The prevention and modification of delinquent behaviour is an issue of increasing concern to society, both in Great Britain and the U.S.A. This concern is aggravated by a growing amount of evidence which suggests that the majority of intervention procedures are not successful in preventing further offending by juvenile offenders (Cornish and Clarke, 1975, Hood and Sparks, 1970, Feldman, 1976). This appears to be true of both penal methods such as fines, probation or imprisonment (Hood and Sparks, 1970) and psychotherapeutic approaches (Logan, 1972).

To increase levels of activity of patients and residents in institutions is seen as an important aim. Work in old people's homes shows that this can be achieved by supplying residents with simple recreational activities. It has also been shown with profoundly mentally handicapped adults that training staff to pay attention to working residents and largely ignore non-active ones leads to increases in resident activity. This study replicates both these results with adult psychiatric day patients. Implications for staff training are discussed.

Effecting change in any organisation is a difficult process (Watson, 1972; Georgiades & Phillimore, 1975), but this is particularly so in hospitals for the mentally handicapped. These are under considerable public pressure to change the aims of the organisation away from simply a caring role, and towards a teaching role aimed at the maximum development of each individual's abilities. Translating these demands into tangible changes presents enormous problems. Very often projects which demonstrate what can be done for the handicapped remain isolated examples of excellence, and do not translate into general service provision effecting the lives of large numbers of handicapped people. The gap between current knowledge and actual practice remains enormous. The particular programmes to be described here arose out of just a small scale “demonstration” project with a group of children on one ward in a mental handicap hospital (Clements, 1976). This programme which was highly staffed aimed at encouraging the all round development of a group of young profoundly, and multiply handicapped children. These children were part of a 30 bedded-ward for multiply handicapped children and young adults. The ages ranged from 12–23 years, no child was fully ambulant, none had any speech, none were continent, and only a few were able to feed themselves. After the success of the demonstration programme, it became necessary to find ways of applying the findings to the ordinary ward situation, where staff ratios were far less favourable. And if a method of sustaining a whole-ward programme were found, this would be of relevance to other wards within the hospital complex.

While behaviour modification techniques are becoming more widely used in primary schools (Ward, 1971; Harrop, 1974; Presland, 1978), special education (McNamara, 1977; Ward, 1975) and even nursery schools (Coleman and Laishley, 1977), only a few studies have demonstrated successful implementation in Secondary Schools (McAllister et al, 1969; Broden et al, 1971). Harrop (1977) found that his in-service training course which had been successful with Primary School teachers was less successful in Secondary Schools. Lane (1977) argues that this is partly due to an inadequate initial functional analysis, whilst McNamara (1977) lists a number of reasons why implementation may be more difficult in the Secondary School setting.

A major stimulus to our paper has been our recent observation of Dr. Vic Meyer at a behavioural workshop. We are concerned therefore with the types of clinical problems which are presented by self-referred “neurotic”, primarily out-patient population. Dr. Meyer particularly excites our interest, since he is a clinician in the instigative mould which we favour. Furthermore he seems to have overcome, for himself at least, the problems we wish to discuss. We are uncomfortable with his claim, however, that he has done so by a rigid adherence to the sort of S-R behaviourist psychology that we can find in textbooks such as Kimble (1967) and other basic learning texts. We feel it to be important to spell out those areas where the term “behavioural” is ascribed to procedures which do not owe their origin to behaviour therapy and is used in some way to authorise and to furnish a rather empty post hoc description of them.

Contrary to traditional models of the emotional effects of alcohol (e.g., Conger, 1956), recent evidence has not supported the notion that alcohol's pharmacological action consistently reduces anxiety in all persons across all drinking situations (see reviews by Cappell, 1975; Freed, 1978; Higgins, 1976; Marlatt, 1976). Instead, emotional responses to alcohol, including changes in anxiety, appear to be critically determined by the drinking context characteristics (e.g., Kalin, 1972; Pliner & Cappell, 1974) and the drinker's expectations of alcohol's effects (e.g., Polivy, Schueneman, & Carlson, 1976; Wilson & Abrams, 1977).

