What is the Socratic Method?
Socratic questioning is named after a famous Greek philosopher from Athens who had a very unique educational style. He believed that learning was most powerful and insightful when the student or person comes to a certain conclusion by themselves.
Thus, Socrates developed a specific type of questioning style that would lead a person to an insight, rather than giving them the answer himself. By assuming ignorance, Socrates gave his students a chance to complete unfinished ideas and critically and logically make conclusions of their own.
This Socratic method of questioning has been adopted by therapist in treatment settings as a way to do the same for patients to get them to test the validity of their beliefs or thoughts – some of which are a bit exaggerated and negatively connotated.
In using Socratic questioning, we allow learning and insight to come from the patient themselves, which can be much more empowering than just telling them the answer. Moreover, we as humans don’t always take kindly to advice from others; and even if we do, it can take away feelings of autonomy, empowerment, and frankly just isn’t as a strong if something were to come from the person themselves. Taking ownership of insights can lead to much greater change and increase adherence to home practice or other recommendations to support their goals.
In two different clinical scenarios, I demonstrate Socratic questioning can be used by in therapy to move them towards insights that help them improve their psychological symptoms and get closer to their goals.
An example of Socratic questioning in insomnia
In my treatments with patients that have chronic insomnia, there is often a conversation about the number of hours as a goal for treatment. This is usually because people have a preconceived notion that they need 8 hours of sleep to feel good and healthy. In reality, people’s sleep needs are different for each person – some people are 8-hour sleepers; others might require more or less. Here’s an example of using Socratic questioning to guide the patient in considering whether they truly value 8 hours of sleep, or if they are interested in quality a bit more than quantity.
Patient: “Well for my sleep goals, I really want 8 hours of sleep”
Therapist: “I hear it’s quite important for you to get a certain number of hours of sleep. Is that right?”
Patient: “Of course, I’ve heard we need 8 hours of sleep to feel good and healthy, so I definitely would like that as a goal.”
Therapist: “That makes complete sense if that is what you’ve heard from others! Can I provide some information on sleep that might be of interest to you?”
Therapist: “In reality, the 8-hour average is just that – an average. Some people can need more and some may need less. Let’s say somebody were a 6-hour sleeper and they feel good on just 6 hours of quality sleep, but they stayed in bed for 8 or 9 hours to get the sleep they think they need. How might they feel to spend so much time in bed despite only producing 6 hours of sleep?”
Patient: “Well, I would imagine that would feel pretty bad. They’d probably be awake a whole lot in the night.”
Therapist: “Exactly right! Having a wrong size fit in terms of how much you are sleeping and how much time you are spending in bed can be like wearing the wrong size shoe for your feet. If the shoe is too large, it can be very uncomfortable. Let me ask you: if I could offer 6 hours of quality sleep or 8 hours of somewhat uncomfortable sleep, which one would you choose?”
Patient: “Definitely the 6 hours! I’d much rather sleep 6 hours and feel good rather than get my 8 and not feel refreshed. I think feeling good during the day is the most important thing.”
Therapist: “Agreed! Fortunately, this treatment is much better for quality than for quantity. CBT for insomnia is great at consolidating our sleep and making sure our sleep is deep and restorative. Let’s now talk about your sleep data to see what recommendations we can take to get some more quality sleep.”
Reflecting on the insomnia case
Although this example seems fairly scripted, it actually goes on very similar lines to my conversations with sleep patients all the time. After some inquiry, many of them realize that their values are with how sleep makes them feel, and not getting a specific number of sleep. Although some people might think Socratic questioning is manipulative, it’s not quite the case because I’m simply working with the patient to determine they find most important. By using the Socratic questioning method, we discovered that the patient values quality more than quantity. If they stuck to their guns in regards to quantity being more important, then it would be important to discuss possible resources to get them to their goals.
An example of Socratic questioning in depression
Here’s another example of Socratic questioning in depression. Oftentimes, people with depression feel unmotivated to exact behaviour change because the depression pulls them to reduce activity. They may also have beliefs about how there’s no point in making a change because it wouldn’t really affect how they feel. Socratic questioning can be a helpful tool to shed light into how these behaviours and beliefs can lead to problems.
Therapist: “I know that we had made a plan to schedule a couple small activities for this week, including a 10-minute short walk and calling one friend to have a lunch. Could you tell me about what happened that made it hard to do these tasks this week?”
Patient: “I was feeling really unmotivated and it just didn’t feel like it would really do anything for me.”
Therapist: “It sounds like you had a thought that engaging in these tasks would not beneficial, is that right?”
Therapist: “It makes sense that if you didn’t feel like these activities would help, that you wouldn’t feel motivated to do so. I am curious, however, have there ever been times where you didn’t want to do something but managed to do it anyways? For example, taking a walk or spending time with friends?”
Patient: “Well, yeah. I have a dog and I have to take her for a walk even when I don’t feel so good about it.”
Therapist: “And how did you feel during and after the walk despite not wanting to go?”
Patient: “I guess it was okay. I started off feeling really tired, but walking through the park was nice and I felt a little bit more energetic after. I was still tired though.”
Therapist: “That’s fantastic! And what do you think these situations tell you about your ability to do something despite not feeling like it and what it means about your belief that engaging in pleasant activities does nothing for you?”
Patient: “From what I just said, I guess it means that I can do things even when I don’t feel like it. And also that I do get a little bit of enjoyment from activities. However, it just feels like a drop in the bucket.”
Therapist: “Absolutely. And you are right about the last point, it will take a lot more than a couple walks to break past your depression. However, I wonder how this might thinking that this work is just a drop in the bucket affect you and your mood?”
Patient: “Well, it would definitely make me not want to do anything and my depression will just get worse.”
Therapist: “Yes, it’s not a very helpful thought. As someone who is in therapy and wanting to improve, what might be something you could say to yourself instead?”
Patient: “That this thought really isn’t helpful and that just because one activity is a drop in the bucket, that doesn’t mean it’s not doing anything. After all, with enough drops, this can eventually turn into a downpour of momentum”
Therapist: “Exactly! One or two activities will not be much help, but if we start incorporating more activities in your life that you enjoy and value consistently, these small steps can lead to some pretty big leaps. As you can see in this example, the goal was to use Socratic questioning to challenge some of the unhelpful thoughts that the patient had about his depression. By getting the patient to recognize how these thoughts are unhelpful and how engaging in the work even when he doesn’t feel like it can be useful in the long-run, we moved the needle to a more positive mindset of slowly getting him towards his goals.
Reflecting on the depression case
As you can see in this example, the goal was to use Socratic questioning to challenge some of the unhelpful thoughts that the patient had about his depression. By getting the patient to recognize how these thoughts are unhelpful and how engaging in the work even when he doesn’t feel like it can be useful in the long-run, we moved the needle to a more positive mindset of taking slow but steady steps towards his goals.
Moreover, the therapist does not tell the patient that they will indeed feel better or they can do something even when the patient is unmotivated, but inquire into past examples where they did to support insight. Telling a patient they should or can do something can sometimes elicit an argumentative response, putting you two in direct conflict with each other.
I hope this article was helpful in understanding a little more about how to incorporate Socratic questioning in therapy!
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