Keywords

1 Introduction

Creativity is viewed as a fruitful and productive activity across many domains of human experience, including in professional practice and education fields. According to Florida’s books on The Rise of the Creative Class (2002) and The Rise of the Creative Class: Revisited (2012), counselors, social workers, psychologists, and educators all belong to the super creative core in the social science, education, and training fields. This professional type of creativity (Pro-C or professional creativity) is defined as a developmental and effortful progression to attain professional-level expertise in a knowledge domain or an industry, according to Kaufman and Beghetto’s (2009) 4C model of creativity. This chapter explores original research on how creative methods were utilized in the two professional practice domains of psychotherapy and social service provision to enhance insight and meaning making. Practical and theoretical implications are discussed along with suggestions for creative educational practices.

2 Insight in Psychotherapy

Insight, broadly defined, is often simply conceptualized as new understanding, awareness, or knowledge. It has often been described as an “aha!” experience or a eureka moment. From its beginnings with the Freudian psychoanalytic notion of insight as the process of bringing unconscious thoughts and feelings into conscious awareness, insight has played a significant role in developing psychotherapy practices. While psychoanalyst Sigmund Freud himself only used the term insight once in his writings, “reverence for the process of learning and the attainment of knowledge that infuses Freudian theory probably laid the groundwork for the assumption that achieving insight into one’s psychic processes correlates with mental health” (cited in Messer & McWilliams, 2007, p. 10). Post-Freud, for many years the psychological study of insight has focused on laboratory-based, problem-solving experiments (Sternberg & Davidson, 1995). Insight has been explored in such domains as human creativity, decision making, psychiatry, and counseling/psychotherapy (henceforth, we use the terms counseling and psychotherapy interchangeably).

Klein’s Triple Path Model (2013) was designed originally to help explain insightful decision making in naturalistic settings. This framework suggests three ways of building one’s own insights or assisting clients in psychotherapy to attain insights. The first insight production method is the connection path (inclusive of coincidences and curiosities) for insights, which involves encouraging clients with making connections to new information provided in a process rather than disapproving their original way of thinking. The second method is the contradiction path for insight, helping clients with making observations of others’ behavior in order to learn new criteria for behavior and to give up holding onto some contradictory beliefs relevant to their own. The third method, the creative desperation path for insight, is for clients whose diagnosis involves unconsciously fixating on a flawed belief and not being aware of assumptions they make. This type of client could be helped with a designed analogous experience that challenges such a belief. The importance of these insight-building methods is that they require therapists to listen and to appreciate clients’ own experience and any thinking that is obstructing them. Disapproving their thinking and providing an answer right away without a developmental participatory process for the client is not what we recommend. Therefore, for a psychotherapist to be competent in creating a process for clients to become insightful, it is important for the psychotherapist to set a goal for him or herself to appreciate this special path for growth.

In the field of psychotherapy, insight continues to be a rich topic of academic investigation, without full consensus regarding issues of research methodology, measurement, and definition (Hill et al., 2007). One reason for the varying definitions and conceptualizations of insight is the different theoretical backgrounds of the practitioners utilizing the term. For example, in cognitive behavioral therapy (CBT), insight has been defined as “the acquisition of new understanding” (Holtforth et al., 2007, p. 57). They further note that insight in CBT has also appeared in the literature under various other names such as “cognitive change, cognitive restructuring, rational restructuring, cognitive realignment, rational re-evaluation, or discovery of irrationality” (p. 59). Alternatively, in humanistic or experiential therapies, insight may be defined as awareness, meta-awareness, or a new perspective (Pascual-Leone & Greenberg, 2007). Regardless of the nuances inherent in describing it, insight has broad relevance to the totality of psychotherapy discourse as it is noted as a factor that is common across various treatment modalities (Lehmann et al., 2015). That is, insight is assumed to play a role in all therapies, no matter the theoretical background in which the therapy is rooted.

