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Assigning Homework in Cognitive Behavioral Therapy

It’s certainly true that therapy outcomes depend in part on the work taking place in each session. But for this progress to reach its full impact, clients need to use what they learn in therapy during their daily lives. 

Assigning therapy “homework” can help your clients practice new skills during the week. While many types of therapy may involve some form of weekly assignment, homework is a key component of cognitive behavior therapy. 

Types of Homework

Some clients may respond well to any type of homework, while others may struggle to complete or find benefit in certain assignments. It’s important for clients to step outside of their comfort zone in some ways. For example, it’s essential to learn to challenge unwanted thoughts and increase understanding of feelings and emotions, especially for people who struggle with emotional expression. 

But there isn’t just one way to achieve these goals. Finding the right type of homework for each client can make success more likely. 

There are many different types of therapy homework. Asking your client to practice breathing exercises when they feel anxious or stressed? That’s homework. Journaling about distressing thoughts and ways to challenge them, or keeping track of cognitive distortions ? Also homework.

Some clients may do well with different assignments each week, while others may have harder times with certain types of homework. For example:

• An artistic client may not get much from written exercises. They might, however, prefer to sketch or otherwise illustrate their mood, feelings, or reactions during the week. 
• Clients who struggle with or dislike reading may feel challenged by even plain-language articles. If you plan to assign educational materials, ask in your first session whether your client prefers audio or written media. 

When you give the assignment, take a few minutes to go over it with your client. Give an example of how to complete it and make sure they understand the process. You’ll also want to explain the purpose of the assignment. Someone who doesn’t see the point of a task may be less likely to put real effort into it. If you give a self-assessment worksheet early in the therapy process, you might say, “It can help to have a clear picture of where you believe you’re at right now. Later in therapy I’ll ask you to complete another assessment and we can compare the two to review what’s changed.” 

Mental Health Apps

Some people may also find apps a useful way to develop and practice emotional wellness coping skills outside of therapy. Therapy apps can help people track their moods, emotions, or other mental health symptoms. They can provide a platform to practice CBT or other therapy skills. They can also offer structured mindfulness meditations or help clients practice other grounding techniques. 

If you’re working with a client who’s interested in therapy apps, you might try using them in treatment. Just keep in mind that not all apps offer the same benefits. Some may have limitations, such as clunky or confusing interfaces and potential privacy concerns. It’s usually a good idea to check whether there’s any research providing support for—or against—a specific app before recommending it to a client. 

Trusted mental health sources, such as the American Psychological Association or Anxiety and Depression Association of America websites, may list some popular mental health apps, though they may not specifically endorse them. These resources can be a good starting place. Other organizations, including Northwestern University’s Center for Behavioral Intervention Technologies and the Defense Department of the United States, have developed their own research-backed mental health apps. 

You can also review apps yourself. Try out scenarios or options within the app to get to know how the app works and whether it might meet your client’s needs. This will put you in a position to answer their questions and help give them tips on getting the most out of the app. 

Benefits of Homework

Some of your clients may wonder why you’re assigning homework. After all, they signed up for therapy, not school. 

When clients ask about the benefits of therapy homework, you can point out how it provides an opportunity to put things learned in session into practice outside the therapy session. This helps people get used to using the new skills in their toolbox to work through issues that come up for them in their daily lives. More importantly, it teaches them they can use these skills on their own, when a therapist or other support person isn’t actively providing coaching or encouragement. This knowledge is an important aspect of therapy success. 

A 2010 review of 23 studies on homework in therapy found evidence to suggest that clients who completed therapy homework generally had better treatment outcomes. This review did have some limitations, such as not considering the therapeutic relationship or how clients felt about homework. But other research supports these findings, leading many mental health experts to support the use of therapy homework, particularly in CBT. Homework can be one of many effective tools in making therapy more successful. 

Improving Homework Compliance

You may eventually work with a client who shows little interest in homework and doesn’t complete the assignments. You know this could impede their progress in therapy, so you’ll probably want to bring this up in session and ask why they’re having difficulty with the homework. You can also try varying the types of homework you assign or asking if your client is interested in trying out a mental health app that can offer similar benefits outside your weekly sessions. 

When you ask a client about homework non-compliance, it’s important to do it in a way that doesn’t anger them, make them feel defensive, or otherwise damage the relationship you’re working to develop. Here are some tips for having this conversation:

• Let them know homework helps them practice their skills outside of therapy. In short, it’s helping them get more out of therapy (more value for their money) and may lead to more improvement, sometimes in a shorter period of time than one weekly session would alone. 
• Bring up the possibility of other types of homework. “If you don’t want to write anything down, would you want to try listening to a guided meditation or tips to help manage upsetting emotions?” 
• Ask about it, in a non-confrontational way. You might say something like, “Is something making it difficult for you to complete the homework assignments? How can I help make the process easier for you?” 

