Many psychotherapists practice an “eclectic” approach to therapy, taking aspects from different theories and approaches to develop their toolbox of skills to utilize in their practice. Cognitive Behavioral Therapy is one approach to counseling that many counselors draw from or practice fully to treat a variety of pathology. Research has shown CBT has efficacy in treatment for anxiety, depression and substance use disorders (Mausbach et al., 2010). One aspect of CBT is the inclusion of therapy homework which typically involves practicing a skill outside of therapy between sessions. Studies have shown that compliance with homework is associated with beneficial treatment outcomes (Mausbach et al., 2010).
Further research has considered homework efficacy for specific pathology. Kazantis et al. (2016) found that from presenting problems of depression, anxiety and other issues, homework was most effective for depression and anxiety compared with other presenting problems. Results were the same across homework types (i.e., relaxation versus social skills) (Mausbach et al., 2010).
Aaron Beck, the creator of the Cognitive Behavioral Therapy approach, saw homework as assignments that should correspond with the therapist’s individualized conceptualization of the client’s presentation (Kazantis, Deane, & Ronan, 2004). Research continues to demonstrate the relationship between homework assignments and improved treatment outcomes.
Applications in the Field
Kazantis, Deane, and Ronan (2004) considered specific factors for application in the field. Client factors include their involvement in setting homework and their enjoyment of homework. Therapist factors included enthusiasm and approach to giving instructions. Task characteristics include difficulty level and content. Their findings indicated that when assigning homework, counselors may want to pay attention to the client’s schema structure that might contribute to non-completion such as high standards or fear of failure. etc. Considering the client’s age when assigning homework can help to ensure completion. For therapist factors, it was indicated that it was important to review homework collaboratively with clients, present a rationale for the homework and ensure client understanding. Regarding task characteristics elements to consider included the importance of checking in with the client to see how difficult they found the assignment and whether or not the client felt that the assignment promoted learning.
For each of the above components, Kazantis, Deane, and Ronan (2004) developed a measurement tool for therapists to use to gauge homework efficacy. Their homework rating scale is available in the appendix of their article (see reference and resources). It is a 12-item client self-report measure to measure client, therapist and task characteristics (Kazantis, Deane, & Ronan, 2004). It may be helpful for a therapist to use this rating scale to determine a client’s view of homework and feelings of usefulness.
References and Resources
Kazantzis, N., Deane, F. P., & Ronan, K. R. (2004). Assessing compliance with homework assignments: Review and recommendations for clinical practice. Journal Of Clinical Psychology, 60(6), 627-641.
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. doi:10.1016/j.beth.2016.05.002
Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy And Research, 34(5), 429-438. doi:10.1007/s10608-010-9297-z