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Socratic Questioning in Healthcare


Socratic questioning, also known as the Socratic Method, is a technique of questioning designed to encourage critical thinking, engagement in discussion and reaching the core of an issue, and is often incorporated in cognitive behavioural therapy.

Braun et al.’s (2015) study showed the ‘first empirical support for a relation of therapist use of Socratic questioning and symptom change in CT (cognitive therapy) for depression.’ This study (Braun et al. 2015) suggested that Socratic questioning could foresee symptom progress for the next session.

What is Socratic Questioning?

The University of Michigan (n. d.) describe the role of Socratic questioning in enhancing critical thinking skills such as reflection, assessment and evaluation of the assumptions behind the behaviours and thoughts of the self and others.

Their definition recognises R. W. Paul’s six types of Socratic questions. These are as follows:

  • Clarification questions (e.g. ‘what makes you say that?‘)
  • Assumption-probing questions (e.g. ‘can you prove or disprove that assumption?‘)
  • Questions to probe reasoning and evidence (e.g. ‘can you give an example of this?‘)
  • Questions about perspectives or viewpoints (e.g. ‘what is a different way to look at this?‘)
  • Probing questions about implications and consequences (e.g. ‘what are the consequences of this assumption or belief?‘)
  • Questioning the question (e.g. ‘what do you think the purpose of this question was?‘)

(The University of Michigan n. d.; Changing Minds 2016)

Socrates, a Greek philosopher who lived from 470-399BC utilised questioning like those above to challenge the correctness of thoughts, and thereby assist his students (or in healthcare, your patient/client) to progress towards their goal.

Socrates’ questioning continued until a contradiction was made; thereby disproving the initial belief. The Law School of The University of Chicago (2017) highlight the usefulness of this Socratic Method in creating critical thinking skills, engagement in discussion, and reaching the core of the issue at hand.

Socratic Questioning in Healthcare - Ausmed Questioning

Incorporating Socratic Questioning into Practice

Burrell (2014) expresses that critical thinking is a crucial nursing skill and definitely vital for nurse educators, therefore, the nursing curriculum incorporation of critical thinking skill development currently includes uses of reflection, concept maps and questioning best practice (Burrell 2014). It can, therefore, be considered that Socratic Method is another important critical thinking skill for nurses to learn, master, and continue to practice or keep-up-to-date with (Burrell 2014).

Farmer et al. (2017) suggest that therapists with high competence using the Socratic questioning method may have better results in helping clients to improve the severity of their PTSD (post-traumatic stress disorder). The narrative review by Clark & Egan (2015) convey that the Socratic Method is an important part of CBT (read: Cognitive Behavioural Therapy – Understanding CBT), an evidence-based treatment for various psychological conditions such as anxiety disorders.

Overholser (2015) recognises that Socratic questioning is compatible with positive psychology. This is due to the common goal of achieving a positive perspective of self and others. Additionally, the Socratic Method and positive psychology both share the objective of creating life-long, sustainable changes; as opposed to short-term ‘quick fixes’. Thirdly, positive psychology and Socratic questioning both involve a collaborative and exploratory approach to therapy. Overholser reveals that these common approaches for Socratic Method and positive psychology help to increase the relevance of treatment for the client.

Further Learning: take the video course, ‘Counselling Your Staff

Potential Concerns When Incorporating Socratic Questioning

Briggs (2014) of InformEd at Open Colleges puts forward that it is important not to ask questions that are: too vague, loaded, general, or closed.

Interestingly, Clark and Egan (2015) demonstrate concern that due to the time needed to effectively apply the Socratic Method, some clinicians may neglect its use when delivering CBT. They assert that there should be more empirical research outlining the benefits and cost-efficiency of the Socratic Method in CBT.

A later study by Heiniger, Clark and Egan (2017) supported the application of Socratic Method in CBT. This study indicated that clients preferred Socratic questioning over didactic therapy and that Socratic questioning was found to be ‘helpful, empathetic and autonomy supporting’.

Stoddard and O’Dell (2016) raise concern that some medical students or learners may be under the impression that Socratic questioning attempts to embarrass them. This is sometimes referred to as ‘pimping’ according to Stoddard and O’Dell (2016). However, Stoddard and O’Dell separate Socratic questioning from ‘pimping’ in the difference that ‘pimping’ questions aim to humiliate the learner, whereas Socratic questions aim to expand the learner’s knowledge and perspective.

Evidently the former (‘pimping’) appears unprofessional and unethical and should not be an approach used by health professionals or educators. Conversely, the latter, Socratic questioning, provides psychological safety in that it does not aim to threaten the dignity of the learner, but rather to probe their understanding in order to improve their education (Stoddard & O’Dell 2016).

 

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