Therapy homework assignments
Use of homework to enhance therapeutic effectivenessyou are here: home / making use of homework to enhance therapeutic , m. Journal of rational– emotive & cognitive-behavior therapy, volume 17, number 1, spring optimal use of homework to enhance your therapeutic rk is a well-established yet extremely under-emphasized aspect of the rational-emotive/cognitive behavioral orientation. This article recognizes homework as being a very powerful tool that needs to be incorporated into treatment in order to make it more efficient and effective. The author presents numerous techniques that can be used with virtually any therapeutic approach to maximize the impact of therapy between sessions. They include audio and bibliotherapy, goal setting, sud scale, mood management, disputation, affirmations, mood diary, list making, guided imagery, visualization, relaxation and meditation techniques, exposure, and thought stopping techniques. The article concludes with a discussion of why clients display resistance to homework along with some approaches that can be taken to address this use of homework in psychotherapy is a well-established protocol of the rational-emotive/cognitive behavioral orientation and one of albert ellis’ many great contributions to the field. Trademark homework assignments include reading, forms of exposure to an anxious situation, making a decision, and taking a risk such as confronting someone or something more easily avoided (ellis, 1962; 1996). To a great degree, homework can enable your client to become your collaborator in their treatment. After all, if you get an agreement to do a certain type of homework and at the next session it is not done, that can tell you much about a client’s motivation. Yet in most rebt and cognitive behavioral literature, homework remains quite rk can also be a great focusing tool. Clear” means that you and your client are on the same page as to what the homework assignment involves; for example, what reading to do or whom to confront. Specific” means that the homework assignment zeros in on your client’s problem in such a way that its relevancy is obvious to both of you. For example, if you were to assign as homework a relaxation exercise, there would be, hopefully, no question about the relationship between that assignment and the issues you are working on in therapy. An example of a bad homework assignment would be to have the client agree to get a job or to get a date. In these examples of homework, no one else’s agreement is necessary for your client to complete the assignment successfully. On the other hand, getting a job or a date requires the compliance of someone other than the main premise of homework is a recognition that real changes occur outside your office, not inside your office. In that spirit, i believe that work done by clients between therapy sessions is often as or more important as what is done in the session itself. Homework assignments need to be designed using the principle of successive approximation making sure that the step or steps assigned to be taken are not too large or too small, especially when you are dealing with difficult clients or axis ii personal preference is to have clients spend at least as much time doing homework as they spend in therapy. All of us who have done therapy for any length of time know that this can be easier said than done, especially with some of your more difficult cases. However, this is still a worthy this article i offer a smorgasbord of ideas designed to help you do what you do more effectively by making maximum use of the 167 hours in between sessions as well as the therapy hour are a variety of techniques that you can use to engage your clients in between sessions. I will give a flavor for how they can be used as homework assignments with the understanding that they need to be tailored and fine-tuned to suit the particular needs they are designed to ques that can be used in between therapy and therapy is assigned reading that is specific to the issue that you are working on in treatment. The main problem with bibliotherapy is that clients are not as likely to read as they are to use approaches that require less effort.
