Descriptive Study of the Socratic Method: Evidence for Verbal Shaping

doi:10.1016/j.beth.2013.08.001

Behavior Therapy

Volume 44, Issue 4, December 2013, Pages 625-638

https://doi.org/10.1016/j.beth.2013.08.001 Get rights and content

Highlights

•
We examine mechanisms that explain changes in patients during the Socratic method.
•
We analyzed therapist-patient interaction in 65 fragments of clinical sessions.
•
Sequential analysis was used to study behavioral sequences.
•
Results suggest that the application of this component may involve verbal shaping.

Abstract

In this study we analyzed 65 fragments of session recordings in which a cognitive behavioral therapist employed the Socratic method with her patients. Specialized coding instruments were used to categorize the verbal behavior of the psychologist and the patients. First the fragments were classified as more or less successful depending on the overall degree of concordance between the patient’s verbal behavior and the therapeutic objectives. Then the fragments were submitted to sequential analysis so as to discover regularities linking the patient’s verbal behavior and the therapist’s responses to it. Important differences between the more and the less successful fragments involved the therapist's approval or disapproval of verbalizations that approximated therapeutic goals. These approvals and disapprovals were associated with increases and decreases, respectively, in the patient’s behavior. These results are consistent with the existence, in this particular case, of a process of shaping through which the therapist modifies the patient’s verbal behavior in the overall direction of his or her chosen therapeutic objectives.

Section snippets

Sample

The sessions we analyzed came from a data base of video recordings that involved a single cognitive-behavioral therapist with 16 years of professional experience at the Instituto Terapéutico de Madrid (ITEMA, Spain). Clinical sessions were included in the data base conditionally on each patient’s informed consent and not on the basis of the type of clinical technique and/or therapeutic success. In all cases different intervention techniques were applied according to the individualized functional

Behavioral Sequence Analysis

In terms of verbal effectiveness, 39 Socratic fragments were classified as total success, 21 as partial success, and 5 as failures. Within each category of verbal effectiveness, global tests of association revealed significant lag-1 relations between the therapist’s and patient’s behavior (chi-square values ranging from 70.28 to 1379.61, degrees of freedom ranging from 24 to 28, all p-values < .01). Thus, it seems that the patient’s behavior affected the therapist’s behavior immediately afterward.

Discussion

The present study has a number of limitations that should be discussed before examining the implications of our results for theories of clinical change. Some of these limitations arise from the restricted nature of the data base at our disposal. The Socratic fragments we analyzed involved only one therapist and seven clinical cases. Furthermore, even though this therapist was highly experienced in cognitive-behavior therapy, she did not implement a manualized form of the Socratic method.

Conclusions

Although restricted by the nature of our data base, our results are consistent with a process of verbal shaping that underlies the Socratic method. In addition, the measures of inter-observer agreement in our study were over established minimum levels in most cases. The psychological meaning of the conclusions derived from these analyses lends further support to the measurement instruments we employed and confirms the usefulness of this methodology for analyzing the mechanisms of change that

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

References (68)

D.H. Barlow et al.
An experimental analysis of the effectiveness of "shaping" in reducing maladaptive avoidance behavior: An analogue study
Behaviour Research and Therapy
(1970)
D.D. Burns et al.
Do changes in dysfunctional attitudes mediate changes in depression and anxiety in cognitive behavioral therapy?
Behavior Therapy
(2001)
A.M. Busch et al.
A micro-process analysis of functional analytic psychotherapy's mechanism of change
Behavior Therapy
(2009)
W.C. Follette et al.
A radical behavioural understanding of the therapeutic relationship in effecting change
Behavior Therapy
(1996)
R.A. Gould et al.
Cognitive therapy for psychosis in schizophrenia: An effect size analysis
Schizophrenia Research
(2001)
S.A. Hamilton
Behavioral formulations of verbal behaviour in psychotherapy
Clinical Psychology Review
(1988)
M. Hamilton et al.
A comparison of systematic desensitization and reinforced practice procedures in fear reduction
Behaviour Research and Therapy
(1973)
R. Jarrett et al.
Mechanisms of change in cognitive therapy of depression
Behavior Therapy
(1987)
R.J. Longmore et al.
Do we need to challenge thoughts in cognitive behavior therapy?
Clinical Psychology Review
(2007)
J. Virués-Ortega et al.
Descriptive analysis of the verbal behavior of a therapist: A known-group validity analysis of the behavioral functions involved in clinical interaction
Behavior Therapy
(2011)

G. Alessi

Models of proximate and ultimate causation in psychology

American Psychologist

(1992)

APA Presidential Task Force on Evidence-Based Practice

Evidence-based practice in psychology

American Psychologist

(2006)

