One of the defining features of cognitive therapy is the spirit of collaboration that the therapist attempts to foster in working with the patient (Beck et al. 1979). A central method for enhancing an atmosphere of collaboration is to encourage the patient to actively talk and think aloud in the session, and for the therapist to listen carefully and reflect accurately. Additionally, it is important to add structure to this process by asking clinically relevant questions that allow the patient to expound his or her feelings and thoughts. Open ended questions serve this purpose well.
A common trap to avoid is lecturing the patients and/or bombarding them with yes/no questions that are reminiscent of interrogation. It is much more collaborative to employ a Socratic style (Overholser1987, 1988, 1993) in which the therapist gently guides the direction of the session material by punctuating the patients' comments with thoughtful, open-ended questions.
The following short dialog serves as an example.
Therapist:
I see on your responses to the questionnaires that you haven't used any drugs or alcohol since our last session. What do you think has helped you to do this?
Patient:
I don't go past that house no more.
Therapist:
The crack house?
Patient:
Yeah.
Therapist:
What do you say to yourself-how do you manage to keep yourself from going to that house?
Patient:
I just remind myself that my life falls apart whenever I start to go there. I just remind myself that I'm kidding myself if I think I can just stop in and say "hi" and shoot the breeze and then just go home. It don't work that way. I just have to stay away.
Therapist:
So you remember the problems that you had when you used to go there, and how your life changes for the worse when you use drugs.
Patient:
That about sums it up. (Frowns)
Therapist:
You looked a little sad just then. What went through your mind?
Patient:
Ahhh. I don't know. (Pause) It's a lonely feeling. I got friends who hang out at the house, and I can't see them no more.
Note that in the example above, the therapist
gets a lot of useful information from the patient by asking open-ended
questions and by carefully listening to the patient's responses.
A good rapport seems to be present in the interaction, with the patient implicitly acknowledging that the therapist understands.
