It is of interest to link behavioural paradigms with the past and see whether the cultural roots of behavioural and cognitive therapies can be found in medieval literature. In this context the attention is drawn to the Icelandic Sagas. Iceland was destined to become a chosen sanctuary for Norse culture, a place where the memories and history of Northern Europe were more diligently preserved than anywhere else, and recorded in books that are today the richest source of knowledge of the Viking Age.

This article is intended to promote consideration and discussion of ethical issues in motivational interventions. The popular concept of client “denial” encompasses a broad range of motivational behaviors including lying, perceptual bias, unawareness, ambivalence, resistance and reactance. The “problem of motivation” typically arises when a therapist perceives a problem and sufficient need for change in someone who does not share this perception. In considering how to respond to such situations, one can conceive of a continuum of levels of readiness to change, and of therapeutic strategies ranging from passivity to coercion. Ethical concerns arise when there is a perceived mismatch between readiness level and intervention strategy. Motivational interviewing is a middle way between passivity and coercion, seeking to evoke intrinsic motivation for change by making salient the inconsistency of problem behavior and that which is more deeply valued. The concern that this approach is “manipulative” combines a descriptive element and an evaluative component. Three possible descriptive meanings are discussed: that it effectively alters behavior, that it does so in persons not seeking or requesting change, and that it may operate through processes not immediately apparent. Ethical concerns regarding motivational intervention are considered within this broader context.

Until the mid 1980s Type A Behaviour (TAB) was considered to confer the same magnitude of risk for CHD as smoking, hypertension and raised serum cholesterol. As such, it was considered a suitable target for modification, particularly in post-infarction populations. More recently, three arguments have been suggested that counter such optimism: (i) recent evidence may suggest TAB is not predictive of heart disease in post-infarction populations; (ii) interventions do not influence physiological processes underpinning TAB and, accordingly, do not reduce risk for disease progression; (iii) there are other, more useful, interventions that may be conducted with cardiac patients. The validity of each of these challenges is critically examined. It is concluded that interventions to modify TAB in patients with manifest heart disease are still of value in reducing risk for further disease progression.

The Early Signs Scale (Birchwood et al., 1989) for the monitoring of prodromal symptoms was used with a schizophrenic inpatient with severe residual psychotic symptoms. Marked changes in the scores were obtained in both self and observer reports during a period in which the patient was considered to “relapse”. The results suggest the possible wider applicability of the Early Signs Scale to patients who experience severe residual symptoms between relapse episodes.

The influence of the personality of asthmatic children and their mothers on the course of their illness is analysed, taking as a basis a sample of 48 asthmatic children. This is done through the assessment of the role of personality in the change that takes place, after the application of various psychological treatments (relaxation, systematic desensitization and stress inoculation) in three variables: number of days of illness, symptomatic relief drug use and school absences. The results obtained highlight the influence of personality on therapeutic success. Consequently, this study shows the importance of tending to personality traits in order to forecast and improve the effectiveness of psychological treatment.

Two patients with longstanding dysmorphic ideas and associated social avoidances refused exposure treatment. A role-play requiring them to research and debate beliefs contrary to their over-valued ideas effected attitude change and facilitated compliance with exposure treatment. In both patients, marked improvement in beliefs and avoidance occurred during treatment and was maintained at follow-up.

It is not clear from the literature whether successful outcomes can be obtained with CBT in chronic, drug refractory patients who require admission to hospital and whose problems date back to childhood. Anecdotal evidence suggests that they can be treated with CBT (e.g. Beck and Freeman, 1990; Young, 1990). However, no detailed reports of successful treatment in this group have been published. The present report will describe the treatment and outcome of one patient, Alison, who was suffering from depression and who was treated with CBT. She had failed to respond to medication and required admission to hospital. She had chronic difficulties that dated back to childhood and had most of the features described by Scott (1992). Her treatment illustrates how the many different aspects of her complex problems could be examined and treated using CBT techniques as these provided a simple way of understanding and dealing with the difficulties she faced.

This single case history highlights the importance of a complete psychological assessment to establish a client's past history rather than simply implementing a behavioural approach for the presenting symptoms. A single session of bereavement work was effective in treating agoraphobia in an elderly lady with a history of affective disorder throughout her adult life.