Socratic Questioning in CPT

[Justmehere]

I am considering Cognitive Processing Therapy (CPT). It's geared for veterans, but my therapist says it has helped others. I'm a little concerned about the role of Socratic questioning in this therapy. I'm glad this therapy helps many. I don't see how it could be helpful for me.

The CPT Therapist Manual describes the role of Socratic Questioning like this:

Socratic Questioning

Within CPT There are several styles of cognitive therapy within the general class of cognitive therapies. CPT is designed to bring patients into their own awareness of the inconsistent and/or dysfunctional thoughts maintaining their PTSD. Accordingly, a cornerstone part of the practice of CPT is Socratic questioning. Throughout the course of treatment, therapists should be consistently using Socratic questioning to induce change, with the goal of teaching patients to question their own thoughts and beliefs. Because the method is so integral to CPT, we have included more general information here about what Socratic questioning is, and types and examples of Socratic questions that can be posed.

Socratic questioning originated from the early Greek philosopher/teacher Socrates. He believed that humans had innate knowledge and that this knowledge could be revealed by another person asking specific questions. He also contended that humans who came into knowledge, versus being told, were more likely to retain the information and build on that knowledge to acquire more knowledge. Socratic questioning is routinely used in American law schools, in some forms of cognitive therapy, and specifically in CPT.

I don't agree with Socrates. I don't believe I have innate inner knowledge or that such magical knowledge will reduce my symptoms. I don't really don't feel comfortable about being questioned all session long via the same manner lawyers are trained to do, as a means into more innate insight as the path to reduce symptoms. My therapist did this already, a few times, without telling me this was the method she was trying to use, and I complied and gave answers because I thought she was trying to get info about my trauma history. I had to testify in court about my trauma, and being questioned like she did, brought me back to that. I had no idea these questions were being asked to try to change my thinking. No clue.

I have no idea she was trying to change me via manipulative Socratic questioning. I left each session feeling much worse. If this is all about finding out my inner wisdom, well my inner wisdom on myself is crap, but being questioned into it? In therapy? I mean I get that therapists have to ask questions to gain information, and from time to time to challenge thinking to think another way, but in my therapy sessions with my therapist using this method, it was like a question, answer, question, answer, question, answer, for 50 minutes. I had no clue that the questions were suggestions or attempt to challenge my thinking nor do I understand how a whole session of this helps. When I try to do the worksheets and the method in sessions, I leave feeling terrible, ashamed, and with many negative thoughts stirred up and worse. Not better.

What am I not understanding? How does this extended socratic questioning help in therapy?

Plain old CBT would make more sense to me. In fact, everything in CPT is basically CBT dropped into Socratic questioning.

 

[Friday]

Anything with being questioned is going to hit your hot spots, yes? Because interrogation is part of your trauma history?

f*ck. I’m really trying not to phrase these as questions :wtf: Although I know it’s probably not questions in general, but the act of being drilled down into, forced to change, forced to break, forced to be what’s necessary and the choice/no-choice of it welding right/wrong/yes/no/all-of-it together. And the consequences. The terrible unthinkable consequences if it’s gotten wrong. Even the tiniest bit wrong.

My only peace is being nothing and no one. Because ^^^that^^^ way lies madness. True madness. All the broken pieces cut too deep.

f*ck. The problem with trying not to ask questions is that you get my truths instead of figuring out what helps with yours. So. As met. These are mine, if they’re helpful, use them. If not, no worries.

Point being... regardless of what kind of trauma processing you do... Questions will need to be a part of it, at some point. For 2 reasons

1. So your truth is on the table
2. So they don’t trigger you anymore, and your truth can be on the table.

Probably should be done backwards. Come at the trigger, first, instead of the root cause. Or not. That’s not usually best practice, for good reason. But usually means other people, and we’re not worrying about other people, now. Just you. So either way, really. Whatever works best for you.

Clear as mud?

 

[Ronin]

Or maybe you could be asking about the questions (you are doing it already with the thread, going at the whole method with the What the hells and Hows)... figure out comfort zones with questions themselves, how much are edges you are able to skirt and normalize, moving the trauma bit further back into the background for a time until you can apply the method at it better.

As in, move questions to be just questions, not interrogative nonsense.
And pieces of trauma be just normal life and legit concerns and filling in gaps and changing a way of looking at these pieces of life.... instead of Nope, totally out.

I thinks what therapists and helpful people mean with it is make better sense of what is an emotional clusterf*ck. It is supposed to make it less cluttery and make it processible again, make it chunks that you can do something about, bringing forth new directions and giving new grounds... instead of destabilizing everything.

