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  • 25 January 2022
  • 8 min read

Socratic Dialogue In Mental Health Nursing

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  • Stuart Sorensen
    Locum Mental Health
    • Richard Gill
    • Aubrey Hollebon
    • Ben Gordon
    • Mat Martin
  • 0
  • 600
“This technique does take time to make second nature, especially so you don't come across as insincere or a know-all.”

What does Socrates have to do with Mental Health Nursing? Well, Stuart is here to answer that question and give you an insight on how to apply one of Socrates’ own techniques to help your Patients.

Topics Covered In This Article

Introduction

What Is Socratic Dialogue?

Using Socratic Dialogue Diligently

How To Implement Socratic Dialogue

How Does It Work?

The Nuances Of Socratic Dialogue

Every Case Is Different

Practice Is Vital

Final Thoughts

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Introduction

I'm Stuart Sorensen.

I'm a Mental Health Nurse and trainer.

In this video, I'd like to talk about one of the most effective and persuasive ways I know, to help people make good decisions.

Not just with regard to their health, but in a whole host of situations.

It's a technique called Socratic dialogue and it's a core skill in a host of Mental Health activities, from health promotion to problem solving, from medication review to cognitive behaviour therapy.

It takes a bit of practice to develop the skill, but the principles are so simple and straightforward, that all it takes is a short video like this to learn them.

How cool is that?

What Is Socratic Dialogue?

Socrates was a philosopher and educator in ancient Athens, who developed a method of using questions to help people reach new insights or knowledge.

Each question helps the other person to move a little closer to a clearer understanding of their situation.

The important thing to know, is that it's all about questions, not statements.

And so we start from a position of not knowing, even if we think we know all the answers.

We probably don't, especially in healthcare, because we don't share the patient's experience and we don't know what it's like to be them.

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Using Socratic Dialogue Diligently

So, we begin by making it clear that we have questions because we don't know the answers, and we ask permission to discuss them.

Without permission, we're just being intrusive, and that's never a good part of any therapeutic relationship.

Arguably, starting conversations like this without permission, and then getting your students to do the same, is major part of what got Socrates condemned to death by the people of ancient Athens. so be warned!

Arguably, starting conversations like this without permission, and then getting your students to do the same, is a major part of what got Socrates condemned to death by the people of ancient Athens, so be warned!

Get permission and be prepared to stop if the other person begins to look uncomfortable.

How To Implement Socratic Dialogue

Socratic questions, though, aren't so complicated as you might first suppose.

They follow a fairly simple pattern and broadly follow a handful of rules.

You can get a sense of what we're trying to achieve with Socratic dialogue, with this little rhyming couplet by Rudyard Kipling: "A man convinced against his will, is of the same opinion still."

Socratic dialogue isn't telling people what to think or do, it's a way of helping them, to convince themselves.

Socratic questions are used to help people connect information from one part of their experience to another.

For example, I might point out that on the one hand, my patient hates all Nurses, but on the other hand, we get on okay, and I'm a Nurse.

How does that work?

Socratic questions should be easy for the client to answer.

They must know the information.

There's no point in asking someone about a subject if you have to explain it to them first.

That's not a route to their understanding, values or beliefs.

It's just a way to try to enforce your own.

So if they're don't understand the thing, don't ask about it.

Start with something simpler.

For example: if you really wanted to help them to understand about steam engines, begin with the question about whistling kettles, and what makes the whistle blow.

Then, using that illustration to establish that boiling water causes steam, which increases pressure, you can begin to relate it, or rather get them to relate it, to a steam engine, by asking them how steam causes motion.

You might need to ask about the pedals on a push bike to establish the action of downward pressure moving wheels, before moving onto the steam engine's pistons, but eventually you'll get there without making them feel stupid.

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How Does It Work?

Socratic questions build step-by-step upon information the client already knows.

There's no benefit in trying to make people learn, when all they really need to do is refocus the information they already have. Socratic questions are used to bring to life, examples, which do not fit the client's beliefs about their current situation or problem.

Ask about contradictions.

For example: you might ask a drug user, if street drugs don't affect mental state then what do you get out of taking them?

