The Forgotten Rebel: Andrew Salter and the Foundations of Modern Therapy
- Martin Middleton
- Mar 22
- 12 min read
Updated: May 5
In 1959, Richard Condon published The Manchurian Candidate. It went on to produce two Hollywood films, redefine the political thriller genre, and influence popular culture for decades. In Captain America: The Winter Soldier (2014), a reference to The Manchurian Candidate is made without explanation, as the concept has become so ingrained in popular culture that further context is unnecessary. It introduced themes of state-controlled minds, conditioned compliance, and the erasure of individual will. These themes continued into works like The Bourne Identity, where audiences readily accept the premise of a highly trained, brainwashed secret agent initiating a covert manhunt.
The man who helped Richard Condon shape those ideas, and who he called "the person without whom it could not have been written" in his own copy, is still mostly unknown outside a small part of therapy history.
While Andrew Salter helped shape fiction and film, he was also changing the field of therapy itself. You can see his influence in today’s therapy practices, just as modern media can mention The Manchurian Candidate without needing to explain it.
I first became aware of Salter's work through my training in Cognitive Behavioural Hypnotherapy at the UK College of Hypnosis and Hypnotherapy. The curriculum I worked from was non-traditional in that it paid more attention to foundational behavioural approaches to CBT — Meichenbaum, Lazarus, Wolpe — and newer third wave approaches such as ACT, alongside the more standard cognitive tradition.
Much of modern CBT training has a strong foundation in Cognitive Therapy, which focuses on a hierarchy of:
Thoughts First → Impact on Feelings → Leading to Changes in Actions
I call this approach capital C CBT as it primarily uses behavioural activation and experiments to test new ways of thinking once unhelpful thoughts have been challenged.
The integrative CBT I trained in has a less linear approach, where change can happen at any point in the thoughts / feelings / actions cycle - all working together. Change your actions, and your feelings change, which changes your thoughts. Change your feelings, and they change your actions, which change your thoughts. The direction of travel is less fixed. A model that accepts change can start with action rather than thought, and is one that can integrate the work of Salter in a way that a cognitive-focused framework can't.
Conditioned Reflex Therapy: New York, 1949
In 1949, Salter published Conditioned Reflex Therapy, which opens like this:
"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."
That is not the opening of an academic text but an unequivocal call for change. To understand what Salter published in 1949, it helps to understand the world into which he published it in to. The 2nd World War had ended four years earlier, and the American economy was booming - it had doubled since 1939. Henry Luce termed this the start of the "American Century". The centre of global political power, science, technology, culture and wealth moved away from Europe and towards America on its way to becoming a "Super Power".
Psychoanalysis had been the dominant mental health framework, but this was now being challenged. As Salter argued, it was slow and expensive, required years of sessions to produce results which were "insipid and unimpressive." (Salter's words!)
Carl Rogers, the pioneer of non-directive person-centred psychotherapy, published Counseling and Psychotherapy in 1942 and was seen as a direct challenge to Psychoanalysis. Behaviourist Psychology had been challenging Psychoanalysis as early as the 1920s when Mary Cover Jones helped "little Peter" overcome his fear of rabbits. B.F. Skinner’s 1938 book, The Behaviour of Organisms, expanded behaviourism to include operant conditioning, and Salter took those ideas and was among the first to articulate them in a coherent clinical practice.
Salter was a self-educated clinician; he did not have a PhD or academic affiliation. He had spent his teenage years at the New York Public Library reading Pavlov instead of Freud, writing a paid column on cryptography for the New York World, and hanging around magic shops studying how attention could be manipulated. Against this background, he caught the attention of Clark Hull and had a paper on Hypnosis published in an academic journal that was covered by the New York Times, Time magazine, and Life. This single journal article generated a waiting list of clients at age twenty-seven.