A recent consensus of experts in the field has defined insight as “a conscious meaning shift involving new connections (i.e., ‘this relates to that’ or some sense of causality)” (Hill et al., 2007, p. 442). While this definition provides some clarity as to what insight is, that is, a shift in meaning involving some sense of newness, connection, or causality, it does not explain an underlying mechanism or process for insight production. To address this gap, Eason (2017, henceforth referred to herein only sparingly with the year), one of the chapter’s authors, designed a participatory research inquiry into the nature of insight as collaboratively (co)produced between the therapist and the client in therapy. His doctoral research resulted in an original collaborative-dialogic model of insight, proposed to be applicable across therapeutic modalities as rooted in something common to all modalities: the therapeutic dialogue. This model of insight is illustrated later in the chapter (see Fig. 13.1).

Due to its all-embracing and transtheoretical nature, Hill et al.’s (2007) aforementioned definition of insight is utilized as our working definition of insight. While Eason’s research and updated definition was also embedded in Hill et al.’s work, the former expanded upon the underlying mechanism of the process and is thus provided here as a new contribution to the literature on psychotherapeutic insight, describing it as

a conscious meaning shift involving new connections, occurring collaboratively between a therapist and a client through the process of a therapeutic conversation or upon post-session reflection of the therapeutic dialogue; the content of the insight may vary from client to client. (Eason, 2017, p. 152)

3 Insight in Social Service Provision/Social Work

As a construct, insight is not as heavily associated with the practice of social work as it is with psychotherapy. For our purposes, it might be more practical to use the term meaning making (instead of insight) when referring to the new knowledge or awareness gained through social work provision, as literature does exist to address that topic. Additionally, meaning making and insight have many similarities and quite often overlap, with the process of meaning making itself being one pathway to insight (Eason). Meaning making is thus an aspect of the insight process. Here, we adopt a postmodern conception of meaning making; i.e., since reality is socially constructed, it follows that insights and meanings—as particular aspects of reality—are also socially constructed, embedded and negotiated through dialogic interaction. So, meaning making is a component or aspect of insight in the reflective practice of social work (Krueger, 2005).

Meaning can be defined as “shared mental representations of possible relationships among things, events, and relationships. Thus, meaning connects things” (Baumeister, 1991, p. 15). Meaning appears important for individuals undergoing different life experiences. Meaning making when confronting stressful life experiences may focus on “restoration of meaning in the context of highly stressful situations” (Park, 2010). In Park’s meaning-making model, the basis of making meaning is referred to as “global meaning,” a cognitive framework that people can use to interpret their experiences and motivation. And, situational meaning is how individuals appraise a particular situation and assign meaning to them. The process of meaning making is initiated when there is a discrepancy between global meaning and situational meaning. If successful, people “restore a sense of the world as meaningful and their own lives as worthwhile” (Park, p. 258).

While individuals may gain insight or meaning into multiple different areas of identity, one particular focus of this chapter is professional identity. Generally, with the identification of various facets including benefit-finding (Sonenshein & Dholakia, 2012), professional identity (Barraclough, 2014) and professional development (Daley, 2001), meanings identified by professionals about their work experience can then be categorized into these three main themes.

The first theme of benefit-finding is a construct referring to the careful appraisal of an event or relevant experience being linked to positive emotions and benefits more than adversity (Tennen & Affleck, 2002). Such events or experience include lessons learnt from previous events (McTighe & Tosone, 2015), the meanings and reasons of experiences (Dutton & Jackson, 1987), and the interpretation of the positive influence on self from experiences (Tennen & Affleck).

A second main theme is professional identity. According to Hutchinson and Tracey (2015), professional identity entails understanding the self, regarding one’s profession, and what is established from our knowledge, actions, and perception of self. Such factors arise from individuals’ personal beliefs, motivation, and characteristics (Lister, 2000), their interpretation on work contents (Pratt, Rockmann, & Kaufmann, 2006), and personal values reflected from conflicts and questions in relation to work content (Postle, 2007). Additionally, such creative and professional identities refer to both self-understanding (how individuals think of themselves) and the reflected appraisals on their understanding of self through a looking glass, shaped outside of oneself (Oyserman, Elmore, & Smith, 2012; Wallace & Tice, 2012).