Socratic questions are used to help people re-evaluate the situation or problem. Ask lots of how, why and what questions.

How does that work?

What impact does this have?

Why do you need to do it this way?

Socratic questions are very different from information giving.

Aim to give us little new information as possible.

The aim is to get the client to put information they already know, together in new ways.

Socratic questions are often open-ended, although not always.

Here's another little rhyme from Rudyard Kipling.

He really should have been a Mental Health Nurse, that man.

"I had six honest serving men who taught me all I knew. Their names were Where and Why and When and What and How and Who."

The Nuances Of Socratic Dialogue

Socratic dialogue typically includes lots of summaries, to make sure that both client and therapist are on the right track.

You don't want to get lost in the middle of a conversation and you certainly don't want to misunderstand.

So checking back on what you think you've both established, is a good way to keep things moving on.

It's also validating for the patients because it shows that they're being listened to.

Almost everybody's happy to keep going in a conversation where they know they're being heard.

Socratic dialogue typically ends, with the therapist asking the client how the new information affects the way they think about the situation at hand.

You said that you think people who ignore their health are likely to become unwell, and yet you're not prepared to listen to all these Doctors and Nurses.

How do these two ideas fit together?

Every Case Is Different

Sometimes though, you'll need to leave that last question out.

If you can see that the patient or client has already realized what you wanted them to know, then there's little to be gained by making them say it, and a lot to lose by making them feel stupid in front of you by asking.

For some people, that can feel as though you're asking them to prostrate themselves before the alter of your superior knowledge, whether that's what you've meant or not, it's never helpful to have someone else feel that way about you, or your message.

In this situation, simply explain that you still don't understand their position, but thank them for taking the time to try and help you see their perspective.

Let them know that you'll give the matter more thought, switch to talk about something else, something entirely non-threatening.

Practice Is Vital

Now these principles are very simple in theory, but they do take practice to perfect.

So tread carefully.

Practice at home or at work, but be sure to ask permission and don't badger people.

Practice at home or at work, but be sure to ask permission and don't badger people.

Remember the principles.

Socratic questioning is used to help people connect information from one part of their experience to another.

It should be easy for them to answer, because they know the information. Socratic questions build step-by-step upon information the client already knows. Socratic questions are used to bring to light examples, which do not fit the client's beliefs about their current problems.

Socratic questions are used to help people to evaluate the situation or problem, and they're very different from information giving.

They're often open-ended, although not always.

Socratic dialogue typically includes lots of summaries, to make sure that both client and therapist are on the right track.

And it typically ends with the therapist asking the question, how the new information fits the situation at hand?

Final Thoughts

And that's it!

All you need to do now, is practice.

If you're a Student, this technique will take time to make second nature, especially so you don't come across as insincere or a know-all.

But once you've mastered it, you'll find it much easier to help people to change their minds about all sorts of things.

And the real beauty, is you get to know when you're wrong, because your questions will show you.

So you won't end up inadvertently advising people to do things that are against their best interests.

What's not to like?

I'm Stuart Sorensen. I'm a Mental Health Nurse and trainer, thank you for watching.

About the author

  • Stuart Sorensen
    Locum Mental Health

Stuart first got into care aged 16, volunteering at a senior citizens’ day centre. A period of homelessness whilst looking for work brought him to a YMCA hostel where he first encountered serious mental disorder. Subsequent support worker jobs led him to begin mental health nurse training, qualifying in 1995. Stuart currently works as a Band 6 (Locum) and also devises and delivers training on mental health, social care and some aspects of related legislation.

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  • Stuart Sorensen
    Locum Mental Health

About the author

  • Stuart Sorensen
    Locum Mental Health

Stuart first got into care aged 16, volunteering at a senior citizens’ day centre. A period of homelessness whilst looking for work brought him to a YMCA hostel where he first encountered serious mental disorder. Subsequent support worker jobs led him to begin mental health nurse training, qualifying in 1995. Stuart currently works as a Band 6 (Locum) and also devises and delivers training on mental health, social care and some aspects of related legislation.

    • Richard Gill
    • Aubrey Hollebon
    • Ben Gordon
    • Mat Martin
  • 0
  • 600

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