Staff’s Countertransference and Implicit Attitudes Toward Insight in Psychotic Disorders – Do We Prefer Psychotic Patients with Insight?

In this study, we investigated the relationship between insight and countertransference in forensic psychiatry. We hypothesized that patients with good insight would elicit positive feelings in clinicians, while those with little or no insight would trigger negative feelings. Countertransference was measured using the Therapist Response Questionnaire. Insight was measured using the clinician-rated VAGUS scale, a 5-item instrument assessing core dimensions of clinical insight into psychosis. Insight was also measured using eight conceptual dimensions derived from a thematic analysis of six established insight scales. Our sample consistent of 118 clinicians, each rating the last patient they had seen in routine clinical care. No clear associations between overall insight and countertransference were found. Using forced-choice pairwise comparisons of the eight insight dimensions identified through thematic analysis, we found that clinicians favored practical aspects of insight, such as detecting symptom changes and intrinsic compliance, over explicit cognitive dimensions. These findings highlight the importance of “usable insight” in therapeutic settings, particularly in fostering a positive attitude toward treatment and therapeutic alliance.