What Salter Actually Did
CRT is a clinical manual written in plain language with case studies, specific techniques, and concrete instructions. Salters' main argument is that human unhappiness is the product of inhibition, which is the suppression of natural emotional responses. The way out is excitation - the direct expression of feeling and the reclaiming of spontaneous response. With practice and skills training, you can "recondition" these inhibitory responses. Hence the name: Conditioned Reflex Therapy. He believed he was working directly with conditioned reflexes (which cause distress when inhibited), building new ones and extinguishing old ones.
In CRT, he identified six excitatory exercises, which are the practical core of CRT. I've written a separate post that goes through each one in detail, including a worksheet you can use to start practising them. But briefly:
Feelings Talk: Expressing emotions directly and honestly, removing the roadblock between what you feel and what you say—not performing feelings but actually saying it.
Face Talk: Allowing your facial expression and body language to match your internal state. Inhibition shows in the body before it shows in words - when you wear a frozen expression, you are wearing an emotional mask.
I Talk: Using the word "I" deliberately when expressing feelings and views. Taking ownership of your emotional experience rather than speaking in the impersonal register that distances you from it.
Contradict and Attack: Disagreeing openly, from a place of authentic feeling rather than reasoned argument. You don't need to be able to explain why something feels wrong; feeling that it's wrong is enough to say so.
Agree with Praise: Accepting compliments without diminishing, deflecting, or rejecting them. Salter understood that the inability to receive positive feedback was itself a conditioned inhibitory response and that practising acceptance was a clinical intervention, not just good manners.
Improvise: Acting decisively on instinct rather than deliberating into paralysis. Trusting the first response and getting off the seesaw of indecision.
Through the Lens of Modern Therapy
Let's look at those again through a contemporary vantage point and consider what we would call them today.
Feelings Talk is Emotional Literacy: Serving as a foundation for almost every evidence-based therapeutic approach currently in use, the ability to identify and name emotional experiences is considered a prerequisite for change across CBT, ACT, DBT, and person-centred modalities alike.
Face Talk is Somatic Awareness: Salter observed that inhibition first appears in physical expression. It shows in a managed face or a frozen posture that the neutrality signals something is being suppressed. And while the body might not literally "keep the score" (Grossman et al., 2026), it does provide a running commentary. Contemporary therapy has moved increasingly in this direction, recognising that what the body is doing in the room is information, not interference.
I Talk is the foundation of Assertiveness Training: A concept so embedded in modern psychology that it appears in every CBT workbook, every communication skills training, every conflict resolution framework. Goldfried and Davison, two of the field's most respected figures, credited Salter directly as the origin of assertiveness training. The field then used assertiveness training for 50 years without citing him.
Contradict and Attack foreshadowed ACT’s focus on values-based action: Before ACT gave us exercises for unhooking/distancing from our own thoughts, Salter argued that polite reasoning was often just a mask for fear. By pushing clients to disagree from feeling rather than reason, and to stop over-intellectualising, he was asking them to be authentic and value-driven.
Agree with Praise is Self-Compassion Training: The inability to receive positive feedback is now understood as a central feature of shame-based work, low self-efficacy, and depression. Salter was treating it as a conditioned response that could be reconditioned through practice, repetition, and deliberately doing the thing the inhibition prevents.
Improvise is Behavioural Activation and Psychological Flexibility combined: It is the willingness to act without certainty, to trust instinct, and to move before the perfect plan exists. This is exactly how current psychotherapy tackles rumination, avoidance, anxiety, and depression - through behavioural experiments and the acceptance of your thoughts and yourself.
When these exercises are taken as a whole, what we see is the practice of noticing what you are feeling in the present moment, without suppressing it, and responding honestly -something we would now call mindfulness. Before we had a clinical word for it, and decades before Jon Kabat-Zinn brought Buddhist meditative practice to the West, Salter was already asking his clients to pay attention to what was actually happening in their emotional experience and respond to it directly.
