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Clin Psychol Rev. 2008 Jul;28(6):963-8. doi: 10.1016/j.cpr.2008.02.003. Epub 2008 Feb 16.

Whatever happened to symptom substitution?

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Fordham University, Department of Psychology, 441 East Fordham Road, Bronx, NY 10458-9993, USA.


Symptom substitution is a theoretical consequence of the psychodynamic model of psychopathology and symptom formation that contrasts markedly with behavioral models. Symptom substitution was a major scientific and clinical question about a half century ago that was abandoned rather than answered partly because it did not seem to occur and partly because perceived methodological problems impeded empirical research. The contemporary relevance of symptom substitution is that the psychodynamic model of psychopathology and symptom formation from which the prediction of symptom substitution stems continues to be widely taught and to broadly inform clinical practice. This article revisits the psychodynamic model of symptom formation and substitution, restates perceived methodological limitations to its empirical study, demonstrates that symptom substitution is an empirically testable prediction, reviews the relevant empirical literature, and discusses implications for the science and practice of clinical psychology including a proposed research design for certifying bona fide psychoanalytic symptoms.

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