The third theme of professional development within the social services field is essential. Social workers, like therapists, must be current on the latest research and best practices associated with their field in order to provide effective and ethical working relationships. Professional development in this context alludes to the continual growth of people’s professional perception of their future career. Beresford, Branfield, Maslen, and Sartori (2007) proposed that professional development could be affected by individuals’ relationships with their service users who may come from a variety of backgrounds. Additionally, relationships with supervisors were also found to influence professional development (Peach & Horner, 2007). Therefore, these two factors (relationships with service users and with supervisors) highlight the importance of the interpersonal component to professional development.

In sum, the research findings on meaning making in social service/social work provision cover a wide range of topics, but these have consistency when it comes to professional development and identity formation. These reflect and overlap with similar findings about insight as a topic in psychotherapy, according to Eason. The way in which some insights in psychotherapy are linked to identity are discussed later herein.

4 Collaborative-Dialogic Model of Psychotherapeutic Insight

As previously mentioned, Eason developed a model of psychotherapeutic insight that can be broadly applied to therapeutic conversations regardless of therapeutic modality. In this model (see Fig. 13.1), insight is viewed as a conversational accomplishment arising from the collaborative therapeutic dialogue and is comprised of three aspects: an object or content, a process or mechanism, and an outcome.

Fig. 13.1
A block diagram illustrates the theoretical framework of psychotherapeutic insight, which involves changing one's desire, awareness, and knowledge through collaborative dialogue.

Collaborative-dialogic Model of Psychotherapeutic Insight (Eason, 2017)

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Eason’s co-participants (clients in ongoing psychotherapy with him) gained insight into five content areas: feelings/emotions, issues/struggles, identity/self, relationships/interpersonal, and gifts/blessings. These insights arose through the process of a collaborative dialogue involving four components: client storytelling, emotional expression, meaning-making, and post session reflection. Ultimately, the outcomes of these insights were compartmentalized into three main themes: change, desire/intent to change, and knowledge/awareness. These components of insight are elaborated further in the Discussion section of this chapter.

Insight has been noted as “something all psychotherapies provide in one way or another” (Wampold, Imel, Bhati, & Johnson-Jennings, 2007, p. 134). While there is definitional confusion regarding the exact nature of insight, its relevance in therapeutic ventures is not under suspicion. But, insight is not confined solely to the practice of psychotherapy; rather, its field of influence extends into other professions, such as education, art, and any endeavor involving creative and novel solutions, actions, or ways of thinking. If conceptualized as a new form of meaning making, then insight is also a relevant factor in social work and playback theatre (PT), as Lam (2017) demonstrated and clarified further.

4.1 Collaborative Therapy (CLS)

Psychologists Harlene Anderson and Harold Goolishian developed CLS, a form of psychotherapy, in the United States. CLS is a postmodern approach to therapy grounded in the theoretical framework of social constructionism, hermeneutics, and narrative theory (Anderson, 1997). A full description of these deeply complex ideas is beyond our scope, but, as a brief overview, social construction theory is the idea that reality is constructed collaboratively through social meaning making. Hermeneutics is the art of interpretation, originally rooted in elucidating religious texts. Narrative theory supports the notion that our lives are storied and that we make meaning by telling stories in some form (Anderson, 1997; Bruner, 1990). Narratives are not just stories about our lives, but narratives are our lives is the idea.

In addition to its theoretical framework, CLS is postmodern in its application and delivery of therapy. It focuses on the therapeutic relationship and decenters the position of the therapist from expert to learner, thus having a focus on “curiosity and ‘not knowing’” (Gehart, Tarragona, & Bava, 2007, p. 375). This nonexpert position is also adopted when one wishes to conduct research from a collaborative stance, as Eason demonstrates in his work on psychotherapeutic insight.

Therapist-client relationships in CLS are more egalitarian than traditional therapy relationships that view the therapist as an authoritative source of knowledge. Knowledge in CLS is not passed directly from the therapist onto the client; rather, it is (co)created through and within the conversational dialogue between therapist and client (Anderson, 1997). As such, the position of curiosity maintained by the therapist involves creating a space in which the client can inquire and be curious around events in her or his life without the therapist presupposing the personal meaning attached to these events. Meaning is coconstructed in this safe space and with the mutual curiosity that guides therapeutic conversations. This spirit of curiosity transforms into “mutual learning as client and therapist coexplore the familiar and codevelop the new, shifting to a mutual inquiry of examining, questioning, wondering, and reflecting with each other” (Anderson & Gehart, 2007, p. 47).

