COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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G.R.A.C.E.
G- For Gap. Often our actions do not correspond with our intentions. The Gap is the space
between what the patient desires and how they behave. In this approach, the therapist’s role is
to listen closely and carefully to the patient’s self-report making the implicit (thoughts, feelings,
etc) explicit (environmental and behavioral interactions), while gently directing patient attention
toward these gaps.
R- For Rolling with Resistance. If it seems that the conversation is not flowing and building on
what has been said then one might conclude that the patient is avoiding or resisting the
therapy. We avoid meeting patient resistance head on. Rather than confront, the therapist
gently and respectfully directs patient’s attention away from topics that are inconsistent with
treatment goals toward a constellation of target behaviors. Remember that the target
behaviors are determined through the therapeutic partnership of patient and clinician.
A- For no Arguing. If we find ourselves arguing with our clients in any way it is a cue for us to shift
tactics as quickly as possible. Any sort of argumentative posture displayed by the therapist
effectively punishes patient verbal behavior. We know that punishment has three effects:
1. Increases the likelihood of emotional responses
2. Increases the likelihood that the patient will avoid the interaction that produced the
punisher
3. And can suppress all behavior within the therapeutic context.
C- For Can Do. Patients have intimate knowledge of what works, what doesn’t, and what their
preferences are. Our job is to help patients recognize they have the skills necessary to make
successful changes. Provide positive feedback for all available skills and help shape those in
need of further practice to be built to fluency.
E- For Expressing Empathy. It is crucial to this method for the therapist to create a reinforcing
environment where the patient can feel comfortable going about the difficult business of
exploring change. This requires more than superficial listening and feedback. Reflective
listening is an important therapeutic tool used in this model to express empathy to the patient.
Reflective listening differs from more casual listening as it requires continuous alert tracking of the
patient’s verbal and nonverbal responses, formulation of reflections at the appropriate level of
complexity, and ongoing adjustment of hypothesis.