Important:

● TCC is not a set of techniques. The techniques serve ONLY to do a

good psychotherapeutic work;
It is essential to have conceptualized before using a technique.
developed a treatment plan that encompasses the therapeutic objectives,
understand the reasons behind the techniques (their indications and contraindications) and know how to
apply them.

Strategies, Methods, and Techniques in the Clinical Practice of CBT

Socratic Questioning

WHAT IS SOCRATIC QUESTIONING?

It can be described as 'a process of discovery', where both therapist and patient
they uncover automatic thoughts through a series of systematically ordered questions,
beliefs and examine the logic and evidence related to these cognitions. Socratic questioning
It is fundamental in the process of cognitive restructuring, which is one of the central strategies of CBT. It
is known as the 'backbone' in our clinical practice of cognitive interventions for change
dysfunctional thoughts and beliefs (WRIGHT et al., 2019), furthermore, it is used throughout
the therapeutic process. Instead of being a single technique, the Socratic questioning is more the basis, the
"style" adopted by the professional working with TCC in each session. According to Freeman (2004) the
Socratic questioning is a radical departure. of the interpretive style of the schools
psychodynamics and the non-directive style of client-centered work.

WHAT IS THE PURPOSE OF USING THIS TECHNIQUE?

It is used both to bring information to the patient's awareness (insight - identifying cognitions)
how much to modify thoughts and beliefs. When the QS is done correctly, it has a strong
impact on the patient's cognitive organization. Thus, the Socratic questioning helps the
client to expand and have a broader perspective on their way of thinking about a certain
Subject. We must help patients to 'think about their thinking' (metacognition) and the
Socratic questioning helps the client or patient in this process, they must learn to do
these questions and apply them to themselves. This technique is also known as Socratic dialogue, it
strengthens the collaborative empiricism between therapist and client.

WHAT AGE RANGE?

Socratic questioning can be used with children, adolescents, young adults, adults, and the elderly.

HOW TO APPLY?
When applying Socratic questioning, we must adopt a gentle stance, be impartial (not
we can be biased when crafting questions - we must be careful that the patients' responses
be genuine, never leading the patient to respond with what we want to hear), and remember that:
it's not about "convincing" the client of something with arguments, but about discussing data
objectives.
Socratic questioning is not a therapeutic debate, in this sense the therapist-patient duo
develop a mutually accepted position, have a shared vision focused on
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investigation. The therapist assumes a role as a facilitator of new understandings and ways of
to signify the events.
Paulo Knapp (2004) exemplifies a Socratic dialogue using the example of a patient who during
the session reports having yelled at her son and states: 'I feel that I am not a good mother'. the author shows
In what way can the therapist question in a Socratic manner:

What does it really mean to be a good mother? Describe characteristics, listed by you, of what it means to be a
good mother, which ones do you have?
Who do you consider to be a good mother? Why is [this person] considered a good mother?
What does a good mother do after she has yelled at her child and feels bad about it?
What do you think you were feeling before yelling at your child?
The skills that a person needs to be a good mother are either born with her, or the person can
learn to be a good mother?

The author continues to provide examples of non-Socratic questioning in the same situation:
"So what if you yell at your kids? Everyone does that."
Why are you being so hard on yourself?
"Did your parents ever yell at you?"

There are Socratic questions that are traditionally taught to cognitive therapists and
these questions continue to be asked to clients, they have stood the test of time and are generally effective in
process of facilitating cognitive change (BECK, 2013; WENZEL, 2018).
Below are examples of these questions:

Questions about the "Evidence"

What is the evidence that supports this idea?

What is the evidence against this idea?

Questions about "alternative explanations"

Is there an explanation or alternative viewpoint?

"Is there another thought that explains this same situation?"

Questions for 'decatastrophizing'

What is the worst thing that could happen (if I am not already thinking the worst)?
And if that happened, how could I face it?
"What is the best thing that could happen?"
What is the most realistic outcome?

Questions about 'the impact of automatic thinking'

What is the effect of believing in that thought?

What would be the effect of changing my thinking?

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 Questions for 'distancing'

What I would say to ___________[a specific friend or relative] if he were in the same situation.
situation?

Questions for 'problem solving'

What should I do?

