Socratic Method and Therapist Adherence as Predictors of Symptom Change in Cognitive Therapy for Depression: A Study of Therapists in Training
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Date
2011-06
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The Ohio State University
Abstract
Cognitive therapy (CT) for depression is a form of psychotherapy that has strong evidence for its efficacy in randomized controlled trials (RCTs), and promising evidence for its effectiveness (Dobson, 1989; Gibbons et al. 2010). However, the specific processes of CT that produce symptom change remain unclear (Garrat et al., 2007). In a recent study, Strunk, Brotman, and DeRubeis (2010) found adherence to cognitive methods predicted session-to-session symptom change among expert cognitive therapists. The purpose of this study is to explore the relationship between therapist adherence to CT and subsequent symptom change in a sample of patients being treated by novice therapists. In addition, given the potential difficulty of novice therapists implementing the Socratic method, process ratings of the use of this questioning method are a special focus.
The sample consisted of 65 adults from with a primary diagnosis of Major Depressive Disorder (MDD), according to DSM-IV criteria. Seven advanced undergraduate students, rated therapy videos (sessions 1-3) on all process variables for each participant. A modified subset of the Collaborative Study Psychotherapy Rating Scale (CSPRS) items and a newly developed Socratic method scale were used. Additionally, 12 expert therapy session videos from the DeRubeis et al. (2005) study were rated to examine differences in expert and novice adherence.
By utilizing a repeated measures regression analysis, we examined three facets of adherence assessed by the CSPRS (i.e., Cognitive Methods, Negotiating / Structuring, and Behavioral Methods) and the Socratic method as potential predictors of early session-to-session symptom change.
The results indicate that adherence to the General Questioning portion of the Socratic method (asking open-ended questions to facilitate client autonomy) emerged as the only significant predictor in our sample of novice therapists (t = -2.07, p < .05), while the Socratic Questioning portion of the Socratic method (asking a series of questions to lead the client through a process of self-discovery) was predictive at a trend level (t = -1.77, p = .08). Additionally, expert therapists appear to ask more open-ended questions (General Questioning) than novice therapists (t = 2.94, p < .01). These results may serve to strengthen CT by shifting therapeutic focus to those processes that will enact the most change, and also indicate the importance of the Socratic method in better defining therapist expertise in CT.
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Keywords
Depression, Process-Outcome, Therapist Adherence, Symptom Change, Socratic Method