10/10/2010 09:29 am ET | Updated Nov 17, 2011

Using Socratic Questioning to Help Social Anxiety

My client, I'll call her Alison, has social anxiety. Like many people with her problem, she holds a strong belief: "I shouldn't call attention to myself." Alison believes at heart that there is something inherently wrong with her, something that could potentially lead people to find her unappealing. Therefore, she believes she should control her behavior and not do anything that could result in criticisms from other people. I asked Alison if she was willing to do a behavioral experiment to see what would happen, for example, if she asked a question in the large office staff meeting or made conversation with a stranger in a crowded elevator. She was a bit horrified at these suggestions.

So I decided to use some self-disclosure. "Alison," I said. "Do you remember when I had to cancel our appointment a couple of weeks ago because I had to report for jury selection?" She nodded. "Well, I did something there that really called attention to myself." This got her curious and she asked what it was.

I explained. "There were 175 potential jurors in this big courtroom. They were taking 20 at a time to a different room for specific questioning. But I was number 159 and I knew I'd be in the last group and would have to wait for hours. I had a manuscript on my laptop that I was under deadline to finish. I worked on it for about an hour, then my battery went dead. So I asked the deputy where I could plug it in. He looked around and the only place was at the court reporter's desk at the front of the room. I would have to sit on a raised platform facing sideways to the rest of the courtroom. He gestured to all the people in the room, and asked if the desk would be all right. He was implying that maybe I wouldn't like having 155 people watching me while I worked. I told him it was fine.

"How could you stand people staring at you?" Alison asked. "I didn't care, "I answered." I figured most people would look at me once or twice, then get back to reading their book or chatting with the person next to them. A few might watch for longer, but I figured they'd get bored soon."

"But what if they criticized you?" she asked. "It didn't bother me," I answered. "I thought most people would only think about me for a few seconds. Some would say to themselves, 'Isn't she smart for getting special treatment.' Others might think, 'Who does she think she is, getting special treatment like that.' But I didn't think they'd dwell on me. They'd start thinking about something else a few seconds later. And even if they did have really negative thoughts about me, so what? It wouldn't mean they were right. It wouldn't mean I did anything bad or that there was anything wrong with me. It didn't really matter what they thought."

"That was really brave," Alison said. "Thanks," I replied, "but I didn't think so. I might have when I was much younger, and shyer--but I would have been wrong. It truly wasn't a big deal." I paused, to give her time to reflect on what I said. "What do you think?"

"I don't know ..." she answered slowly. "Okay," I countered. Let's say someone thought, "Look at her. She thinks she's such a big shot." Would he have been right?" "No," Alison said. "I don't think you see yourself that way." "What if he had thought, "She shouldn't have asked to sit up there." Would he have been right?" She replied in the negative. "Are you sure?" I asked. "Yeah. I guess you had the right to ask. I guess anyone could have asked. Just because it was you doesn't mean you did anything wrong."

"Can you think of any other criticisms someone might have had?" I went on. "Well, someone could always have criticized you for how you looked or what clothes you were wearing." "That's true," I reflected. "And if there had been a fashionista in the audience, for sure I would have been criticized. But so what? If someone has a critical opinion, does that necessarily reflect badly on me? Could it say more about the personality of the person doing the criticizing?"

Alison pondered that for a moment. "I'm not sure I ever thought about it like that." "Well, let's say you're in a crowded elevator and you start making conversation about the weather with someone," I said. "One person thinks, 'That's nice that she's--that is, you--are reaching out to say something." A second person thinks, 'Why is she saying that? I don't want to talk to her.' Who is right?"

Alison said, "Well, I'm not sure it's a matter of being right or wrong. One person wants to talk and the other doesn't." "Exactly," I responded. "And are you right or wrong for trying to start a conversation?" She looked puzzled. "I guess I'm right. It's a nice thing to do, even if the second person doesn't appreciate it." "And if the second person thinks negatively of you, does that say more about you or more about her?" "About her, I guess," Alison responded.

I returned to the courtroom example. "Now, when I was in the courtroom, did my character suddenly change? Was I an 'okay' person when I first went in but suddenly a 'not okay' person when someone criticized me?" "No, that doesn't make sense," said Alison. "And how about you?" I asked. "If you do the experiment of starting conversations in the elevator, do you change from an okay person before you get in the elevator to a not okay person if the second woman criticizes you?"

"No, I guess not."

This discussion, a typical example of the Socratic questioning process in cognitive therapy, guides the client to evaluate her assumptions and modify her thinking so she can reach her goals. In the following weeks, Alison not only spoke up in elevators and staff meetings but also initiated conversations in public places such as bookstores and at social gatherings. She received mostly positive or neutral reactions from people, which helped erode the idea that there was something wrong with her. She may not be ready to voluntarily sit in front of a courtroom, but she's on her way.