4.2 PT

PT is a form of theatre developed by Jonathan Fox and Jo Salas in the USA during the mid-1970s. Audience members share personal stories from their lives during an improvisational production. These are then spontaneously acted out on stage by a group of performers, called “the troupe” in PT. Far from being an unknown phenomenon, PT is conducted in a variety of settings, such as schools, hospitals, and community centers, and was performed as of well over a decade ago in 50 countries worldwide (Salas, 2005). For example, the Hudson River Playback Theatre in New York developed programs to help more than 15,000 students of various ages deal with bullying. Salas also reported that the PT process fosters a sense of solidarity, empowerment, and compassion around the problem of bullying.

PT as a process also involves a performer who serves as a conductor and a participant who takes the role as a “teller.” In a performance session, the conductor invites the teller to come on the stage and share his or her narrative, or personal story of their choosing. During this sharing, the conductor asks questions that guide the teller to explore the meaning of his or her narrative. After the teller has finished, the actors and musician(s) improvise on the narrative while performing it. When the enactment ends, the teller shares feedback on the performance, a self-reflection, generating new meaning or insights before the conductor invites the next teller onto the stage.

It should be noted that the founders of PT do not equate it with psychotherapy. Nevertheless, there are commonalities between PT and some forms of therapy focusing on storytelling and meaning making, such as Michael White’s (2007) narrative therapy and the field of psychodrama. In the Cognitive Behavioral Narrative Psychodrama model proposed by Azoulay and Orkibi (2015), the components of narrative therapy are integrated in its second phase of role playing. Through dramatic externalization, the problem-saturated narrative is deconstructed; individuals learn to externalize the problem, i.e., to separate it from their sense of identity and instead attribute it to modifiable situations. This aesthetic distance from the problem enables individuals to step back and reflect on the problem, and to be ready for initiating a dialogue to make a change.

There is also evidence that PT can be a useful tool in mental health recovery. In their study from the mental health field, Moran and Alon (2011) utilized PT with 19 adults recovering from depression, schizophrenia, and bipolar disorder. Using both quantitative measures and qualitative reports, after a 10-week PT course, participants reported benefits of enhanced self-esteem, self-knowledge, fun and relaxation, connection, and empathy for others. Additionally, in another study (Salas et al., 2013), PT was incorporated into a training program for 1st-year medical students at the Baylor College of Medicine in Texas, USA. These students were able to share stories openly, thus creating more solidarity than is typical in such intense programs and lessened feelings of pressure and isolation. Results indicate that PT can be a useful tool for improving students’ reflections and communication skills and for fostering a sense of community while assisting in professional identity development. Such outcomes suggest that PT could be integrated successfully into mental health recovery programs. PT is also an example of thinking-outside-the-box by using an innovative method for enhancing Pro-C within a professional practice domain.

PT and CLS therapy can be viewed as creative modalities for use in professional practice domains. These share many basic concepts, such as stories and storytelling as a means of communication and human connection. CLS and PT also find common ground in the framework of social constructionism and its emphasis on collective meaning making. As PT cofounder Salas (2009) states, “People need stories in order to know who we are as individuals and as a society. The stories we tell of ourselves and our world crystallize and communicate social and personal self-knowledge” (p. 447). To clarify, the professional practice stories we are exploring here are located in the fields of social work and psychotherapy, with the respective creative modalities of PT and CLS therapy.

4.3 Study Description Using CLS

In Eason’s study, the researcher Michael Eason invited his therapy clients to participate in the research process. Mindful of the potential ethical issues involved, he employed multiple safeguards against researcher bias effects. Such due care included participant verification (clients reviewed the interpretation of results, with freedom to agree or disagree) and triangulation (multiple sources of data and data collection techniques, such as therapy transcripts, research interviews, clients’ completion of open-ended questionnaires, email correspondences, etc.) Moreover, the study aligned with a collaborative, participatory approach to research methodology. Eight participants engaging in ongoing psychotherapy with the therapist contributed to the project. A small but diverse sample, demographics constituted a mix of four different nationalities, a 50/50 male-female split, ages ranging from 21 to 52, with a median age of 33.75, and a variety of occupations. Also, they gave different reasons for seeking psychological treatment. Treatment reasons included depression, anxiety, depression and anxiety mixed cluster, and relationship issues. Such diversity lends validity to the theoretical generalizability of the sample, despite its size.

