognosis and aetiology of syndromes, in the years 1966, 1970, 1973. Psychometric and psychophysiological studies were also excluded if they related to differential diagnosis of psychiatric states. The figures were 11, 13 and 23% for the three years, suggesting a slowly accelerating utilization of concepts derived from experimental psychology. If the rate of growth continues, models derived from experimental psychology will be dominant by 1980.

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.

The areas of agreement within the Workshop were greater than areas of disagreement. What follows is a general summary which tries to pick up emphases in the proceedings and discussion.

The large number of recent reviews testify to the importance of modelling in the experimental and clinical literature on behaviour modification (Bandura, 1969, 1971; Flanders, 1968; Goldstein, 1973; Rachman, 1972, 1975).The initial resurgence of interest has been, without doubt, largely due to Bandura's experimental investigations of imitation learning, and his assignment of modelling to a central role in his social learning theory (Bandura, 1971). He and his colleagues have demonstrated the importance of modelling in such diverse areas as aggression, anxiety-reduction, self-control and the acquisition of moral judgements. In very recent years there has been a veritable explosion of studies with direct or indirect relevance to a clinical population. This is exemplified in the two reviews conducted by Rachman. Prior to 1972, seventeen experimental investigations had appeared. In the next two years a further twenty-six studies were reported (Rachman, 1972, 1975).

An important aim of the B.A.B.P. is to stimulate training programmes among the disciplines from whose ranks it draws its members. At least three big issues affect the kinds of training programmes which may be desirable. The first is the clinical setting in which the behavioural psychotherapy is to be practised, e.g. is the work going to be primarily with subnormal children, or with adult neurotics? While there are certain common therapeutic principles which can be generalised across most settings, skilled behavioural psychotherapy also requires detailed and expert knowledge of the particular clinical problems concerned. Those who have worked with adult neurotics may know very little about subnormals, and vice versa: A practitioner thus requires good experience of the clinical area involved. Recognition of the fact that different areas need differential training is attested by the separate trainings which the nursing and psychiatric professions offer for subnormality and for general psychiatry.

British nursing has the honour of being the first profession to produce a nationally recognised syllabus in behavioural psychotherapy. This notable event is signalled by the approval of an 18-month course for the training of nurse-therapists in adult behavioural psychotherapy (course No. 650) by the Joint Board of Clinical Nursing Studies, which is responsible for post-certificate training of nurses in England and Wales. Some details of the syllabus appear in the appendix. The appearance of this course was the culmination of a three-year operational research program funded by the D.H.S.S. at the Maudsley Hospital. During that project a psychiatrist and psychologist trained five R.M.N. qualified nurses to become full-time therapists. In a final year of the program the trained nurse-therapists were seconded to four hospitals in the London area and to a General Practice Health Centre to see whether their therapeutic skills transferred to work in a new setting - they did.

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.