The prospect of homework in therapy may surprise some clients, but for many people, it’s an essential element of success. Those put off by the term “homework” may view “skills practice” or similar phrasing more favorably, so don’t feel afraid to call it something else. The important part is the work itself, not what you call it.    References:

• Ackerman, C. (2017, March 20). 25 CBT techniques and worksheets for cognitive behavioral therapy. Retrieved from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets
• ADAA reviewed mental health apps. (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/finding-help/mobile-apps
• 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. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939342
• Mental health apps. (n.d.). The American Institute of Stress. Retrieved from https://www.stress.org/mental-health-apps
• Novotney, A. (2016). Should you use an app to help that client? Monitor on Psychology, 47 (10), 64. Retrieved from https://www.apa.org/monitor/2016/11/client-app
• Tang, W, & Kreindler, D. (2017). Supporting homework compliance in cognitive behavioural therapy: Essential features of mobile apps. JMIR Mental Health, 4(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481663

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What Is Therapy Homework?

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Types of Therapy That Involve Homework

If you’ve recently started going to therapy , you may find yourself being assigned therapy homework. You may wonder what exactly it entails and what purpose it serves. Therapy homework comprises tasks or assignments that your therapist asks you to complete between sessions, says Nicole Erkfitz , DSW, LCSW, a licensed clinical social worker and executive director at AMFM Healthcare, Virginia.

Homework can be given in any form of therapy, and it may come as a worksheet, a task to complete, or a thought/piece of knowledge you are requested to keep with you throughout the week, Dr. Erkfitz explains.

This article explores the role of homework in certain forms of therapy, the benefits therapy homework can offer, and some tips to help you comply with your homework assignments.

Therapy homework can be assigned as part of any type of therapy. However, some therapists and forms of therapy may utilize it more than others.

For instance, a 2019-study notes that therapy homework is an integral part of cognitive-behavioral therapy (CBT) . According to Dr. Erkfitz, therapy homework is built into the protocol and framework of CBT, as well as dialectical behavior therapy (DBT) , which is a sub-type of CBT.

Therefore, if you’re seeing a therapist who practices CBT or DBT, chances are you’ll regularly have homework to do.

On the other hand, an example of a type of therapy that doesn’t generally involve homework is eye movement desensitization and reprocessing (EMDR) therapy. EMDR is a type of therapy that generally relies on the relationship between the therapist and client during sessions and is a modality that specifically doesn’t rely on homework, says Dr. Erkfitz.

However, she explains that if the client is feeling rejuvenated and well after their processing session, for instance, their therapist may ask them to write down a list of times that their positive cognition came up for them over the next week.

"Regardless of the type of therapy, the best kind of homework is when you don’t even realize you were assigned homework," says Erkfitz.

Benefits of Therapy Homework

Below, Dr. Erkfitz explains the benefits of therapy homework.

It Helps Your Therapist Review Your Progress

The most important part of therapy homework is the follow-up discussion at the next session. The time you spend reviewing with your therapist how the past week went, if you completed your homework, or if you didn’t and why, gives your therapist valuable feedback on your progress and insight on how they can better support you.

It Gives Your Therapist More Insight

Therapy can be tricky because by the time you are committed to showing up and putting in the work, you are already bringing a better and stronger version of yourself than what you have been experiencing in your day-to-day life that led you to seek therapy.

Homework gives your therapist an inside look into your day-to-day life, which can sometimes be hard to recap in a session. Certain homework assignments keep you thinking throughout the week about what you want to share during your sessions, giving your therapist historical data to review and address.

It Helps Empower You

The sense of empowerment you can gain from utilizing your new skills, setting new boundaries , and redirecting your own cognitive distortions is something a therapist can’t give you in the therapy session. This is something you give yourself. Therapy homework is how you come to the realization that you got this and that you can do it.

"The main benefit of therapy homework is that it builds your skills as well as the understanding that you can do this on your own," says Erkfitz.

Tips for Your Therapy Homework

Below, Dr. Erkfitz shares some tips that can help with therapy homework:

• Set aside time for your homework: Create a designated time to complete your therapy homework. The aim of therapy homework is to keep you thinking and working on your goals between sessions. Use your designated time as a sacred space to invest in yourself and pour your thoughts and emotions into your homework, just as you would in a therapy session .
• Be honest: As therapists, we are not looking for you to write down what you think we want to read or what you think you should write down. It’s important to be honest with us, and yourself, about what you are truly feeling and thinking.
• Practice your skills: Completing the worksheet or log are important, but you also have to be willing to put your skills and learnings into practice. Allow yourself to be vulnerable and open to trying new things so that you can report back to your therapist about whether what you’re trying is working for you or not.
• Remember that it’s intended to help you: Therapy homework helps you maximize the benefits of therapy and get the most value out of the process. A 2013-study notes that better homework compliance is linked to better treatment outcomes.
• Talk to your therapist if you’re struggling: Therapy homework shouldn’t feel like work. If you find that you’re doing homework as a monotonous task, talk to your therapist and let them know that your heart isn’t in it and that you’re not finding it beneficial. They can explain the importance of the tasks to you, tailor your assignments to your preferences, or change their course of treatment if need be.

