Andrew Salter (psychologist)
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Andrew Salter (May 9, 1914 – October 7, 1996) was an American
clinical psychologist Clinical psychology is an integration of social science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and persona ...
who introduced
behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or ...
, developed many of its conceptual foundations, and created numerous techniques still used today across its varied descendants, including
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
. His work in the early 1940s demystified
hypnosis Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
, interpreting it as a form of
conditioning Conditioning may refer to: Science, computing, and technology * Air conditioning, the removal of heat from indoor air for thermal comfort ** Automobile air conditioning, air conditioning in a vehicle ** Ice storage air conditioning, air conditio ...
, now the widely accepted view. He was one of the founders of the Association for the Advancement of Behavioral Therapies, now the
Association for Behavioral and Cognitive Therapies The Association for Behavioral and Cognitive Therapies (ABCT) was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therap ...
. He maintained an active clinical practice in Manhattan until shortly before his death. His key ideas are documented in his book, ''Conditioned Reflex Therapy'', (hereafter ''CRT''), originally published in 1949 and reprinted many times, with a new edition published by Watkins Press in 2019. All citations from CRT refer to this edition.


Family life

Salter's parents were
Russian Jews The history of the Jews in Russia and areas historically connected with it goes back at least 1,500 years. Jews in Russia have historically constituted a large religious and ethnic diaspora; the Russian Empire at one time hosted the largest pop ...
. His father, Morris, was a
Social Democrat Social democracy is a political, social, and economic philosophy within socialism that supports political and economic democracy. As a policy regime, it is described by academics as advocating economic and social interventions to promote soc ...
, sent into internal exile to the same penal village as
Trotsky Lev Davidovich Bronstein. ( – 21 August 1940), better known as Leon Trotsky; uk, link= no, Лев Давидович Троцький; also transliterated ''Lyev'', ''Trotski'', ''Trotskij'', ''Trockij'' and ''Trotzky''. (), was a Russian M ...
’s first wife, after which the family
emigrated Emigration is the act of leaving a resident country or place of residence with the intent to settle elsewhere (to permanently leave a country). Conversely, immigration describes the movement of people into one country from another (to permanentl ...
to the U.S. after the 1905 Revolution. In the U.S., Morris worked as a watchmaker in the factories of
Waterbury, Connecticut Waterbury is a city in the U.S. state of Connecticut on the Naugatuck River, southwest of Hartford and northeast of New York City. Waterbury is the second-largest city in New Haven County, Connecticut. According to the 2020 US Census, in 20 ...
, where Andrew was born on May 9, 1914. After his
union organizing A union organizer (or union organiser in Commonwealth spelling) is a specific type of trade union member (often elected) or an appointed union official. A majority of unions appoint rather than elect their organizers. In some unions, the orga ...
got Morris
blacklisted Blacklisting is the action of a group or authority compiling a blacklist (or black list) of people, countries or other entities to be avoided or distrusted as being deemed unacceptable to those making the list. If someone is on a blacklist, ...
, the family moved to the
Bronx The Bronx () is a borough of New York City, coextensive with Bronx County, in the state of New York. It is south of Westchester County; north and east of the New York City borough of Manhattan, across the Harlem River; and north of the New Y ...
where Morris opened a small watch repair shop. Salter's mother, Fanny was a homemaker. Andrew had a brother who died before he was born and a younger sister, Bertha, who died in 2001. In 1943, Salter married Rhoda Kazan, who had a B.A. from
Queens College Queens College (QC) is a public college in the Queens borough of New York City. It is part of the City University of New York system. Its 80-acre campus is primarily located in Flushing, Queens. It has a student body representing more than 170 ...
and an M.A. in
sociology Sociology is a social science that focuses on society, human social behavior, patterns of social relationships, social interaction, and aspects of culture associated with everyday life. It uses various methods of empirical investigation an ...
from the
University of Minnesota The University of Minnesota, formally the University of Minnesota, Twin Cities, (UMN Twin Cities, the U of M, or Minnesota) is a public land-grant research university in the Twin Cities of Minneapolis and Saint Paul, Minnesota, United States. ...
. She managed the clinical practice, handled his finances, and was an essential contributor to his success. They had two sons: William, born in 1947, and Robert, born in 1952. Salter lived in
Manhattan Manhattan (), known regionally as the City, is the most densely populated and geographically smallest of the five boroughs of New York City. The borough is also coextensive with New York County, one of the original counties of the U.S. state ...
for fifty years and very much enjoyed its museums, theaters, movies and music. He had many friends who were active in the arts, especially writers. On a deeper level, he believed it was an individual's responsibility to help others when possible, and so his colleagues—and even some of his professional antagonists—came to him when they or their family members needed help, because they appreciated his therapeutic insights and deep commitment to his work. As Gerald Davison wrote, "Those of us who knew Salter personally appreciated his sheer brilliance, his wit, his warmth, decency and consideration for others, his supportiveness, his keen intuitive grasp of human nature, his infectious zest for life, his love of art and literature, and his devotion to family and friends." (p. 32) Salter always gave great credit to his wife, Rhoda, for her help, intelligence and insight. Indeed, he took pride in the fact that quite a few of his patients came to sessions early so they could get “free time” with his wife before their official session began. (''CRT'', p. 260) Verbally quick, he loved puns, vivid expressions, clever turns of phrase and especially jokes. His office became an informal joke exchange, and some patients strived to bring a new joke to each session, confident that they would be rewarded by new ones to take away. Occasionally, a patient reported that they had told a joke at a party and was then approached by a stranger who asked if they were seeing Andrew Salter. (''CRT'', p. 246)Salter, A. (2019). ''Conditioned Reflex Therapy''.  London, England: Watkins


