The Search for Insight Into Ourselves
When we watch great movies and read impactful novels, we often find that the main character develops greater self-knowledge. In creative works, this is often presented as a moment of “epiphany.” The character suddenly recognizes some truth about their past that they have been blind to or some way in which they have been serving as their own worst enemy. In real life, we are all capable of gaining self-knowledge. However, it is less common for these real-life gains to occur as sudden flashes of insight. More commonly, insight grows gradually over time through paying attention to ourselves through deliberate effort.
Insight and the Aims of Therapy
Psychotherapy is one vehicle that allows us to develop insight about ourselves throughout a therapeutic process. Some therapies, more than others, have this aim. Psychodynamic therapy, which derives from psychoanalysis, is probably the paradigm example of an insight-oriented therapy. It is based on the idea that many people can benefit from devoting sustained attention to themselves to learn about what they are like as people and how they came to be the individuals they currently are.
If the idea that insight can be of great importance resonates with you, you are not alone. A research review (Jennessen et al.) examined several psychotherapy studies to understand whether insight is important in therapy. They understood the words “insight” and “self-understanding” to refer to patients’ understanding of a few connected things:
- the associations between their past and present experiences
- their typical relationship patterns
- the relation between their interpersonal challenges, emotional experience, and psychological symptoms
Their findings led them to conclude that insight can be important for psychotherapy outcomes and appears to be a relevant mechanism of change across different treatment modalities. The effect size of insight was comparable in magnitude to the effect sizes of established treatment factors, such as the therapeutic alliance.
It makes sense to think that different people – perhaps at different points in their lives – may be more interested in seeking insight through psychotherapy. In looking into this idea of “tailoring” therapy to particular clients, I found a very interesting qualitative study (Nilsson et al.). The researchers interviewed people who had completed either psychodynamic therapy or CBT. The format of the CBT that was offered was highly structured and educational. Unlike the psychodynamic therapy provided, CBT had less of an emphasis on open-ended exploration to develop insight.
The clients who were most satisfied with their experiences in psychodynamic therapy reported the following to the researchers:
- they liked that therapy helped them feel they were starting to understand themselves better than before
- they liked that they were developing a feeling of now having a more coherent life story
- they found that this self-understanding went along with accepting themselves more easily
How Can Therapy Foster Deeper Insight?
“One never goes so far as when one doesn’t know where one is going.”
– Goethe
Insight can occur in any psychotherapy. However, psychodynamic therapy processes are deliberately structured in a way that is meant to allow for novel insights to emerge. Most importantly, the emphasis in a “pure” psychodynamic therapy process is on the client gaining comfort in free association. This means that the sessions will not be structured by the therapist, but the client will develop the capacity to spontaneously talk about what is most at the front of their mind. This contrasts with psychoeducational ways of structuring the therapy, where, at the extreme end, the therapist serves as a kind of “teacher.” Each of these two emphases can be beneficial, in different ways. But if we are looking to develop insights into what you are like as a highly unique individual, the imposition of a teaching-style therapeutic framework may create limitations.
In practice, there is no such thing as “pure” therapy. Psychodynamic therapy often includes elements from CBT, depending on the needs of the client at a given time. Still, we can say that psychodynamic therapists will tend to promote therapeutic processes that lead in the direction of fostering insight over time. This is because psychodynamic therapists believe strongly in the importance of insight.
Conclusion
With so many different types of therapy out there, it is important to be able to point to factors that distinguish different approaches. This helps clients make informed decisions throughout treatment planning. Psychodynamic therapy is certainly worth considering for those who are seeking a process that includes an emphasis on the development of insight over time.
References
Jennissen, S., Huber, J., Ehrenthal, J. C., Schauenburg, H., & Dinger, U. (2018). Association between insight and outcome of psychotherapy: Systematic review and meta-analysis. American Journal of Psychiatry, 175(10), 961-969.
Nilsson, T., Svensson, M., Sandell, R., & Clinton, D. (2007). Patients’ experiences of change in cognitive–behavioral therapy and psychodynamic therapy: a qualitative comparative study. Psychotherapy research, 17(5), 553-566.
