How to Engage Clients in Therapy Homework
Homework assignments that engage the client are essential for improved outcomes in cognitive
behavioral therapy. Shaw et al found that therapists that were the most competent in administering cognitive
behavioral homework had the best outcomes1. But engaging clients in homework is not easy. Being able to negotiate
and include homework assignments is a difficult skill for therapists.
Psychotherapists that successfully incorporate homework in the therapeutic process manage a variety of
factors related to (1) the client, (2) their own beliefs and views on psychotherapy, and (3) the task
itself. Let's review them:
- His/her attitude toward homework: A basic aspect of getting clients interested in homework is to avoid
implying that homework is yet another annoying chore in their lives. It is important to frame homework as a
practice that will improve their coping skills and help them achieve their goals. The good news is that,
contrary to common belief, the vast majority of psychotherapy clients have a positive attitude towards
- His/her symptoms: Something important to consider is that the patient's active symptoms could interfere
with homework (e.g. low motivation, high anxiety levels). Therapists need to adjust the homework load and
complexity to the patient's symptoms and avoid making him/her feel overwhelmed. Another piece of good news,
however, is that it has been found that the severity of depression does not influence clients' compliance with homework.3
- Encouraging the patient's participation when planning homework assignments: It has been shown that
therapists that involve the patient in planning the homework have better completion rates.4,5
- Task explanation: Studies show that therapists have more success with homework when they give a
detailed description of the task.6,7
- Therapist's working style: Therapists that emphasize a collaborative working alliance are more
likely to see their patients complete homework.6
- Difficulty/complexity: Studies have gathered evidence that homework that is too difficult or provokes
anxiety is less likely to be completed.7,8 Successful therapists start with simple tasks, and
then periodically assess the readiness of the patient to move to higher levels of complexity. One example is to start with the recording
of stressful situations, related emotions and automatic negative thoughts only, and at a later time take the next step to
challenge those thoughts.
- Correspondence to therapy sessions: Homework should have a close relation to the content of the
- Relevance to overall patient goals: Homework should be closely related to what clients most want to change
and to the general goals of psychotherapy.7,9
Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Shaw, Brian F.; Elkin, Irene; et al. Journal of Consulting and Clinical Psychology, Vol 67(6), Dec 1999, 837-846.
Patients' perspective on homework assignments in cognitive–behavioural therapy, Lydia Fehm, Jana Mrose, Clinical Psychology & Psychotherapy. Volume 15, Issue 5, pages 320–328, September/October 2008.
Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? Burns, D. D, Spangler, D. L, Journal of Consulting and Clinical Psychology, 68, 46–56, 2000.
Modifying therapeutic homework for patients with personality disorders. Arthur Freeman, Brad Rosenfield. Journal of Clinical Psychology. Volume 58, Issue 5, pages 513–524, May 2002.
The role of homework assignments in cognitive therapy for depression: Potential methods for enhancing adherence. Detweiler, J. B., & Whisman, M. A. Clinical Psychology: Science and Practice, 6, 267-282; 1999.
Critical issues in using homework assignments within cognitive–behavioural therapy for schizophrenia. Glaser, N.M., Kazantzis, N., Deane, F.P., & Oades, L.G. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 18(4), 247–261; 2000.
Making optimal use of homework to enhance your therapeutic effectiveness. Broder, M.S. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 18(1), 3–18: 2000.
Improving homework compliance in the treatment of generalized anxiety disorder. Leahy, R.L. Journal of Clinical Psychology, 58(5), 499–511: 2002.
Guidelines for enhancing homework compliance. Tompkins, M.A. Journal of Clinical Psychology, 58(5), 565–576; 2002.