Socratic Dialogue in CBTCol. Dr. Ehab Elbaz

Psychiatry hospital – Maadi Military Medical Complex

What CBT looks like ?

What are the main tools?

Cognitive tools ( techniques ) Behavioral Tools ( techniques )

What is Socratic Questioning looks like?

So , here is the man……

Why it is Socratic ?

The Socratic Method takes its name from Socrates, the Greek Athenian philosopher who avoided the use of direct teaching and instead used enquiry to encourage students to reach their own conclusions .(Kennerley 2007)

What is a question?

a sentence, phrase, or word that asks for information or is used to test someone's knowledge

doubt or uncertainty about something

( Merriam Webster)

What are the types of Socratic questions ?

R.W. Paul classified Socratic questions into 6 types : 1. Questions for clarification: Why do you say that? How does this relate to our discussion?

2. Questions targeting assumptions: What could we assume instead? How can you verify or disapprove that assumption?

3. Questions targeting reasons and evidence: What would be an example? What do you think causes to happen...? Why:?

4. Questions about Viewpoints and Perspectives: What would be an alternative? What is another way to look at it? What are the strengths and weaknesses of...?

5. Questions targeting consequences: What are the consequences of that assumption? How does...(A)…affect...(B)…?

6. Questions about the question: What was the point of this question? Why do you think I asked this question?

What is the Socratic Method? A method of guided discovery in which the

therapist asks a series of carefully sequenced questions to help to :

1. define problems .2. assist in the identification of thoughts and

beliefs.3. examine the meaning of events .4. assess the ramifications of particular

thoughts or behaviours .(Beck and Dozois , 2011)

What is the rationale for Socratic questioning ?

The fundamental rationale for employing this technique within CBT is that engaging in reflective questioning will be more helpful to patients than an approach where the therapist adopts a didactic approach

(Padesky 1993).

What is the rationale for Socratic questioning ( cont.)? Therapists help patients identify key cognitions and

adopt more realistic, adaptive perspectives, which leads patients to feel better emotionally, behave more functionally, and/or decrease their physiological arousal.

They do so through the process of guided discovery, using questioning (often labeled or mislabeled as “Socratic questioning”) to evaluate their thinking (rather than persuasion, debate, or lecturing).

(Judith Beck , 2011)

So, What are the benefits ?

Reducing distress associated with unhelpful cognitions (Beck 2011)

Allowing patients to internalize the Socratic Method and develop skills in critical thinking in order to evaluate unhelpful cognitions (Padesky and Beck 2003)

Resulting in more ‘‘memorable and convincing’’ insights and conclusions (Westbrook et al. 2011)

Increasing engagement and autonomy in therapy (Overholser 1987)

Improving the outcome of CBT and reducing the likelihood of relapse.

What is the structure of the Socratic Method?

that Socratic Method followed three stages: Start—The therapist decides to apply restructuring in

response to a non-adaptive verbalization and aims to challenge this through verbalizations.

Course—The therapist provides alternatives and checks whether the client expresses the proposed alternatives.

End—When the client emits the ‘‘target verbalization’’ the therapist expresses approval , assigns homework and/or summarizes previous information.

(Parga et al.2009)

Is it guided discovery or not ?

Padesky (1993) suggests that therapists should employ the Socratic Method in a manner where they do not guide the patient to a pre-determined conclusion and the therapist does not know the conclusion that they wish the patient to reach.

In contrast, Beck (2011) suggests that when an unhelpful belief is identified, therapists will formulate more adaptive beliefs that may be more appropriate before addressing the unhelpful belief.

It has been suggested that a CBT therapist balances a desire to be curious and collaborative against actively guiding a patient to a particular conclusion

(DeRubeis et al. 2009).

What would be the attitude of the therapist ?

What are the limitations of the Socratic Method ?

Time consuming Can be perceived by clients as

confrontational

Finally……….