Early life and education

Salter's intellectual gifts were recognized in elementary school: researchers from the
Gesell Institute The Gesell Institute of Child Development is a 501c(3) non-profit organization located in New Haven, Connecticut, United States. It promotes to and educates child care professionals on the principles of child development originally laid down by ...
at
Yale Yale University is a private research university in New Haven, Connecticut. Established in 1701 as the Collegiate School, it is the third-oldest institution of higher education in the United States and among the most prestigious in the wor ...
interviewed and tested him repeatedly as a child, and his parents fostered his intellectual interests. The family moved from Waterbury to
New York City New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
when Andrew was fourteen, first living in two rooms behind his father's store, then moving to an apartment. (''CRT'', p. 238) As a boy he was fascinated by magic tricks and
cryptography Cryptography, or cryptology (from grc, , translit=kryptós "hidden, secret"; and ''graphein'', "to write", or '' -logia'', "study", respectively), is the practice and study of techniques for secure communication in the presence of adv ...
and frequented a magic shop in Manhattan, listening to older magicians and learning tricks. He was fascinated by the ways in which they manipulated attention in their work. He wrote a (paid) weekly column on codes and cryptography for the
New York World The ''New York World'' was a newspaper published in New York City from 1860 until 1931. The paper played a major role in the history of American newspapers. It was a leading national voice of the Democratic Party. From 1883 to 1911 under pub ...
in his early teens. His interest in
conditioning Conditioning may refer to: Science, computing, and technology * Air conditioning, the removal of heat from indoor air for thermal comfort ** Automobile air conditioning, air conditioning in a vehicle ** Ice storage air conditioning, air conditio ...
arose in part from these youthful observations of the ways magicians manipulated attention and suggestion to achieve some of their effects.(''CRT'', p. 238) Salter graduated from Morris High school in the Bronx, New York, and entered the uptown campus of
NYU New York University (NYU) is a private research university in New York City. Chartered in 1831 by the New York State Legislature, NYU was founded by a group of New Yorkers led by then-Secretary of the Treasury Albert Gallatin. In 1832, the ...
in 1931, majoring in physics. He found physics unsatisfying and dropped out of college for two years to spend most of his time at the
New York Public Library The New York Public Library (NYPL) is a public library system in New York City. With nearly 53 million items and 92 locations, the New York Public Library is the second largest public library in the United States (behind the Library of Congress) ...
. He read deeply in hypnosis and psychology, preferring Pavlov, Bekhterev, and the
Russians , native_name_lang = ru , image = , caption = , population = , popplace = 118 million Russians in the Russian Federation (2002 '' Winkler Prins'' estimate) , region1 = , pop1 ...
to
Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts i ...
and his followers.(''CRT'', p. 238) He read widely about yogis and mystics, about popular ideas on hypnosis through the years, and about the mastery of suggestibility practiced by the stage and parlor magicians he had encountered as an adolescent. In his time out of college during the height of the Great Depression, he also spent time as a union organizer and enjoyed debating
Communists Communism (from Latin la, communis, lit=common, universal, label=none) is a far-left sociopolitical, philosophical, and economic ideology and current within the socialist movement whose goal is the establishment of a communist society, a s ...
on the street corners of the
Bronx The Bronx () is a borough of New York City, coextensive with Bronx County, in the state of New York. It is south of Westchester County; north and east of the New York City borough of Manhattan, across the Harlem River; and north of the New Y ...
from his youthful perspective as a
Socialist Socialism is a left-wing economic philosophy and movement encompassing a range of economic systems characterized by the dominance of social ownership of the means of production as opposed to private ownership. As a term, it describes the ...
. (He retained his dislike of
Communism Communism (from Latin la, communis, lit=common, universal, label=none) is a far-left sociopolitical, philosophical, and economic ideology and current within the socialist movement whose goal is the establishment of a communist society, ...
as he grew older, though not his beliefs as a
democratic socialist Democratic socialism is a left-wing political philosophy that supports political democracy and some form of a socially owned economy, with a particular emphasis on economic democracy, workplace democracy, and workers' self-management within ...
.) (''CRT'', p. 238) Upon returning to NYU he switched his major to psychology and graduated in 1937 with a B.S., ending his formal involvement with an academic institution.