Or it can be useful for questioning the lies abusive pricks taught us about ourselves and deconstruing them.
Or giving an agency that you CAN question things that would seem given for absolute and the freedom in that.

(Tldr: Flip the table, and mind it is just an ordinary table, while at the same parallel.)

 

[Abstract]

Do you know what this type of questioning would usually sound and look like? It seemed to me that your t was asking the same question repeatedly, again and again, regardless of your obvious discomfort and the recent issues you had experienced in therapy with her.

I'm not familiar with this type of therapy so not the best person to answer. I however can't help but feel there are two choices here. Either questioning in this context could be very different from what you experienced recently (and you would have to start off discussing the trigger and the mindset you are currently in) or it isn't going to suit you at present. If the t uses more than one approach maybe she can smoosh something together for you that is more suitable.

Personally I find questions helpful as they can pries out what I want to say but not the type your t used recently. That would feel like an interrogation for me as well as feeling loaded/pointed and leave me feeling self doubting.

Who suggested this approach to you?

 

[Abstract]

Is this a good example?

 

[Justmehere]

Good videos. In the first one, for 30 seconds he reflects back what is said, sets up the exercise, there is a clear goal to focus on the assumption. All things not done in my therapy. And throughout the exercise he says “Sure, right, so they...” and reflects back what is said. That is a lot more dialogue than my current therapist does with me. But, we have been working together for some time.

That all being said, if I was the person being asked questions in the video, that would trigger the crap out of me right now.

I’m trying to think back to the trial, where it was Socratic questioning but my life wasn’t in immediate danger. Stressful as all get out, but it got at the truth. It was doable. The traumatic interrogation is something that is haunting me right now. I get it. Makes sense. I’d be able to handle it better a year ago before we stirred up this cluster of trauma. Now? By the end of 50 minutes of that, I would have a hard time not thinking “why am I always wrong? What do you want from me?”

Not logical. Not here-and-now. Not reasonable.

What I really think I keep going back to -- when I couldn’t give the right answer to make the perp stop. Probably some kind of distorted thought in that statement itself. I can’t really control a perp. But trying to satisfy him kept me alive. It also left me disgusted with myself. I guess it hard to feel like I’m safe now. Freaking PTSD.

I get that questions can get my truth. My conclusions. My doing the work. Maybe I’m too triggered and maybe we do this method as exposure work right now.

I just don’t get it and my resistance might be all fight or flight.

Gotta go, will write more later.

 

[ILoveLife]

Can you ask your therapist to help separate the waters first? In the sense of being a grounding ability for you not to equate therapy with torture or therapists with perpetrators.

I think the method might be helpful for you, in the long run, if not in the short.

 

[Sandstone]

I believe the French judicial system utilises questioning to seek the truth - an inquisitorial system. In the UK where I am, and the US where I believe you are, questions are used, but not to seek the whole truth. The objective in our courts is to reveal only that part of the truth that serves the agenda of one party to the trial. So I think the experience you had in court can only make this harder for you; it isn't a foretaste of what decent therapeutic questioning should be like, and isn't a reason to reject the whole approach.

However I do have doubts about the idea of a valid innate inner truth. My inner truths are distorted - that is part of PTSD. Socratic questioning may be useful to reveal those distortions, but in itself can't change them. So I am now aware that I believe I have no right to exist. I genuinely believe that, it isn't a surface image with a "better" truth hidden beneath it. I can be led by questioning to recognise that others think they are entitled to live, that I think others are allowed to exist and most of them think I share that right, but knowing all those things doesn't alter my truth. Something other than logic will be needed to restructure my world into one where I am not an affront.

 

[Mach123]

I have some small exposure to this because of the option institute in western mass. It's funny it came up because I just mentioned them yesterday (I think) to my wife. They used the "Socratic method" as a therapy tool.

 

[ladee]

After watching the videos, I feel it depends on where we are in recovery. I went along with the questions, and it helped me to take my thoughts to a different level.


But I also feel if it was the beginning of this journey, I could not have made any significant distinctions and would have felt 'bad and wrong' regardless of what answer I gave. There is no authentic self at the beginning. It's what we are searching for.

I guess too, it depends on the T's approach. These two T's were gentle in their questioning and giving space to think and answer. If I felt interrogated I would walk out and slam the door behind me.

I hope you and your T can reach a middle ground, because I do understand how you are feeling about it at this place in your life. But can also see how it would benefit, if you have a 'self foundation', for lack of a better term, to work from.