The collaborative research methodology involved an iterative process of co-participatory inquiry. After the client agreed to participate in the study, the next regularly scheduled therapy appointment was chosen for the project. This arbitrary selection eliminated any potential bias in terms of selectively choosing only positive or successful sessions. The chosen therapy session was audio-recorded and transcribed solely by the researcher. This decision follows guidelines for collaborative research and qualitative interviewing (as per Anderson & Gehart, 2007; Brinkmann & Kvale, 2015) for being fully involved in the data and “creating maximum familiarity with the text and ultimately allowing for a more thorough and efficient analysis” (Gehart et al., 2007, p. 381).

After transcribing the therapy session, the therapist/researcher analyzed the text using thematic analysis, specifically Angus, Hardtke, and Levitt’s (1996) narrative processes coding system (NPCS). The NPCS segments of the analysis underwent interrater reliability checking with a psychologist not connected to the study, and high levels were established (90% and 85.7%). The clients (also acting as co-researchers) were given a copy of the transcript as well to analyze, providing any feedback regarding their experience of reading it. The clients also completed a modified Helpful Aspects of Therapy (HAT) form (adapted from Elliott, Slatick, & Urman, 2001).

Following an average of 3 weeks from the recorded session, client and therapist met for a second interview, this time as co-researchers coming together to investigate together the original transcript. In this different role, the client is empowered as an equal participant, sharing a curiosity around the subject matter and given space to freely and openly provide her or his feedback. In this collaborative research dialogue, co-participants compared their respective analyses, and this sharing session was transcribed in its entirety. In the final work, Eason produced convergent and divergent perspectives, themes/patterns, and analyses in a narrative product reflecting the voices of both therapist and client. A key contribution from the work was the development of a collaborative-dialogic model of psychotherapeutic insight (Fig. 13.1), as already described.

4.4 Study Description Using PT

As previously noted, PT involves the impromptu performance of personal life stories from audience members. For Lam’s (2017) study, the conductor, a collaborator of the researcher, was an experienced member of the PT company. The conductor began the PT by inviting audience members to share their narratives. Those responding were practicing social workers and social service associates (including project officers in the social service teams of some non-governmental organizations), and in-training social service associates with initial experience providing social services through practicums and internships.

Based on Lam’s quantitative results, these tellers/participants showed greater reflexivity after watching performances in PT, with higher scoring in reflections reported along with more initiations in reflective narration in post-performance interviews. In-service tellers and those with more job experience demonstrated greater initiations for reflection on the performance. Tellers with trust towards the conductor also reported more reflections after watching performances. Lam’s analyses indicated that tellers’ themes based on their reflections on professionalisms before performances were as follows: benefit-finding, professional identity, and professional development. Participants found benefits from their experience of the interview for helping them organize and make meaning on their social service experience. They also identified features that would in turn contribute to the construction of their professional identity, such as listening to people, better understanding of the service user group (client base), and more. And they further commented on their future career and professional goals. After performances, tellers also reported reflections inspired by the actors and symbolizations and metaphors from the reenactments in their performance evaluations.

4.5 Therapeutic Path of Insight: Collaboration and Playback

In alignment with a collaborative approach to both research and therapy, Eason’s collaborative-dialogic model emphasizes the value of the therapeutic relationship in insight development. Insight is thought of as a conversational accomplishment between two parties: the therapist and the client. This conceptualization of insight is different from other domains, such as creativity or decision making, wherein the development of creative insight typically occurs as a solo or individual accomplishment. Psychotherapy (as the talking cure) is by its very nature collaborative, so it makes intuitive sense that results emerging from the psychotherapeutic endeavor, such as insight or lifestyle changes, are collaboratively inspired. Eason’s research provides preliminary empirical support for the notion that effective psychotherapy is more of a collaboration than a solo accomplishment.

