Why insight fails

Psychoanalysts rely on insight to promote therapeutic change. However, even when a great deal of insight has been attained, significant change may not be forthcoming in some patients, more often in borderline-level patients. The author examines such a case with particular reference to E. Kris' major points on insight, including the role of the ego's integrative functions in the attainment and utilization of insight. The author contends that failure to utilize insight is overdetermined and not necessarily owing to impairments in the integrative functions or to resistance in all its expressions. The author postulates that failure to make progress is due to a combination of the strength of the unmodulated drives, general ego weakness, poor early object relations, particularly preverbal experience, and constitution, in interaction. The whole of the personality is implicated in the inability to utilize insight.