Socratic Dialogue in Action-Packed CBT
Part 1 – Four Stages of Socratic Dialogue

By Lynn Mollick

On March 12, 2021, Dr. Christine Padesky described her “Socratic Dialogue” CBT to 93
NJ-ACT members via Zoom. Dr. Padesky believes that in-session patient action is a more
effective change agent than talk. Below are the 4 stages of Socratic Dialogue in “Action-Packed”
CBT.

1. Informational questioning. First the therapist asks patients to close their eyes and imagine an actual, problematic experience unfolding — to re-experience the situation in the therapy session. Then the therapist asks the patient for as many specific details about the situation as possible including what happened and what thoughts and feelings the patient experienced.

2. Empathic listening. Dr. Padesky emphasizes listening for details that the patient omitted from the description of the problematic experience. These omitted details are often the details that provoked negative feelings in the patient. The therapist can comment on these omissions and ask about them. In this way, patients and therapists learn important information that patients have kept out of their awareness.

Active Listening is usually described as paraphrasing the essence of what the patient is saying and feeling. Instead, Dr. Padesky recommends repeating the patient’s exact words. Paraphrasing may not be accurate, which may cause the patient to feel that the therapist was not listening carefully and does not understand the patient. recommends repeating the patient’s exact words rather than paraphrasing them. Also, paraphrasing may include a slightly different connotation than the patient intended and thereby lead the conversation in a direction the therapist prefers instead of letting the patient direct the conversation.

3. Interactive, written summaries. Dr. Padesky prefers written rather than oral summaries of what patients learned during the session. She asserts that important points from the session can easily be forgotten if they are not put in writing. She encourages patients to write summaries in longhand to maximize learning. She also recommends that the summaries be in the patient’s own words so patients will recognize the conclusions as their own.

4. Analyzing/synthesizing questioning. Finally, the therapist asks the patient to review the written summaries. The therapist then asks questions about how the written summaries support or contradict the patient’s beliefs.

Here are two analyzing questions:
“What does the information in our written summary mean to you?”
“How do these ideas/observations/experiences fit with your beliefs?”

Here are two synthesizing questions:
“How do the ideas in our written summary fit with your beliefs?”
“How can you use what we talked about today to improve your life during the coming week?”