Staff Perspective: Socratic Dialogue, Part 2 - Professing Ignorance

Staff Perspective: Socratic Dialogue, Part 2 - Professing Ignorance

Socrates believed that there are two phases to enable others in search of an understanding of their own truth.  The Socratic Method is used in almost all behavioral health treatment and at its most simplistic is termed the use of open-ended questions.  However, Socratic Dialogue is so much more than that – an art form that allows patients to begin the process of opening up to what is the actual truth.  The truth that is based on evidence and the practice of disciplined, thoughtful dialogue.

Many patients are focused primarily on the outcome of an event and work hard at explaining the “why” of the event in a way that fits into their world belief and provides a sense of efficacy and control over future events. In order to do this, however, the patient may delete important details of the event that don’t fit into their attempted reconciliation or blame themselves as having caused the event. It is our job to ask questions that will allow the patient to take a closer and more in-depth look at their thoughts to decide if they are, in fact, true statements.

In order to do this, Socrates devised two phases of questioning. The first phase could be called deconstruction.  The goal of this phase is to demonstrate the patient’s contradictions and inconsistencies in their thinking, asking them to be curious about other possible ways of looking at the event.  The goal of the second stage is to restore their thinking onto a more solid foundation, based on truth and evidence. The point of the questions is to get them to see what they would not otherwise see.  Socratic dialogue is about perceiving truth.  Careful use of Socratic questioning enables a therapist to challenge recurring or isolated instances of a person's illogical thinking while maintaining an open position that respects the internal logic to even the most seemingly illogical thoughts.

The role of the therapist is to ask specific questions that will bring to light the meaning, function and consequences of the patient’s beliefs. It then becomes the patient’s decision whether to accept, reject or in some way modify or maintain their beliefs.  This is done with the help of the therapist by weighing both the emotional and behavioral consequences. In more concrete terms, the therapist professes ignorance of the topic in order to engage in dialogue with the patient. The therapist professing ignorance or asking for the patient’s help in understanding allows the patient to develop the fullest possible knowledge about the topic.

Of utmost importance, and a frequent stumbling block for therapists, is the timing of questions and the patience to allow the patient to measure and evaluate the efficacy of their initial thoughts. Few patients undergo lasting change because a therapist has shown their thought processes to be illogical.  Rather, it is a large part of the Socratic Method to work with the patient to their own discovery of more accurate ways of viewing an event.  This is where true change takes place.  In both giving them a new method of looking at their thoughts and the independence to arrive at their own conclusions.

Previous Related Post​: Staff Perspective: CPT and the Use of Socratic Dialogue/Questioning

Laura Copland, MA, LCMHC, is the Senior PTSD Treatment Trainer for the Center for Deployment Psychology’s headquarters in Bethesda, MD.