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.

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.

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.