Insight attainment from a collaborative-dialogic perspective suggests a therapeutic path or underlying mechanism of insight. In the professional practice of psychotherapy, insight seems to be generated from a type of collaborative dialogue consisting of four components: client storytelling, emotional expression, meaning making, and post-session reflection. The three key processing modes in therapy (i.e., client storytelling, emotional expression, and meaning making) were pre-established by Angus and Greenberg (2011) in working with emotion-focused therapy.

Based upon his 2017 collaborative research project, Eason added the process of post-session reflection to these three pre-established modes. Post-session reflection occurs after the session has ended. At this time, clients have the opportunity to reflect on thoughts and emotions that arose during the co-constructed dialogue, as with Eason’s study whereby the client in session arrived at new insights through this process of reflection. These post-session reflection opportunities are considered extensions of the therapeutic collaborative dialogue. Even though the therapist is not physically present during the post-session reflection, reflections are focused upon the therapeutic dialogue; thus, post-session insights have their seeds in the actual therapeutic hour but sometimes tend to sprout only afterwards.

As for PT, the path of insight is more ambiguous as PT is not primarily a therapy. Indeed, “most writings that address PT’s therapeutic attributes avoid defining it as a therapy and therefore do not supply the reader with a clear therapeutic route to follow” (Barak, 2013, p. 109). We address this knowledge gap by suggesting that the therapeutic route of PT follows a similar path to the route of insight development in psychotherapy and by showing examples of commonality from original research (i.e., Eason, 2017; Lam, 2017) that support this claim.

5 Discussion

We have presented research from two creative approaches: CLS and PT. In exploring insight production in the professional practice domains of psychotherapy and social work, Eason’s model of insight was utilized as a framework to suggest a causal mechanism. Through the process of his analysis, insight as a construct was broken down into an object/content, while simultaneously consisting of a process/mechanism. Insight also results in some form of an outcome for the client. Thus, insight has these three components: object/content, process/mechanism, and outcome. Similarities and differences related to the model as applied to the domains of psychotherapy and social work are now discussed.

5.1 Object/Content: Component of Insight

In Eason’s study, insights as experienced by clients were divided into five content areas: feelings/emotions, issues/struggles, identity/self, relationships/interpersonal, and gifts/blessings. This finding implies that clients do not simply have ambiguous insights; instead, insights seem to occur in relation to an object or a subject matter, such as relationships with family member(s), their past or future, or a specific feeling. To elaborate, a client may experience insight about a repressed emotion from their past, about a struggle with an aspect of their identity, about a toxic relationship in their life, and so forth. The content of an insight varies from client to client.

Elliott (2007) previously identified five content areas around which insight events in therapy are themed: interpersonal patterns, reason/goal, specific emotions, type/kind of experience, and responsibility/attribution. Eason’s study replicated Elliott’s content areas of internal patterns and specific emotions and further identified three additional content themes: issues/struggles, identity/self, and gifts/blessings. (While these are largely self-explanatory, the theme of gifts/blessings may require clarification. These are simply positive traits or strengths the client identifies as having, such as being a good friend or having high self-esteem). These three alternative themes reflect the insight contents found amongst Eason’s group of respondents, as different from Elliott’s group, suggesting that other researchers could further identify different as well as additional themes in their own work with clients on this topic.

From Lam’s (2017) PT study, tellers’ insights from the analyzed interviews matched the contents in the collaborative-dialogic model, such as feelings/emotions and relationships/interpersonal. Although all these contents were related to the tellers’ professions, these could still be matched with the terms under the “object/content” category. Feelings/emotions corresponded to the theme of feelings identified in tellers’ performance evaluations. The other content areas corresponded to themes identified in tellers’ reflexive narrative process—issues/struggles and relationship/interpersonal to the theme of professional development, identity/self to professional identity, and gifts/blessings to benefit-finding.

5.2 Process/Mechanism: Component of Insight

For the process of insight production in psychotherapy, Eason recently proposed his collaborative-dialogic model of insight. The mechanism of insight is a form of collaborative dialogue involving the components of client storytelling, emotional expression, meaning making, and post-session reflection. This collaborative dialogue shares certain commonalities with the process of PT in Lam’s (2017) study.

