Clinical Psychologists' Constructions of Insight in Adult Mental Health

Abstract

Insight is a term used in adult mental heath to try to think about and understand how service users’ understand their difficulties. There has been a growth in interest in its potential use in practice. This has led to the development of multiple theories and scales. Research in this area has yielded a vast array of results. Although to date, this enterprise has yielded inconsistent results. While the various insight theories implicate different factors in their models, there is convergence on three recurrent themes: acceptance of mental illness, agreement with treatment, and ability to label experiences as pathological. However, insight in adult mental health is a term that is often used but rarely defined. This research took a social constructionist stance to explore the way insight is deployed by clinical psychologists in practice. It sought to explore the degree to which ideas about insight are used in practice. Conversely it also looked to explore if insight was not used what, if any, analogous psychological theories were deployed in their day-to-day work. The research actively explored a variety of contexts in which clinical psychologists might encounter “insight talk” and how they negotiate these contexts. Nine clinical psychologists working in a variety of adult mental health services within one NHS trust were recruited. Semi-structured interviews were used to explore if, and how, insight is used. The transcripts were analysed using a mixed design of Discursive Psychology and Foucauldian Discourse Analysis. The results suggest that insight and analogous terms are used at different levels of practice. In terms of service user contact (micro-politics) “insight talk” considered insight as psy-model, narrative insight, and formulation. In discussion with colleagues (meso-politics), psychologists constructed their colleagues “insight”. At a system level (macro-politics) psychologists constructed systems as lacking insight and the promotion of a psychologically minded workforce.