D.B. Arnkoff

A comparison of the coping and restructuring components of cognitive restructuring

Cognitive Therapy and Research

(1986)

R. Bakeman

Behavioural observation and coding

R. Bakeman et al.

Lags and logs: Statistical approaches to interaction (SPSS version)

R. Bakeman et al.

Observing interaction: An introduction to sequential analysis

(1986)

R. Bakeman et al.

Observing interaction: An introduction to sequential analysis

(1997)

R. Bakeman et al.

Analyzing interaction: Sequential analysis with SDIS and GSEQ

(1995)

A.T. Beck

Depression: Clinical, experimental, and theoretical aspects

(1967)

A.T. Beck et al.

Cognitive therapy of depression: A treatment manual

(1979)

A.T. Beck et al.

Cognitive therapy of substance abuse

(1993)

J. Bennett-Levy

Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experiments

Behavioral and Cognitive Psychotherapy

(2003)

E.V. Brestan et al.

Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids

Journal of Clinical Child Psychology

(1998)

Calero-Elvira, A. (2009). Análisis de la interacción entre terapeuta y cliente durante la aplicación de la técnica de...

A. Calero-Elvira et al.

¿Qué hace el psicólogo cuando aplica la técnica de reestructuración cognitiva?

Revista Mexicana de Psicología

(2011)

T.A. Carey et al.

What is Socratic questioning?

Psychotherapy: Theory, Research, Practice, Training

(2004)

T.A. Carey et al.

Socratic questioning in psychotherapy: A history of crossed purposes

Counselling Psychology Review

(2007)

A.C. Catania

Learning

(1992)

D.L. Chambless et al.

Update on empirically validated therapies, II

The Clinical Psychologist

(1998)

D.L. Chambless et al.

An update on empirically validated therapies

Clinical Psychologist

(1996)

S. Dimidjian et al.

Randomized trial of Behavioral Activation, Cognitive Therapy, and antidepresant medication in the acute treatment of adults

Journal of Consulting and Clinical Psychology

(2006)

K.S. Dobson et al.

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression

Journal of Consulting and Clinical Psychology

(2008)

W. Dryden et al.

A primer on rational emotive behavior therapy

(2003)

A. Ellis

Reason and emotion in psychotherapy

(1962)

Cited by (19)

Functional analysis in clinical treatment: Twelve years of progress, current status, and future directions
2020, Functional Analysis in Clinical Treatment, Second Edition
Applied Behavior Analysis has a long history of application to understanding psychopathology and changing psychopathology-related behavior. Over the last twelve years the field has gradually expanded to address a larger range of problems, to continue to develop the technology of functional assessment and analysis and to address chronic health problems. Some measurement problems may be solved by use of web-based technology to measure behavior in real time outside the therapy room and closer integration of third wave therapies into Applied Behavior Analysis (ABA).
Relevant factors in treatment adherence: A case study
2015, Clinica y Salud
Citation Excerpt :
Being unequivocally aversive in certain circumstances favors the discriminative power of the therapist, and the differential and comparatively sparse use of appetitive utterances prevents the client from habituating to any verbal behavior the therapist might use. Besides, if we conceptualize the clinical process as a verbal shaping, this would be coherent with the results that show that this shaping is more effective if the therapist not only reinforces pro-therapeutic utterances, but also punishes anti-therapeutic verbalizations (Calero-Elvira, Froján-Parga, Ruiz-Sancho, & Alpañés-Freitag, 2013). Anticipation of contingencies.
In this paper, a case study is presented. The client had been in therapy before, and had abandoned all previous treatments before any significant improvement had taken place. In the treatment reported here, she committed to the therapy and made progress. Possible reasons for this change in adherence are discussed.
En este estudio se presenta un caso. La cliente había estado ya en terapia, abandonando todos los tratamientos previos antes de que su problema hubiera mejorado significativamente. En el tratamiento reseñado aquí finalmente se comprometió con la terapia y mejoró. Se discuten posibles explicaciones para este cambio en la adhesión terapéutica.
Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression
2015, Behaviour Research and Therapy
Socratic questioning is a key therapeutic strategy in cognitive therapy (CT) for depression. However, little is known regarding its relation to outcome. In this study, we examine therapist use of Socratic questioning as a predictor of session-to-session symptom change. Participants were 55 depressed adults who participated in a 16-week course of CT (see Adler, Strunk, & Fazio, 2015). Socratic questioning was assessed through observer ratings of the first three sessions. Socratic ratings were disaggregated into scores reflecting within-patient and between-patient variability to facilitate an examination of the relation of within-patient Socratic questioning and session-to-session symptom change. Because we examined within-patient variability in Socratic questioning, the identification of such a relation cannot be attributed to any stable patient characteristics that might otherwise introduce a spurious relation. Within-patient Socratic questioning significantly predicted session-to-session symptom change across the early sessions, with a one standard deviation increase in Socratic-Within predicting a 1.51-point decrease in BDI-II scores in the following session. Within-patient Socratic questioning continued to predict symptom change after controlling for within-patient ratings of the therapeutic alliance (i.e., Relationship and Agreement), suggesting that the relation of Socratic questioning and symptom change was not only independent of stable characteristics, but also within-patient variation in the alliance. Our results provide the first empirical support for a relation of therapist use of Socratic questioning and symptom change in CT for depression.
Do counselor techniques predict quitting during smoking cessation treatment? A component analysis of telephone-delivered Acceptance and Commitment Therapy
2014, Behaviour Research and Therapy
Citation Excerpt :
In addition, this study builds upon the results of a previous study published in this journal (Hesser et al., 2009) by exploring the full range of processes of change proposed by the ACT model, and by prospectively focusing on a fine-grained analysis of counselor-level session-to-session components and participant outcomes. Furthermore, as discussed by others (Forman et al., 2012; Hesser et al., 2009), overreliance on global self-report measures to assess processes of change limits our ability to understand key factors responsible for behavior change, and therefore this study adds to the growing body of literature examining the role of adherence to counseling techniques in behavior change processes and outcomes (e.g., Amrhein et al., 2003; Calero-Elvira et al., 2013; Tollison et al., 2013). Lastly, the fact that the study population consisted of a sample of uninsured and low socio-economic status individuals shows the promise of ACT counseling techniques in predicting smoking cessation in a challenging treatment population.
No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors' use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors' use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists' techniques as predictors of outcome during the course of treatment.
Verbal Behavior Analysis of Expert and Inexperienced Therapists Applying the Socratic Method
2022, Spanish Journal of Psychology
What works in the Socratic debate? An analysis of verbal behaviour interaction during cognitive restructuring
2021, Behavioural and Cognitive Psychotherapy

