Socratic Dialogue in Action-Packed CBT
Part 2 – Five Socratic Dialogue Techniques

By Lynn Mollick

On March 12, 2021 Dr. Christine Padesky described her “Socratic Dialogue” CBT to 93 NJ-ACT members via Zoom. Dr. Padesky asserted that patient experiences in therapy sessions are a more powerful change agent than talk. Socratic Dialogue modifies Beck’s Cognitive Therapy by utilizing the following active, in-session techniques:

1. Socratic dialogue instead of Socratic questioning. Socratic questioning is Beck’s technique of asking patients questions that gently lead them to change their dysfunctional thinking. In Socratic dialogue the therapist does not lead the patient to any particular conclusion but allows the patient to take the dialogue in any direction the patient wishes. This enables the therapy to focus on information that is relevant to the patient. In addition, this modification allows the patient to become aware of thoughts and feelings that were previously outside the patient’s awareness.

2. Interactive writing. The therapist and the patient collaborate in preparing a written summary of the most important points covered during the session.

3. Role-playing evokes more thoughts and feelings about the patient and significant others than just talking about these relationships. Role playing can also enable the patient to try out new ways of relating to significant others.

4. Behavioral experiments. Instead of asking patients to do behavioral experiments between sessions, do them right in the session. For example, if patients say they are too depressed to be active, ask them to do learning experiments in the session. Have patients get up or look closely at a picture or look out the window and describe their reactions to what they see. Or ask patients how they feel before and after walking outdoors or around their home to demonstrate that activity increases energy and decreases depression.

5. Imaginal practice. Toward the end of the session ask your patients to vividly imagine performing their homework. This exercise will increase the likelihood that patients will actually do their homework. It will also help the therapist and the patient identify obstacles to doing the homework. Give patients the opportunity to think of ways to overcoming the obstacles to doing their homework.