a therapy homework assignments

a therapy homework assignments

The Effectiveness of Therapy Homework Assignments in Mental Health Treatment

1. Introduction to Therapy Homework Assignments

Many individuals who suffer from mental health problems find it difficult to get the help they need. For those patients who do obtain services, a large number do not receive care that is of optimum quality. For example, many patients discontinue treatment prematurely for reasons that may or may not be related to the quality of services that they receive. Developing effective solutions for these and other problems of mental health care requires input from studies of usual patterns of treatment as well as of alternative approaches. The utility of common methods or techniques for increasing the availability, accessibility, and cost-effectiveness of treatment is seldom directly investigated.

Therapy homework is an important component of many of the most effective and/or rapidly expanding approaches to mental health treatment. However, there is a paucity of research on the most effective means for ensuring that therapy homework is completed by the largest proportion of patients possible.

Therapy homework assignments are an integral portion of most contemporary cognitive-behavioral therapies. Indeed, it is expected that treatment will be unsuccessful in the majority of cases that clients do not do assignments relating to their behavior and thought processes. A number of non-cognitive-behavioral treatments rely heavily on homework assignments to similarly reinforce the use of new skills, cognitive structures, or lifestyle changes. Homework assignments play a similar role in couples and family therapies, as an adjunct to or extension of family or partner work completed during the session.

Beyond these interventions that require extensive participant preparation in order to maximize the utility of the work accomplished in therapy, many other empirically supported or rapidly growing treatments similarly include or recommend the use of therapy homework. There are therapeutic components that go beyond conventional “homework” assignments in the strict sense that they require more therapy time per session to introduce and that necessitate a higher monitoring and/or support level in order to achieve than those tasks such as between-session practice of new skills, monitoring of internal processes, review of session content or previously learned material that typically come under the heading of therapy homework.

2. Benefits and Challenges of Therapy Homework Assignments

Psychologists have long used homework assignments as a stage in therapy that builds and fosters client progress. Homework assignments form the bridge between therapy and real life. Homework usually means giving clients something to do between sessions that will benefit from ongoing therapeutic work. The material usually is prepared in therapy and extends this work outside the session. It keeps therapy going and points the focus toward change. The literature suggests that homework assignments have a positive effect on client coping, mood, anxiety reduction, increases retention and treatment success. Total client attempts at homework have been significantly associated with symptom improvement. In order to achieve these benefits, both the client and therapist have to work together and facilitate their learning. It is important to assure that homework meets three basic client needs: current readiness levels, reasonable task demands, and appropriate structure or guidance. Most therapists agree that homework is an essential part of therapy and will use it. They have the idea that without homework the therapeutic journey is incomplete.

3. Strategies for Designing and Implementing Effective Therapy Homework Assignments

Making therapy homework assignments more effective is imperative if they are to remain a standard part of therapy practice. A number of strategies could be used to increase the beneficial effects of therapy homework. Alphabetically, these methods include (a) generating patients’ desire to do homework, (b) increasing the observability of the therapy homework sessions, (c) simplifying or modifying the therapy homework, (d) linking the therapy homework to the therapeutic relationship, and (e) refining the therapist’s role in the therapy homework situation. These methods have been validated in previous research or receive support based on current theories, qualitative data, or patient and therapist needs.

The current study found face validity for every question on a measure that assessed these strategies and included a minor modification based on the results of factor and scale reliability analyses of the measure. A strength of this measure is its brevity – there are only 21 items. In addition, the measure has strong internal consistency, temporal stability, and construct validity. Further research is required to replicate the factor structure of the measure and to assess its concurrent and predictive validity. Such research would help clarify whether the measure is indeed a valuable tool for studying the effectiveness of therapy homework. Because of the measure’s brevity and other strengths, we recommend the development of this area to further understand the effectiveness of therapy homework and to improve standards of practice.

4. Case Studies and Examples of Successful Therapy Homework Assignments

Though this study is to evaluate more the phenomenon, rather than evaluating the evidence for it, the case examples might provide some tentative assistance to therapists in deciding what to assign as therapy homework, depending on the patient’s problems and goals. This list of successful therapy homework may provide helpful suggestions to achieve a number of treatment goals. Although in the Emotion Management program therapists never told patients that a discussion around issues they raised during group sessions should continue after the session termination, but the cases presented here suggest this may be good advice in any form of out-of-session activities. This can be achieved by making the completion of daily records or other in-session exercises “compulsory” so they do not go unnoticed, to link in-session activities to the patient’s own problems, goals, and the ways they attempt to reach these goals, and to give explicit assignments on topics that were discussed during the session.

The therapy examples described before strongly underscore the need to focus therapy homework activities on in-session work. Clearly, following the manual or protocol, as is often done in research, is not enough. In the emotion management program, for instance, participants are required to read the CBT chapter on feeling expression. This did not have a substantial effect on increasing the level of feeling communication. In contrast, analyses revealed that the content of the CBT group climate feedback was most strongly related to changes in levels of problem discussion and clarifying/flash-out. These examples directed attention to the PCT model and diagnostics as the basis for effective therapy homework procedures. First, they give guidelines for singling out specific patient’s problems that require in-session work; second, they provide a clue to the patient’s goals to guide therapy homework development; third, the cases offer a vision of a number of patient’s actions that need consideration.

5. Future Directions and Research Opportunities

Several research projections fill the gaps and broaden our knowledge on homework in mental health therapy. We have discussed how researchers could frame and study homework from different disciplinary viewpoints (philosophical positions, epistemological foundations, methods, etc.) to deepen our understanding of the matter. This includes improved homework taxonomy; refined conceptualization, operationalization, and measurement of homework; and a diversity of perspectives that can enrich this broad domain. This would enable scholars to derive more complex and systemic findings that can be translated into everyday practice. It is a recurrent plea in the literature to move research forward at these respective levels. More specifically, future research can address the following areas:

Theory Development: Despite notable efforts to refine the theoretical framework of homework in therapy, several questions are still unanswered. Given the paucity of theory-testing empirical work on which related theories (e.g., practice theories, behavior change theories) are related to homework, researchers need to develop and test a multidisciplinary theoretical model that untangles the multifaceted and interactive dynamics underlying the overarching homework construct. First, we need to be clear about what we mean by “homework” as an umbrella term, and differentiate further versions of it, which should draw on existing homework taxonomies and capitalize on new researcher initiatives in extending and refining it. Second, a comprehensive understanding of all the factors determining the value of homework completed as well as those capable of explaining homework’s effectiveness. Third, we need to identify the sophisticated active ingredients of therapeutically relevant dialogical interactions and co-design strategies of incorporating them into psychotherapy practice in the ways that are acceptable and engaging for both patients and therapists. Since therapy homework is by its nature a multifaceted, idiosyncratic element of the clinical process, several temporal dimensions of undertaking homework need to be scrutinized.