Andrew Salter (May 9, 1914 – October 7, 1996) was an American clinical psychologist who introduced behavior therapy, developed many of its conceptual foundations, and created numerous techniques still used today across its varied descendants, including cognitive behavioral therapy. His work in the early 1940s demystified hypnosis, interpreting it as a form of conditioning, 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. 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. His father, Morris, was a Social Democrat, sent into internal exile to the same penal village as Trotsky’s first wife, after which the family emigrated to the U.S. after the 1905 Revolution. In the U.S., Morris worked as a watchmaker in the factories of Waterbury, Connecticut, where Andrew was born on May 9, 1914. After his union organizing got Morris blacklisted, the family moved to the Bronx 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 and an M.A. in sociology from the University of Minnesota. 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.
Early life and education
Salter's intellectual gifts were recognized in elementary school: researchers from the Gesell Institute at Yale interviewed and tested him repeatedly as a child, and his parents fostered his intellectual interests. The family moved from Waterbury to New York City when Andrew was fourteen, first living in two rooms behind his father's store, then moving to an apartment. (CRT, p. 238) 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. Time magazine, and in an extensive article in Life magazine, after which he always had a waiting list. 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 to 1000 Park Avenue 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 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)
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, 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 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; 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 was convened at the University of Virginia in Charlottesville, followed two years later by the volume of edited conference papers, The Conditioning Therapies. 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 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 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)
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, and in his actions his history repeats itself. Through psychotherapy we manufacture new history, which repeats itself in his new actions.” (CRT, p. 232) (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.” 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. 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. 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.” in order to substitute a more adaptive behavior for the ‘escape’ and ‘denial’ afforded by ‘hysterical symptoms.’” (p. 262)
Similarly, Kazdin 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.” illustrates the importance of this insight.
Brief Therapy
The idea of brief therapy, 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 [autohypnosis] routine 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) “One of the most influential exposure techniques is the procedure of systematic desensitization developed by Salter (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. Of course Pavlov was a physiologist, but Salter's interest in neurology 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) 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.”