Study of the Socratic method during cognitive restructuring

The art and science behind socratic questioning and guided discovery: a research review

Socratic questioning is used to enhance the process of guided discovery in psychotherapy sessions.

OBJECTIVE

Socratic questioning and guided discovery are defined, and assorted clinical examples are provided.

METHODS

The limited research on the impact of Socratic questioning is reviewed and integrated with 30 + years of clinical experience.

RESULTS

The scant research suggests that Socratic questioning significantly reduces depression from one session to the next, particularly for patients with a pessimistic cognitive bias, but there is no research on patient improvements at the end of psychotherapy.

CONCLUSION

Socratic questions and guided discovery can facilitate sensitivity to issues related to diversity and can be useful in psychotherapy training. The Socratic approach relies on an integration of the research evidence, ancient philosophy, and contemporary cognitive therapy.

Verbal Behavior Analysis of Expert and Inexperienced Therapists Applying the Socratic Method

The Socratic method, as an eminently verbal procedure, will be analyzed from a behavioral perspective in order to clarify how verbal conditioning works within. This work compares the verbalizations that expert and inexperienced therapists emit during Socratic method to find out which and why certain therapist verbalizations are most successful in changing client responses. The sample consisted of 113 Socratic method fragments from 18 cases, analyzed by observational methodology. The expert therapists had more than 6 years of experience, the inexperienced less than 2. Experts had fewer failure Socratic method fragments, but there were no differences in successful ones. The way of questioning had a different pattern: Inexperienced therapists suggested more the response, experts used more didactic verbalizations; also, experts used the aversive component more and contingently. The creation of guidelines based on functional description of verbal interaction and the need for novice psychologists training are some implications of these results.

What works in the Socratic debate? An analysis of verbal behaviour interaction during cognitive restructuring

BACKGROUND

Cognitive restructuring is one of the most complex application procedures in psychotherapy. It is widely used by psychologists from different orientations. However, the guidelines on how to apply it do not usually have empirical evidence and there is a lack of knowledge about the mechanisms of change that explain it.

AIMS

The analysis of verbalizations that therapists emit during the Socratic method could help to better understand the functioning and strategies of effective debates.

METHOD

In this study, specific verbal interaction sequences were analysed using observational methodology. The sample consisted of 113 Socratic questioning fragments belonging to 18 clinical cases, treated by behavioural therapists.

RESULTS

Among other findings, it was found that using questioning together with certain previous verbalizations directed the client's response more effectively and those successful debates were characterized by using the aversive component in a frequent and contingent way.

CONCLUSION

This study shows the most effective way to establish such an interaction in the Socratic method (following a style closer to Ellis's argumentative debate), which entails relevant practical applications in therapy.

Effects of Brief Communication Skills Training for Workers Based on the Principles of Cognitive Behavioral Therapy: A Randomized Controlled Trial

OBJECTIVE

Stimulating communication is an important workplace issue. We investigated the effects of a brief communication skills training (CST) program based on the principles of cognitive behavioral therapy (CBT).

METHODS

A randomized controlled trial was conducted on 206 white-collar workers. The intervention group underwent a 2-hour CST group training conducted by an occupational physician.

RESULT

The results of the intention-to-treat analysis using a mixed-effects model showed that there was a significant interaction between group and time observed for the item "thinking together to solve problems and issues" (P = 0.02). The effect size (Cohen d) was 0.35 (95% confidence interval, 0.07 to 0.62).

CONCLUSIONS

The present study suggests that a brief CST based on the principles of CBT could improve the communication behavior of workers.

Socratic Questions With Children: Recommendations and Cautionary Tales

This clinically focused article offers cognitive behavior therapists recommendations and cautionary tales for using the Socratic method when working with children. The importance of the therapeutic relationship in combination with developmental considerations is discussed. The use of Socratic method in various cognitive behavioral modules is illustrated by means of case examples. Dialogues provide examples of how the cognitive specificity hypothesis and downward arrow technique can be used to support young clients in eliciting negative automatic thoughts. The importance of pacing, the mixing of closed and open-ended questions, and behavioral experiments to aid cognitive restructuring are also highlighted through extracts from clinical conversations. Finally, the article emphasizes that the purpose of the Socratic method is to broaden thinking and to access new knowledge rather than just giving young clients new thoughts and problem solving strategies.

Studying the Therapeutic Process by Observing Clinicians' In-Session Behaviour

This paper presents a further step in the use and validation of a systematic, functional-analytic method of describing psychologists' verbal behaviour during therapy. We observed recordings from 92 clinical sessions of 19 adults (14 women and 5 men of Caucasian origin, with ages ranging from 19 to 51 years) treated by nine cognitive-behavioural therapists (eight women and one man, Caucasian as well, with ages ranging from 25 to 48 years). The therapists' verbal behaviour was codified and then classified according to its possible functionality. A cluster analysis of the data, followed by a discriminant analysis, showed that the therapists' verbal behaviour tended to aggregate around four types of session differentiated by their clinical objective (assessment, explanation, treatment and consolidation). These results confirm the validity of our method and enable us to further describe clinical phenomena by distinguishing psychologists' classes of clinically relevant activities. Specific learning mechanisms may be responsible for clinical change within each class. These issues should be analysed more closely when explaining therapeutic phenomena and when developing more effective forms of clinical intervention.

KEY PRACTITIONER MESSAGE

We described therapists' verbal behaviour in a focused fashion so as to develop new research methods that evaluate psychological work moment by moment. We performed a cluster analysis in order to evaluate how the therapists' verbal behaviour was distributed throughout the intervention. A discriminant analysis gave us further information about the statistical significance and possible nature of the clusters we observed. The therapists' verbal behaviour depended on current clinical objectives and could be classified into four classes of clinically relevant activities: evaluation, explanation, treatment and consolidation. Some of the therapist's verbalizations were more important than others when carrying out these clinically relevant activities. The distribution of the therapists' verbal behaviour across classes may provide us with clues regarding the functionality of their in-session verbal behaviour.

Descriptive study of the Socratic method: evidence for verbal shaping

In this study we analyzed 65 fragments of session recordings in which a cognitive behavioral therapist employed the Socratic method with her patients. Specialized coding instruments were used to categorize the verbal behavior of the psychologist and the patients. First the fragments were classified as more or less successful depending on the overall degree of concordance between the patient's verbal behavior and the therapeutic objectives. Then the fragments were submitted to sequential analysis so as to discover regularities linking the patient's verbal behavior and the therapist's responses to it. Important differences between the more and the less successful fragments involved the therapist's approval or disapproval of verbalizations that approximated therapeutic goals. These approvals and disapprovals were associated with increases and decreases, respectively, in the patient's behavior. These results are consistent with the existence, in this particular case, of a process of shaping through which the therapist modifies the patient's verbal behavior in the overall direction of his or her chosen therapeutic objectives.