Socratic questioning CBT

Socratic questioning, Socratic questioning CBT

Socratic questioning CBT (Cognitive Behavioral Therapy) lies - unsurprisingly - with the ancient philosopher Socrates. He took a novel approach for his time – he used questions to help another person move toward self-realization, rather than simply teaching them specific beliefs. 

Socratic questioning is one of the main techniques used in cognitive-behavioral therapy (CBT). In CBT, ineffective thought patterns are challenged and more adaptive thinking is nurtured to take its place. This more effective thinking, in turn, leads to emotional stability and more productive behavior. 

Socratic questioning CBT is the primary mechanism used by the therapist during this cognitive restructuring. Therefore, it is not an exaggeration to say that Socratic questioning is one of the most important tools in all of CBT. 

What is Socratic Questioning?

Socratic questioning CBT involves therapists asking a series of questions to help clients reevaluate a previous conclusion or construct a new idea.

Socratic questions typically have the following characteristics:
  • Open-ended: Open-ended questions are intended to facilitate further thought. For example, “how are you feeling?” is an open-ended question that allows the person to answer in any way they wish. In contrast, “are you feeling good?” Is a closed question that leads to shorter and less thoughtful answers.

  • Focused on a specific topic: The therapist has a goal when asking Socratic questions. They want the client to explore particular thoughts that may not be working for them. For example, when a client makes an irrational statement, the therapist may ask, “can you provide evidence that supports your thought?”

  • Unbiased: Socratic questions are meant to foster honest examination that doesn’t push the client toward a foregone conclusion. You want the client to consider different viewpoints and come up with the most adaptive solution for them. Although it may be tempting to guide a client toward an answer that you endorse, the therapist must remain non-judgmental. For instance, a therapist might ask, “what would your friends or family think of that assumption?” 

  • Uncomplicated: No ten-part questions here. Socratic questions are usually short, easy to understand, and to the point. For example, a therapist might ask, “is there a real-life example that reinforces what you are saying”?

Socratic Questioning CBT steps
The process of Socratic questioning CBT involves the following steps:
  1. The process of Socratic questioning CBT involves the following steps: Identify the maladaptive thought. In order to examine a thought, you first need to identify it. In CBT, the premise is that thoughts lead to feelings, which then influence behavior. A person’s beliefs start the whole chain of events so they must be recognized. Encourage your clients to record whatever thoughts pop into their heads that may lead to problematic situations. Then make sure you clarify the belief so it is clear to both you and the client.
  2. Look at the evidence. The second step is to explore the evidence behind the thought. In other words, is the client’s thought supported by the evidence or do they believe it without any proof?
  3. Challenge the thought. If the evidence does not support the thought, it is time to challenge it. This can be done through Socratic questioning that pokes holes in the client’s beliefs. For example, “are there any reasons to doubt your assertion?” or clients that may cling to irrational beliefs, it is useful to suggest a behavioral experiment. A behavioral experiment asks the client to perform a behavior that helps them understand that their thought is unfounded. For instance, a client with social anxiety tells you that if they attend a work social function, it is sure to end in embarrassment and disgrace. As an experiment, you suggest that they attend a work happy hour and report on what happens.
  4. Develop an alternative thought. Once you have determined that the client’s belief does not stand up to scrutiny, it is time to help them develop a more realistic thought. A therapist might ask, “is there an alternative view that is better supported by the evidence?”
Resources to understand this process better include:
  • A useful worksheet from Therapist AID that takes you through the Socratic questioning process. 

  • It can be difficult to understand how the entire Socratic questioning CBT process works just by reading examples of individual questions. This article provides two vignettes of psychologist Christine Padesky, Ph.D., using Socratic questioning in a session. 

Socratic Questioning CBT benefits

Socratic questioning is an integral part of CBT therapy, but does it really help?

Let’s take a look at some of its benefits: 
  • The theory behind cognitive therapy claims that negative thoughts lead to negative feelings. Since Socratic questioning is posited to lead to more realistic thinking, it makes sense that Socratic questioning would lead to an increase in positive feelings. In one study, clinically depressed individuals experienced a significant reduction in symptomatology as a result of Socratic questioning.

  • One of the purported strengths of Socratic questioning is that it fosters a collaborative approach between therapist and client. But maybe clients would rather have their therapist just present information and tell them what to do. After all, aren’t therapists supposed to be experts in helping people? You might be surprised to find that clients find Socratic questioning more helpful than didactic teaching. This supports the teamwork approach that is central to CBT. 

  • One of the most important aspects of Socratic questioning is how it invites clients to challenge their distorted thoughts and come up with solutions to their problems. In other words, enhance their critical thinking. This is a coping skill that will benefit them for the rest of their lives and—hopefully–enable them to avoid therapy and/or medication in the future.

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Socratic Questioning CBT is a valuable tool for altering maladaptive thoughts and enabling self-discovery. If you’re looking for ways to document questions or treatment as part of Socratic Questioning CBT, Theraplatform, an all-in-one EHR, practice management and teletherapy tool, for clinicians can help.

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