What do you Know and how do you Know it: Socratic Dialogue II

One of the difficulties with Carey and Mullans paper discussed in the first post is that you come away from it thinking Socratic question is multi-defined with a number of different purposes and therefore is not a useful or functional technique. Nothing in my view could be further from the truth. I think a more useful way to look at this is that a lot of techniques have received the same label but this has nothing to do with their usefulness. I want to look at a couple of these in more depth. I think with any technique it is useful to look at both the technique as well as the purpose or purposes for which it is to be used. It can also be useful to think about the outcomes that occur in therapy as a result of using this technique. For myself I have found it far more useful to go outside of psychotherapy literature to find helpful stuff on Socratic questioning.A good example would be R Pauls book: Critical Thinking: What Every Person Needs to Survive in a Rapidly Changing World. Of all places I came across this useful summary of Paul on a site about teaching engineering. Here is another useful site with a summary of Socratic Techniques also citing Paul. Both these sites have a good range of questions you can also use as a therapist. I have included a range of them below. Socratic questioning is a simple yet strong method for exploring ideas or statements in depth and breadth. In its simplest form, it involves:

Selection of a question or issue of interest Clarification of the question or issue Listing and critical examination of Support, Reasons, Evidence, and Assumptions related to the central statement Exploration of the Origin or Source of the statement Developing and critically examining the Implications and Consequences of the statement Seeking and fairly examining Conflicting Views (alternative points of view).

Paul divides the questioning up into six types. I find understanding these different types of questioning really useful as it helps me to keep in my head where we are up to in the Socratic process. It is much more useful in my view to view Socratic questioning as a process with a set of steps than to see as a tool to get to some place. In my experience going through the process of one type of question after the other always yields something useful. As Padesky would put it, when you do it this way the client ends up owning the discovery or insight with no pressure to accept the therapists point of view on anything. This fits well with one of my little sayings in therapy along the lines of that it is the clients job to do the work i.e. they have responsibility for the outcome. Usually in supervision it gets framed in the reverse when I say to a supervisee if you are working then the client is not working.

Paul's six questions include: Clarifying questions

What do you mean by ______? What is your main point? How does ____ relate to ____? Could you put that another way? Let me see if I understand you; do you mean _____ or _____? Could you give me an example? Could you explain that further? Could you expand upon that?

Assumption questions

What are you assuming? What could we assume instead? You seem to be assuming ____. Do I understand you correctly? You seem to be assuming ____. How would you justify taking this for granted? Is it always the case? Why do you think the assumption holds here? Why would someone make this assumption?

Reason and evidence questions

How do you know? Why do you think that is true? Do you have any evidence for that? What difference does that make? What are your reasons for saying that? Can you explain how you logically got from ____ to ____? Do you see any difficulties with your reasoning here? What would change your mind? What would you say to someone who said ____? Can someone else give evidence to support that response? By what reasoning did you come to that conclusion? How could we find out whether that is true?

Origin and sources questions

Where did you get learn this? Do your friends or family feel the same way? Have you always felt this way? What caused you to feel this way? Did you originate this idea or get it from someone else?

Implication and consequences questions

What are you implying by that? When you say ____, are you implying ____? But if that happened, what else would happen as a result? Why? What effect would that have? Would that necessarily happen or only probably happen? What is the probability of this result? What is an alternative? If this and this are the case, then what else must also be true?

Viewpoint and perspective questions

You seem to be approaching this issue from ____ perspective. Why have you chosen this rather than that perspective? How would other groups/types of people respond? Why? What would influence them? How could you answer the objection that ____ would make? What might someone who believed ____ think? Can/did anyone see this another way? What would someone who disagrees say? What is an alternative?

What I like about this way of framing the questions is that the client is first led to explore and then by the very nature of quite simple questions forced to look at themselves from different perspectives. As long as you cover each of the six areas in relative order then this is a natural process. You dont even have to try or think hard although at times it does help. Padesky has a different set of questions for her Socratic technique. Among therapists there is a vast difference between one who thinks cognitive therapy involves changing distorted thinking in the client to the therapist who thinks cognitive therapy is process of teaching clients to evaluate their thoughts behaviours moods like circumstances on the site physiological reactions to make choices that are adapted. Clearly, I want the therapist to do Socratic questioning as this guided discovery. To this end I offer up some guidelines for what we should teach therapists when they learn to use questions in cognitive therapy. As a starting point, I offer a definition of Socratic questioning which incorporates guided discovery. Socratic questioning involves asking the client questions which:

The client has the knowledge to the answer. Draw the client's attention to information which is relevant to the issue being discussed but which may be outside the client's current focus. Generally move from the concrete to the more abstract.

