Psychotherapy and psychoanalysis aim to help the patient develop insight into his problems, such that with understanding comes incremental, and at times, transformational change. This is what we, in the psychoanalytic world, term “therapeutic action”. However, there is much debate about what exactly is meant by “insight”. Generally speaking, this is the understanding of the underpinnings, the back story of unpleasant, or self-sabotaging behaviors. The patient who discovers that he screams at his wife, mostly because he remembers his father screaming at this mother, and so he feels that is how relationships work. With this discovery, the patient garners greater control the next time he is about to scream at his spouse. His ego is expanded such that he begins to think of other options in which he can communicate his disappointment or his frustration.
Luca, fifty-two, comes to mind. He repeatedly tells me how ashamed he is of his behavior towards his teenage sons. He yells at them for getting Bs on examinations because he is fearful this will hurt their chances for an ivy league school. At the same time, Luca understands that shaming his boys could lead to psychological damage, which, even if it caused better grades, his verbal abuse is more harmful than helpful. Yet, when he sees grades which are not As, he “goes off the handle,” to use his words. Months of talking about this problem has taken us to his deeply fearful place that his sons will not be self-sufficient. In Luca’s mind, the only path to self-sufficiency is an ivy league education. As he says this out loud, he sees the absurdity. We talk more. Luca feels his own disappointment about not going to a “good college” and how in his mind, that his hurt his entire career path. Again, he recognizes that absurdity as well. We talk about how different paths lead to different places, but that his disappointment in himself goes deeper than not getting into the college of his choice. Luca is developing insight into his deep sense of personal failure, manifests by his “need” to shame his boys, for their academic performance. Understanding that his disappointment with them, is a displacement from his disappointment with himself, allows Luca to be more respectful of his son’s school work, such that he accepts their grades as representations of their current performance, and not a source of deep fear for their future. Insight gave Luca perspective, which was lost due to his compelling need to transfer his disgust with himself on to his children.