Professional career

Salter was determined to do something important in psychology building on learning theory and behaviorist psychology, but “had no desire to spend the rest of my life studying the reactions of rats lost in labyrinths”.(Wickware, 1941, p. 86) With only his B.S. from NYU, he started his clinical practice in Manhattan in 1941—which he continued for 55 years until a few months before his death in 1996. He had been interested in hypnosis for years. (''CRT'', p. 239) He became convinced that hypnosis was deeply linked with the phenomena of
conditioning Conditioning may refer to: Science, computing, and technology * Air conditioning, the removal of heat from indoor air for thermal comfort ** Automobile air conditioning, air conditioning in a vehicle ** Ice storage air conditioning, air conditio ...
being investigated in laboratory animals by the behaviorists of that era, and began to use hypnosis with stutterers, nail-biters, and some phobics. Within a few years he had developed his ideas sufficiently to write the article Three Techniques of Autohypnosis, eventually accepted by
Clark Hull Clark Leonard Hull (May 24, 1884 – May 10, 1952) was an American psychologist who sought to explain learning and motivation by scientific laws of behavior. Hull is known for his debates with Edward C. Tolman. He is also known for his work in ...
for the Journal of General Psychology after he “Americanized” his name from Saltzman. This article clarified the concept of
self-hypnosis Self-hypnosis or auto-hypnosis (as distinct from hetero-hypnosis) is a form, a process, or the result of a self-induced hypnotic state. Frequently, self-hypnosis is used as a vehicle to enhance the efficacy of self-suggestion; and, in such case ...
, introduced the idea of using it in therapy, and presented three practical methods for self-hypnosis. This brief article in a professional journal by an unknown 27-year-old was discussed approvingly in the New York Times, Time magazine, and in an extensive article in Life magazine, after which he always had a waiting list. The Time article was titled “Everyman His Own Svengali,” complete with a photograph of Salter. The publicity from major publications, and Salter's own diligent work, helped him develop a clinical practiced that thrived from the time he moved his office from the
Waldorf Astoria The Waldorf Astoria New York is a luxury hotel and condominium residence in Midtown Manhattan in New York City. The structure, at 301 Park Avenue between 49th and 50th Streets, is a 47-story Art Deco landmark designed by architects Schultze ...
to
1000 Park Avenue 1000 Park Avenue is an apartment building on the Upper East Side of the New York City borough of Manhattan. It is located at the northwest corner of the intersection of Park Avenue and East 84th Street. It was built in 1915–16 by the develo ...
in 1943 until he stopped seeing patients shortly before he died in 1996. By 1944 he had expanded his ideas on hypnosis into a small volume titled ''What Is Hypnosis'', which also vigorously attacked the dominant
Freudian Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts i ...
thinking of the day as unscientific and useless to patients. This little book (less than 100 pages) made a strong impact, with reviews pro and con in specialist and general interest publications. The book remained in print for thirty years and was eventually used in many college psychology courses. Its most important feature was Salter's strong argument that hypnosis was a form of verbal conditioning. This early work can be seen as a major step toward cognitive behavior therapy, since it fundamentally involves patients telling themselves things to change how they feel. (''CRT'', p. 241) He treated hundreds of patients, honing his methods for brief therapy and constructing an overarching intellectual framework based firmly on the
Pavlovian Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus (e.g. food) is paired with a previously neutral stimulus (e.g. a triangle). It also refers to the learn ...
paradigm. As his clinical experience accumulated, his techniques expanded beyond hypnosis to conditioning more broadly, specifically conditioning focused on making people more “ excitatory” and less “ inhibitory,” ideas explicitly credited to Pavlov when he documented them later in his most important book, ''Conditioned Reflex Therapy'' in 1949. When the book was published, Freud had died just a few years before, Joseph Wolpe was still conducting his early research in South Africa, and
psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might ...
was the dominant approach to treating psychological issues. “ The American century” was well underway—