"When the therapy homework starts 'hitting home' for you, that’s when you know you’re on the right track and doing the work you need to be doing," says Erkfitz.

A Word From Verywell

Similar to how school involves classwork and homework, therapy can also involve in-person sessions and homework assignments.

If your therapist has assigned you homework, try to make time to do it. Completing it honestly can help you and your therapist gain insights into your emotional processes and overall progress. Most importantly, it can help you develop coping skills and practice them, which can boost your confidence, empower you, and make your therapeutic process more effective.

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Conklin LR, Strunk DR, Cooper AA. Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression . Cognit Ther Res . 2018;42(1):16-23. doi:10.1007/s10608-017-9873-6

Lebeau RT, Davies CD, Culver NC, Craske MG. Homework compliance counts in cognitive-behavioral therapy . Cogn Behav Ther . 2013;42(3):171-179. doi:10.1080/16506073.2013.763286

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

The importance of homework in therapy

by Elyssa Barbash | Jul 25, 2018 | change , growth , Self-improvement , success , Therapy , Uncategorized , worry | 0 comments

There has been significant research conducted on the use of homework in therapy. Findings consistently indicate that homework maximizes the benefit of therapy and allows clients to realize gains in their life.

At the beginning of therapy, homework is a topic that I review with all of my patients. However, there still comes the times where I have to re-review the importance of homework with my patients after they share they have not completed their work!

Purpose of Homework

Homework in therapy is intended to allow the person to implement the strategies that are being learned in therapy so that they can actualize the changes and gains they are seeking to make in their life. I like to put it this way: therapy sessions do not consume a very large portion of your life. At most, we are talking about 45 to 50 minutes out of your week that you are in a therapy session. While the therapy session lays the foundation for the changes to occur in your life, the actual therapy session is such a small portion of your time and is a false reality.

The place is where you will actually see the gains and progress being made is in your every day life.

This is where homework comes in. To maximize the value of therapy, homework helps you to implement the strategies being learned in your life so you can actually see changes. Homework is usually skills oriented, though not always. When it is skills oriented, it teaches the person how to deal with their problems on their own and not have to rely on their therapist. (Bonus: Any ethical therapist will approach treatment in this way. However, not all therapies are intended to be skills building so this is not to say that those therapist to don’t assign homework are unethical!).

Benefits of Homework

Remember, this is not school. Homework being assigned is not being given to you to keep you busy. If your therapist assigned the homework, it is with the best intentions that what they are asking you to do is going to help you. It is also likely to lead to shortened treatment times, which means overall reduced costs related to treatment and less time dedicated to the therapy process in the long run.  

A Strong Indication of your commitment to Therapy, and to yourself

Finally, completing your homework is an indication of your commitment to therapy, which is a greater indication of your commitment to yourself. When you do not follow through and complete your homework, the message that you are sending is that you really don’t care. And a therapist cannot truly help you if you do not care.

So the next time you want to skip that homework assignment your therapist gave you, remember what the true purpose of it is and how much you want that change in your life.

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Contact us today to schedule an appointment. Whatever the reason, give us a call.  Remember, there are many reasons why people seek therapy. Professional mental health assistance can greatly benefit you in many ways, including making important changes in your life.

We are committed to providing therapy and counseling services in a comfortable, relaxing, encouraging, and non-judgmental environment to yield the most realistic and best outcomes.   Give us a call or email us today to schedule an appointment.

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How to Design Homework in CBT That Will Engage Your Clients

Take-home assignments provide the opportunity to transfer different skills and lessons learned in the therapeutic context to situations in which problems arise.

These opportunities to translate learned principles into everyday practice are fundamental for ensuring that therapeutic interventions have their intended effects.

In this article, we’ll explore why homework is so essential to CBT interventions and show you how to design CBT homework using modern technologies that will keep your clients engaged and on track to achieving their therapeutic goals.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with a detailed insight into positive CBT and give you the tools to apply it in your therapy or coaching.

This Article Contains:

Why is homework important in cbt, how to deliver engaging cbt homework, using quenza for cbt: 3 homework examples, 3 assignment ideas & worksheets in quenza, a take-home message.

Many psychotherapists and researchers agree that homework is the chief process by which clients experience behavioral and cognitive improvements from CBT (Beutler et al., 2004; Kazantzis, Deane, & Ronan, 2000).

We can find explanations as to why CBT  homework is so crucial in both behaviorist and social learning/cognitive theories of psychology.