Hope you get to talk with your T about this, and am interested in the outcome. If this does not fit for where you are in life right now, then that is not wrong, it just doesn't fit. Wishing you the best of outcomes and appreciate that you are questioning if this is right for you. That is growth, in and of itself!!

 

[Tinyflame]

@Justmehere, not sure if this is helpful at all, but the strangest thing happened to me this morning/ late last night: I woke up to I guess youtube cycling through on my computer, I vaguely recall leaving a podcast on for insomnia.

Though I totally find SQ'ing helpful, I think it depends on who is asking and how, as @ladee said. Thinking of any questioning process however as a trigger itself adds another layer. It's in response to these statements below:

I get that questions can get my truth. My conclusions. My doing the work. Maybe I’m too triggered and maybe we do this method as exposure work right now.

I just don’t get it and my resistance might be all fight or flight.

But I also feel if it was the beginning of this journey, I could not have made any significant distinctions and would have felt 'bad and wrong' regardless of what answer I gave. There is no authentic self at the beginning. It's what we are searching for.

I guess too, it depends on the T's approach. These two T's were gentle in their questioning and giving space to think and answer. If I felt interrogated I would walk out and slam the door behind me.

that I am going to link what podcast was playing. I am not entirely in agreement with Gabor Mate's theories, and have my own thoughts on his needs for some of the theories- which has no bearing as it is only a sense I have (and I find actually 'watching' him as distracting), and I haven't listened to it from the start, but I did wake up to it at about 1:30 or 1:40 in the video. He speaks of when do we not say no when we should if we are being authentic, why we don't and the implications; the difference between intuition and our reactions with trauma; and he does SQ with people/ a person in the audience (who are willing), and it's quite shocking how it develops for the person. There's 1 or 2 or 3 people (I can't remember), one that starts with saying she had a 'great childhood with wonderfully nurturing parents'- but hid in the closet when she was upset; another (or the same?, a therapist herself) who intellectualized her situation and getting angry at dirty dishes to such a degree it originally missed what she 'felt' entirely, or where it was coming from. Most importantly it developed too how we can choose the most hurtful explanation (or she did), and don't think of alternative explanations- automatic reactions not to what happens, but our interpretation to it. (The questions you can answer in your own head). But I think it's worthwhile to hear, simply to realize how much intellectualizing really, really, really, can end up cutting ourselves off more than getting to our own personal truths, our own authenticity. How it totally can color our interpretation of external events, and shows up each day.

I think with SQ, it's about your answers- your authentic self. Which is affected by implicit and explicit memory. Sort of like what someone said here- that if we were able to survive/ accomplish/ are existing as we are- it's testimony to being smart, brave little people as children.

(As an aside, in hearing this- which I never would have googled- I realized I have zero need to say no at work to most clients- it is the workplace (only); that (apparently) myself being able to be present to the clients in playfulness or stillness or whatever- meeting them where they are- greatly improves their quality of life. :) I actually woke up to 'what happened the last time you didn't say 'no'- well I got chest pains, blacked out, and cut my head, lol. And really- I had wanted to say no but had committed to yes to be 'mature', brave, or make 'progress'. My body decided otherwise- the right choice my mind should have made- were I being authentic. Which ironically- is probably more brave). Hope that makes sense! Haven't even had coffee.

I think obvious traumas become the focus to process- and rightfully so. But we have to begin where we are now (even if we've been at it for 30+ years). It seems to me it would make more sense to use SQ on yourself as regards the feelings you have about doing SQ. Not conclusions others draw, what you yourself believe. Or rather, finding out what the beliefs are, and then you can decide what to do about them (seeing where and why the belief needed to be formed, first).

just doesn't fit. Wishing you the best of outcomes and appreciate that you are questioning if this is right for you. That is growth, in and of itself!!

^^Totally agree with this. There is no wrong choice. :hug:

 

[Abstract]

But trying to satisfy him kept me alive. It also left me disgusted with myself. I guess it hard to feel like I’m safe now. Freaking PTSD.

This is the crux of it it seems.
By the way, you engaged and ultimately won rather than had pride stop you from doing so. You came out of it so need to be proud of that. You don't deserve self disgust. Survival is an amazing thing. Disgust belongs to the perp. Its normal to try to satisfy someone doing this.

Maybe I’m too triggered and maybe we do this method as exposure work right now.

Those do sound like the two options. For me it usually depends on where I am at. If unstable enough then it can be best to first stabalise a bit. If not then exposure of course wins over. Never used to consider that before but I try these days.

There are other types of approaches. You could look at what you think will work at present and do a short stint of that until you settle. I'm assuming normal teaching type CBT may be fine as well as talk therapy which is on the warm and less questioning spectrum.