Comprehensive process analysis of insight events in cognitive-behavioral and psychodynamic-interpersonal psychotherapies.

Comprehensive Process Analysis (CPA) is an interpretive, qualitative research method for analyzing significant therapy events. CPA was used to analyze 6 client-identified significant insight events in 2 treatments. Two events are presented in depth. The psychodynamic-interpersonal therapy event documented the existence of 2-part significant events and the value of key words. The cognitive-behavioral therapy event illustrated the role of context in transforming small therapy events into significant events. Events in both therapies involved therapist interpretations of recent difficult life events that were delivered in a firm but interactive style. Interpersonal therapy events were distinguished by links to themes from previous sessions and led to awareness of painful emotions. Cognitive therapy events were externalizing reattributions given to more clinically distressed clients. A revised 5-stage microprocess model of the insight is presented. What is insight? A key concept in psychotherapy theories since Freud, insight seems at once both simple and difficult to define. The sense of suddenly seeing a previously missed perceptual pattern, or the ah-hah experience of solving a difficult intellectual or personal puzzle, is a familiar one. Although insight is a central concept in the modern institution of psychotherapy and counseling, relatively little is actually known about it. For example, the defining features of insight have not been properly clarified, nor is it clear what factors give rise to therapeutic insight, how insight unfolds, or what its consequences are. An analysis of standard words, definitions, and usage, as well as client accounts (Elliott, 1984), suggests that insight may have four major elements. The first element is metaphorical vision, or seeing with figurative eyes (e.g., "It made me see I have a tremendous conflict there"). This element also includes the metaphorical illumination that makes the "seeing into" possible ("The light went on"). This visual metaphor is in keeping with the etymology of the word insight as "internal seeing" (The Compact Edition of

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