Behaviorist theory

Behaviorist models of psychology, such as classical and operant conditioning , would argue that CBT homework delivers therapeutic outcomes by helping clients to unlearn (or relearn) associations between stimuli and particular behavioral responses (Huppert, Roth Ledley, & Foa, 2006).

For instance, imagine a woman who reacts with severe fright upon hearing a car’s wheels skidding on the road because of her experience being in a car accident. This woman’s therapist might work with her to learn a new, more adaptive response to this stimulus, such as training her to apply new relaxation or breathing techniques in response to the sound of a skidding car.

Another example, drawn from the principles of operant conditioning theory (Staddon & Cerutti, 2003), would be a therapist’s invitation to a client to ‘test’ the utility of different behaviors as avenues for attaining reward or pleasure.

For instance, imagine a client who displays resistance to drawing on their support networks due to a false belief that they should handle everything independently. As homework, this client’s therapist might encourage them to ‘test’ what happens when they ask their partner to help them with a small task around the house.

In sum, CBT homework provides opportunities for clients to experiment with stimuli and responses and the utility of different behaviors in their everyday lives.

Social learning and cognitive theories

Scholars have also drawn on social learning and cognitive theories to understand how clients form expectations about the likely difficulty or discomfort involved in completing CBT homework assignments (Kazantzis & L’Abate, 2005).

A client’s expectations can be based on a range of factors, including past experience, modeling by others, present physiological and emotional states, and encouragement expressed by others (Bandura, 1989). This means it’s important for practitioners to design homework activities that clients perceive as having clear advantages by evidencing these benefits of CBT in advance.

For instance, imagine a client whose therapist tells them about another client’s myriad psychological improvements following their completion of a daily thought record . Identifying with this person, who is of similar age and presents similar psychological challenges, the focal client may subsequently exhibit an increased commitment to completing their own daily thought record as a consequence of vicarious modeling.

This is just one example of how social learning and cognitive theories may explain a client’s commitment to completing CBT homework.

Let’s now consider how we might apply these theoretical principles to design homework that is especially motivating for your clients.

In particular, we’ll be highlighting the advantages of using modern digital technologies to deliver engaging CBT homework.

Designing and delivering CBT homework in Quenza

Gone are the days of grainy printouts and crumpled paper tests.

Even before the global pandemic, new technologies have been making designing and assigning homework increasingly simple and intuitive.

In what follows, we will explore the applications of the blended care platform Quenza (pictured here) as a new and emerging way to engage your CBT clients.

Its users have noted the tool is a “game-changer” that allows practitioners to automate and scale their practice while encouraging full-fledged client engagement using the technologies already in their pocket.

To summarize its functions, Quenza serves as an all-in-one platform that allows psychology practitioners to design and administer a range of ‘activities’ relevant to their clients. Besides homework exercises, this can include self-paced psychoeducational work, assessments, and dynamic visual feedback in the form of charts.

Practitioners who sign onto the platform can enjoy the flexibility of either designing their own activities from scratch or drawing from an ever-growing library of preprogrammed activities commonly used by CBT practitioners worldwide.

Any activity drawn from the library is 100% customizable, allowing the practitioner to tailor it to clients’ specific needs and goals. Likewise, practitioners have complete flexibility to decide the sequencing and scheduling of activities by combining them into psychoeducational pathways that span several days, weeks, or even months.

Importantly, reviews of the platform show that users have seen a marked increase in client engagement since digitizing homework delivery using the platform. If we look to our aforementioned drivers of engagement with CBT homework, we might speculate several reasons why.

• Implicit awareness that others are completing the same or similar activities using the platform (and have benefitted from doing so) increases clients’ belief in the efficacy of homework.
• Practitioners and clients can track responses to sequences of activities and visually evidence progress and improvements using charts and reporting features.
• Using their own familiar devices to engage with homework increases clients’ self-belief that they can successfully complete assigned activities.
• Therapists can initiate message conversations with clients in the Quenza app to provide encouragement and positive reinforcement as needed.

The rest of this article will explore examples of engaging homework, assignments, and worksheets designed in Quenza that you might assign to your CBT clients.

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Let’s now look at three examples of predesigned homework activities available through Quenza’s Expansion Library.

Urge Surfing

Many of the problems CBT seeks to address involve changing associations between stimulus and response (Bouton, 1988). In this sense, stimuli in the environment can drive us to experience urges that we have learned to automatically act upon, even when doing so may be undesirable.

For example, a client may have developed the tendency to reach for a glass of wine or engage in risky behaviors, hoping to distract themselves from negative emotions following stressful events.

Using the Urge Surfing homework activity, you can help your clients unlearn this tendency to automatically act upon their urges. Instead, they will discover how to recognize their urges as mere physical sensations in their body that they can ‘ride out’ using a six-minute guided meditation, visual diagram, and reflection exercise.