Overholser (1993, cited in STALLARD 2007, p.74) identifies the Socratic process in stages, and in
each of these stages based on careful systematic questioning (note that we are talking
of therapeutic intentionality, that is, it is not enough to use socratic questions, but it is necessary
to know why each question is being used), to help the client identify and evaluate
critically your universal definitions. For this, he highlights 7 (seven) types of questions used.
in this process:

Memory Questions (create a shared factual understanding)

(we identify the meaning attributed to events) → 3. Interpretation Questions (explore the relationship
among events) → 4. Application Questions (identify useful knowledge regarding
experiências) → 5. Perguntas de Análise (promovem avaliação lógica) → 6. Perguntas de Síntese
(encourage alternative/creative thinking) → 7. Evaluation Questions (promote re-evaluation and
reflection)

Below, see some examples of these questions:

Memory Questions
When did this start?
What do you do when you feel this way?
How often does this happen?
When was the last time it happened?
What happened at this moment?

Translation Questions
How do you understand this?
Why do you think you have these somewhat strange feelings?
"Why do you think this happens to you?"
How could we make sense of this?

●Interpretation Questions
"The feeling you have when _____ is the same as when _____?"
Do you notice any connection between these negative thoughts and how you feel?
Are there moments when you notice these negative thoughts more?
How could these two situations be similar? Where do they differ?

Application Questions
What did you used to do in the past when you felt this way?
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You told me that the last time this happened, it wasn't so bad. Was there something that you
"Did you do it in a different way that might have helped?"
You don't seem to have those troubling thoughts when you are ___. Is there something different there?
What helps you ignore those thoughts?
What did you try to do to solve this problem before?
What other things could you do to solve this problem? How do you believe you will be able to
make these changes?

Analysis Questions
When you think that way, what evidence supports your thoughts?
"Is there any evidence that you ignored?"
What would your best friend say if they heard you thinking this way?
You told me that this always happens, but are there times when it doesn't happen?
Were there moments when this happened, but was it due to something else?
What do you believe is causing this problem? What evidence do you have to support that?
Are there things that can improve this situation? Are there things that can worsen this situation?

●Synthesis Questions
Let's make a list of all the ways we could deal with this, even if it might seem
a little strange or silly.
What do you think your best friend would do?
Are there other ways we could explain what happened?
In what different ways could you see this situation or problem?

Evaluation Questions
So, how do you understand this now?
Do you still see yourself as a failure?
Is there another way to think about this?
What does it mean to you to be successful?
How do you see yourself as a person?

The choice of these questioning formats will be based on therapeutic objectives of a

determined point of therapy (what is appropriate at that point in therapy), according to the need.
The Socratic dialogue is not a technique where questions are asked randomly. From the
conceptualization and objectives, the therapist knows the direction and meaning of how to facilitate the
discovery process. Good Socratic questions are open, short, focused, directed,
involve the patient in the process of learning to think about their own thinking and getting to know more
about himself. He feels respected, comfortable, and confident, not deviating from the Socratic questioning.
feeling stupid for "thinking that way".

Amy Wenzel (2018) warns that 'it is important to realize that it is not necessary to stay'
linked to traditional Socratic questions; in fact, cognitive restructuring can be
particularly effective when the Socratic questions are singular and correspond to circumstances
of current life." In this sense, the author encourages creativity in the formulation of Socratic questions.
to facilitate cognitive restructuring. She exemplifies with some questions that usually

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they are not found in TCC texts, some of the questions mentioned in your book are described
below:

Think of someone who has overcome adversity in life and ultimately prospered. How did that happen?
Could a person see this situation?
Think of an adult you trusted when you were a child (e.g., father or mother). How
Would this person see this situation? How would this person view your competence to deal with it?
this situation?
How many times have you gone through a situation that you initially considered catastrophic?
How many times did a catastrophe actually occur? [Encourage the customer to calculate a proportion]
or real percentage.
[For parents] How can you model an adaptive way to view this situation? What
What message would you like to convey to your son (or sons)?
If you have to be in this horrible situation, then what wisdom can you acquire? How do you
Can you achieve personal growth?

References
• BECK, Judith S. Cognitive-Behavioral Therapy: Theory and Practice. (2nd ed.). Porto

Alegre: Artmed, 2013. 413 p.

• FREEMAN, Arthur. Encyclopedia of Cognitive Behavior Therapy. United States of

America: Springer Science, 2004. 451 p.

• KNAPP, Paulo. Cognitive-Behavioral Therapy in Psychiatric Practice. Porto Alegre:

Artmed, 2004. 520 p.

• STALLARD, Paul. Therapist's Guide to Good Thoughts - Good Feelings:

using cognitive-behavioral therapy with children and adolescents. Porto

Alegre

• WENZEL, Amy. Innovations in Cognitive Behavioral Therapy: interventions

strategies for a creative practice. Porto Alegre: Artmed, 2018. 216 p.

• WRIGHT, et al. Learning Cognitive-Behavioral Therapy by the authors: A guide

illustrated (2nd ed.).

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