The RCPsych Article of the Month for November is ‘Socratic questioning put into clinical practice‘ and the blog is written by author Carlos Carona published in BJPsych Advances.

Socratic questioning is a core communication skill in the process and delivery of cognitive-behavioural therapy (CBT). The mastery of this clinical skill requires enduring training, practice and supervision, which are intrinsically linked to therapists’ competence development and personal growth. Surprisingly, there are few practical and theoretical resources to assist clinicians’ and psychotherapy trainees’ learning, and little research has been conducted on the process and mechanisms of change underlying the use of Socratic questioning in CBT.

The Socratic questioning method classically unfolds along two steps: first, the person is invited to question held beliefs, while recognizing contradictions or misassumptions in reasoning that tend to be embedded in social conventions and prejudices; and second they are encouraged to think for themselves about alternative, coherent, meaningful perspectives. Given the focus of CBT on fostering the client’s critical thinking, flexible appraisals, and self-determination within a collaborative empiricism framework (i.e., therapist and client work “shoulder to shoulder” to willingly explore and try out different perspectives), the Socratic method in CBT is perhaps best labelled as “Socratic dialogue”.

 Although changing irrational beliefs and rigid patterns of thought may be highly therapeutic, the primary aim of Socratic dialogue in CBT is not to change a client’s mind, but to guide a process of personal discovery instead. In fact, from a cognitive-evolutionary point of view, irrationality (i.e., any behaviour that leads to self-defeating or self-destructive consequences) is part of our uniquely human cognition, where features such as demandingness, security, competition, and ranking are easily overemphasized as a (“by default”) means of ensuring reproductive success, survival, and crucial advantages in development. Therefore, in the opposite direction of trying to change the client’s mind, the use of Socratic questioning for guided discovery in CBT enables both the therapist and the client to explore and experience creativity and helpful divergent thought in therapy.

In this brief article citing some of the most influential work on the topic (from Beck’s classical foundations, to Padesky’s and Overholser’s contemporary developments), the reader will find a didactic presentation of the Socratic method, an illustrative description of its use in therapy, and a succinct review of its current empirical status in CBT. Hopefully, this concise clinical review will inform, update, and inspire the effective application of Socratic questioning in the practice of CBT-based interventions.

“This very interesting paper is unusual in that it demonstrates a philosophical approach to questioning in the context of psychotherapeutic pracatice. This is novel and a brief paper such as this Refreshment introduces the novice psychotherapist, and perhaps more mature therapists also, to a tool possibly unused by them hitherto.”

Patricia Casey, BJPsych Advances Editor-in-Chief