Insight as a common and specific impact of psychotherapy: therapist-reported exploratory, directive, and common factor interventions.
Academic Article
Overview
abstract
The facilitation of insight-broadly defined as forming new connections about one's self, others, and emotions-is viewed as a key process in many forms of psychotherapy. However, relatively little empirical work has addressed what types of therapeutic techniques may facilitate or hinder insight, especially in applied settings. In this practice-research network study, 31 clients and 16 therapists completed questionnaires after 401 sessions of psychotherapy. Multilevel linear modeling was used to explore whether insights are associated with various types of treatments and therapist-reported interventions, while taking into account differences between clients, therapists, and sessions. The results indicate that the types of treatment, as defined by the theoretical orientation of therapists' supervision, were not related to client-rated insight, although this analysis requires more statistical power. However, sessions that included more therapist-reported exploratory interventions than usual for a given client were found to be lower in insight than other sessions for the same client. Similarly, therapists who reported using more exploratory interventions than other therapists had clients who reported experiencing less insight after sessions than other clients. In contrast, therapists who reported using more directive interventions than other therapists, on average, had clients who reported more insight. However, interaction effects revealed that a more complex interpretation of the data was necessary. Specifically, therapists who reported using more directive interventions than their peers, on average, had clients who reported more insight only if the therapists did not also report using high levels of exploratory interventions. Furthermore, directive interventions were associated with insight only when they were used in sessions that also had high levels of common factors. Overall, this study shows that there are both treatment-specific interventions and common factors that are associated with insight, suggesting that understanding differences between types of psychotherapy may require more nuanced analyses within and between treatments.
