Evaluating Pretreatment Patient Insight as a Factor in Early Therapeutic Technique Meaghan E. Lehmann, Saryn R. Levy, Mark J. Hilsenroth, Joel Weinberger, and Jairo Fuertes Adelphi University Marc J. Diener Long Island University–Post The Shedler-Westen Assessment Procedure (SWAP) Insight Scale (Lehmann & Hilsenroth, 2011) was used to assess patient insight before treatment, and the Com- parative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman, Bonge, & Blais, 2005) was used to assess subsequent therapist techniques in early treatment sessions. Participants in this study (N = 93) were seeking outpatient treatment at a university-based community clinic. Therapists completed the SWAP Insight Scale to describe their patients after the therapeutic assessment and the first 2 therapy sessions. External raters completed the CPPS from an early treatment session (3rd/4th). Patient pretreatment level of insight was significantly related to CPPS ratings of early session techniques: therapists’ identification of similar relationships over time (CPPS #5; r = .24, p = .02), presentation of alternative understanding of experiences through inter- pretations (CPPS #13; r = .26, p = .01), and association of recurrent patterns of action/feelings/experiences (CPPS #14; r = .21, p = .05). Evaluation of mediation with different psychotherapy process scales revealed that patient’s agreement with therapists may impact the relationship between insight and CPPS #5. After accounting for therapist effects, the association between insight and CPPS #5 was no longer signifi- cant. In sum, these analyses indicate that greater patient insight was associated with more frequent therapist focus on patients’ diverse understanding of experiences, as well as on recurrent patterns of actions, feelings and thoughts throughout the session, during early treatment sessions. These results (CPPS #13 & 14) remained significant when examining issues of global psychopathology, a range of related psychotherapy process variables, and therapist effects. The clinical application of these findings is discussed. Keywords: CPPS, insight, psychodynamic psychotherapy, SWAP The ability to achieve self-understanding and meaningful insight has been an important area of focus in philosophy and psychological theory and practice. In the realm of psycho- therapy, the concept of a patients’ inherent capacity to engage in a psychotherapeutic process was first expressed by Freud (1953) in his discussion of analyzability. He recognized early on that certain patient capacities were important factors in fostering various forms of psychological growth that would impact treatment and outcome. For Freud, insight occurred by making the unconscious con- scious, as well as developing the individual’s capacity to experience emotion rather than to think about emotions (intellectualization). In- sight has since been defined as the level of complexity regarding knowledge of the psy- chological processes of the self and/or others (Fonagy, Steele, Steele, Moran, & Higgitt, 1991). Specifically, insight is described as the progressive ability to understand that human This article was published Online First July 20, 2015. Meaghan E. Lehmann, Saryn R. Levy, Mark J. Hilsenroth, Joel Weinberger, and Jairo Fuertes, Derner Institute of Ad- vanced Psychological Studies, Adelphi University; Marc J. Diener, Department of Psychology, Long Island University– Post. Correspondence concerning this article should be ad- dressed to Mark J. Hilsenroth, The Derner Institute of Advanced Psychological Studies, Adelphi University, 302 Weinberg Bldg, 158 Cambridge Avenue, Garden City, NY 11530-0701. E-mail: hilsenro@adelphi.edu This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Journal of Psychotherapy Integration © 2015 American Psychological Association 2015, Vol. 25, No. 3, 199 –213 1053-0479/15/$12.00 http://dx.doi.org/10.1037/a0039560 199