Emergence of Insight in Psychotherapy for Early Psychosis: A Qualitative Analysis of a Single Case Study

Objective: Engaging individuals experiencing early psychosis (EP) in mental health treatment is broadly recognized as a challenging endeavor, especially when persons with EP experience impaired insight or relative unawareness of the psychiatric challenges they face. With limited insight they may see little point to treatment and have difficulties forming an alliance with providers. Tackling the issues of poor insight in EP is further complicated by a lack of knowledge of the processes within psychosocial interventions that lead to improved insight. Method: To explore this, qualitative methods were used to identify content, process, and therapist factors that appeared before and seemed to support insight in a patient experiencing EP as well as the frequency with which insight and psychological problems emerged. The case examined was a 6-month psychotherapy from a pilot study examining the use of metacognitive reflection and insight therapy in EP. Results: Five prominent codes were identified across 24 psychotherapy transcripts that appeared to support the development of insight: narrative details, interpersonal relationships, therapist curiosity, therapist support, and therapist challenges. These appear to have allowed for the emergence of psychological problems first and then finally insight into mental health needs. Conclusions and Implications for Practice: Addressing metacognitive capacity in psychotherapy may allow persons with low insight to recognize psychological problems and then develop a complex idea about their psychiatric challenges. Impact and Implications Addressing metacognitive capacity in the psychotherapy for individuals with early psychosis and poor insight may lead to improvements in insight. In a detailed case study, we found that these procedures enabled him to first recognize general psychological problems and then to form a more nuanced picture of the psychiatric challenges he had been facing for several years, integrating his experience of mental illness.