Socratic Questioning

The psychodynamic, existential and humanist thinkers also agree that the goal of psychotherapy must respect the client seeking help. All therapists aspire to aid clients improve their quality of life and reduce symptoms through their work.

If the objective is to be effective (and efficient) in generating mental health, one must learn how best reach such target, simultaneously being ethical and responsive to context and client.

I myself when started the process of becoming a therapist asked such questions: How to be effective? What should I learn? What should I practice? As an engineer and mathematical thinker in a field of subjectivity, I struggled a lot, but it served me well too. I searched for the best scientific literature available for me to structure my curriculum… I also struggle with authority and am an iconoclast at times.

I figured two major things from my first dive in psychotherapy research: Carl Rogers hit the most important targets, and CBT is the best possible model and the most practiced in the world with remarkable results across several conditions. Let’s start with the second: Since CBT is effective and very pragmatic, I must study it. I did.

There is a behavioral aspect to it, but the core is cognitive restructuring. Simply put it is about helping a person to change her beliefs, be it by reasoning or experimenting. At the heart of CBT is its arguably most important technique: Socratic Questioning. To ask strategic questions to restructure belief systems.

We have a clear target: Master Socratic Questioning.

At this point my answer to our question was:

Why should therapists master Socratic Questioning? In order to be effective and generate benefit to my future clients it is important to master Socratic Questioning because it is the key technique that targets the driving force of change of the most influential therapeutic model in the world. The method’s clinical importance stems from its capacity to facilitate lasting and meaningful cognitive change.

But there is more to it, for it serves multiple purposes that also adds more therapeutic power to the encounter, but right now let’s not distract ourselves with details. I am diligent, so don’t worry, we will dive deep later on. For now, let’s continue exploring only our key questions.

In order to be effective, one must master the most effective technique for the key target of therapy. Is the technique effective?

It produces superior learning outcomes compared to traditional teaching methods (Slamecka & Graf, 1978) because more in-depth processing during encoding is linked with increased memory retention (Craik, 1983).

But we must be attentive to context, therapists are not teachers, and although learning is important in therapy, we are not in pursuit of philosophical truth or correct answers, we are therapists and must prioritize generating mental health. We want the philosopher tool to change one’s thinking patterns, not primarily his conclusions. As a pragmatic, the implied thesis I see in this is:

Better thinking patterns may lead to better conclusions, but therapists care mostly that it will lead to less problematic cycles of thinking and weaken one of the key sources of power of many psychiatric disorders.

In my journey, I had already made a deep dive in active listening, the therapeutic stance and presence. As I understood, it was foundational, but the rationale I present in other text. This is my second deep dive. I write this here because I believe understanding the questions that drive an investigation help tremendously all involved (writer and reader alike) to visualize the implications of studying a topic based on its relative relevance to a goal.

The goal was the same, becoming an effective therapist, and after focusing on listening and presence, I came to understand that the next part of the puzzle was to learn what to say or question after mindfully listening. I had good intuition, and the path forward feels natural to me, but I can’t ignore the skeptic in me: What now? How can I employ my metacognition to optimize the process?

Within my first research I stumbled upon the concept of Phenomenological Understanding and from the core of therapeutic presence and mindful listening emerged my next topic of research: Socratic Questioning. To strategically question requires understanding what is said in multiple layers. Thus, I understood that presence and listening are nested in a process more or less structured underlying the classic therapeutic models. From bottom up I was coming from Active Listening to Socratic Questioning; from top down I was coming from effective therapy to Therapeutic Alliance and Real Relationship within CBT.

I knew that adherence to treatment manuals showed minimal correlation with patient improvement across various therapeutic modalities (Webb et al., 2010) and that effective therapists demonstrate flexibility in applying interventions based on individual client needs while maintaining core therapeutic principles (Owen & Hilsenroth, 2014) which suggested that responsiveness is of greater value than structure.

I learned that completely unstructured approaches show suboptimal results (Yulish et al., 2017) and that the principles that were key were: to establish boundaries of the work delimiting what is and what is not helpful; to sequence its delivery to ensure predictability in manner and form; and accurately appraise the effectiveness of the process in an ongoing and systematic fashion (Miller et al., 2023).

The paradox made me, an already systems-oriented person, balance method and responsiveness. The Socratic Questioning was beautifully matched to multiple dimensions both in me and in the science of effective therapy: It provides a rather flexible structure, it nested mindful presence in its stages which strengthens the relationship and most importantly: could be a model in itself by mobilizing the common factors (e.g., empathy, therapeutic alliance, hope) of therapy.

It matters mastering Socratic Questioning because it is both flexible and structured, it is targeted at the core of change in CBT model while it allows a research-informed therapist to also hit the common factors and invite all the known therapeutic powers to effect on the results.

I knew adherence to specific treatment components showed minimal correlation with patient improvement, but I thought the Socratic Questioning was not only a technique or component of the CBT model (Webb et al., 2010). I wasn’t focused on CBT because it provided clear instructions, but because it was effective, and I question steadfast and vigorously: why is it effective?

That is how the driving question of my investigation was born:

Why does therapy work?

And with this question I started investigating the technique as the vehicle of multiple factors that I know builds the results and make therapy itself work but didn’t know why and how. I said to myself: If I knew exactly why and how, my metacognition would no longer be lost and blind.

And the first challenge came: Socratic Questioning happens to be one of the most technically challenging skills for therapists to master (Clark & Egan, 2015; DeRubeis et al., 2009).