Simple Conditioning versus the Dynamic Approach to Symptoms and Symptom Substitution: A Reply to Yates
A basic conceptual difference between two major approaches to psychotherapy, viz., the simple conditioning (18, 19, 20) and the psychoanalyticallyoriented or dynamic, is highlighted with respect to the problem of symptom removal and symptom substitution. Thus, those of the simple conditioning persuasion maintain that sympcoms can be treated direccly with various conditioning techniques, in contrast with the usual approach of dynamic psychotherapy, which is to treat the underlying difficulty. Yates' recent discussion of the problem (19) can be considered to be representative of the simple conditioning approach. The purpose of this paper is ro present the dynamic viewpoint on this problem and then attempt to clarify and resolve some of its significant issues, which were raised in Yaces' paper. A case history involving symptom removal will now be presented (17, pp. 419-421 )"in order to facilitate the discussion to follow. Wolberg treated a physician who was very agitated about his impending New York State Board examinations because he was unable to remember his medical studies. He was hypnotically regressed to his medical school days and was able to recall che material. Wolberg also gave him a post-hypnotic suggestion to the effect that during the examination he would recall as much as was necessary for him to remember. During a follow-up interview, the patient reporced that he had overslept the examination and felt very calm upon awakening. He told Wolberg that he could now go back to the Midwest to practice and marry the girl he had met while on his internship there. It turned ouc that his parents wanted him co practice in New York and because he felt obligated to them for putting him through medical school, he was going to give up his plan to settle in his girl's home town. Wolberg interpreted the parient's problem as being a conflict between passing his Boards and practicing in New York vs. failing them and marrying his Midwestern girl friend. His thinking block was a symptom aimed at failing his boards and thereby returning to his girl friend; this motive was ap-