What Socrates has taught me
The Socratic approach has been shown to promote deeper and more enduring learning than simply receiving instructions. It gently guides the client to enlighten herself with alternative possibilities that have previously been outside her awareness. She is thereby facilitated to discover more realistic and helpful mental frameworks for herself. So what’s not to like?
Here’s my honest list of why it sometimes feels tricky for me to do it:
- I’m the ‘expert’ so I should know what to do and tell her how to do it right. (This is probably the GP in me, but you might know what I mean…)
- Even worse, when I’m feeling a bit out of my depth, this concept of how the expert delivers her expertise seems even more resonant and I’m likely to tighten up even more into ‘telling’ rather than ‘showing’
- I can’t help feeling frustrated on occasion and thinking ‘oh, for goodness sake, duh!’ And I just want to lead the client down the path to Nirvana, as quickly as possible.
- I’ve tried the textbook classic downward arrowing question ‘… and what would that mean to you?’ and not been sure if we’ve hit the bottom layer of belief or not. And it always feels like an unhelpfully vague question to me.
- I’ve had the experience of downward arrowing what appears to be a promising negative automatic thought (NAT) and then finding it fizzles out in a blind alleyway that doesn’t link to anything else and then having to ditch it surreptitiously.
- I’ve used Socratic questioning with a highly anxious client, whose attention then became drawn to worrying and catastrophic possibilities she hadn’t previously thought of!
So how can Socrates redeem himself and his methods? Well, repeated practice of his approach and methods are slowly revealing to me that:
1. What I’m really doing in session is role modeling to the client how she will become her own therapist eventually. She is already the expert on herself and only she can actually change her own patterns of thinking and behaving and making meanings. If her expertise is in the content of her mind, my expertise resides in knowing about the process of how minds in general tend to work. So I don’t need to tell her what to do, but rather help her work it out in a way that makes sense for her. Which means asking her questions that she has the ability to answer (even if she doesn’t yet realise it) and where the answer is in some way enlightening or expanding of her possibilities. This is the definition of a Socratic question.
2. Paradoxically it’s often easier for me to be Socratically curious and open if I stop trying so hard.
3. It follows from point two above that if the content of the enlightenment is generated by the client herself, it will be more authentic and credible to her. It will also be less open to being contaminated by my personal perspectives. My Nirvana won’t be her Nirvana, so it can’t help to lead her down my path, only to help her find her own. Neither does the Socratic approach aim to point out that the client has been ‘wrong’ or ‘mistaken’ thus far – on the contrary, good Socratic process often leads to the therapist saying ‘No wonder you felt terrible when you thought/felt/did X, if the meaning of X for you was …’ The Socratic process can therefore validate the client’s current experiences whilst simultaneously offering alternative perspectives moving forward.
4. A practical point about downward arrowing. Downward arrowing helps clients to get deeper into their negative automatic thoughts (NATs), often right down to their fundamental belief system i.e. core beliefs. But how to tell when the belief is really the core, bottom layer one? When we have elicited a likely core belief about the self, such as ‘I am a failure’, I ask ‘If that were to be true of you, what impact would it have on people you’re close to? Or on your future?’ If the answers all fit one another coherently, then we’ve probably reached Beck’s cognitive triad of core beliefs about the self, the world and others and the future. Also, I ask myself ‘If I held this view about myself and believed it as strongly as she does, would I feel the way she does?’ If the answer is yes, then we’ve probably unearthed a core belief.
5. Downward arrowing fizzling out in blind alleyways invariably happens when I haven’t related the NAT to the factors maintaining the client’s problems and the formulation. Clients may have lots of NATs, but only some of them are significantly relevant to maintaining their current distress and it’s only these that we want to explore. This means that the Socratic enquiry needs to be led by my hypothesis of what’s maintaining her problems, which in turn means it must be guided by the formulation.
6. Sometimes an anxious patient can start to catastrophise in response to Socratic methods. If so, we’ll try to name this process as one that is maintaining her distress. ‘Ok, can you identify what you’re doing here that’s making you feel distressed right now? Yes, that’s right, your old friends “catastrophising and worrying” seem to have shown up’. Then we’ll consider how to cope with worrying rather than disputing the content of each worry.
7. Similarly some clients may seek reassurance by exploring their thoughts and feelings to the nth degree with the therapist. They can unwittingly subvert the Socratic approach into providing collusion with their unhelpful maintaining behaviour of reassurance seeking. I deal with this by helping the client to name their behaviour, pretty much as in point six.
Finally, the Socratic questions that I use most commonly and with highest yield are:
1. 'What would you say to a friend in the same position?' Most clients find it surprisingly easy to generate helpful alternative perspectives for others!
2. 'What does it mean to you to feel out of control? Why is that so bad for you?' These are helpful in most anxiety states to uncover assumptions/rules for living and beliefs respectively.
Summary points
• My highest yielding Socratic questions are: 'What would you say to a friend in the same position?' 'What does it mean to you to feel out of control? Why is that so bad for you?'
• The NATs most worth pursuing down to the client’s core beliefs are those that may shed light on how the client’s problems are being maintained.
• Beware of the anxious client who inadvertently subverts the downward arrowing technique into chaining one worry into another and then another.