Insight - Recognising Insight

RECOGNISING INSIGHT

“O wad some Pow’r the giftie gie us
To see oursels as others see us!”
[O would some power the gift to give us to see ourselves as others see us.]
Burns (1786)

We need to be cautious of being certain that we have insight into another person's behaviour, feelings or performance. Sometimes we do not recognise that there is a problem until things come to a head. Although some people can identify early-warning signs in themselves, others may take longer to become self-aware. We all have different thresholds for these signs. If you are the one who observes a problem in another person it can therefore be hard for that person to take on board what you say, regardless of how skilfully you say it. There are multiple conditions that influence this awareness threshold, including cognitive ability, neurodiversity factors, cultural factors, and personal influences from upbringing and family origin.

A lack of insight, especially if this is a change from the person’s usual demeanour, may be a symptom of something else going on in their life. It is important to consider this possibility and to decide if it is appropriate to ask them.

How does Insight occur?

Insight may come from being helped to see things from new positions or others' perspectives.

For this reason, many of the activities that provide input into appraisal can be useful for developing insight e.g.

clinical audit
reflecting on significant events and near misses
feedback from patients and colleagues.

Do you believe that it is possible to help others develop insight through the provision of effective educational and psychological support?

In helping another person to develop insight it can be helpful to challenge them to think in new ways rather than re-creating repetitive patterns. This requires the person in question to be willing to change. In addition, both parties need to be able to think creatively. Since new angles on a situation are helpful for promoting insight it can be useful to have a conversation about the way that different ideas may be used constructively.

What promotes and what hinders Insight?

A good question to consider is who the insight benefits. We need to be wary of pejoratively labelling people as ‘lacking insight’ and of writing them off. Think about some of the factors that may promote or inhibit someone from demonstrating that they have insight. It is possible that someone has insight but is unable to show it in particular contexts and for various reasons. What might some of these reasons be? Note down a few thoughts.

In considering the factors that promote insight, one of the main psychological concepts is that of emotional intelligence (Goleman 1996). Goleman suggests that awareness of one’s own emotions and ability to manage them is important in how to deal successfully with other people. Insight always takes place within a context. This may affect how easy or difficult it is for an individual to demonstrate their insight to another person. Two of these contexts that are sometimes connected and which may be particularly influential are those of power and culture.

If there is a big difference in workplace hierarchy between individuals, the person lower in the hierarchy may feel that they must agree to what the other is saying because it would otherwise be disrespectful. Conversely a person may have insight but the difference in power can lead them to feel unable to share it.

Although the word ‘insight’ can be literally translated into other languages, the concept does not necessarily make sense in some cultures. In the UK value is given to acknowledging fault or uncertainty and to learning from these. However other cultures may have the view that doing so is unprofessional. Patients and colleagues are culturally diverse and may have expectations and interpretations of words and actions that are different from the way that was intended. Within some cultures it is important to be deferential to those in authority and confrontation is considered rude and undesirable (Hofstede et al 2010). This may mean that someone will apparently agree with what the person in charge says to them face to face but without really taking the message on board. In this situation there may be no learning and no subsequent change in behaviour. It is also important to recognise that people might respond in ways that protect their own feelings and save face. These factors can lead to a situation where someone does not seem to have insight in that moment because the meaning of the interaction is not culturally congruent or because they do not feel sufficiently emotionally comfortable.

CLICK HERE if you would like to watch a short video interview that demonstrates this.

In their guidance document for the Medical Practitioners Tribunal Service (MPTS 2017 p.17), the GMC acknowledges that: The tribunal should be aware that cultural differences and the doctor’s circumstances (e.g. their ill health) could affect how they express insight. For example, how they frame and communicate an apology or regret.

Hays et al (2002) argue that professionals with low insight may never have had sufficient feedback on their performance to become skilled at analysing their own capacities. It is also important for professionals to be supported in the development of their ability to reflect on any such feedback and to feel safe enough to explain how they will make use of the information in relation to their performance.

A further reason why a person might not show immediate insight is that they may need time for reflection. Others may find it easier to process information or to review a situation with someone else. In these circumstances the process of developing insight may be more like observing an old piece of film where the picture slowly comes into view rather than switching on a light.