World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...
had just ended, the power of modern science had been demonstrated at
Hiroshima is the capital of Hiroshima Prefecture in Japan. , the city had an estimated population of 1,199,391. The gross domestic product (GDP) in Greater Hiroshima, Hiroshima Urban Employment Area, was US$61.3 billion as of 2010. Kazumi Matsui ...
and
Nagasaki is the capital and the largest city of Nagasaki Prefecture on the island of Kyushu in Japan. It became the sole port used for trade with the Portuguese and Dutch during the 16th through 19th centuries. The Hidden Christian Sites in the ...
, and the U.S. economy had doubled in size since 1939. Salter's most important work was very much an example of the optimism of his time. ''Conditioned Reflex Therapy'' is largely composed of chapters of case studies, each beginning with explanatory prose documenting Salter's approach to the problems the cases illustrate—shyness, the addictions, problems of the creative, and the like. It introduced many of the key techniques that have become standard in modern psychotherapy: brief therapy; the use of relaxation, imagery, and self-talk to achieve behavior modification, training in assertiveness—an essential application of his key Pavlovian idea of “excitation”—and the use of “homework” in which the patient applies the lessons of therapy to the real world. See below, Professional Contributions. Like virtually all of Salter's writings, ''Conditioned Reflex Therapy'' made its case in clear, lively prose that is still enjoyable today. Salter was extremely proud of the fact that his writing was praised by some of the authors he admired most including
Aldous Huxley Aldous Leonard Huxley (26 July 1894 – 22 November 1963) was an English writer and philosopher. He wrote nearly 50 books, both novels and non-fiction works, as well as wide-ranging essays, narratives, and poems. Born into the prominent Huxle ...
,
Vladimir Nabokov Vladimir Vladimirovich Nabokov (russian: link=no, Владимир Владимирович Набоков ; 2 July 1977), also known by the pen name Vladimir Sirin (), was a Russian-American novelist, poet, translator, and entomologist. Bor ...
and H.G. Wells.Davison, G. (1996). Andrew Salter APS Observer, 9(6), 30-31. In 1952 Salter published ''The Case Against Psychoanalysis'', in which he explained why, as he had stated earlier in ''Conditioned Reflex Therapy'', “It is high time that
psychoanalysis PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might ...
, like the elephant of fable, dragged itself off to some distant jungle graveyard and died. Psychoanalysis has outlived its usefulness. Its methods are vague, its treatment is long drawn out and more often than not, its results are insipid and unimpressive. (CRT, p7.) The book combined methodological critiques, a review of therapy outcome studies, and what might be called common-sense arguments, as Salter and many others saw them. Since psychoanalysis was by far the dominant method of
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
in the U.S. at the time, the book was quite controversial; as an example, the New York Times published a review by Rollo May that was quite dismissive. ''The Case Against Psychoanalysis'' led Salter to many interviews and television appearances, mostly debates with Freudians. Salter did well in these contests, due in part to his quick wit and excitatory personality as well as the rigor of his arguments. This book led Vladimir Nabokov's wife to send Salter a letter which stated, “My husband asked me to tell you that he read your book with glee.” Gradually, Salter's ideas about behavior therapy began to spread. Joseph Wolpe first came to America from South Africa in 1956, on a fellowship at
Stanford Stanford University, officially Leland Stanford Junior University, is a Private university, private research university in Stanford, California. The campus occupies , among the largest in the United States, and enrolls over 17,000 students. S ...
; he had contacted Salter earlier, encouraged by Leo Reyna, then also in South Africa. Wolpe's most famous contribution to psychotherapy, “systematic desensitization by reciprocal inhibition,” is largely based on techniques that Salter introduce in ''Conditioned Reflex Therapy''. (See below, Relaxation via Imagery and Systematic Desensitization). Arnold Lazarus, a student of Wolpe's, first came from South Africa to the U.S. in 1963 on a fellowship to Stanford, permanently relocating in 1966, when he began his influential American career and life-long friendship with Salter. In 1962 the first conference on
behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or ...
was convened at the