To explain, during PT interviews, the conductor would ask tellers questions to guide their reflection on emotions and the life experiences under discussion. This process is similar to collaborative dialogue in Eason’s study in the way that it involved tellers’ storytelling and the conductor’s inviting their review of their own personal narratives. Emotional expressions were encouraged to let the tellers both recall emotions in that experience as well as reflect upon them. When tellers engaged in the dialogue and later performance, they interpreted the actions and words of the actors and symbols involved, suggesting they had made meaning from both the dramatic elements and their own narratives. In Lam’s study, a post-performance evaluation/review was added, and some tellers reported their reflections based on the performance. This post-performance evaluation/review is similar to the post-session reflection in Eason’s study. Therefore, both the interview and performance can be theorized as therapeutic routes to insight in PT.

From both these studies, the path to insight or meaning-making involves a reflective component and an externalizing component. In CLS, the reflection can occur as therapy and client reflect together on their conversation within the therapeutic hour. It can also occur post-session as the client independently continues to reflect on and draw meanings from the therapeutic dialogue. In PT, meaning making can be instigated when the teller asks the audience member for feedback on the performance just witnessed. In addition to reflection, both these processes involve a component of externalization, or outwardly representing inner states, feelings, thoughts, narratives, etc. In therapy, client stories are externalized verbally through collaborative dialogue, while in PT an audience member’s stories are externalized through the improvisational performance.

5.3 Outcomes of Insight: Component of Insight

In Eason’s study, the outcomes of insight are identified as change, desire/intent to change, or knowledge/awareness. There has long been a debate in the psychotherapy literature about whether insight is only useful if linked to some form of behavioral change or, alternatively, if insight has intrinsic value even in the absence of change (e.g., Castonguay & Hill, 2007). The collaborative-dialogic model supports the latter notion: insight may sometimes, but not always, lead to change. But, even without change, the new knowledge and awareness gained are of value to the client. For example, in the Eason study, one client (#1) came to the following insight: “I deeply and truly miss my father. More than I thought I would. I feel if he was around things would have more clarity” (p. 132). This client-identified moment of insight is not linked to making behavioral change or any other in her life; instead, it is a cathartic release of previously repressed or unacknowledged painful feelings.

While Lam’s (2017) research was not focused on insight per se, insight development and meaning making did occur during PT and reflection on the improvisational performance. The finding that tellers showed greater engagement in reflection after watching their performance suggests that PT performances can serve as a catalyst for insight, as reflection is necessary for insight production (Friedman, 2013; Lacy, Michaelson, & van Laar, 2007). The boost in reflection following the witnessing of a performance again reiterates the importance of externalizing our narratives as a way of gaining new perspectives on them.

As PT is an endeavor that involves components of storytelling, emotional expression, meaning making, and reflection—all of which are attributes of insight-producing collaborative dialogue—it is likely that PT is also capable of producing insight. While the insight is not “psychotherapeutic” in nature (as it is not embedded in the dialogue of therapist and client), it is nonetheless a version of insight that seems to have salubrious and meaningful effects on those experiencing it.

6 Limitations and Future Directions

Due to time constraints on both of the original 2017 studies, neither Eason nor Lam was in a position to gather longitudinal data. Thus, it would be useful for future study to be of the impact of insights from CLS and PT over time to determine if these insights are of a temporary or more permanent nature. A long-term study would also allow for more direct observation of potential causal links between insight and change, as change tends to occur gradually. Because Lam’s (2017) study was more focused on the process of meaning making than insight development, understanding that these terms share similarities, it would be useful to examine solely the nature of insight as a construct in PT.

It is also important to note that both research projects presented in this chapter were pilot studies by emerging scholars Eason and Lam, both of whom were supported by mentors at City University of Hong Kong who are also the co-authors of this chapter. These two research projects were conducted in educational settings at university level in the multicultural climate of Hong Kong. As noted, Eason’s study was doctoral research that resulted in his dissertation, while Lam’s was an undergraduate final year product. As with most pilot studies, these are open to be amended and expanded in the future research.

