An Exploratory Study of Psychotherapeutic Insight as It Emerges Both within A Counseling Conversation and Post-session

探索從心理治療對話中衍生的洞察

Student thesis: Doctoral Thesis

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Detail(s)

Awarding Institution
Supervisors/Advisors
Award date3 Aug 2017

Abstract

While insight has long been a topic of interest in the field of psychotherapy, much about both its process and its content remains unclear. A recent consensus definition of the term provides some needed clarity but focuses more on the “what” of insight than the “how.” The current study expands the existing knowledge of both the content and the underlying process of insight in psychotherapy, with an emphasis on its collaborative co-construction through therapeutic dialogue.

The present work adopts the guiding framework of insight as dialogic co-construction; i.e., psychotherapeutic insight is a conversational accomplishment. Unlike the solo activity that insight is in other domains, such as problem-solving or decision-making, insight in the context of psychotherapy is a mutual endeavor involving two parties: the client and the therapist. This framework is grounded in a post-modern, collaborative, and constructionist approach to both research and counseling.

In alignment with the aforementioned framework, this study utilizes a collaborative research methodology in which my own counseling clients were invited to act as co-researchers in examining a phenomenon (insight) co-produced during our therapy sessions. A sample size of eight clients participated in the study, each with two interviews (one full hour therapy session along with one full hour co-researching session), for a total of 16 transcripts. All sessions were transcribed solely by the researcher and verified for accuracy with the clients, resulting in a cumulative transcription time of roughly 128 hours. In sum, the 16 transcripts amount to 366 single-spaced pages available for analysis. The work is qualitative in nature, employing two analytic modalities: thematic analysis and narrative processes coding system. The thematic analysis component underwent participant verification. Regarding the narrative processes coding system, an interrater reliability level of 90% was established for identification of topic segment shifts, while an interrater reliability level of 85.7% was established for identification of narrative process sequences within insight moments.

The findings suggest that insight is a collaborative product of the counseling conversation, sometimes therapist initiated, sometimes client initiated, but always embedded in the dialogue between the two participants. The findings also show that insight can occur during the process of post-session reflection on the part of the client. Previous research has identified three main client processing modes during therapy: external, internal, and reflexive, while further stating that most insight moments tend to occur in the reflexive mode. The present research demonstrates that insight can originate in any of the three processing modes, but some processing in a reflexive mode seems to be necessary. The reflexive mode processing, however, may occur during post-session reflection instead of in the therapeutic hour. Additionally, the work expands the corpus of lexical discourse markers for insight that therapists can be attuned to as potential areas of insight generation.

Both clinical implications for therapists and theoretical contributions are identified and discussed. A collaborative-dialogic model of psychotherapeutic insight that captures its narrative and intersubjective nature is developed and elaborated along with an updated definition of psychotherapeutic insight. The current thesis thus positions itself as an original contribution to knowledge on the study of psychotherapeutic insight by providing a better understanding of the dialogic mechanism underlying insight-producing therapeutic conversations.

    Research areas

  • psychotherapeutic insight, collaborative co-construction, insight-producing therapeutic conversations, collaborative-dialogic model of psychotherapeutic insight