This is because publishers have long recognized that women out-buy men by a margin of more than four-to-one in the category of bibliotherapy_ type (self, help) materials (holm, 1998). Of the best ways to address these bibliotherapy problems is by using audiotherapy or assigning clients to listen to appropriate audiotapes that reinforce the material covered in your session in between sessions_ i have found that audiotherapy is more effective than its bibliotherapy counterpart simply because people are way more likely to listen than to read. In addition, both men and women can listen to audiotherapy assignments while driving cars, exercising or walking, and at other times when they mao the mood to take on one more activity-such as listening not distract them from what they are doing. When us assigned correctly, audio therapy goes a long way to free the hour so that you may concentrate on resistance and other issue5 more unique to your tion is an important aspect of teaching difficult info in my experience, an overwhelming number of clients are more to listen again and again to get that needed repetition than the~ read and reread bibliotherapy example, if self-evaluation is the issue, they need to learn in the session and by virtue of the homework they are assign whenever they engage in global rating as “i am no good,” an generalization is taking place (broder, 1995). Where better can a learn that these myths could explain why they may negate sex doing reading or listening to material that makes these points to force what they have learned in their therapy mes the easiest part of therapy is communicating info and misinformation about an issue, but at the same time it can one of the most time-consuming parts of treatment. Tired of going over the same points with client after client after and, therefore, find that they develop a tendency to avoid doing remember the function of biblio- and audio therapy is to give that mation that you the therapist may take for granted, to encourage tition of it, and to reinforce what you are teaching and working the session. Thus, audio- and bibliotherapy can be considered a e ine form of are several other audiotherapy approaches you can therapists make up relaxation tapes for their clients as well as tapes on other topics. Another fine technique is to encourage your clients to tape their therapy sessions for re-listening. This can be done by bringing their own tape and tape recorder to therapy sessions. An often helpful follow-up to this approach is to give your client a short (but expected) “quiz” on things that were said during the previous session, based on the tape they produced in therapy and, hopefully, listened to in between sessions. Over the past few years i developed a series of audiotherapy programs that incorporate numerous techniques into a series of self-contained homework assignments with reproducible exercise worksheets which i call the therapist’s assistant (broder, 1995; 1996). This series was edited by albert ellis and is one of many resources at your ng all the steps and ramifications of goal setting and goal prioritizing is often impossible to do within the time constraints of a therapy session. So having your client work on goals-whether or not they were goals established during your session-is a great use of homework time. A basic goal-setting homework assignment exercise will have the client come into the next session with answers to all of these questions: what is the goal? Once your client’s issue or reason for being in therapy is defined and fine-tuned, then the goal (what the situation would be if that issue were resolved) needs to be just as finely next step in goal setting is to think about and write out a strategy or plan which is defined as the shortest route between point a (the issue) and point b (the goal); and then, lining up whatever support is needed to achieve the goal becomes the next homework step. This can be done at home; and is also excellent material for your next there are many goals, prioritizing them is important; and goal prioritizing is also an excellent homework assignment. Doing this as homework can afford your client the quiet introspection this task a part of goal setting, it is also helpful to have your client break each defined goal into manageable steps or sub-goals. But an effective homework assignment is to haveyour clients create a customized anxiety barometer by having them identify on the scale of zero to ten something that would help trigger each level of anxiety they could feel. As a homework assignment, i routinely have clients who talk about anger, depression, anxiety or guilt start keeping track of just how angry, anxious, depressed or guilty they feel during the week by identifying what their potential range of the emotion is. It can also be used in conjunction with several of the homework techniques to be discussed later in this management is teaching a client how to anticipate and then master a mood-when it occurs-instead of becoming overwhelmed by it. Then, by using mood-changing techniques at the appropriate moment such as certain breathing and posture exercises, they can learn a degree of empowerment over their of my favorite mood management exercises that employs numerous techniques you can use as homework is called the “emotional fire drill” (broder, 1992), where i have clients anticipate-that is, identify and visualize a dreaded situation (e. Disputations are generally questions that you can ask clients or, in the case of homework, clients can ask themselves.