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Moving From Cognitive Fusion to Defusion

Central to CBT is the understanding that how we choose to think stands to improve or worsen our present emotional states. When we get entangled with our negative thoughts about a situation, they can seem like the absolute truth and make coping and problem solving more challenging.

The Moving From Cognitive Fusion to Defusion homework activity invites your client to recognize when they experience a negative thought and explore it in a sequence of steps that help them gain psychological distance from the thought.

Finding Silver Linings

Many clients commencing CBT admit feeling confused or regretful about past events or struggle with self-criticism and blame. In these situations, the focus of CBT may be to work with the client to reappraise an event and have them look at themselves through a kinder lens.

The Finding Silver Linings homework activity is designed to help your clients find the bright side of an otherwise grim situation. It does so by helping the user to step into a positive mindset and reflect on things they feel positively about in their life. Consequently, the activity can help your client build newfound optimism and resilience .

As noted, when you’re preparing homework activities in Quenza, you are not limited to those in the platform’s library.

Instead, you can design your own or adapt existing assignments or worksheets to meet your clients’ needs.

You can also be strategic in how you sequence and schedule activities when combining them into psychoeducational pathways.

Next, we’ll look at three examples of how a practitioner might design or adapt assignments and worksheets in Quenza to help keep them engaged and progressing toward their therapy goals.

In doing so, we’ll look at Quenza’s applications for treating three common foci of treatment: anxiety, depression, and obsessions/compulsions.

When clients present with symptoms of generalized anxiety, panic, or other anxiety-related disorders, a range of useful CBT homework assignments can help.

These activities can include the practice of anxiety management techniques, such as deep breathing, muscle relaxation, and mindfulness training. They can also involve regular monitoring of anxiety levels, challenging automatic thoughts about arousal and panic, and modifying beliefs about the control they have over their symptoms (Leahy, 2005).

Practitioners looking to support these clients using homework might start by sending their clients one or two audio meditations via Quenza, such as the Body Scan Meditation or S.O.B.E.R. Stress Interruption Mediation . That way, the client will have tools on hand to help manage their anxiety in stressful situations.

As a focal assignment, the practitioner might also design and assign the client daily reflection exercises to be completed each evening. These can invite the client to reflect on their anxiety levels during the day by responding to a series of rating scales and open-ended response questions. Patterns in these responses can then be graphed, reviewed, and used to facilitate discussion during the client’s next in-person session.

As with anxiety, there is a range of practical CBT homework activities that aid in treating depression.

It should be noted that it is common for clients experiencing symptoms of depression to report concentration and memory deficits as reasons for not completing homework assignments (Garland & Scott, 2005). It is, therefore, essential to keep this in mind when designing engaging assignments.

CBT assignments targeted at the treatment of depressive symptoms typically center around breaking cycles of negative events, thinking, emotions, and behaviors, such as through the practice of reappraisal (Garland & Scott, 2005).

Examples of assignments that facilitate this may include thought diaries , reflections that prompt cognitive reappraisal, and meditations to create distance between the individual and their negative thoughts and emotions.

To this end, a practitioner looking to support their client might design a sequence of activities that invite clients to explore their negative cognitions once per day. This exploration can center on responses to negative feedback, faced challenges, or general low mood.

A good template to base this on is the Personal Coping Mantra worksheet in Quenza’s Expansion Library, which guides clients through the process of replacing automatic negative thoughts with more adaptive coping thoughts.

The practitioner can also schedule automatic push notification reminders to pop up on the client’s device if an activity in the sequence is not completed by a particular time each day. This function of Quenza may be particularly useful for supporting clients with concentration and memory deficits, helping keep them engaged with CBT homework.

Obsessions/compulsions

Homework assignments pertaining to the treatment of obsessive-compulsive disorder typically differ depending on the stage of the therapy.

In the early stages of therapy, practitioners assigning homework will often invite clients to self-monitor their experience of compulsions, rituals, or responses (Franklin, Huppert, & Roth Ledley, 2005).

This serves two purposes. First, the information gathered through self-monitoring, such as by completing a journal entry each time compulsive thoughts arise, will help the practitioner get clearer about the nature of the client’s problem.

Second, self-monitoring allows clients to become more aware of the thoughts that drive their ritualized responses, which is important if rituals have become mostly automatic for the client (Franklin et al., 2005).

Therefore, as a focal assignment, the practitioner might assign a digital worksheet via Quenza that helps the client explore phenomena throughout their day that prompt ritualized responses. The client might then rate the intensity of their arousal in these different situations on a series of Likert scales and enter the specific thoughts that arise following exposure to their fear.

The therapist can then invite the client to complete this worksheet each day for one week by assigning it as part of a pathway of activities. A good starting point for users of Quenza may be to adapt the platform’s pre-designed Stress Diary for this purpose.

