In a field that claims to possess knowledge of the unconscious, Altman asserts, this constitutes an occupational hazard. To counter the temptation to feel more knowledgeable than others, whether patients or the public in general, therapists who practice psychoanalytic therapy, need to remember that the depths of their own unconscious realms are as unfathomable as those they treat. Psychoanalysis, nevertheless, possesses particularly valuable offerings, despite numerous attacks on meaning. Due to the fact that people currently, continuing to move faster and faster as they pursue success and security. Consequently, "thoughtfulness and self-reflection get crowded out. People are instrumentalized, working around the clock, on their cell phones and e-mail and Blackberries, allowing themselves to be exploited in the service of the corporate bottom line" (Altman, 2007, ¶ 4). A recent study related in the New York Times and Newsweek, regarding the treatment of depression, found antidepressant medication alone proved superior to psychotherapy alone. The addition of psychotherapy, nevertheless, complemented the efficacy of the medication. One individual who conducted the study contends that as people currently do not have time for psychotherapy; in turn, medication proves to be effective.

In the journal publication, "Whatever happened to symptom substitution?" Warren W. Tryon (2008), Fordham University, Department of Psychology, Bronx, New York, Tryon (2008) examines the empirical evidence for symptom substitution. Tryon contends that without psychoanalytic intervention, a person's ongoing unconscious conflict, will not resolve itself. Tryon explains: "A neurotic symptom is held to be a compromise formed in response to an unresolved conflict between a forbidden unconscious impulse and the ego's defense against it (Tryon, 2008, p. 964)." According to this perception, the symptom is held to be persistent at any time by a coexisting symptom.

Hence, Tryon (2008) argues, if the individual's repressed unconscious wish is not psychoanalytically lifted, the person's underlying neurosis will continue, even if/when his/her therapy smothers the particular symptom the neurosis evidences at the time. While the neurotic conflict persists, the patient's psyche will recall the defensive service the banished symptom.that was previously rendered. Consequently, particularly in severe cases, "the unresolved conflict ought to engender a new symptom" (Tryon, 2008, p. 964). Fifty or so years ago, symptom substitution constituted a significant scientific and clinical question. Concerns regarding this issue, however, were abandoned rather than answered as some contended that it did not seem to occur. In addition, a number of perceived methodological problems hampered empirical research.

Tryon (2008) initially concludes that the reviewed empirical evidence supports the immense exaggeration of clinical concerns regarding the perils of symptom substitution and argues that his study did not reveal clear evidence of symptom substitution. Nevertheless, although the scientific method cannot confirm that symptom substitution is nonexistent, "the lack of credible evidence for it over more than half a century combined with the motivation by psychoanalytic proponents to find and report such evidence strongly suggests that supportive evidence is unlikely to be forthcoming" (Tryon, 2008, p. 967). In regard to symptom substitution, Tryon purports:

The contemporary relevance of the symptom substitution question is that the psychodynamic perspective continues to be widely taught in both Psy.D. And Ph.D. programs. Freud introduced his psychodynamic model of psychopathology, symptom formation, and psychotherapy to America in 1909 during his invited Clark University lectures. This was the only psychological model of mental disorder and it rapidly spread throughout America as the sole psychological basis for clinical training.

The psychodynamic view & #8230; maintains that underlying psychopathology gives rise to symptoms, continues as a core component of contemporary psychodynamic clinical case formulations. This view compels the corollary conviction that effective psychotherapies must address underlying psychological issues in order to produce lasting results. (Tryyon, 2008, p. 964)

In 1948, 39 years after Freud introduced his psychodynamic model of psychopathology, the American Psychological Association began to accredit clinical training programs. These programs "had to demonstrate that their students were receiving training in psychopathology which meant that their training was based on the psychodynamic model of psychopathology and symptom formation"...

965). In time, even though numerous models in/for training have been introduced, nevertheless, numerous contemporary clinical psychology training programs continue to confirm and communicate the psychodynamic perspective; some to a greater than others.
In psychoanalytic therapy, Tryon (2008) asserts symptoms can clearly be alienated from hypothesized underlying psychodynamic conflicts. The "Diagnostic and Statistical Manual of Mental Disorders & #8230; [DSM-IV] contains and codifies many psychological symptoms" (Tryyon, p. 965). Perhaps, Tryon, concludes, questioning DSM-IV diagnostic criteria relating to symptom substitution, these criteria do not compose bona fide psychoanalytic symptoms, but depict mere behaviors. If patients receiving psychoanalytic therapy do improve and symptom substitution occurs in patients who receive symptom oriented therapy, the hypothesized symptom may be considered a bone fide psychoanalytic symptom Although current literature does not demonstrate the presence of bona fide psychoanalytic symptoms, if/when psychoanalytic therapy helps these patients improve, additional ethically responsible evidence would prove supportive.

The application of psychoanalytic techniques would be appropriate and warranted, Tryon (2008) contends, only if / when the therapist empirically verifies psychoanalytic symptoms. As Freud argued for the need for psychoanalytic therapy, yet advised: "A man should not strive to eliminate his complexes but to get into accord with them, for they are legitimately what directs his conduct in the world" (Sigmund Freud Quotes, 2009). He also noted: "Being entirely honest with oneself is a good exercise" (Ibid.). Whether getting into accord with one's complexities requires psychoanalytic therapy or another type of another narrative, the researcher contends, understanding one's self seems to signify a positive starting point for both the one utilizing the therapy, as well as the one the treatment intends to help.

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