The client can in the end apply the new information to either re-evaluate a previous conclusion or construct a new idea.

Padesky identifies four stages to her Socratic questioning. Asking informational questions The questions asked will follow the guidelines in the definition above. The client will know the answers, they will bring into awareness relevant and potentially helpful information and these questions will initially strive to make the client's concerns concrete and understandable to both client and therapist. Listening It is critical that the therapist, not just ask questions. She or he must learn also to listen well to the answers. In Socratic questioning with a goal of changing mindsets it often seems that the client answers to a single question are irrelevant. The therapist is building a case and as long as most of the questions are answered in the expected direction the case will be proven. In contrast, if the Socratic questioning is done to guide discovery, the therapist must be open to discovering the unexpected, even if she or he anticipates a specific cancer. Listening is the second half of questioning. If you are not truly curious to know the answer, don't ask the question. Summarising Socratic questioning often occurs over several minutes in a session. Often a number of pieces of information retrieved and discussed. As this is going on, the client may be highly charged emotionally or uncertain why you're asking about particular parts of their experience. One of the most common mistakes I notice therapist making in the Socratic questioning process is that they don't summarise enough. In the portions of the session, where we are using Socratic questioning; there should be a summary every few minutes. When a summary is particularly relevant or meaningful to the client, he or she should write it down for later review. Finally, the summary gives the client chance to look at all the new information as a whole, which sometimes has a greater impact than considering each bit of data as a single piece. Synthesising or analytical questions. Finally, after the new information has been discovered, idiosyncratic meanings have been heard and explored, and a summary has been constructed, the therapist completes the guided discovery process by asking the client a synthesising or analytical question which applies this new information to the clients original concern or belief. In its simplest form this question might be, Stewart how it does all this information fit with your idea of I'm no good. Again, therapists often stop short of this critically important final stage of guided discovery. As a beginning cognitive therapist I remember worrying so much about thinking of questions that I forgot to help the client tie up the answer together in a

meaningful way at the end. And yet the synthesising questions are one last chance for the client to discover something unexpected. As much as I like Padeskys ideas in that they reflect many of my own on this technique I think she lacks clarity in presenting these ideas. My observation is that most therapists learn their Socratic stuff using Padeskys model but have a great deal of difficulty applying this in a structured way in the room. This is what I like about Pauls stuff even though it does not come from psychology. It has a precise structure and simple labels for what you are doing at each stage of the process. Padeskys stuff seems to me more what I would call active reflective listening with the added twist of having to add a synthesising or analytical question which applies the new information to the clients original concern or belief. As she notes this is where many clinicians fall down and I do to as well. It is not easy to perceive exactly what she means by this. Utilising Pauls ideas in a structured manner is far simpler and yields better results in my view. One of debates in the first posting was around the purpose of this technique. I see no reason not to use the technique both for the purpose of an open ended exploration as well as moving the client to some pre-ordained place in their awareness or thinking. Knowing what the purpose is the critical thing at the outset. I tend to lean towards a more open ended exploration as Padesky does however at times particularly when there is risk to the client or others then I may be a little more forceful in working the dialogue to a place of safety for the client. Using this technique provides a number of benefits for the client. Not the least of which you may get to throw in some great quotes by Socrates such as the deep and meaningful: A life unexamined is a life not worth living. Or my favourite: Children nowadays are tyrants. They contradict their parents, gobble their food and tyrannise their teachers. (Like nothing has changed in 2000 years). But seriously the proper use of this technique enables the client to:

Explore and gain understanding and insight into themselves. This type of process if done well enhances a sense of empathy and strengthens the therapeutic alliance as the client feels understood at a deeper level. The very process is a model of critical thinking that the client can apply to other situations.