Insight and responsibility: A psychodynamic-existential approach to psychotherapy.

Abstract

This article aims to address Rangell's (2011) observation that psychoanalytic insight-often regarded as at or near the center of therapeutic action for psychoanalytically informed psychotherapy (Jones, 2000;Stark, 2000)-is an insufficient vehicle of patient change because it often leaves patients asking their therapists, "So what?" (Rangell, 2011, p. 34). I encountered the insufficiency of psychoanalytic insight in my clinical work with a patient I saw in therapy at a community mental health center. My work with this patient inspired me to hypothesize that the introduction of an existential line of inquiry into psychoanalytically informed psychotherapyparticularly around the construct of existential responsibility-could resolve the insufficiency of insight Rangell (2011) and I observed. I reviewed and critiqued the literature on the role of insight in psychoanalytic psychotherapy-as well as the literature on existential responsibility in existential philosophy and psychotherapy-in working toward a resolution. Reexamining my work with this patient from this perspective, I then put forth my own formulation of existential responsibility in psychotherapy and argue-using clinical material-how it could potentially bolster and complement the psychotherapeutic effects of insight. The importance and implications of this article's findings are drawn out and suggestions for future research are presented.