The task here both in therapy sessions and as homework is to teach clients to challenge their own irrational beliefs identified both in and out of the session. The answer to these disputation questions might prompt you to assign the client as homework to make a list of things they would advise their children to do in that situation; and you will often see an entirely different level of wisdom come ive affirmations are both coping statements and rational beliefs. As homework, you can have clients make any number of lists such as “all the people who care about me,” “things i am proud of,” “things i can do to feel better when i’m tense,” or “a list of everything that is bothering me” (including every problem, then rank them in order as though they were totally independent of each other), then a “list of solutions. After awhile, they will begin to use these skills with very little great advantage you have with audiotherapy is that the tape can actually become the therapist. That is a time projection technique that combines visualization with goal setting and can be done in your office or completed at home with the exercise on another variation of this technique that can be assigned as homework is to have your clients look ahead and ask “what would i do differently in my life if i had an unlimited amount of self-confidence? If any of these visions get too difficult to do in between sessions, chances are they bring up a lot of material that is worth revisiting in the next therapy session with your help in getting through the obstacles tion and meditation are many relaxation and meditation approaches clients can use in between sessions when they are anxious or stressed (broder, 1993). More direct relaxation homework technique is (again with eyes used) for clients to count backwards from ten to one, telling themselves that at the count of one they will feel completely at peace, totally relaxed and that this relaxed state can be maintained for as long – they choose. Clients can benefit from assignments such as going alone to a nice restaurant, to the ballet, to a wedding or to someplace where they have repeatedly felt they could not bear to be unless they were with some special person. As well, clients can make a list of things that can be distracters, such as music or anything that will interrupt their negative thought rk resistance: causes, can you do with clients who do not complete agreed-upon homework assignments? Consider some of these possibilities: perhaps, some of your homework assignments are too difficult and need to be more carefully fine-tuned. Likewise, for many discomfort dodgers, it is much easier in the short run to avoid doing the homework, even though in the long run the changes they are seeking in therapy may not be forthcoming. Chances are once you have identified this strand of resistance it will be related to the cause of the presenting problem itself as well as to the resistance to doing whatever it takes to resolve ely poor self-evaluation is another possibility for clients failing to complete homework assignments. In these cases, smaller steps resulting in some success are usually called r factor that can undermine homework compliance is that of a higher order disturbance. For example, clients who resist assignments that will help them to become emotionally free of an ended love relationship, may already be fearing and thus avoiding what they have identified as the next logical step the fear of rejection in developing a new relationship. That in mind, here are some simple strategies you can employ immediately to make homework more of a staple in your treatment protocol:Communicate the importance of homework as early in treatment as possible with emphasis on its benefits to your your sessions are limited, space them out in such a way as to make treatment as effective as possible by giving ample time to complete homework assignments and exercises. Make sure your client understands that sessions are precious lots of feedback and positive reinforcement when it becomes apparent that homework was your client see how therapy supplements what is being done in between sessions as well as the both positive and negative contingencies to shape the completion of homework sessions by following up on homework assignments. By not following up, homework may be perceived by clients as not being very important. In addition, following up gives you a built-in opportunity to reinforce whatever progress has been made in between you teach clients to do homework you are also teaching them relapse prevention. Those same skills they have mastered in doing homework assignments are the very skills they will need to call upon when the process of life tests them, as it will, over and over , a. Privacy is rk in wikipedia, the free to: navigation, rk in psychotherapy is sometimes assigned to patients as part of their treatment. In this context, homework assignments are introduced to practice skills taught in therapy, encourage patients to apply the skills they learned in therapy to real life situations, and to improve on specific problems encountered in treatment. 1] for example, a patient with deficits in social skills may learn and rehearse proper social skills in one treatment session, then be asked to complete homework assignments before the next session that apply those newly learned skills (e.
Is most often used in cognitive behavioral therapy (cbt) for the treatment of mood and anxiety disorders, although other theoretical frameworks may also incorporate homework. 3][4] some of the types of homework used in cbt include thought records and behavioral experiments. Behavioral experiments are used as homework to help patients test out thoughts and beliefs directly. Studies have shown that homework completion and accuracy predict favorable outcomes in psychotherapy and may help patients stay in remission. 6][7] however, some therapists are concerned that assigning homework makes therapy too formal and reduces the impact of the individual sessions. Problems and of the literature published on homework in psychotherapy to date focuses on homework use during cbt, which involves changing patients' thoughts and behaviors to reduce the symptoms of the mental disorders from which they are suffering. In practice, these homework assignments are meant to help patients lift their mood, practice and master skills they developed in therapy, and progressively improve between treatment sessions. Research has found that homework compliance positively predicts successful outcomes in therapy, and therapists are now looking for better ways to implement homework, so that more individuals may receive its benefits. Although each therapist makes his or her own choices regarding homework assignments, some of the other therapies that may assign homework include exposure therapy, psychodynamic therapy, and problem solving therapy. 