In memoriam: Professor Joseph Wolpe, 1915-1997

Professor Wolpe Died just over a week ago. He changed our understanding of anxiety disorders profoundly. I have posted below an obituary which was published in the Gaurdian, a UK national newspaper.

Changing the face of psychotherapy and common sense

In 1958, Dr Joseph Wolpe published a book ("Psychotherapy by reciprocal inhibition") in which he not only claimed that it was possible to treat the symptoms of anxiety by helping patients to confront their fears, but also systematically to evaluate such effects. These suggestions were greeted with scorn by the psychoanalytic establishment, which maintained that symptomatic treatment which did not deal with the "cause" of neuroses would inevitably result in "symptom substitution". The prevailing view was that problems such as phobias were defences against deep seated conflicts, and that the removal of such symptoms would at best be ineffective, and at worst be harmful by destabilising the patient's psyche. The notion that the effectiveness of psychotherapy could be scientifically evaluated in controlled studies was also rejected by analysts as irrelevant to their work. Forty years later the work instigated by this quiet, gentle and determined man has resulted in cognitive-behavioural therapy substantially replacing psychoanalysis as the psychological treatment of choice. Furthermore, Wolpe's view has passed into "common sense" which now maintains that anxieties are best reduced by confronting them. His emphasis on controlled evaluation of the efficacy of the treatment he advocated anticipated current interest in "evidence based" approaches to mental health by more than three decades. After his medical training in South Africa, Wolpe developed an interest in Freudian theory. His wartime experience of the ineffectiveness of psychoanalytic treatment of traumatised soldiers led him to look for alternative accounts of psychological problems. Inspired by the work of Ivan Pavlov and others on "conditioning", Wolpe began to investigate whether laboratory research on the learning and unlearning of fear reactions in animals might provide a basis for devising new treatments for phobic fears. Drawing on his own series of studies in which he showed that it was possible to rid cats of experimentally induced "neuroses", Wolpe devised a treatment approach which he described as "systematic desensitisation". In effect, this involved teaching patients suffering from phobias to relax deeply whilst they were progressively exposed to more and more anxiety provoking stimuli. This approach readily lent itself to detailed evaluation and refinement, culminating in current treatment approaches to specific phobias in which 70% of patients are completely "cured" in between one and a half and three hours of focussed treatment. Along with Andrew Salter, he devised the approach known as "assertiveness training" which has had a considerable impact outside the psychiatric setting. During the 1950s, Wolpe's work began to attract attention both within South Africa and beyond. During this period he began to work with several psychologists, notably Stanley Rachman (subsequently professor of clinical psychology at the Maudsley Hospital and Institute of Psychiatry and later at the University of British Columbia, Vancouver) and Leo Reyna (now at Nova University, Florida). Both men remained lifelong friends and scientific collaborators. In 1956, Wolpe was invited to spend a year at the Centre for Advanced Studies in the Behavioural Sciences in Stanford, travelling there via London, where he exchanged ideas with Hans Eysenck. In Stanford, Wolpe had the opportunity to develop his ideas alongside other prominent scholars, notably Karl Popper. Wolpe moved to the USA permanently in 1960. His reception by the psychotherapy establishment (including his own department at the University of Virginia) was cool verging on icy, and often overtly hostile. He came to London for a year in 1962 to explore the possibility of moving here, but received little encouragement and resumed his work in the USA. It was only on his move to Philadelphia in 1965 (to the department of Behavioural Sciences, following his initial rejection by the department of Psychiatry) that Wolpe was able to establish a behaviour therapy unit in Temple University. This unit was crucial in the development of theory, research and practice in behaviour therapy. Wolpe and others continued the process of developing conditioning and learning approaches to the treatment of anxiety and other disorders on the basis of carefully controlled experimental studies. The rapid and successful development of this field can be directly attributed to Wolpe's work. A crucial aspect of his success was Wolpe's ability to link theory, research and clinical practice. Throughout his career he spent a high proportion of his time listening to, understanding and helping his patients. Many clinicians and researchers who initially disagreed with what they saw as an overly simplistic approach to complex human problems changed their views as a result of discussing specific clinical cases with him, or observing his sensitivity in working with people troubled by psychiatric problems. With a small group of scientifically-oriented clinicians, Wolpe founded the Association for Advancement of Behavior Therapy in the 1960s, and the Journal of Behavior Therapy and Experimental Psychiatry, which he edited from its inception in 1970 until his death. In addition to his outstanding scientific achievements, he was a brilliant teacher. His lectures and case demonstrations inspired two generations of psychiatrists and psychologists. His list of graduates reads like a roll of honour in the field of behaviour therapy, and there can be few major figures in the field who did not benefit from his genius. More importantly, millions of people suffering from psychological problems have benefited from the creation and development of an approach to therapy which continues to increase in effectiveness and require less and less time. On his retirement in 1988, he moved to California where he held an emeritus position at Pepperdine University. Shortly after this move, his wife of 40 years, Stella, died of cancer. He continued to write and speak prolifically after this, with a continuing passionate commitment to empirical approaches to treatment, strongly supported by his second wife, Eva. He is survived by Eva and two sons from his first marriage. This September, Joe Wolpe attended a meeting in Venice to celebrate the 35thanniversary of Behaviour Research and Therapy, the foremost journal in the field. When he addressed the meeting, he made challenging and illuminating suggestions about the future of scientifically based psychotherapy. As ever, there was a mischievous twinkle in his eye. We will miss his modesty, kindness and inspiration.

Paul Salkovskis

Joseph Wolpe, researcher and psychiatrist, born 20th April, 1915 in Johannesberg, South Africa. Died December 4th, 1997.

• biographical information by katie mitchell, 2/6/98