Symptom treatment and symptom substitution in enuresis.

Abstract

This study explored the hypotheses that (a) Aspects of the therapist-patient relationship are responsible for successful behavior therapy; and (b) substitute problems will arise following remission of symptoms. Thirty enuretic children were treated either by a conditioning method or by methods devised to duplicate its motivational aspects. Adjustment measures on the enuretic Ss and control children were obtained independent of treatment. Conditioning was superior to other methods, suggesting that successful treatment was not based solely on the therapist-patient relationship. Subsequent to treatment, test measures did not indicate a decline in adjustment; on several measures, significant improvement was found. Two questions are frequently posed to the behavior therapist. First, what are the total effects of treatment on the individual? Traditional psychiatry (e.g., Freud, 1959) views maladjustive behavior as a sign that there is an underlying disorder, and warns that even if a problem can be removed by a nondynamic therapy a relapse or another new problem will follow, since the basic causes have not been treated. This symptom substitution hypothesis is probably the principal theoretical reason why many clinicians hesitate to use behavior therapy. Yet while the vast majority of behavior-ther apy follow-up reports indicate that no new problems have arisen following successful treatment (e.g., Baker, Kahn, & Weiss, 1968; Lang & Lazovik, 1963; Lazarus, 1961, 1963; Wolpe, 1961), there has been no well-controlled study of this hypothesis. Second, why does behavior therapy work when it does? Although behavior therapists stress the role of the learning paradigm in treatment, the learning theory upon which 1 Based on a dissertation submitted to the faculty of the Graduate School of Yale University in partial fulfillment of the requirements for the PhD degree.

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