When I was asked by Professor Aubrey Lewis (later Sir Aubrey Lewis) to undertake the establishment of the first school of clinical psychology in this country, and to establish a profession of clinical psychology, I went to the United States of America in order to study how this profession was organised (Eysenck, 1980a). The very hospitable reception I received did not lead me to advocate the establishment of a similar system in this country. It seemed to me that there were three major faults inherent in the American system.

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.

The purpose of this paper was to review the methodological rigor and clinical implications of behavior modification studies in which social skills have been taught to socially deficient children. Thirty two studies were reviewed. The following four treatment approaches were identified and reviewed: adult contingent attention; peer-mediated strategies; modeling; and treatment packages. The clinical merits and limitation of each approach are discussed. Identification and possible target behaviors for neglected and rejected children are outlined. It appears however that conclusions are not warranted at this time about the relative effectiveness of the four treatment strategies. Research issues such as subject selection and the need to document that skills acquired during training are associated with relevant outcome measures are discussed. Finally, suggestions for future social skills studies are offered.

Self-efficacy is normally measured by a pencil-and-paper test, and two separate studies involving snake phobics have indicated that this test does not have significant reactive effects on related behaviour. Two experiments are reported which examine the possibilities of measurement reactivity with a different type of behaviour, the social skill of assertiveness. In the first experiment, 46 non-assertive female students served as subjects. Measuring efficacy was shown to have reactive effects on later behaviour. These reactive effects showed consistent changes during the course of an assertiveness training programme, with the effect of measurement being initially to enhance performance and later to produce slight decrements. A second experiment examined the possibility that this change was related to differing levels of assertiveness. Sixty female students of varying levels of assertiveness participated in this study; again, reactive effects occurred, but they were not related to level of assertiveness. The question of possible therapeutic advantages and disadvantages of using efficacy measures at various points during therapy was raised.

Social dysfunction in a 45-year-old man was treated by a combination of exposure in vivo, social skills training and cognitive modification. Social skills training utilized broad conversational targets designed to help the patient to engage flexibly in social interactions and to be able to generate them in order to achieve his personal goals: to expand and increase his social contacts and meet the opposite sex.

Change was assessed on the basis of the patient's records of daily frequency of performance of targeted behaviours and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact.

The intervention resulted in an increased performance of social targets in real life, general social activity, and a related decrease in associated anxiety. The outcome was maintained for an available 1 year follow-up; systematic data collection was stopped after 6 months. A general improvement in the patient's personal, social and vocational life has also occurred.

This case study explores the therapeutic usefulness of self-exposure instructions by telephone. With very little contact (2 h 20 min over 11 weeks), the agoraphobic client made considerable progress in traveling by bus and shopping in crowded stores. As he lived a considerable distance from the hospital and could not have attended for regular out-patient sessions, a home-based programme would have been the only other alternative. This would have been much less cost-effective.

Current evidence supports the effectiveness of behavioural methods in the treatment of trichotillomania (compulsive hair-pulling). In particular, the Habit Reversal Method has been demonstrated to be effective. Some discussion has centred on defining the active components of this “package” and whether it is applicable to all clients. This case study reports on the successful use of the method to treat a 19-year-old female. Treatment produced an immediate reduction in the number of hairs pulled out, although the client relapsed. Functional analysis was unable to detect any factors associated with this other than loss of client-therapist contact, and the re-introduction of treatment with an emphasis on client self-reinforcement for progress produced significant improvement. This continued upon withdrawal of treatment and was maintained at a follow-up 6 months later. In addition, the intervention resulted in the client being able to exhibit increased control over the behavioural chain which culminated in hairs being extracted. A relationship appeared to exist between these two forms of behaviour change. The findings were discussed with regard to the proposed active change agents in the treatment of trichotillomania.