*Therapy is Not the Place for Insight

If you're at all familiar with psychodynamic approaches to psychotherapy, you've probably heard them referred to as "insight oriented." The premise is simple: by exploring the therapeutic relationship (usually and especially via transference) and connecting these experiences to relational themes in the patient's past and present, she can develop deeper insight into conflictual relational patterns that are causing or exacerbating mental health symptoms.

This premise seems sophisticated especially insofar as it eschews the notion that it is mere insight which facilitates a change in unconscious dynamics, and emphasizes that the here-and-now working through of the transference is what leads to this particular form of change-inducing understanding. It also represents a growing trend away from manualized treatments promising freedom from one's mental health symptoms in a timely and prescribed manner—for who could possibly predict the timing and content of what may unfold in any relationship, let alone a therapeutic one? This is especially seductive for folks who've tried therapy before and left with little more than institutionally acceptable ways to describe how they were suffering.

However, the very notion of insight-oriented treatment raises two questions worth considering: what exactly is being understood, and why should understanding be privileged as an aim of treatment? One familiar conception of insight presupposes that the unconscious contains something somewhere inside the mind, in readable, retrievable form, waiting to be discovered (popular use of the term subconscious would imply a topological position somewhere "below" the conscious). Additionally, interpretation, when it works, must unearth that repressed piece of knowledge, information, memory, etc. waiting in the unconscious. An interpretation, in this sense, is the connection between an acting-out in the transference with another important relational theme in the patient’s life. In other words, the discovery of something repressed. Finally, the patient, via its unearthing, must come to know it and understand it, it now being part of the conscious mind. Not every psychodynamic clinician conceives of insight this way. Insight may instead be understood as something produced via the therapeutic relationship rather than discovered within the patient. But this distinction, though critical, leaves our second question unanswered: why should the production of understanding constitute the aim of treatment? If you see nothing problematic just yet, let's explore these assumptions more in depth.

Lacan states in Seminar I, when referring to the unconscious, “…it is something which will be realized in the symbolic, or, more precisely, something which, thanks to the symbolic progress which takes place in analysis, will have been” (p. 158). He goes on to say, "The symptom initially appears to us as a trace, on which will continue not to be understood until the analysis has got quite a long way, and until we have discovered its meaning...” and then, “…what we see in the return of the repressed is the effaced signal of something which only takes on its value in the future, through its symbolic realization, its integration into the history of the subject” (p. 159). Put more plainly, yes the unconscious exists—we can be certain it exists because of the way it affects our everyday lives: slips of the tongue, bungled actions, repetition, etc. But this does not mean it exists as a kind of ready-made, readable, and knowable alter-ego or shadow self. The very formations through which the unconscious makes itself known suggest that its truth cannot simply be retrieved as though it were a prior written account, merely awaiting discovery. Its significance is constituted retroactively through the symbolic work of analysis. If the unconscious were already organized into a fixed set of meanings that we could read, interpretation would amount to little more than deciphering what was there all along.

Recall that the conception of insight as the discovery of repressed knowledge must rely on something tangible, knowable-in-advance, and thusly discoverable in the unconscious to be brought into consciousness via the transference. But, as stated, this is precisely the paradox of the unconscious: its truth is not simply something that is prior to its articulation, but something which will have been constituted retroactively through the course of treatment via the symbolic. Bruce Fink is instructive on this point, stating in his 1997 text A Clinical Introduction to Lacanian Psychoanalysis, “Insofar as interpretation hits the real, it does not so much hit the truth as create it. For truth only exists in language (it is a property of statements), and thus there is no truth of that which cannot yet be said. Truth is not so much 'found' or 'uncovered' by interpretation as created by it” (p. 158).

And yet, perhaps the more consequential problem remains. Even if one concedes that insight is produced rather than discovered, why should its production be considered the aim of treatment? An understanding may be newly constituted, plausible, and even deeply meaningful to the patient without necessarily altering anything about the unconscious dynamics with respect to their symptom or suffering. The question, then, is no longer simply whether interpretation discovers or produces truth, but whether understanding that truth is what makes treatment effective.

What, then, is the status of understanding as it relates to truth? In Seminar III, Lacan says quite plainly that “understanding is evoked only as an ideal relation. As soon as one tries to get close to it, it becomes, properly speaking, ungraspable” (p. 7). Bruce Fink would make a treatise against understanding in his titular essay stating, “the primary goal of psychoanalysis with neurotics is not understanding but change,” going on to add that “speaking this material aloud to someone else is not the same as understanding why the fantasy came into being. Understanding may at times accompany change, but it is not a necessary prerequisite to change and may in many cases constitute an obstacle to it. Bringing things to speech with another person is what is essential” (Against Understanding Vol. 1, pp. 5-6, 2013). Psychoanalytic work, then, must not be organized around insight as its governing aim. There may be moments of insight in treatment, but the understanding and resulting meaning it generates for and about an individual should not be mistaken for unconscious knowledge. Indeed, such understanding may very well become “something the ego crystallizes around…[serving] the purpose of rationalization, which keeps the unconscious at bay” (Ibid. p. 7). An insight, however seductive, may therefore serve not to advance analytic work but to bring it to a halt. If one wishes to work at the level of the unconscious, one must relinquish the assumption that understanding is either a prerequisite for change or evidence that change has occurred.

A final question remains: if not insight, then what? If not to arrive at conclusions or understanding, or to achieve conscious mastery of unconscious knowledge, then what is the point of your therapy at Venue Clinic?

Were you expecting an answer?

Are you disappointed?

Frustrated?

Curious?

So?

What do you have to say about that?

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Fink, Bruce. A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique. Harvard University Press, 1997.

Fink, Bruce. Against Understanding, Volume 1: Commentary and Critique in a Lacanian Key. Routledge, 2013.

Lacan, Jacques. The Seminar of Jacques Lacan, Book I: Freud's Papers on Technique, 1953–1954. Edited by Jacques-Alain Miller, translated by John Forrester. W. W. Norton, 1988.

Lacan, Jacques. The Seminar of Jacques Lacan, Book III: The Psychoses, 1955–1956. Edited by Jacques-Alain Miller, translated by Russell Grigg. W. W. Norton, 1993.