Joseph Wolpe

Introduction

Joseph Wolpe (20 April 1915 – 4 December 1997) was a South African–born American psychiatrist and one of the founders of behavior therapy. Working at a time when psychoanalysis dominated outpatient psychiatry, Wolpe argued that neurotic fear is learned, and that what has been learned can be unlearned through procedures testable in the clinic and the laboratory. His best-known invention, systematic desensitization, pairs graduated exposure to a feared stimulus with a response that competes with anxiety, and it became the first psychological treatment for phobia with a substantial empirical literature behind it.

Wolpe is unusual among the major figures of twentieth-century psychotherapy because he came to it from medicine rather than from academic psychology. A 2002 survey published in Review of General Psychology ranked him the 53rd most cited psychologist of the century — a position earned by a man whose appointment was in a department of psychiatry and whose professional identity was that of a clinician-researcher.

Early Life and Education

Wolpe was born in Johannesburg, South Africa, to Michael Salmon Wolpe and Sarah Millner Wolpe, and grew up there, attending Parktown Boys' High School. He took his medical degree at the University of the Witwatersrand, intending to practice medicine.

The decisive experience of his early career came during the Second World War, when he served as a medical officer in the South African army and was posted to a military psychiatric hospital. There he was responsible for soldiers diagnosed with what was then called "war neurosis" and would today be recognised as post-traumatic stress. The standard treatment of the day was narcotherapy: patients were given a sedative such as sodium amytal and encouraged to relive the traumatic episode in the belief that abreaction would discharge the repressed emotion and dissolve the symptoms.

Wolpe later described himself as having begun the war a convinced Freudian. What he saw in the wards changed that. Abreaction produced dramatic scenes and very little durable improvement, and the patients' symptoms returned as soon as the drug wore off. The failure of a theory he had accepted largely on authority pushed him toward a literature that psychoanalysts of the period largely ignored: the experimental work on conditioning coming out of animal laboratories.

Academic and Professional Career

After the war Wolpe returned to the University of the Witwatersrand, where he began the animal experiments that would produce his central idea. In 1956 a Ford Fellowship took him to the Center for Advanced Study in the Behavioral Sciences at Stanford University for a year — an immersion in American learning theory that consolidated the framework he had been building in isolation. He moved permanently to the United States in 1960, taking a post at the University of Virginia.

In 1965 he joined Temple University Medical School in Philadelphia as professor of psychiatry, and in the same year established a behavior therapy unit at the Eastern Pennsylvania Psychiatric Institute. Temple remained his base until his retirement in 1988, and it was there that he trained many of the clinicians who carried behavior therapy into American and European practice. He founded the Journal of Behavior Therapy and Experimental Psychiatry in 1970 and edited it until his death, served as the second president of the Association for Advancement of Behavior Therapy, and received that association's lifetime achievement award.

After leaving Temple and moving to California, Wolpe found retirement unsatisfying and accepted a distinguished professorship in the Graduate School of Education and Psychology at Pepperdine University, where he continued teaching and seeing patients until about a month before his death. He died of lung cancer in Los Angeles on 4 December 1997.

Major Contributions to Psychology

Experimental neurosis in cats

Wolpe's first systematic work used cats. He confined animals in a cage and delivered electric shocks paired with a distinctive stimulus — a tone, a visual cue — until the cue alone reliably produced a fear response the animals did not lose over many trials. Having produced an experimental counterpart of a human phobia, he then tried to remove it.

Simply repeating the cue did not help. What worked was feeding the animals while the cue was present, first in a distant room and then progressively closer to the cage where the shocks had been given. Eating, which is physiologically incompatible with fear, appeared to inhibit the anxiety, and the inhibition transferred up the gradient. Wolpe named this reciprocal inhibition: a response antagonistic to anxiety, evoked in the presence of the anxiety-provoking stimulus, weakens the bond between that stimulus and fear.

Systematic desensitization

The clinical translation of that finding became systematic desensitization, Wolpe's most influential procedure. It has three components following an initial behavioural analysis.

First, the patient is trained in muscular relaxation. Wolpe adapted Edmund Jacobson's progressive relaxation, which took many sessions to teach, into a shortened form that could be learned in a handful of appointments. Second, patient and therapist build an anxiety hierarchy — a list of situations related to the fear, ordered from least to most disturbing, and later quantified on Wolpe's Subjective Units of Distress scale, where 0 is calm and 100 is the worst distress the patient can imagine. Third, the patient, deeply relaxed, imagines the lowest item on the hierarchy; when it produces no distress they move one step up, and when it produces distress they return to a lower item. Sessions end only on a scene the patient can hold without anxiety.