Additionally, Eason (2017) suggested that insights occur in relation to feelings/emotions, issues/struggles, identity/self, relationships/interpersonal, and gifts/blessings, adding to content areas Elliott (2007) had already identified in the literature. These, however, were the content areas reported from the analysis of his relatively small client sample. Future researchers may develop additional content areas that would help further extend the model by adding to the corpus of insight-producing content areas in psychotherapy.

6.1 Theoretical Implications

The proposed collaborative-dialogic model of psychotherapeutic insight may be applicable to insight production in professional practice domains other than therapy, such as PT and social work provision. This adaptability of the model was demonstrated with reference to similarities of the meaning making processes intrinsic in these endeavors. Insights clearly occur outside the context of a therapeutic dialogue; however, the underlying process (or therapeutic route) of insights may be similar, involving an experience of meaning making and often reflection or a reflexive component.

The externalization of inner narratives also seems to play a role in the creative production of insight. In therapy, clients externalize their inner stories through dialogue with the therapist; in PT, participants visually witness their inner stories played out on a stage, sometimes with various alternative endings that allow one to re-author their lives. Both processes have the potential to shift perspectives and be empowering for those involved.

6.2 Professional Implications

PT and CLS can be viewed as educational tools for aspiring therapists and social workers. Each method is creative in its own right and seems to have an efficacious result on reflection, meaning making, and insight. Trainees and students could participate in PT or CLS as routes for further reflection on both professional and personal identify formation.

Moreover, Eason’s (2017) collaborative research approach suggests that students and aspiring professionals could benefit from using creative research methodologies as a way of expanding their horizons. One specific suggestion regarding the collaborative approach is that training programs for counseling/therapy (including internships and practicums) should require counseling interns to transcribe a few of their own sessions for self-review and review with a client of their own (Anderson & Gehart, 2007). The transcription process and collaborative reviewing of transcripts can be a rich source of insight formation, as Eason’s (2017) study demonstrates in these clients’ quotes (pp. 138–140):

I also realized that I am a lot more emotionally vulnerable in these sessions than I thought I was and that I’ve opened myself up a lot more to introspection and reflection. It was a very hard experience, reading back my thoughts and my words because often, I will talk about how I am feeling and events in my life and there is still a bit of a barrier between what I am saying and my takeaways. To actually see my words in written form, it has given me a new perspective on what I have been saying. (Client #5)

It’s allowing me to probably self-reflect a lot more than I probably usually would. Which I think is a good thing. (Client #5)

So I think just the process of looking back over this is helpful because it gives you a second chance, you know a second bite of the apple as they say, so you can analyze your analysis. Or rather than it just being the first, the first discussion being the only one, to then go back and look at it. It’s like reading a book a second time and picking up things that you didn’t notice the first time because the first time you were just trying to follow the plot. (Client #4)

Similarly, the use of PT can prove effective in social work training programs and professional development for meaning making and gaining empathy (Lam, 2017). The ongoing process of professional development can be fostered by engaging in activities such as PT. These creative, educational learning opportunities seem to encourage a growth mindset by encouraging reflection and reflexive engagement.

From an educational perspective, the somewhat nontraditional methods of CLS and PT offer a plethora of practical applications for supporting both creative learning and creative teaching. They can be used as educational tools that support ongoing professional and personal identity development while providing opportunities for insights and reflections that might otherwise be missed in more traditional or restrictive educational settings. In such environments, teacher authority and rote learning may sometimes eclipse opportunities for creativity, as Mullen’s (2018; also Chap. 1 in the present volume) recent educational study, set in China, has demonstrated, with the rich promise of younger and older students and teachers’ creative engagement, expression, and innovation in impossibly restrictive circumstances.

7 Conclusion

Counselors and social workers belong to the super creative core, being professionals who work with others in creative ways to achieve creative ends. The research we have presented demonstrates how the nontraditional methods of CLS and PT are capable of generating insight and meaning making for both clients and professionals. An original collaborative-dialogic model of psychotherapeutic insight that suggests an underlying mechanism for the process was discussed along with an updated definition of psychotherapeutic insight. As such, this chapter utilizes original creative research from educational settings to stimulate future research while addressing real-world applications for professional practice.