View all citing articles on Scopus

^☆: This research was funded by the Spanish Government (Ministerio de Ciencia e Innovación, I + D + I Research Grants SEJ2007-66537-PSIC, PSI2010-15908). Ana Calero-Elvira was also supported by a FPI research fellowship (Consejería de Educación, Comunidad de Madrid and European Social Fund) to conduct this research as part of her doctoral thesis. The funding sources had no involvement in design, collection, analysis and interpretation of data, writing of the paper, or in the decision to submit the article for publication. We would like to thank François Tonneau, Juan Botella, Manuel Suero and Ricardo Pascual Verdú for their advice on the manuscript.

View full text

Descriptive Study of the Socratic Method: Evidence for Verbal Shaping☆

Highlights

Abstract

Section snippets

Sample

Behavioral Sequence Analysis

Discussion

Conclusions

Conflict of Interest Statement

Behaviour Research and Therapy

Behavior Therapy

Behavior Therapy

Behavior Therapy

Schizophrenia Research

Clinical Psychology Review

Behaviour Research and Therapy

Behavior Therapy

Clinical Psychology Review

Behavior Therapy

Models of proximate and ultimate causation in psychology

American Psychologist

Evidence-based practice in psychology

American Psychologist

A comparison of the coping and restructuring components of cognitive restructuring

Cognitive Therapy and Research

Behavioural observation and coding

Lags and logs: Statistical approaches to interaction (SPSS version)

Observing interaction: An introduction to sequential analysis

Observing interaction: An introduction to sequential analysis

Analyzing interaction: Sequential analysis with SDIS and GSEQ

Depression: Clinical, experimental, and theoretical aspects

Cognitive therapy of depression: A treatment manual

Cognitive therapy of substance abuse

Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experiments

Behavioral and Cognitive Psychotherapy

Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids

Journal of Clinical Child Psychology

¿Qué hace el psicólogo cuando aplica la técnica de reestructuración cognitiva?

Revista Mexicana de Psicología

What is Socratic questioning?

Psychotherapy: Theory, Research, Practice, Training

Socratic questioning in psychotherapy: A history of crossed purposes

Counselling Psychology Review

Learning

Update on empirically validated therapies, II

The Clinical Psychologist

An update on empirically validated therapies

Clinical Psychologist

Randomized trial of Behavioral Activation, Cognitive Therapy, and antidepresant medication in the acute treatment of adults

Journal of Consulting and Clinical Psychology

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression

Journal of Consulting and Clinical Psychology

A primer on rational emotive behavior therapy

Reason and emotion in psychotherapy