Insight-oriented psychotherapy is a form of treatment that helps people through understanding and expressing feelings, motivations, beliefs, fears and desires. The understanding develops in the context of a therapeutic relationship. Insight-oriented psychotherapy has developed from psychoanalysis, a form of therapy first established by Sigmund Freud. Central concepts include the belief that psychiatric symptoms and patterns of behaviour, are partially determined by unconscious forces related to a patient's early life experience. Insight-oriented psychotherapy, as practiced today at Psychiatric Services is quite different from the image of the patient lying on a couch with the silent analyst in the background, working with classical drive theory. Clinicians working here are influenced mainly by the more contemporary models of object relations and self-psychology, which stress the importance of both early and current relationships in mental health.
The therapist and the patient meet face to face. The patient is instructed to speak as freely as possible, saying whatever comes to mind. The therapist's task is to listen in an empathic way, paying attention to the feeling component of the material including any discomfort or anxiety that the patient experiences. The therapist looks for patterns in the patient's material that suggest recurrent conflicts that the patient may be unaware of. The therapist comments on what the patient says and asks questions in order to further the patient's self-understanding. In asking questions the therapist helps the patient to become aware of fears and expectations that he/she may not have been previously consciously aware of.
The length of treatment varies depending on the needs and circumstances of the patient. Sometime in the process of an assessment of two to six sessions a great deal can be clarified and ongoing therapy may not be necessary. In some instances, the /counsellor/clinician may propose a course of time-limited or brief insight-oriented psychotherapy where the therapist and patient agree to focus on one key goal or issue and to impose a time limit, (usually sixteen sessions). When therapy is open-ended it may last from several months to several years. When a patient requires lengthy therapy, the Service will facilitate a referral to an appropriate community therapist, as the Service has limited resources.
Insight-oriented psychotherapy can be effective for many clinical conditions including mood disorders, anxiety disorders, substance abuse disorders, eating disorders, sexual dysfunctions, adjustment disorders and some personality disorders. As well it can provide a beneficial approach for people experiencing relational, family or academic problems.
Insight-oriented psychotherapy can be extremely challenging for patients. People often feel quite anxious when given the opportunity to say anything that comes to mind. It can be distressing for a person to reveal thoughts and feelings that he or she may experience as embarrassing or shameful. The therapist is sensitive to the fact that patients may experience strong and sometimes disturbing feelings, as well as painful memories in the course of therapy. Patients may also experience a variety of feelings about the therapist, both positive and negative. Talking about these feelings with the therapist can be challenging and difficult, but it can ultimately be very rewarding.
Prior to starting insight-oriented psychotherapy, the counsellor/clinician thoroughly assesses the patient for diagnosis and suitability for this type of therapy. The therapist develops an initial understanding of the patient that will help guide therapy. Insight-oriented therapists use an expressive-supportive continuum of interventions. The therapist varies the emphasis on providing support versus insight, depending on the need of a particular patient and on the needs of each patient at a particular time. Often as a result of the assessment, the clinician will discuss the benefits of combining medication with psychotherapy.