a therapy homework assignment

a therapy homework assignment

Enhancing Therapy Outcomes: A Guide to Effective Homework Assignments

1. Introduction to Therapy Homework Assignments

It is well known that dedicated practice outside of therapy sessions, often known as homework or between-session practice, is a key element for successful therapy outcomes for many people. Homework assignments have been found to facilitate positive outcomes of therapy in many psychological issues, populations, and treatments. When done correctly, homework assignments offer several advantages, including improved client insight, increased motivation, the formation of new habits, extending the therapeutic influence beyond the therapy hour, and the facilitation of transfer of learning to everyday life.

Further, the impact of homework completion on therapy outcomes is large and robust, regardless of the theoretical orientation and autonomy of the therapist and client, or of the client’s presenting problem.

Recent studies attempting to explain the effectiveness of homework completion on therapy outcomes found that a number of identified factors at the client or within-therapy level help to predict homework completion rates and that homework completion leads to large changes on therapeutic process variables. Clients also experience homework as helpful but prefer some strategies over others. Furthermore, there is evidence that considering and manipulating variables relative to context and influence on those contexts, such as the situational and motivational dimensions, may lead to improved results. Clients would also like to be guided by their therapist in the selection of the most effective therapy assignments. Finally, clients report, and studies often confirm, that homework adherence is often very low, meaning that homework amounts to wasted effectiveness and time and, if not managed correctly, may lead to higher therapy dropouts.

Despite these known facts, practical and available homework assignment systems applied in today’s psychotherapeutic contexts are limited.

2. Theoretical Foundations and Evidence-Based Practices

Regardless of one’s theoretical orientation, it is the exercise of therapeutic interventions that leads to positive change. As part of this process, administering treatments related to homework assignments can extend the therapy session and reinforce positive changes effected by the therapist. By educating clients about issues, asking for completion of tasks that will help to address the problems, and following up on these tasks in the subsequent therapy session, the client is given further opportunity to absorb information and reinforce involving knowledge. Not only can these assignments strengthen the therapeutic process, they can provide further enlightenment to the therapist about the client that may otherwise be unexplored. Additional knowledge of the client helps to reinforce the therapist’s role, the self-perception, and therapeutic impact.

Therapy should be a learning experience that is self-reinforcing through change and the forming of new behaviors. The client desperately wants the therapist’s help. Time must be set aside specifically for what the client is saying or reading. These principles reinforce the value of asking clients to take some formalized responsibility by doing homework. In structuring homework assignments, it may be helpful to look at evidence-based findings. J.C. Cully and colleagues identify five main reasons most assignments are not done by outpatients. They also offer suggestions to researchers about how to incorporate enhancements in future studies. It is an excellent piece of advocacy for day to day assignments. Many insights that are offered may be implemented in any given therapy session.

3. Designing Tailored Homework Assignments

When homework assignments are tailored to the needs of the clients, patients learn they can control their own therapy outcomes. Clients perceive such control as empowering, and this sense of empowerment leads to a variety of favorable therapy outcome effects. The first step in designing homework that inspires clients involves asking for their goals. Seeking clients’ goals signals the therapist’s view that clients are experts about themselves, that they have unique strengths and qualities that will become powerful assets in their journey toward healing and growth. When the therapist asks, he or she collects information needed to craft a homework assignment that is a direct adjunct to the therapy. Because clients are not as separated from the therapy process outside of sessions as we often imagine, therapy-relevant homework is more likely to happen.

When homework is wanted, needed, and relevant, the client is more likely to do it. When the homework assignment is exactly what the client wants, needs, and finds relevant, there is a good chance that it will meet that magic 75% threshold for compliance. After developing a clear understanding of the client’s goals and making sure that the client is willing to try homework, the therapist reforms these goals into specific, well-defined tasks that directly follow the activities that occur in the therapy sessions actually done with the client. Because clients may have different ideas than do therapists about the variety of meaningful homework exercises, we also list the countless homework tasks that have been suggested by our friends and clients. This list helps therapists take chance out of the homework equation by increasing the probability of finding something that clients perceive as potential stepping-stones toward their goals. The creative invention of homework that inspires a client keeps him or her growing before, during, and after the therapy sessions.

4. Implementing and Monitoring Homework Assignments

Implementing homework assignments should generally follow a specific pattern. The patterns should be consistently repeated until a client can implement the measures without relying heavily on a therapist, and it is likely that the positive changes will be maintained. A general behavior modification program involves pinpointing the behavior to be changed, determining potential reinforcers and consequences, selecting the most promising procedure, planning to alternate procedures if the initial effort does not seem to be working, and then starting gradually. The role of homework in therapy is to transfer learning into behavior. Therapists need to help clients implement and monitor homework and should also check clients’ motivation and provide a rationale for homework assignments.

There is abundant evidence that the home-based form of applied relaxation with graded exposure is the most effective in the treatment of nocturnal panic. This is not surprising because it is often the least anxious of the home visits that the client finds initially the most difficult, simply because it is a home visit. There is a growing body of clinical work suggesting that this treatment is helpful in the treatment of panic disorder and other phobias. The rationale for the effectiveness of the home-based form of applied relaxation with self-exposure (HARAT) can be described as low anxiety activity equals panic for at least some clients.

5. Overcoming Challenges and Enhancing Engagement

Despite the effectiveness of many homework assignments, previous research suggests that the frequency of assignment completion during a course of therapy is approximately 30%. Addressing and overcoming potential obstacles is likely to enhance the effectiveness of homework. Engaging and involving the patient in the assignment process are the first steps for overcoming potential challenges and enhancing engagement in homework activities. At the initiation of therapy, the clinician should discuss the reason for having the patient complete homework assignments, the types of assignments the patient might expect, and how each assignment is likely to be of help during the therapy process.

5.1. Potential Obstacles An initial task is to ascertain whether there are any obstacles that would prevent the patients from successfully completing the homework activities. Patients might offer any number of valid reasons for not completing an assignment. It may be that they are uncertain about the exact instructions, do not see the relevance of the activity to their individual situation, or are concerned about what others will think about the task and the results. Additionally, some patients might hide the fact that they did not complete the homework assignment. Understanding key obstacles to completing the activity is the first step in finding solutions.