At the end of the week, the therapist and client can then reflect on the client’s responses together and begin constructing an exposure hierarchy.

This leads us to the second type of assignment, which involves exposure and response prevention. In this phase, the client will begin exploring strategies to reduce the frequency with which they practice ritualized responses (Franklin et al., 2005).

To this end, practitioners may collaboratively set a goal with their client to take a ‘first step’ toward unlearning the ritualized response. This can then be built into a customized activity in Quenza that invites the client to complete a reflection.

For instance, a client who compulsively hoards may be invited to clear one box of old belongings from their bedroom and resist the temptation to engage in ritualized responses while doing so.

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These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

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Developing and administering engaging CBT homework that caters to your client’s specific needs or concerns is becoming so much easier with online apps.

Further, best practice is becoming more accessible to more practitioners thanks to the emergence of new digital technologies.

We hope this article has inspired you to consider how you might leverage the digital tools at your disposal to create better homework that your clients want to engage with.

Likewise, let us know if you’ve found success using any of the activities we’ve explored with your own clients – we’d love to hear from you.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist , 44 (9), 1175–1184.
• Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., & Wong, E. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed.) (pp. 227–306). Wiley.
• Bouton, M. E. (1988). Context and ambiguity in the extinction of emotional learning: Implications for exposure therapy. Behaviour Research and Therapy , 26 (2), 137–149.
• Franklin, M. E., Huppert, J. D., & Roth Ledley, D. (2005). Obsessions and compulsions. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 219–236). Routledge.
• Garland, A., & Scott, J. (2005). Depression. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 237–261). Routledge.
• Huppert, J. D., Roth Ledley, D., & Foa, E. B. (2006). The use of homework in behavior therapy for anxiety disorders. Journal of Psychotherapy Integration , 16 (2), 128–139.
• Kazantzis, N. (2005). Introduction and overview. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 1–6). Routledge.
• 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., & L’Abate, L. (2005). Theoretical foundations. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 9–34). Routledge.
• Leahy, R. L. (2005). Panic, agoraphobia, and generalized anxiety. In N. Kazantzis, F. P. Deane, K. R., Ronan, & L. L’Abate (Eds.), Using homework assignments in cognitive behavior therapy (pp. 193–218). Routledge.
• Staddon, J. E., & Cerutti, D. T. (2003). Operant conditioning. Annual Review of Psychology , 54 (1), 115–144.

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3 Positive CBT Exercises (PDF)

• Last edited on September 9, 2020

Homework in CBT

Table of contents, why do homework in cbt, how to deliver homework, strategies to increase confidence.

Homework assignments in Cognitive Behavioural Therapy (CBT) can help your patients educate themselves further, collect thoughts, and modify their thinking.

Homework is not something that you just assign randomly. You should make sure you:

• tailor the homework to the patient
• provide a rationale for why the patient needs to do the homework
• uncover any obstacles that might prevent homework from being done (i.e. - busy work schedule, significant neurovegetative symptoms)

Types of homework

Types of homework assignments.

You should also decide the frequency of the homework should be assigned: should it be daily, weekly?

If your patient does not do homework, that’s OK! Explore as a team, in a non-judgmental way, to explore why the homework was not done. Here are some ways to increase adherence to homework:

• Tailor the assignments to the individual
• Provide a rationale for how and why the assignment might help
• Determine the homework collaboratively
• Try to start the homework during the session. This creates some momentum to continue doing the homework
• Set up systems to remember to do the assignments (phone reminders, sticky notes
• It is better to start with easier homework assignments and err on the side of caution
• They should be 90-100% confident they will be able to do this assignment
• Covert rehearsal - running through a thought experiment on a situation
• Change the assignment - It is far better to substitute an easier homework assignment that patients are likely to do than to have them establish a habit of not doing what they had agreed to in session
• Intellectual/emotional role play - “I’ll be the intellectual part of you; you be the emotional part. You argue as hard as you can against me so I can see all the arguments you’re using not to read your coping cards and start studying. You start.”

Is Therapy Homework Getting You Down? 8 Ways to Help

There is no failing with therapy homework, as long as you try..

Posted October 6, 2023 | Reviewed by Tyler Woods

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Homework between therapy sessions is a practice dating back decades and based on the idea that a client can improve therapy outcomes through practice. But what happens if therapy homework itself is too challenging or difficult? I have eight ways you can explore to understand and navigate therapy homework.

Before we go any further, though, I want to highlight the most important idea for you to take away: there is no failing with therapy homework, as long as you try .

History, Theory, Practical Use

So, what is the theory behind therapy homework? It's based on the principles of cognitive behavior therapy: by changing ways of thinking, we can change how we react and behave in challenging situations. Also, the inverse is true: by changing the ways we behave, we can change the way we think. Some therapy homework offers practice to help change the way we think, while other approaches focus on changing behavior.

