Insight as a dual-perspective construct: Convergence between patients' and professional evaluators' perspective on baseline level of insight and on changes in insight.

Insight gained by patients during treatment has been theorized to be a central mechanism of change in psychotherapy, but empirical studies examining the association between patients' insight and psychopathological symptoms have produced mixed results. The present study addresses these inconsistencies by investigating convergence between the perspectives of patient and professional evaluator on insight and disentangling two potentially distinct components of insight: pretreatment individual differences and changes in insight during treatment. A sample of 393 patients receiving psychodynamic psychotherapy completed pre- and posttreatment measures on symptoms and insight. Professional evaluators evaluated patients' insight based on clinical interviews pre- and posttreatment. Polynomial regression and response surface analyses were used to examine congruence. The results indicate that when there was agreement between the patient and the evaluator on insight, both baseline level of insight and the changes in insight during treatment were found to be related to symptomatic change, although showing different patterns of association. Lower baseline levels of insight were significantly associated with greater symptomatic improvement than were higher levels of insight. At the same time, greater increase in insight during treatment was moderately significantly associated with greater reduction in symptoms, as long as the changes in insight were not minimal. The findings underscore the importance of assessing the congruence between patients' and professional observers' perspectives on patient insight and the potentially distinct roles of between-patients baseline differences and within-patient changes in insight during treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

How do supportive techniques bring about therapeutic change: The role of therapeutic alliance as a potential mediator.

Although supportive techniques play an important role in supportive-expressive psychodynamic psychotherapy, little is known about the mechanisms responsible for their effect on treatment success. In this study, we propose and investigate a model according to which the mechanism of change underlying the effect of supportive techniques on therapeutic improvement is the strengthening of the therapeutic alliance. According to the proposed mediation model, the implementation of supportive techniques brings about strengthening in the alliance, which in turn results in subsequent reduction in symptoms. The present study was designed to test the proposed mediation model. Analyses were conducted on a sample of 61 patients diagnosed with major depressive disorder and enrolled in an ongoing psychotherapy trial. For each patient, Session 4 of the supportive-expressive treatment was coded for therapist adherence to supportive techniques, using the Penn Adherence-Competence Scale. The therapeutic alliance was assessed using a self-report scale, and the Hamilton Rating Scale for Depression was used to assess the subsequent change in symptoms. The analyses suggest a significant mediation model, according to which the implementation of supportive techniques resulted in improvements in the alliance, which in turn resulted in reduction in symptoms at the subsequent session (bootstrapping for the indirect effect, 95% confidence interval [-1.96, -0.16]). The findings support the proposed mediation model, suggesting that the alliance may act as a mechanism of change underlying the effect of supportive techniques on treatment success. (PsycInfo Database Record (c) 2020 APA, all rights reserved).