University of Virginia The University of Virginia (UVA) is a public research university in Charlottesville, Virginia. Founded in 1819 by Thomas Jefferson, the university is ranked among the top academic institutions in the United States, with highly selective ad ...
in Charlottesville, followed two years later by the volume of edited conference papers, ''The Conditioning Therapies''.Salter, A. (1964). The Theory and Practice of Conditioned Reflex Therapy. In J. Wolpe, A. Salter, & L. Reyna. ''The Conditioning Therapies: The Challenge in Psychotherapy'' (pp. 21–37). New York, NY: Holt, Rinehart & Winston. Salter conceived of this conference, helped to invite speakers and attendees, and funded it with money from a foundation he had established a few years earlier to support various research projects. In 1966 he was one of the founders of the American Association for Behavior Therapy, or AABT—now the Association for Behavioral and Cognitive Therapies (ABCT). The AABT had its first meeting in Salter's living room. Other founders include Reyna, Wolpe, Joseph Cautela, Edward Dengrove, Herbert Fensterheim, Cyril Franks, Leonard Krasner, Arnold Lazarus, Robert Leiberman, John E. Peters, and Dorothy Susskind. It is now the leading professional organization of a scientifically validated approach to psychotherapy that is used all over the world. Behavior therapy was on its way to becoming legitimized as a central component of
clinical psychology Clinical psychology is an integration of social science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and persona ...
. Salter was quite involved in the AABT during its early years, serving on the board and in various official and unofficial capacities, attending the national meetings and often giving presentations which were always well-attended. Gradually, as behavior therapy became more mainstream, Salter's involvement diminished and he began to be cited less frequently, in part because his ideas had been incorporated into the
zeitgeist In 18th- and 19th-century German philosophy, a ''Zeitgeist'' () ("spirit of the age") is an invisible agent, force or Daemon dominating the characteristics of a given epoch in world history. Now, the term is usually associated with Georg W. ...
and in part because he had no academic affiliation and essentially stopped publishing in 1964. However, just a few months after his death, he received a
Lifetime Achievement Award Lifetime achievement awards are awarded by various organizations, to recognize contributions over the whole of a career, rather than or in addition to single contributions. Such awards, and organizations presenting them, include: A * A.C. ...
from the
Association for Behavioral and Cognitive Therapies The Association for Behavioral and Cognitive Therapies (ABCT) was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therap ...
. In the realm of mass culture, Salter became friendly with the novelist Richard Condon in the mid-fifties. They had many conversations about conditioning and hypnosis and their potential applicability in brainwashing. Condon transmuted those ideas into The Manchurian Candidate (1959). Salter's father's work is discussed at length in the book, and he is mentioned in the
movie A film also called a movie, motion picture, moving picture, picture, photoplay or (slang) flick is a work of visual art that simulates experiences and otherwise communicates ideas, stories, perceptions, feelings, beauty, or atmosphere ...
by the chief North Korean brainwasher, Yen Lo. In the copy of the book he inscribed to Salter, Condon wrote that all those pages about Yen Lo “could not have been written” without him. (''CRT'', p. 244) Some friends and patients even saw aspects of Salter's personality in Yen Lo's cheerful extroversion and conversational breadth. Salter was glad that his ideas about “feeling-talk"(''CRT'', p. 67) became transmuted by others into “assertiveness training” and especially pleased that the growing women's movement found value in his ideas. He cherished the letters and inscribed books he was sent by first-wave feminists thanking him as the
women's movement The feminist movement (also known as the women's movement, or feminism) refers to a series of social movements and political campaigns for radical and liberal reforms on women's issues created by the inequality between men and women. Such is ...
advanced. (''CRT,'' p. 253) Salter maintained his clinical practice in Manhattan until a few months before his death, working earnestly to help them achieve what he always believed was the essential goal of psychotherapy: becoming happy. Salter died at home on October 6, 1996, of complications from abdominal surgery.