There are three practical reasons to do therapy homework:

• If you’re able to practice noticing the state of mind and emotion you fall into during problematic moments, you’re halfway on your way to changing.
• Then, you have the opportunity to “talk back” to the difficult mindset that gets triggered.
• From there, you have the opportunity to nudge yourself into taking more healthy or intentional actions, instead of acting on impulse or out of detachment.

But the main reason is a classic that is still important: practice makes you better at what you’re doing .

Common Challenges to Doing Therapy Homework

Overcoming challenges always starts with beliefs and feelings. CBT therapists like to use the term “home practice” instead of homework to try and limit your association with school homework. Most of us have negative feelings or dread about homework and link it to the idea of getting a grade and the possibility of “getting it wrong.”

Negative Reactions to Homework

If your therapist suggests home practice, you may notice thoughts and feelings such as:

• Anticipating shame
• Drawing attention to your perceived flaws
• Intense self-criticism
• Anticipating disruptive ruminating
• Fear that you will be criticized for doing a “bad job”

Common Problems Completing Homework

Sometimes, behaviors communicate thoughts and feelings. So, if you find yourself doing the following, you may want to explore underlying feelings and beliefs:

• Procrastinating
• Avoiding or forgetting
• “Doing it in your head”
• Faking it (giving answers you think your therapist is looking for)

The Therapist's Role

As a therapist, I know our homework goal is complete when you simply tried to do the home practice. That’s it. It doesn’t have to be perfect, it doesn’t have to be exactly what the assignment was, it doesn’t have to be complete. As long as you give it a try, we start there. (Of course, if you had trouble with getting started, we start there!)

If you had a hard time motivating yourself to do the home practice, were unclear on how to complete it, or it just didn’t work as intended, I consider that my responsibility. I can change the assignment, improve our communication, or just try at a more opportune time in the therapy process.

8 Ways to Success with Therapy Homework

• Home practice is all about the experience, not the result. This means seeing what thoughts and feelings come up, or what behavior change challenges appear. As long as that is happening, the homework is a success.
• Be sure that you feel you understand the home practice, the goals and reasoning behind doing it, and that you are comfortable doing it. If you have any concerns, don’t hesitate to share.
• Be practical: Ensure you clearly understand what actions or steps are involved in completing the homework, so you’re not stuck wondering later.
• Be sure you have a specific plan for completing homework, including when you will do it, how long you will spend on it, and any obstacles you anticipate. Once you have a plan, ask yourself, on a scale of 1-10, how confident are you that you can do it?
• Be sure your therapist follows up with you on homework. It keeps you motivated and keeps the therapy on track.
• From the beginning, be as honest and direct as you can about your reactions and feelings on the topic of homework. If you have a history of difficulty with homework, it is important for your therapist to know. This will improve the odds of therapeutic success and make the process easier for you.
• Collaborate with your therapist on goals, assignments, and steps. The best therapy home practice is one where the client helps create it.
• Maybe now is not the time for homework? Maybe there is too much going on in your life, and you need more support or insight now.

If you follow these guidelines, you can take the discomfort and dread out of home practice, improve understanding with your therapist, and increase the odds that the therapy will be successful.

Oh, and you may also find yourself with some skills you can use to take care of yourself long after the therapy has ended.

Richard Brouillette, LCSW, is an online schema therapist working with entrepreneurs, creatives, and professionals.

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• Impact of CBT

What is the Status of “Homework” in Cognitive Behavior Therapy, 50 Years On?

By Nikolaos Kazantzis, PhD

The comedian Jerry Seinfeld once asked:

“ What’s the deal with ‘homework?’ It’s not like you’re doing work on your home… ”

The great thing about that quote is that it conveys that the “H” word has some of the most unpleasant associations for clients in CBT. In July 2016, Dr. Judith S. Beck and Dr. Francine Broder wrote an important contribution to the Beck Institute blog giving good reason for a move away from the “H” word in practice.

When developing Cognitive Therapy, Dr. Aaron T. Beck was inspired by existing therapies, including behavior therapy, wherein the educative model to generate clinically meaningful change had been adopted. The inclusion of homework as a crucial feature of Cognitive Therapy made perfect sense 1 . Homework is a collaborative endeavor. It is also ideally empirical and can help to promote the reappraisal of key cognitions 2 .

Asking clients to engage with therapeutic tasks between sessions, in a form of action plan has been subject to more empirical study than any other process in CBT 3 .  However, the evidence supporting homework is almost wholly derived from dismantling studies that contrast CBT with CBT without homework, or correlational studies of homework adherence and symptom reduction. Findings from our most recent meta-analysis suggest that homework quantity and quality have little difference in their relations with outcome 4 . As clinicians, we can take from this that we should use homework consistently and be especially encouraged when clients engage with tasks 5 .