The innovation was not exposure as such — that had antecedents — but the packaging of exposure into a graded, measurable, and repeatable procedure, delivered in a dozen or two sessions rather than the years psychoanalysis implied.

Measurement

Two instruments Wolpe built for his own clinical work outlived the theory they were designed to serve. The Subjective Units of Distress Scale (SUDS) gave therapists a common metric for fear intensity, and the Fear Survey Schedule asked patients to rate fear across a large set of common situations, generating a profile of what actually frightened them. Both remain in routine use in anxiety clinics, in forms their originator would still recognise.

Assertiveness training

Wolpe extended reciprocal inhibition to social anxiety through assertiveness training. His premise was that a person cannot be simultaneously relaxed and anxious, and cannot be simultaneously assertive and passive; rehearsing assertive responses while relaxed should therefore inhibit the anxiety attached to social encounters. The technique proved useful for patients whose difficulty was interpersonal, though Wolpe himself acknowledged that it did not generalise well to simple phobias.

Insisting on evidence

Wolpe's most consequential contribution may have been methodological. He insisted that psychotherapy be treated as an applied science in which outcomes are evaluated rather than asserted, he published case material with follow-up data, and he pressed his colleagues to specify what they did in a session well enough that someone else could do it. In the 1950s this was a hostile position to take, and it placed him alongside Hans Eysenck in the campaign against psychoanalytic claims of efficacy.

Major Publications

Psychotherapy by Reciprocal Inhibition (1958) — the foundational statement of his theory and technique
The Conditioning Therapies, edited with Andrew Salter and L. J. Reyna (1964)
Behavior Therapy Techniques: A Guide to the Treatment of Neuroses (1966)
The Practice of Behavior Therapy (1969; 2nd ed. 1973, 3rd ed. 1982, 4th ed. 1990)
Theme and Variations: A Behavior Therapy Casebook (1976)
Our Useless Fears, with David Wolpe (1981)
Life without Fear: Anxiety and Its Cure (1995)

Impact and Legacy

Systematic desensitization made behavior therapy respectable, and the exposure principle at its core survives in the front-line treatment of phobia, panic disorder, obsessive-compulsive disorder and post-traumatic stress. Wolpe's insistence on measurement is now simply what outcome research in psychotherapy does. Several generations of clinicians learned their trade from The Practice of Behavior Therapy, and the randomized trial as a standard for psychological treatment owes something to the standard he set for his own claims.

The theory underneath the technique did not survive intact. Beginning in the late 1960s, dismantling studies took systematic desensitization apart component by component, and each piece turned out to be dispensable. Krapfl and Nawas reported in 1970 that the procedure worked as well without a hierarchy. Stern and Marks (1973) and Emmelkamp and Wessels (1975) found imagined scenes less effective than real ones. Gillan and Rachman (1974) found the relaxation unnecessary. Meanwhile flooding and implosive therapy — which present the most frightening stimulus immediately and pair it with nothing at all — worked about as well, which is difficult to reconcile with a counterconditioning account, since nothing incompatible with fear is being conditioned in. Van Egeren's physiological recordings found little support for reciprocal inhibition as a mechanism.

By 1975 Isaac Marks could review the literature and conclude that the active ingredient was exposure itself, not the relaxation supposedly inhibiting anxiety. The field took that conclusion seriously: the label shifted from "systematic desensitization" to "exposure therapy", and the theoretical account shifted from counterconditioning to extinction and, more recently, to inhibitory learning. Wolpe's own evidence base was thinner than his confidence suggested — his widely cited success figures came largely from uncontrolled case series rather than the controlled designs he advocated for others.

Wolpe also misjudged the cognitive turn. He regarded the emergence of cognitive therapy, associated with Aaron Beck and Albert Ellis, as a regression to the unmeasurable, and as editor of his own journal he was not shy about saying so. History has not sided with him on that point: cognitive and behavioral methods merged, and the resulting CBT dominates contemporary practice. What survives of Wolpe's position is the part he cared about most — that a therapy should say plainly what it does, and should be judged by whether patients get better.

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References

Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford University Press.