11][12] homework can also be assigned even if therapists are not physically present with the patients being treated. 15] although the efficacy of this self-help-like treatment is still under scrutiny, preliminary data suggest that completion of homework is one factor predicting positive treatment outcomes for patients who receive treatment over the internet. The quality and quantity of thought records completed during therapy have been found to be predictive of treatment outcomes for patients with depression and/or an anxiety disorder. 18] furthermore, rees, mcevoy, & nathan (2005) found that accuracy ratings of patients' thought records mid-treatment was positively correlated with post-treatment outcomes, and that doing homework in cbt was overall preferable to not doing homework in cbt. Is generally associated with improved patient outcomes, but it is still uncertain what other factors may moderate or mediate the effects that homework has on how much patients improve. That is, some researchers have hypothesized that patients who are more motivated to complete homework are also more likely to improve; other researchers have suggested that only individuals with less severe psychopathologies are even capable of completing homework, so it would be effective only for a subset of individuals. 23] to test these possibilities, burns and spengler (2000) used structural equation modeling to estimate the causal relations between homework compliance and depressive symptomatology before and after psychotherapy. 24] still, there may exist factors that improve homework compliance during therapy, such as general therapist competency and therapists' reviewing homework completed since the previous session. Types of homework used in psychotherapy are not limited to thought records and behavioral experiments, which tend to be relatively structured in their implementation. 5] in fact, even though researchers have found that psychotherapy with homework is generally more effective than psychotherapy without homework, there have not been many efforts to research if specific types of homework are better at effecting positive treatment outcomes than others, or if certain environments help promote the positive effects of homework. 7] for example, helbig-lang and colleagues found that, in an environment where systematic homework assignment procedures were rare but where overall homework compliance remained high, homework compliance was not positively related to treatment outcomes. 26] another group of researchers looked at patients with depression who were in remission and undergoing maintenance therapy and found that homework compliance did not correlate with treatment outcomes in this sample, either. 27] more research can help elucidate the relations among the types of homework used in psychotherapy, the environments in which they are incorporated, and treatment outcomes for patients with the various disorders for which the homework is being directions[edit].
Clinicians and patients encounter difficulties in incorporating and complying to homework procedures throughout a treatment. 28][29] factors that have been found to be associated with homework compliance during treatment include having the therapist set concrete goals for completing the homework and involving the patient in discussions surrounding the assigned homework. 30] if homework compliance is as important to treatment outcomes as most research suggest, however, then there is room for improvement and future studies could focus on how to improve compliance more effectively. The psychotherapies in which they are incorporated, homework may not be effective at helping all people with all different kinds of psychological disorders. 32] it is thus important to research for which disorders and in which general situations homework would enhance a therapy. Example of a specific situation in which homework may be helpful is the mitigation of safety-seeking behaviors with behavioral experiments. So, designing behavioral experiments in therapy to test these behaviors could potentially be a helpful means for reducing their occurrence. Mechanisms of change in cognitive therapy: the case of automatic thought records and behavioural experiments. The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. Internet administered guided self-help versus individualized e-mail therapy: a randomized trial of two versions of cbt for major depression. Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression and associations with clinical outcome. The role of homework and skill acquisition in the outcome of group cognitive therapy for depression. The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavior therapy a review of empirical studies. Does psychotherapy homework lead to improvements in depression in cognitive–behavioral therapy or does improvement lead to increased homework compliance? Therapist skill and patient variables in homework compliance: controlling an uncontrolled variable in cognitive therapy outcome research. The relationship between therapist competence and homework compliance in maintenance cognitive therapy for recurrent depression: secondary analysis of a randomized trial. A lesson in assigning homework: therapist, client, and task characteristics in cognitive therapy for depression. The role of homework assignments in cognitive therapy for depression: potential methods for enhancing adherence. Behaviour research and therapy, 37(6), 559–ive behavioral sion focused tical behavior al emotive behavior ed with applied behavior al behavior analysis or onal analytic ance and commitment -centered nally focused ctional ic ative heoretical ntial factors tioner–scholar y for psychotherapy d behavior analysis (aba) (formerly behavior modification). Psychotherapycognitive behavioral logged intalkcontributionscreate accountlog pagecontentsfeatured contentcurrent eventsrandom articledonate to wikipediawikipedia out wikipediacommunity portalrecent changescontact links hererelated changesupload filespecial pagespermanent linkpage informationwikidata itemcite this a bookdownload as pdfprintable page was last edited on 8 november 2017, at 17: is available under the creative commons attribution-sharealike license;. A non-profit rk in wikipedia, the free to: navigation, rk in psychotherapy is sometimes assigned to patients as part of their treatment.