Socratic Questioning for Therapists and Counselors (Modern Integrative Cognitive Behavioral Therapy)

Foreword When I first learned how to do therapy it was all psychodynamic. The therapist maintained distance, neutrality, refrained from giving direction, and interpreted the motives, unconscious thoughts, and pointed to analogies and parallels with earlier childhood experiences. It all seemed rather deep, complicated, and -in fact–it put the power of interpretation in the hands of the therapist. And, most importantly, it didn’t seem to work very well. Beck’s model broke me out of my pessimistic view of psychotherapy and appealed to my inquisitive, sometimes logical, and even disputatious mind. As I learned cognitive therapy from the founder, I realized that I needed to step back from a professorial and didactic stance to enter into a dialogue with the patient. Watching Beck I realized that effective cognitive therapy was not like a prosecutor cross-examining a patient. It was a gentler, more inquiring, more respectful examination of the beliefs and experiences that the patient reported. Indeed, watching Beck do therapy often made you feel that he wasn’t using the techniques that he wrote about. But, then, on careful reflection, you realized that he seamlessly wove into his dialogues examination of the consequences of thoughts, evidence of their validity and alternative ways of looking at things. Beck wasn’t “talking at” the patient. He was sharing perspectives and examining how the patient thought about things. He was trying to make sense of what often seems senseless. I recalled courses in philosophy that I had taken in college. One in particular was taught by Paul Weiss, an eminent philosopher of that time. Weiss was a cantankerous, charismatic and spontaneous lecturer who refused to lecture. He had about 100 Yale students waiting for each of his questions which–when one of us was brave or impulsive enough to answer–led to another Weiss question. His was the true Socratic dialogue—- question after question, pointing out the implications and contradictions of our answers. What Weiss did–and what Socrates did–was not teach us the facts. No, they did something much more important. They taught us how to think. That is what good therapy does. So, is Socratic question didactic and power-driven? Or, is it a way of empowering, teaching the patient how to think, how to reflect, how to see another point of view? I suggest it is the empowerment of the patient who now is asked to reflect. The goal is to think about thinking, reflect about feeling, stand back and examine why your thoughts lead you to feel and act in ways that -on reflection–seem self-defeating. I suggest we call this “insight”. In fact, the Socratic method is the tool to engage insight, develop it, and use it to construct new realities and opportunities. The cognitive therapy approach owes a great deal to philosophy. Indeed, I think that some of the best preparation for the Socratic method is to read Plato’s Republic. And the best background for understanding Ellis is to read Epictetus. And, of course, as in most other things that matter in life, the best description of the cognitive model is to be found in Shakespeare (Hamlet Act, 2, Scene 2) where our despondent, ambivalent, self-reflective Hamlet observes,”Why, then, ’tis none to you, for there is nothing either good or bad, but thinking makes it so. To me it is a prison. Well, then it isn’t one to you, since nothing is really good or bad in itself–it’s all what a person thinks about it. And to me, Denmark is a prison.” But how do we escape the prison that our thoughts may serve as confining barriers? How do we break free? Therapists often like to divide themselves into camps–much as religious acolytes who believe that they hoard the truth. But this book, written by four sophisticated, thoughtful psychologists, will help liberate those readers whose minds seek to open to new ways of thinking, new curiosities and new challenges. Indeed, this book is a tour de force. It is an intellectual jaunt across the landscape of a range of cognitive behavioral therapies, breaking new ground, climbing new heights. When I first began thinking of reading this book, my first thought was, “Is there anything new under the sun?” in understanding Socratic dialogues? And, the answer, is “Yes!”. The answers are here, in this book. This is a book that anyone interested in serious reflection about psychological inquiry in psychotherapy should read. Yes, not only should they read this book, but they should reflect on it. Even our Third Wave approaches have Socratic elements, even behavioral approaches ask us to think and observe and extract ideas, even in prescribing medications we need to consider how the patient is thinking about it. We don’t just hand patients a solution. We don’t say to the patient suffering from anorexia, “Here’s a bagel. Eat it.” We need to make sense of where the patient is coming from, how resistance, non-compliance, even suicidal gestures make sense. And we need to help them reflect on their thinking, emotions and behavior. As Socrates implied in his inquiry, the answer lies within. It is there to be elicited, elucidated. Indeed, the Socratic method reflects the Latin derivation of the word “education” which is “to lead out”. The goal is to lead the suffering out of their habits of thinking and acting. It is to make clear what was automatic and often self-defeating and to make clear that there are different ways of thinking, feeling, and acting. Similar to the flexibility concept in ACT, this book reveals the need for flexibility on the part of both patients and therapists. By helping patients think in new ways, by demonstrating that questioning one’s ideas one can access new tools, the examples in this thoughtful book will help therapists from any school of CBT find new ways to help patients become their own therapists. I found this book encouraging, given the past turf-wars of the various waves that seemed to drown us at times. There is a lot of wisdom to be gained in reading this book. It is there if you are curious enough to find it. Robert L. Leahy, PhDNew York City, NYDirector, American Institute for Cognitive TherapyPast-President, Association for Behavioral and Cognitive TherapiesPast-President, International Association for Cognitive PsychotherapyPast-President, Academy of Cognitive TherapyAssociate Editor, International Journal of Cognitive TherapyHonorary Life-time President, New York City Cognitive Behavioral Therapy AssociationClinical Professor of Psychology, Department of Psychiatry, Weill-Cornell University Medical College, New York Presbyterian Hospital