Major Publications

''Three techniques of autohypnosis''. Journal of General Psychology, 24(2), 423–438, 1941 ''What is Hypnosis'' New York, NY: Richard R. Smith, 1944
''Conditioned Reflex Therapy'' London, England: Watkins, 2019
''The Case Against Psychoanalysis'' New York, NY: Henry Holt, 1952


Professional Contributions


Excitation and Inhibition

As his clinical experience accumulated, his techniques expanded beyond hypnosis to conditioning more broadly, specifically conditioning that was focused on making people more “ excitatory” and less “ inhibitory,” ideas explicitly credited to Pavlov. These ideas and techniques are the focus of ''Conditioned Reflex Therapy'', formed the basis of his practice until his death, and widely influenced the work of many others to the present day. Salter's therapy was driven by one essential goal: enabling people to be happier. They came to him because they were unhappy or unsatisfied, sometimes with an identified problem, sometimes with more general malaise. He believed that the path to greater happiness, whatever the problem, required action rather than focusing on insight. “The history of the individual is stored in his
protoplasm Protoplasm (; ) is the living part of a cell that is surrounded by a plasma membrane. It is a mixture of small molecules such as ions, monosaccharides, amino acid, and macromolecules such as proteins, polysaccharides, lipids, etc. In some defi ...
, and in his actions his history repeats itself. Through psychotherapy we manufacture new history, which repeats itself in his new actions.” (''CRT'', p. 232) His recommended action was of a particular kind: being more excitatory (“assertive” in today's language) in their daily lives. “Inhibition becomes excitation only through action.”(''CRT'', p. 142) This would provide positive feedback and in turn help to form new, healthy habits. These ideas were revolutionary in 1 949. His emphasis on excitatory behavior pervades ''Conditioned Reflex Therapy''. Although his therapeutic strategy was the same for virtually all his patients, his tactics were widely varied and tailored to the personality and life circumstances of the patient, as he discusses in “The Constructive Use of Past Conditionings” in therapy. (''CRT'', pp. 48–57) He provides a number of examples of how he used elements from his subjects’ prior lives and relationships and their relationships with him – in a possibly unconscious echo of the Freudian idea of
transference Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
– to encourage excitatory behavior. Once they became excitatory in their lives outside the office, they would get positive reinforcement from their actions and interactions. “People are faithful to the grooves in their emotional phonograph records,” he posited, “and rather than bemoaning this, it means that with a masochist we must be stern, with a club man type we must be amusing, and with a scholarly person we must be as analytical as possible.” (''CRT,'' p. 48) The quote concludes: “As I have stressed, there is no communication except in terms of the person being treated.” Or, as he says in the prior paragraph, “We must talk to people in their private, personally conditioned language. Anything else is gibberish.” While Salter documented his firm belief that all of his therapeutic techniques were derived directly from the theoretical framework he built on
Pavlovian Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus (e.g. food) is paired with a previously neutral stimulus (e.g. a triangle). It also refers to the learn ...
principles, even those who admired his work and practices did not fully share this conviction. Goldfried and Davison (1976) note that “While many would disagree with alter's characterizationof the relationship between his theory and his practice, he nonetheless occupies a central role in the development of behavior therapy.”Goldfried, M. R., & Davison, G. C. (1976). ''Clinical Behavior Therapy''. New York, NY: Holt, Rinehart and Winston. (p. 5). Kazdin (1978) agrees that Salter's professed linkages between theory and practice were unconvincing but affirms the importance of its contributions: “Although the specific Pavlovian notions of inhibition and excitation that were posed as the theoretical base of conditioned reflex therapy have been refuted, fuller versions of techniques initiated by Salter are still being employed.” (p. 174) This remains true today.


Hypnosis

In ''Three Techniques of Autohypnosis,'' Salter clarified the concept of
self-hypnosis Self-hypnosis or auto-hypnosis (as distinct from hetero-hypnosis) is a form, a process, or the result of a self-induced hypnotic state. Frequently, self-hypnosis is used as a vehicle to enhance the efficacy of self-suggestion; and, in such case ...
, made the case that hypnosis was a form of word association and therefore of conditioning, introduced the idea of using it in therapy, and described three practical methods for self-hypnosis he had developed. Essentially, Salter taught “subjects” (as he called them) how to rapidly induce a hypnotic trance in themselves, using procedures quite similar to those he used when hypnotizing them. They were to invoke these brief self-induced hypnotic states to reinforce in their everyday lives the learning and changes made in his office via hypnosis. This allows subjects to maintain the desirable effects of hypnosis (such as eliminating nail-biting, overeating, procrastination, and so on), overcoming the common problem of hypnotic therapy that its effects quickly fade. As Salter put it, “Autohypnosis completely surmounts this diminution of hypnotic suggestion.” (p. 435) Second, through this ability to voluntarily reinforce the effects of hypnosis, the subject learns to feel—and actually to be—in control. This increases feelings of self-efficacy (not that Salter used the term) and rapidly “weakens the feeling of dependency upon the psychologist held by most cases under treatment.” (p. 435) Salter expanded his ideas on hypnosis into a small volume titled ''What Is Hypnosis,'' in which he also vigorously attacked the dominant Freudian thinking of the day as unscientific and at best generally useless to patients—a theme he returned to.