The use of behaviour modification techniques in educational settings is growing steadily in this country. (Ward, 1971; Atkinson, 1975; Tsoi and Yule, 1976; and Brown, 1977). Many teachers are being attracted to these techniques because of the logical approach, the verified principles from which they are derived, the possibility of objective evaluation, the general interest of children in their use and—importantly—the fact that techniques are only a more systemised version of teaching children than they have been using themselves for decades. Clarizio and Yelon (1967) have given several reasons why teachers are appropriate people to use behaviour modification. They note that behaviour modification focuses on behaviour as it presents, rather than on its causes which helps the teacher as he is not normally trained to probe for such causes, is rarely in a position to directly manipulate the cause to effect change and probably knows from experience that even when causes have been isolated and manipulated by other professionals, the behaviour may still persist in the classroom. Unfortunately in some descriptions of the use of behaviour modification not enough thought is given to distinguishing for the reader what are the essentials for experimental design and what are the essentials for a practising teacher in the classroom.

The behavioral treatment of obesity is based upon the largely unverified theoretical assumption that many forms of overweight are acquired and maintained through deviant eating styles characterized by problems in meal/snack initiation and termination. Since overweight persons are theorized to display an exaggerated responsiveness to salient external stimuli, such as the sight, smell, and taste of food, more frequent meal/snack initiations might be anticipated from persons with weight concerns (Hawkins, 1977). Several recent observational studies (e.g. as recently reviewed by Mahoney, 1975, and Stunkard & Kaplan, 1977) have provided equivocal support for the contention that overweight persons eat at a faster rate in single ingestions occuring in naturalistic or laboratory settings. There is a dearth of information, however, regarding the frequency of meals and snacks for normal and overweight persons in naturalistic contexts. One problem is that such normative studies require the collection of data across several ingestions occurring in different situations.

There seems to be little doubt that smoking can be dangerous to your health. A growing body of scientific data has linked the excessive use of tobacco to an increased incidence of a wide range of disorders including cancer of the lung, bladder and oral cavity, cardiovascular disorders such as coronary heart disease and atherosclerosis and pulmonary disorders such as bronchitis and emphysema (USPHS, 1975, 1877). yet, the development of effective and durable treatments for smoking behavior has been an elusive goal. While there are some encouraging signs of progress, recent literature reviews (Bernstein & McAlister, 1976; Frederiksen & Simon, in press; Lichtenstein & Danaher, 1976) continue to conclude that the treatment of smoking is characterized by good initial success but very high rates of “relapse”. Despite our best efforts we are unable to effectively help anywhere from 20–80% of smokers attempting to quit. While the abovementioned reviewers agree that we do have far to go, they also argue that a “behavioral” approach offers us our best chance for advancement, both from a methodological and treatment outcome perspective.

Alcohol treatment outcome studies during the past twenty years have consistently reported that some alcoholics treated via abstinence orientated approaches obtain controlled responsible drinking (Selzer & Holloway, 1957; Bailey & Stewart, 1967; Davies, 1962). Moreover, recent outcome research suggests that controlled drink training may be an effective treatment at least for some abusive drinkers (e.g., Armour, Polich & Stambul, 1976; Caddy, Addington & Perkins, 1978; Sobell & Sobell, 1973; Vogler, Compton & Weissbach, 1975). Controlled drinking as a viable treatment goal for alcoholics, however, remains an area of continued controversy which appears to involve three major issues: (a) Do controlled drinking goals increase the probability of abusive drinking dispositions (Blume, 1977); (b) Are there unique characteristics of those alcoholics choosing controlled drinking goals (Bell, 1963; Lloyd & Salzberg, 1975; Miller & Caddy, 1977; Nathan, 1976); and, (c) Will controlled drink training encourage alcoholics to “try their luck” at other-than-abstinence goals (i.e., will it induce, “… despondent alcoholics to rationalize that the therapeutic goal of reducing excessive drinking to socially acceptable dimensions may be more easily attainable than complete abstinence” (Thimann, 1963, p.325)?