Behavioral treatment of hysterical neurosis: symptom substitution and sympton return reconsidered

One of the major areas of disagreement between therapists working within the psychodynamic and behavioral frameworks involves the issues of symptom substitution and symptom return, the psychodynamicists holding that treatment of symptoms alone cannot result in permanent improvement, and the behavioral therapists arguing that it can. However, a reexamination of the data indicates that psychoanalysts base their conclusions primarily on cases of hysterical neurosis whereas the behaviorists base their conclusions primarily on the treatment of phobia. Heeding the call of the recent American Psychiatric Association Task Force on Behavior Therapy (1973), in this paper we seek to reconcile the apparently contradictory data, illustrating our arguments with case reports. Moreover, we will attempt to obtain a greater degree of rapprochement and cross-fertilization between the dynamic and behavioral schools of thought.