General Contributions to Behavior Therapy

Salter was a founder of
behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or ...
. He was the first to base his overall clinical approach firmly in conditioning and learning theory, and he also created associated therapeutic approaches and used them clinically. (p. 173) ''Conditioned Reflex Therapy'' is widely considered a landmark in the history of behavior therapy. (pp. 202–203) As Kazdin wrote in his review of the 2002 edition of ''Conditioned Reflex Therapy'', “ alter'sleap from learning theory and research to treatments for clinical practice was novel and groundbreaking.”Ellis, A. (2003). Cognitive Restructuring of The Disputing of Irrational Beliefs. In W. O'Donohue, J. Fisher, & S. Hayes (Eds.); ''Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Practice'' (pp. 79-83). Hoboken, NJ: John Wiley & Sons. (p. 408) And yet, as Gerald Davison put it in his obituary, “Ironically, being an innovator often makes a given contribution less visible. Just as references to psychoanalysis seldom cite Freud, one often encounters ‘assertion training’ and the origins of behavior therapy with no citation to Salter.” (p. 31)


Cognitive Behavioral Therapy

Some methods now used in cognitive behavior therapy (CBT) are also present in ''Conditioned Reflex Therapy''. Indeed,
Albert Ellis Albert Ellis (September 27, 1913 – July 24, 2007) was an American psychologist and psychotherapist who founded rational emotive behavior therapy (REBT). He held MA and PhD degrees in clinical psychology from Columbia University, and was certi ...
, widely considered the founder of CBT, thought so: “I was not the first therapist to use what became known as cognitive behavior therapy (CBT), since a few practitioners—such as Herzber (1945) and Salter (''CRT'', p. 255)—had employed aspects of it previously.” (p. 91)


Assertiveness

Salter's goal of enabling patients to be more excitatory in their lives outside the office is the idea of assertion, stressed in many self-help books. The chapter “Conditioning Excitatory Reflexes” in ''Conditioned Reflex Therapy'' is the first concrete description and explanation of how “assertiveness” works, and why it is important for a patient to practice. “Early recognition of the problem of unassertive behavior was provided by Salter,” according to Goldfried and Davison. (p. 153) The “patient was given training in assertive behavior.(''CRT'', pp. 67-72) in order to substitute a more adaptive behavior for the ‘escape’ and ‘denial’ afforded by ‘hysterical symptoms.’”Franks, C. (1969). ''Behavior Therapy: Appraisal and Status''. New York, NY: McGraw-Hill. (p. 262) Similarly, KazdinKazdin, A. (1978). ''History of Behavior Modification: Experimental Foundations of Contemporary Research''. Baltimore, MD: University Park Press says that: “The use of assertive responses had been advocated by Andrew Salter, whose therapy technique was based upon Pavlovian concepts. Salter claimed successful treatment of several disorders by having individuals behave assertively in everyday interpersonal situations. Wolpe was impressed with Salter's results although he rejected the theoretical basis of the technique. Wolpe used assertive responses for inhibiting anxiety in interpersonal situations but interpreted the technique according to the principle of reciprocal inhibition.” (p. 156) “Pavlov's theory inspired a number of applied behavior therapists, most notably Andrew Salter who developed his conditioned-reflex therapy.... Wolpe's ‘assertive’ response approach represents a very similar technique and conceptualization.” As part of his excitatory training, Salter encouraged patients to use the word “I” intentionally; indeed, his discussion of General Eisenhower's healthy emotions in ''CRT.'' (''CRT'', pp. 18–22) makes much of his use of that word. One of his “six techniques for increasing excitation” is “the deliberate use of the word I as much as possible.” (''CRT'', p. 68) Fritz Perls' emphasis on “I-Talk” illustrates the importance of this insight.


Brief Therapy

The idea of
brief therapy Brief psychotherapy (also brief therapy, planned short-term therapy) is an umbrella term for a variety of approaches to short-term, solution-oriented psychotherapy. Overview Brief therapy differs from other schools of therapy in that it emphas ...
, and specific approaches to it, originated in Salter's work years before managed care and the strictures of insurance coverage (which, like virtually all individual health care providers, he loathed). As early as 1941, Salter was committed to the idea of brief therapy. He was convinced that successful therapy—“successful” defined as the patient's being happier—could often be accomplished much more rapidly, building on the work of the behaviorists and applying his approach to hypnosis. In the article in Life, the author reports that “The majority of Salter's cases learn the utohypnosisroutine after five or six interviews, and rarely see him afterwards”—as opposed to the hundreds of sessions commonly required by psychoanalysis. On the first page of ''CRT'' Salter stakes out a typically strong position: “I say flatly that psychotherapy can be quite rapid and extremely efficacious. I know so because I have done so. And if the reader will bear with me, I will show him how... we can... help ten persons in the time that the Freudians are getting ready to ‘help’ one.” (''CRT'', pp. 7-8)


