Painful Insights

Can Patients 'Forget' Unwelcome Discoveries Achieved in Therapy?

Posted Oct 05, 2013

Insights permanently change how we view the world, other people, or even ourselves. Just as we can’t unfry an egg, we can’t undo what we’ve discovered. As Hilary Mantel described in her book Wolf Hall, “Insight cannot be taken back. You cannot return to the moment you were in before” (p. 189).

At least, that’s what I claimed in Seeing What Others Don’t. But then I got an e-mail from my sister-in-law, Sandie Johnson, a therapist in Michigan. Sandie had just read my book and had many good things to say about it, but she also raised a question about this notion of not going back. Here is the way she put it:

“While this may personally resonate within me, as a psychotherapist, I only wish it could be true more often than it seems to be. Of course, I specialize in trauma recovery and it can, on occasion, be a bit maddening when a patient achieves insight but it somehow evaporates. I have to think more about this issue within this very traumatized population…Sometimes, it can be too painful to challenge one’s way of thinking, especially if a patient is very attached to the perpetrator.”

Hmmm. I would like to show that Sandie is wrong because I am attached to the notion of not being able to undo an insight. Nevertheless, I think Sandie is correct, and I will have to modify my views. Personal insights, particularly painful ones achieved in therapy, may indeed come undone.

This revision opens up a new topic if I ever have a second edition of my book. Under what conditions can insights evaporate? Does this depend on the level of emotion? The level of trauma? Perhaps neurobiological issues come into play — Sandie wonders if high glucosteroid levels might interfere with the permanence of the insight.

Also, are there ways to reduce the chance that an insight will evaporate? Will more repetitions help to stamp the insight in? Or having the patient actively use the insight in examining other issues? Or working through the emotional arousal created by the insight? I welcome comments from psychotherapists who have wrestled with this problem.

At any rate, in talking with therapists I now appreciate how frustrating it is to work hard to help a patient achieve an insight and then have to start over in a future session. This is one reason why therapists are not satisfied with insights — they want to see the insights translated into behavior changes and incorporated into a new and healthier worldview.

Follow me on Twitter @KleInsight for updates on decision making and insight.