Socratic Questioning in Healthcare

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Published: 19 November 2017

Socratic questioning, also known as the Socratic Method, is a technique of questioning designed to encourage critical thinking, increase engagement in discussions and reach the core of an issue. It is often incorporated into cognitive behavioural therapy (CBT).

Braun et al.’s (2015) study on the Socratic Method 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 suggests that Socratic questioning could foresee symptom progress for the next session.

What is Socratic Questioning?

The University of Michigan (n.d.) describes the Socratic Method as a way to enhance 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:

  1. Clarification questions (e.g. What makes you say that?')
  2. Assumption-probing questions (e.g. 'Can you prove or disprove that assumption?')
  3. Questions to probe reasoning and evidence (e.g. 'Can you give an example of this?';)
  4. Questions about perspectives or viewpoints (e.g. 'What is a different way to look at this?')
  5. Probing questions about implications and consequences (e.g. 'What are the consequences of this assumption or belief?')
  6. 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 to 399 BC, utilised these types of questions to challenge the correctness of thoughts, and thereby assist his students (or in healthcare, your patient/client) to progress towards their goals.

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

Socratic Questioning in Healthcare - Questioning

Incorporating Socratic Questioning into Practice

Critical thinking is a crucial nursing skill that is vital for nurse educators. Therefore, the Socratic Method can be considered an important skill for nurses to learn, master and continue to practice and keep-up-to-date with (Burrell 2014).

Farmer et al. (2017) suggest that therapists with high competence using the Socratic Method may have better results in helping clients improve the severity of post-traumatic stress disorder (PTSD) symptoms. A narrative review by Clark & Egan (2015) also notes that the Socratic Method is an important part of cognitive behavioural therapy (CBT), an evidence-based treatment for various psychological conditions such as anxiety disorders.

Overholser (2015) recognises that the Socratic Method is compatible with positive psychology. This is due to their shared goal of achieving a positive perspective of the self and others. The Socratic Method and positive psychology both share the objective of creating life-long, sustainable changes as opposed to short-term ‘quick fixes’. Additionally, the Socratic Method and positive psychology both involve a collaborative and exploratory approach to therapy.

Potential Issues When Incorporating Socratic Questioning

Briggs (2014) suggests that it is important not to ask questions that are too vague, loaded, general or closed.

Interestingly, Clark and Egan (2015) note 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) supports the application of the Socratic Method in CBT. This study suggests that clients prefer Socratic questioning over didactic therapy and that Socratic questioning is ‘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’. However, Stoddard and O’Dell separate Socratic questioning from pimping, noting that pimping questions aim to humiliate the learner, whereas Socratic questions aim to expand the learner’s knowledge and perspective.

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


References

Author

Portrait of Madeline Gilkes
Madeline Gilkes

Madeline Gilkes, CDE, RN, is a Fellow of the Australasian Society of Lifestyle Medicine. She focused her Master of Healthcare Leadership research project on health coaching for long-term weight loss in obese adults. Madeline has found a passion for preventative nursing. She has transitioned from leadership roles (CNS Gerontology & Education, Clinical Facilitator) in the acute/hospital setting to education management and primary healthcare. Madeline’s vision is to implement lifestyle medicine to prevent and treat chronic conditions. Her research proposal for her PhD involves Lifestyle Medicine for Type 2 Diabetes Mellitus. Madeline is a Credentialled Diabetes Educator (CDE) and primarily works in the academic role of Head of Nursing. Madeline’s philosophy focuses on using humanistic management, adult learning theories/evidence and self-efficacy theories and interventions to promote positive learning environments. In addition to her Master of Healthcare Leadership, Madeline has a Graduate Certificate in Diabetes Education & Management, Graduate Certificate in Adult & Vocational Education, Graduate Certificate of Aged Care Nursing, and a Bachelor of Nursing. She is working towards her PhD. See Educator Profile