Insight as a dyadic construct: Disentangling trait-like and state-like components

Or Front & Sigal Zilcha-Mano

Since the early days of psychotherapy, a central goal has been to facilitate the conditions needed to help patients gain insight into their inner conflicts and maladaptive patterns of relating to others. Psychodynamic theories about the process of change generally agree that such gain in insight is expected to lead to better treatment outcome. Yet, the empirical literature is mixed, and whereas some studies demonstrate the importance of insight, others fail to do so. We identify two gaps in the empirical literature that may have led to the inconsistency across studies. We believe that addressing them may lead to a more comprehensive examination of the role of insight in treatment. First, whereas some previous studies examined the level of insight based on patients' self-report, other have done so based on a clinicians’ report. Patients' self-report and a clinicians’ report reflects different perspectives of the same concept. Focusing on the agreement between them may demonstrate a more reliable concept of insight, whereas focusing on the differences between them may highlight how disagreements between them may affect the course of treatment. Second, when measuring the patient's level of insight, it is crucial to distinguish trait-like characteristic of the construct, or the initial level of agreement and disagreement between patient and the clinician, from the state-like changes in their levels of agreement and disagreement over the course of treatment. As has been repeatedly demonstrated in many fields of inquiry, trait-like and state-like components may capture different elements of treatment, and show different associations with treatment outcome. The aim of this study is to investigate the association between insight and outcome, when disentangling the trait-like and state-like components of insight as a dyadic construct, referring to both agreement and disagreement between patients and the clinician. To this end, we use data collected at a university counseling center. Symptomatic level was measured at the beginning and at the end of the treatment. The patients’ level of insight was assessed from their own perspective, as well as from that of a clinician who conducted an interview with them. To test our hypotheses, we will conduct a response surface analysis by polynomial regression. This statistical method will enable us to examine the relation between treatment outcome and insight as a dyadic construct.