Evaluating psychological insight in a clinical sample using the Shedler-Westen assessment procedure

Using the Shedler-Westen Assessment Procedure (SWAP)-200 Q-Sort items in a large clinical sample of outpatients (N = 105), we developed the SWAP insight scale. The rationale, psychometric properties, and convergent validity of this insight scale are reported. Through factor analysis, six of the SWAP-200 items were identified as psychometrically optimal in the assessment of insight (presence or absence) with an alpha coefficient of 0.78. We examined the construct validity of this SWAP insight scale using independent clinical videotape ratings of the Capacity for Dynamic Process Scale, specifically the items "appears introspective" and "manifests insight." We also examined the relationship between the SWAP insight scale using independent clinical videotape ratings of the Social Cognition and Object Relations Scale-Global Ratings, specifically ratings of "complexity of representations" and "social causality." The results demonstrated significant positive correlation between the SWAP insight scale and all five of these criterion measures. Partial correlations demonstrated that, even when the effects of global psychiatric severity are controlled for, the SWAP insight scale maintains a significant relationship with independent clinical videotape ratings of patients manifesting insight during sessions. Future research directions and clinical implications of the SWAP insight scale are discussed.