Why Counselors Assign Homework |

Why I ask my clients to complete work between sessions

More and more therapists are assigning homework to their clients. Not only have short‐term therapy models endorsed this practice, but the benefits are being recognized by many traditional therapists as well. I would like to share why you should consider doing homework betwen sessions. Assigning homework is beneficial for several reasons. With the evolution of health insurance company’s plans and practices, therapists assign between‐session homework to help maximize the effectiveness of treatment. Homework is an extension of the treatment process, provides continuity, and allows you to work between sessions on issues that are the focus of therapy. Homework is also a tool for more fully engaging you in the process of change. Assignments place more responsibility with you to resolve presenting problems, counteracting the expectations that some may experience— that it is the therapist alone who can cure the client. For some, an action plan with homework can even bring a sense of self‐empowerment.

Another added benefit of homework is that these assignments give you the opportunity to implement and evaluate insights or coping behaviors that have been learned and discussed in therapy sessions. Practice often heightens awareness of various issues. Furthermore, homework increases the expectation for you to follow through with making changes rather than just talking about change.

Homework requires participation, which creates a sense that you are taking active steps toward change. Homework allows you to try new behaviors, bringing these experiences back to the next session for processing. Tracking your progress with assessments, diary cards, and journals makes the process tangible and objective. Modifications can then be made to your thoughts, feelings, or behaviors as the homework is processed in the therapy session. Occasionally treatment processes can become vague and abstract. By adding focus and structure, homework assignments can reenergize therapy.

Moreover, homework can improve discipline and increase your motivation to change as it provides something specific to work on. Additionally, homework may increase the involvement of your family members and significant others in your process by using assignments that call for their participation. It promotes more efficient care by encouraging you to actively develop insights, positive self‐talk, and coping skills between therapy sessions.

Consequently, many clients express increased satisfaction with the therapy process when homework is given. They are empowered by doing something active that facilitates the change process, and it reinforces their sense of control over the problem. All of these advantages have made the assignment of therapeutic homework increasingly prevalent.

Homework is also an important component of cognitive behavior therapy (CBT) and other evidence-based treatments for psychological symptoms. Developed collaboratively during therapy sessions, homework assignments may be used by clients to rehearse new skills, practice coping strategies, and restructure destructive beliefs. Although some clients believe that the effectiveness of psychotherapy depends on the quality of in-session work, consistent homework during the rest of the week may be even more important. Without homework, the insights, plans, and good intentions that emerge during a therapy session are at risk of being buried by patterns of negative thinking and behavior that have been strengthened through years of inadvertent rehearsal. Is an hour (or less) of therapeutic work enough to create change during the other 167 hours in a week?

Research on homework in therapy has revealed some meaningful results that can be understood collectively through a procedure called meta-analysis. A meta-analysis is a statistical summary of a body of research. It can be used to identify the average impact of psychotherapy homework on treatment outcomes across numerous studies. The results of four meta-analyses listed below highlight the value of homework in therapy:

Kazantzis and colleagues (2010) examined 14 controlled studies that directly compared treatment outcomes for clients assigned to psychotherapy with or without homework. The data favored the homework conditions, with the average client in the homework group reporting better outcomes than about 70% of those in the no-homework conditions.
Results from 16 studies (Kazantzis et al., 2000) and an updated analysis of 23 studies (Mausbach et al., 2010) found that, among those who received homework assignments during therapy, greater compliance led to better treatment outcomes. The effect sizes were small to medium, depending on the method used to measure compliance.
Kazantzis et al. (2016) examined the relations of both quantity (15 studies) and quality (3 studies) of homework to treatment outcome. The effect sizes were medium to large, and these effects remained relatively stable when follow-up data were collected 1-12 months later.

Taken together, the research suggests that the addition of homework to psychotherapy enhances its effectiveness and that clients who consistently complete homework assignments tend to have better mental health outcomes. Finally, although there is less research on this issue, the quality of homework may matter as much as the amount of homework completed.

To enhance the quality of homework, homework assignments should relate directly to a specific goal, the process should be explained with clarity by the therapist, its method should be rehearsed in session, and opportunities for thoughtful out-of-session practice should be scheduled with ideas about how to eliminate obstacles to completion.

References

Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in Cognitive and Behavioral Therapy: A meta‐analysis. Clinical Psychology: Science and Practice, 7(2), 189-202.

Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta‐analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144-156.

Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755-772.