Relaxation via Imagery and Systematic Desensitization

''CRT'' introduced the idea of using relaxation via imagery linked to positive affect for reducing
phobia A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoi ...
s and anxieties and for changing behavior such as nail-biting, insomnia, smoking, stuttering, and more complex social problems. It also introduced a number of specific techniques for inducing relaxation and employing imagery. The method of systematic desensitization, later named and elaborated by Joseph Wolpe (who had just finished training as a psychiatrist in South Africa when ''Conditioned Reflex Therapy'' appeared) is a detailed application of Salter's approach to phobias and related disorders, though Salter used relaxation and imagery much more broadly, Kazdin observed, “Salter (1949) may have been the first to employ imagery in behavior modification. He manipulated imagery to alter the client's mood and feelings in the therapy sessions as well as in his everyday experience to overcome maladaptive reactions such as anxiety. In therapy, Salter's use of imagery paralleled desensitization very closely.” (p. 222) The core of “ systematic desensitization” is the association of a positive response, typically relaxation, with
aversive stimuli In psychology, aversives are unpleasant stimuli that induce changes in behavior via negative reinforcement or positive punishment. By applying an aversive immediately before or after a behavior the likelihood of the target behavior occurring in t ...
. This concept pervades the case studies in ''Conditioned Reflex Therapy''. Various academic psychologists support Salter's primacy. Two quotations above from Kazdin (pp. 156 and 222) and one from Franks (p. 262) say this explicitly, as do Hazlett-Stevens and Craske:Hazlett-Stevens, H., & Craske, M. C. (2008). Live (In Vivo) Exposure. In W. O’Donohue, J. Fisher, & S. Hayes (Eds.); ''Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Practice'' (pp. 223–228). Hoboken, NJ: John Wiley & Sons. “One of the most influential exposure techniques is the procedure of systematic desensitization developed by Salter and by Wolpe (p. 223). His obituary in The New York Times also noted his contribution to systematic desensitization: “The therapy Mr. Salter employed encouraged patients to express their emotions and used visual imagery to reduce anxiety. It also moved people past their fears by gradually getting them accustomed to being around the things they feared.”


Therapeutic “Homework”

Salter emphasized the importance of patients being excitatory in their real life outside the office, with spouses, colleagues, friends, and strangers. These interactions would provide positive feedback, thereby producing healthy new habits. This emphasis on homework, rehearsal, or in vivo exposure has become another central feature of behavior therapy as well as cognitive behavioral therapy. Franks (1969) calls it “instigation therapy,” and defines it as “the systematic use of specific suggestions and assigned tasks in the patient's daily environment....The patient is taught to modify his extratheraputic environment and to apply learning techniques to his own behavior. The approach is best characterized as one in which the patient learns to become his own therapist” (p. 552). He reports that “Salter has applied instigation techniques to a host of neurotic problems” (p. 457). Hallam (p. 63) puts it well: “Salter's aim was to arrange for new emotional experiences through what the person did. What was new about this at the time was his emphasis on action.... His objective was to get the person to do the correct thing by himself.”


Cognitive Neuroscience

Salter was greatly intrigued by what has come to be termed
cognitive neuroscience Cognitive neuroscience is the scientific field that is concerned with the study of the biological processes and aspects that underlie cognition, with a specific focus on the neural connections in the brain which are involved in mental process ...
. Of course Pavlov was a physiologist, but Salter's interest in
neurology Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
went beyond Pavlov and lasted his entire life. In typically vigorous phrasing, he wrote: “Psychological events are physiological events, and conditioning is the modification of tissue by experience” (''CRT'' p. 232) His basic theoretical framework – that learning consists of strengthening cortical pathways and that such pathways can be either reinforced or inhibited – has become a commonplace in contemporary neuroscience. His interest in neurology was so great that he and a colleague developed a digital electroencephalograph that was awarded U.S. patent number for “a method of analyzing bioelectric outputs of living things by sensing, amplifying and comparing such outputs with selected predetermined values and providing indications of each occurrence of the departure of a discrete value of such outputs from such predetermined values.” And he anticipated, in general terms, that progress in electronics might revolutionize investigation of mental processes: “ the end of the century... ogress in electronic miniaturization will allow us to check, in our offices, how the patient ‘really’ felt when he visited his mother last Sunday, or got up before an audience, or had an argument with his wife.” (p. 23)


References

{{DEFAULTSORT:Salter, Andrew 20th-century American psychologists American hypnotists 1914 births 1996 deaths 20th-century American non-fiction writers