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jpomerantz October 29th, 2008 01:10 PM

help construction socratic dialogue
Hi there :) I was wondering if I could ask for some help and input. I am struggling with constructing a socratic dialogue ("guided discovery") for a twelve year old. this client is a "terror" at home and, according to parents is constantly provoking, annoying, bullying, and fighting with his siblings. he is adhd and presents with an egocentric and somewhat immature attitude (very into immediate gratification, everything is now now now and what can I get and what's in it for me etc...)
everyone else in his life (I've interviewed parents and siblings) say that he "starts it" or significanty overreacts to minor provocation, but in his view - someone else almost always "starts it" and his actions are totally justifiable. I am looking for an approach to chip away at the rationalization and defensiveness to help him see and acknowlege the perspectives of others. anyone? :-) thanks so so much!

Rod Whiteley October 31st, 2008 12:22 PM

Re: help construction socratic dialogue
A certain A.T. Beck once wrote:


It is useful to conceive of the patient-therapist relationship as a joint effort. It is not the therapist's function to try to reform the patient: rather, his role is working with the patient against "it," the patient's problem. Placing the emphasis on solving problems, rather than his presumed defects or bad habits, helps the patient to examine his difficulties with more detachment and makes him less prone to experience shame, a sense of inferiority, and defensiveness.
Which of these people is your patient? And what is your patient's problem?

jpomerantz November 1st, 2008 04:53 PM

Re: help construction socratic dialogue
Thanks for the reply! my patient here I suppose really would be the family of the particular child. to borrow a term from some of my family systems colleagues, one particular child is the IP (identified patient) and his behavior has been deemed by everyone else to be completely inconsiderate, self-centered, obnoxious, annoying, bullying, you get the picture. I am trying to get to the level with him that we can, indeed, begin to collaboratively examine the problem (the "it" that Beck referred to...) -but I need a strategy to help him see that in fact there is a problem here. I've been working with the family for a long time and have seen the situation from a number of angles. at this point, I'm convinced that, for the most part, the other members of the family are correct and that this child's behavior is just not ok. the thing is, as I posted before - he has constructed a wall of rationalization around himself that I'm having trouble penetrating... it is always the other child who started it, always someone else's fault, etc

Rod Whiteley November 4th, 2008 08:28 AM

Re: help construction socratic dialogue
So one aspect of this seems to be that the boy has constructed a wall. He must have had a reason for constructing the wall. Whatever that reason was is "it" for him. His behaviour is not his problem: his behaviour is his solution.

Another aspect is that being a child he might not necessarily have the power to implement a different solution, even if you were ever able to develop one with him. So you are probably not in a position to make any promises to him at this stage.

And another is the feeling I get from, "I'm convinced that, for the most part, the other members of the family are correct," that he is the black sheep of the family and you are with them. That feels to me like good reason to keep a wall well-maintained.

I feel like I want someone to be on his side of the split in the family, so that that person can eventually be on his side of the wall, seeing it from his point of view. That person could be you or another family member.

I think if you and I were talking about this face-to-face, I would now want to know a lot more about what you think of the other family members, looking for clues in their individual histories, brainstorming to create a spectrum of hypotheses, and also testing assumptions that you might share with family members.

I'm not sure that this forum is a good place to do that kind of work.

James Pretzer November 4th, 2008 10:28 PM

Is socratic dialogue the way to go?
If the goal is to decrease family conflict and/or change the identified patient's behavior, I'm not sure that trying to use socratic dialog to help him to see and acknowledge the perspectives of others is a very promising approach. Developmentally, I wouldn't expect a 12-year-old to be very good at grasping the perspectives of others and taking them into account. If he is immature and has ADHD, the idea that he would change his behavior because he can acknowledge the perspectives of others seems even more unlikely.

You haven't said anything about how the parents have been dealing with this situation thus far and whether they have been able to deal with his behavior effectively. I assume that they haven't been able to deal with his behavior effectively since they probably wouldn't consult you if they could.

How about starting with a more behavioral approach (such as Barkley's approach to dealing with behavior problems/conduct disorder/oppositional defiant disorder). Suppose the parents could do an effective job of reinforcing appropriate behavior, setting clear limits, and enforcing limits effectively. In addition to improving the identified patient's behavior, it would reduce the level of conflict within the family, it would increase positive interactions, and it would reduce negative interactions. It would also provide a great opportunity to work on communication, on anticipating the consequences of actions, negotiation, problem-solving, etc. One part of working on communication, negotiation, problem-solving, etc. could be working to see and acknowledge each other's perspectives.

jpomerantz November 11th, 2008 05:51 PM

Re: help construction socratic dialogue
Thank you both so so much for taking the time to respond. I've been learning so much from this forum - but asking my own questions and getting responses is by far the most enlightening.
the truth is that, being the loyal trainee of Dr. Pretzer that I am, I actually DID try the behavioral approach - i was basing my approach on Kazdin's PMT treatment manual, which I've had a great deal of success with. in this case, for a number of reasons, progress has been slow and the parents are pretty burned out. follow through was very hard for them, father not around, mother overwhelmed etc. I am going to try to take a step back; try to regroup, think more systemically as Rod suggests, being working on some different angles, such as increased communication, negotiation and compromising skills, problem solving, etc. and most likely bring in a colleage to prevent myself from getting burned out. sometimes it "goes" and sometimes it doesn't i guess.
thanks again so much!

James Pretzer November 13th, 2008 11:08 PM

Re: help construction socratic dialogue
One of the situations that can be very difficult is when the parents don't have the time and energy to do what is needed. Unfortunately, despite the fact that the parents don't have the time and energy, clear consequences that are consistently enforced usually are necessary.

Sometimes one can take a hard look at the practicalities of the situation to see if the parents' load can be temporarily lightened in some way or if someone can help out for a bit. Perhaps cutting back on work hours a bit, or getting Grandma to help out, or cutting back on cooking and laundry, or all of the above.

Sometimes parents are putting time and energy into optional activities and need to let someone else run the PTA, etc.

Sometimes the parents need to make hard choices. If having both parents work full time means that they don't have time and energy for the kids, they can either put up with the consequences or they can cut back on work hours, accept a lower income, and make adjustments in their lifestyle.

Being an effective parent isn't easy.

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