The Third Wave: Catching Up to Salter’s Blueprint
A very brief summary of the history of therapy (with an emphasis on CBT): Freud dominated the early twentieth century. The early behaviourists - Watson, Skinner, Pavlov- offered a more scientific approach, but it was viewed as cold and reductive. Then the cognitive revolution of the 1960s and 70s produced CBT, providing the field with its research-backed "gold standard." Finally, the third wave—ACT, DBT, MBCT—moved CBT toward acceptance, mindfulness, and values-based living.
This third wave is not a post-behavioural development; in many ways, it is a return to behaviourism. Steven Hayes grounds ACT in Relational Frame Theory and functional contextualism and extends the work of B.F Skinner. DBT also relies on a core of radical behaviourism, which is wrapped in a dialectical and Zen philosophical framework (the ability to acccept 2 contradictory views and that be ok). Even MBCT is heavily indebted to behavioural activation.
The cognitive revolution didn't replace the behavioural tradition; rather, behaviourism synthesised with it, adopting new frameworks to cover its historical blind spots. And the figures who were pioneering clinical behaviourism before this shift, Andrew Salter, chief among them, are owed a massive retrospective acknowledgement.
Recent developments have seen a shift towards a transdiagnostic approach to therapy - moving away from specific disorders (where traditional CBT built its large evidence base to make the "gold standard" claim) and instead treating underlying psychological processes. Salter was already doing this in 1949, whether a client presented with a phobia, a social difficulty, or an addiction, the core process was the same: the degree to which a person's natural excitatory response had been suppressed (inhibition), and what behaviour needed to change to restore it. While his specific ways of working and theoretical grounding were a product of his time, his structural architecture was decades ahead of its time. The irony is that the more modern the approach, the more Salterian its foundation tends to be.
The Patent
Something else is worth noting about the kind of thinker Salter was. In 1970, working with psychophysiologist Robert Fried, who published work focused on breathing and biofeedback, Salter filed a patent for a computerised system for analysing cerebral electrical actiUSty. US Patent 3,841,309 was granted in October 1974.
The patent critiques conventional EEG analysis as requiring so much specialist skill that it excludes most practitioners. Salter and Fried's system digitised brain signals, compared them against stored reference patterns, and produced readable outputs without requiring expert interpretation of analogue traces.
This impulse to make specialised knowledge accessible rather than impenetrable is the same one that produced CRT in plain language for a general audience, that pushed back against psychoanalysis that took thousands of hours to get results, and who had the confidence to get an academic paper published alongside authors with PhDs while himself only having a bachelor's degree.
I think it also shows something about how he lived by his convictions and followed his gut and intuition. He was curious enough about the neurological impact of human behaviour to co-develop an improvement in the way brain activity was measured. And, "I feel" he would have been more than comfortable in the modern world of neuroscience. This is not my area, so if it is yours, I'd welcome your input on how the concepts of CRT map onto modern neuroscience, retrospectively. A brief review of the literature looking at self-directed neuroplasticity and bottom-up regulation seems to correlate strongly.
The Man the Field Forgot
Gerald Davison, one of the most respected figures in the history of behaviour therapy, wrote in his obituary for Salter:
"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 behaviour therapy with no citation to Salter."
This is the pattern that repeats: the techniques become so standard and absorbed into the general practice that the person who developed them stops being cited. You will have seen from the description of the 6 exercises outlined above just how commonplace the innovations of Salter's approach are in the modern work. And while I've covered Assertiveness training in this post and argued that he used a transdiagnostic approach before there was a word for it, I haven't covered all of his innovations and contributions:
The introduction of brief therapy
Relaxation via imagery as a precursor to Systematic Desensitisation
The use of "homework" / in vivo (real-world exposure) in Therapy.
This was not a man who lacked presence or whose ideas went unnoticed. When the field moved forward, the citations thinned; the academic world moved without him. This is not a something particualr to Salter as can been seen in this paper (A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes) there was a sharpe drop off in citations for anyone that wasn't Aran Beck or Albert Ellis - the traditonal founders of CBT - after 1981 (and Salter wasn't even part of the discussion). This can be shown in part because he had no university affiliation and stopped publishing after 1964; in part because the cognitive revolution that followed needed its own founding figures and its own origin story (reaching back to Socratic philosophers), and Salter didn't fit neatly into either.
