Is insight necessary?

A major influence of psychoanalytic theory on contemporary psychotherapy is the notion that insights can be breakthrough experiences, opening the door to liberation from undesirable behaviors.  Freud posited that repressed memories and emotions could block our progress, and that insight into the blockage in psychoanalysis could “resolve ” it. He also identified resistance as a phenomenon in treatment. The patient might want to change his dysfunctional behavior, but unconsciously resists the change, not knowing what’s on the other side of the door.

Epiphanies can happen in or outside of the therapy session, but is insight necessary for a client in treatment to choose to change her behavior in a positive way? I’ve witnessed “Aha!” moments in therapy sessions that led to chosen changes in behavior in short order. In therapy, as in standup comedy, timing is crucial. You may, as a therapist, know something about your client that he isn’t ready to face or accept yet. If you’re a strategic therapist, you try to help build a framework that will facilitate eventual insight. A poem about psychotherapy put it this way: “I do not open that rusty door/I show you how you’ve locked it, nothing more.” When epiphanies have occurred in session, it’s almost like the cliché of seeing the lightbulb light up.

Such an epiphany in therapy can be a watershed in treatment. As Carl Rogers put it, once you accept yourself as you are, you can begin to change. Susan’s sudden realization that she harbors a lot of justified anger toward her father might allow her either to forgive him, or to place the blame where it belongs without feeling guilty for doing so. Tom’s breakthrough understanding, that accepting he’s gay isn’t the end of the world, opens up a new world of possibilities. So insight has its place in therapy, but is it necessary?

Not necessarily. I’ve had alcoholic clients who declared that they couldn’t stop drinking until they understood why they turned out to be alcoholics in the first place – why they couldn’t control their drinking once they got started, unlike their friends who could. Because I often used sly humor in therapy, I’d earnestly ask clients with this rationalization, “Were you breast-fed or bottle-fed?” Regardless of their response, I’d frame it as the answer to their question. “Now that we’ve established why you can’t control your drinking, let’s discuss what you’re going to do about it.” The what is often more important to focus on than the why.

Sometimes people who aren’t in treatment choose to change their behavior in positive ways, then have insights into their past problem behaviors. Avoidance reinforces avoidance, because it relieves you of anxiety for the moment. People in therapy can be given behavioral prescriptions (as in cognitive behavioral therapy) to do things they typically avoid. It’s called exposure, and it can not only extinguish the fears underlying the avoidance, but result in insight into the origins of those fears. There is value in studying the ways that positive change occurs spontaneously in people’s lives, and adapting the findings for use in psychotherapy. Ericksonian therapists work in this manner.

In conclusion, insight isn’t necessary for a person to change dysfunctional behavior patterns, in or outside of therapy, although it can be helpful sometimes. Waiting for insight to kick in can be a means of avoidance. We’re more likely to learn from the consequences of our changed behavior than by insights we don’t act on. Insight can be a motivating factor in changing your behavior, but not necessarily. I think there’s something to Freud’s notion of resistance. Some  clients in therapy are deeply ambivalent about changing their behavior, and insight might not serve to resolve that ambivalence. I used to say to clients, “Insight and a dollar will get you a cup of coffee.” Now it’s more like two bucks, minimum.

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