A future post in this series will dive deeper into the relationship between Salter's work and the therapies that followed: specifically, how much of REBT's architecture bears his fingerprints, and why the places it departs from his model might actually be its weakest links.
Read the Book
If parts of this post have landed, the next step is to read the words of the man himself in the 2019 Watkins edition of Conditioned Reflex Therapy.
Salter leaps off the page. You get an immediate sense of exactly who he was.
William J. Salter, Andrew's son and a psychologist in his own right, provides the afterword with personal reflections about a fascinating character. And an introduction by Mark R. Davis which encourages the reader to "grab a pen and underline; highlight and scribble in the margins; laugh (or scowl) at his one-liners...Read it, feel it, interact with it! Have an opinion! Disagree! Tell others what you feel about it! Feelings, as Salter says, are to be felt out loud."
If you found The Happiness Trap useful - Russ Harris's ACT - based self-help book, itself sitting within the behavioural tradition that Salter helped found - CRT will feel immediately familiar in many ways.
Watch the launch event of the new edition below and hear from Davis directly about why it is still relevant today.
For now, the next time you are asked to notice what you are feeling and say it out loud, or to disagree from your gut rather than your head, or to accept a compliment without flinching, or to act before you have talked yourself out of it you are doing what Andrew Salter was asking his clients to do since 1949.
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References & Further Reading
Primary Sources: Andrew Salter
Salter, A. (2019). Conditioned Reflex Therapy (Updated Edition). Watkins Publishing.
Note: This is the modern edition referenced in this post. It includes an introduction by Mark Davis, an afterword by William J. Salter, and an endorsement by ACT creator Steven Hayes.
Salter, A. & Fried, R. (1974). System for analysing cerebral electrical activUS (U.S. Patent No. 3,841,309).
Note: The patent filed by Salter and psychophysiologist Robert Fried for a digitised EEG machine designed to make brain wave analysis accessible to non-specialists.
The History of Behaviorism & Assertiveness Training
Davison, G. C. (1997). Obituary: Andrew Salter (1914-1996). American Psychologist, 52(10), 1125.
Note: Written by a highly respected figure in behaviour therapy.
Goldfried, M. R., & Davison, G. C. (1976). Clinical Behaviour Therapy. Holt, Rinehart, and Winston.
Note: The textbook explicitly credits Salter as the originator of assertiveness training.
Jones, M. C. (1924). A Laboratory Study of Fear: The Case Of Peter. The Pedagogical Seminary and Journal of Genetic Psychology, 31(4), 308–315.
Note: Sometimes called the “mother” of behaviour therapy - I think the founder of behavioural therapy is more than sufficient. Her most famous paper of phobia
Ruggiero GM, Spada MM, Caselli G, Sassaroli S. A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes. J Ration Emot Cogn Behav Ther. 2018;36(4):378-403. doi: 10.1007/s10942-018-0292-8. Epub 2018 Apr 13. PMID: 30416258; PMCID: PMC6208646
Note: Evidence of a drop in citations after 1981 (and the absence of Salter. Also an interesting discussion on CBTs move from content of thoughts to the context of thoughts (I'm stressed to I'm having the thought I'm stressed).
The "Third Wave" Lineage (ACT & DBT)
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. Springer.
Note: This text grounds Acceptance and Commitment Therapy (ACT) within the behavioural tradition.
Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
Note: The foundational text for DBT details its core behavioural mechanisms (distress tolerance, emotion regulation).
About Martin Middleton
Martin Middleton is a Cognitive Behavioural Hypnotherapist based near Leicester and Hinckley, specialising in anxiety, shame, and confidence building. He combines Cognitive Behavioural Therapy (CBT) and Hypnotherapy to help clients silence their inner critic and move from "surviving" to "thriving." Martin offers judgment-free sessions online across the UK and in person.
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