However, if we try to seriously answer Jerry’s question above, we have to ask ourselves another important question – what are we actually really interested in with CBT homework?

Current definitions of homework adherence have been derived from the literature on pharmacotherapy, and that might be the source of the problem. Take our two client examples below, Bob and Rob. Both have been prescribed a daily medication script, and if we look at the quantity of what was “done,” Rob looks more “adherent” than Bob.

However, when we take into account the cognitive impairment that Bob has, as well as his capacity to swallow medication following a head injury, then his 6/7 days’ worth of adherence is particularly noteworthy. Of course, in CBT, the content of homework varies on a weekly basis, and is tailored for the client in its design and plan. Therefore, the scope for subjective views of difficulty, and array of unique practical barriers is considerable. Thus, if we are genuinely interested in “engagement,” we need to take into account the inherent difficulties of the homework and practical obstacles to it for each individual client, at each session 6 .

Dr. Judith Beck’s earliest teachings emphasize the importance of the client’s subjective evaluation of homework. Those who are depressed are less likely to recognize their achievements, those with anxiety presentations often have negative predictions about its utility or their ability to carry it out, and many clients abandon the task when encountering obstacles. Those with pervasive interpersonal difficulties often have their core beliefs triggered in carrying out the action plan.  When they do, they may experience intense negative emotion, viewing themselves and/or their therapist negatively. The working alliance may become strained. Dr. Beck has also advocated for use of the cognitive case conceptualization to understand clients’ patterns of engagement and anticipate problems of this nature 7-8 .

Fortunately, the research underpinning CBT homework is moving towards more clinically meaningful studies. Therapist skill in using homework has been shown to predict outcomes 9-10 , and recently a study found that greater consistency of homework with the therapy session resulted in more adherence. 11 Our Cognitive Behavior Therapy Research Lab (currently based at the Turner Institute for Brain and Mental Health at Monash University) is centrally focused on how clients’ adaptive beliefs about homework strengthen their sense of self-efficacy in engaging in homework tasks, despite the difficulties and obstacles they experience. Thus, for several reasons, we can be optimistic that the evidence for homework is an example of how a bridge between science and practice is being built on solid foundations.

A half century after the first practice guide for Cognitive Therapy was published (Beck et al, 1979), we can be curious in the personal meaning our clients attribute to the action plan. How do beliefs about coping and change affect engagement? Are there important maladaptive assumptions and compensatory strategies that might make it difficult for the client to engage? How does the task align with the client’s values? What might be the pros and cons to the client in choosing not to engage? It’s important to focus less on trying to achieve perfect – or even a close approximation of perfect – “adherence” and to focus more on facilitating engagement. An empathic  understanding of challenges clients face completing the homework tasks will better equip us to design and plan future homework. Rather than a focus on “compliance,” let us inspire our clients to tolerate the discomfort and uncertainty in their homework. Let us also celebrate in their discovery of new ideas and perspectives that homework brings.

Nikolaos Kazantzis, PhD is Editor of “Using Homework Assignments in Cognitive Behavior Therapy” (2 nd edition), currently in preparation with Routledge publishers of New York.

• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford Press.
• Kazantzis, N., Dattilio, F. M., & Dobson, K. A. (2017). The therapeutic relationship in cognitive behavioral therapy: A clinician’s guide. New York: Guilford.
• Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42 (4), 349-357. doi: 10.1007/s10608-018-9920-y 
• Kazantzis, N., Whittington, C. J., Zelencich, L., Norton, P. J., Kyrios, M., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47 , 755-772. https://doi.org/10.1016/j.beth.2016.05.002
• Callan, J. A., Kazantzis, N., Park, S. Y., Moore, C., Thase, M. E., Emeremni, C. A., Minhajuddin, A., Kornblith, S., & Siegle, G. J. (2019). Effects of cognitive behavior therapy homework adherence on outcomes: Propensity score analysis. Behavior Therapy, 50 (2), 285-299. https://doi.org/10.1016/j.beth.2018.05.010
• Holdsworth, E., Bowen, E., Brown, S., & Howat, D. (2014). Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors. Clinical Psychology Review, 34 (5), 428–450. https://doi.org/10.1016/j.cpr.2014.06.004
• Beck, J. S. (2011). Cognitive therapy for challenging problems: What to do when the basics don’t work . New York: Guilford.
• Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford.
• Weck, F., Richtberg, S., Esch, S., Hofling, V., & Stangier, U. (2013). The relationship between therapist competence and homework compliance in maintenance cognitive therapy for recurrent depression: Secondary analysis of a randomized trial. Behavior Therapy, 44 (1), 162–172. doi:10.1016/j.beth.2012.09.004
• Conklin, L. R., Strunk, D. R., & Cooper, A. A. (2018). Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression. Cognitive Therapy and Research, 42 (1), 16–23. https://doi.org/10.1007/s10608-017-9873-6
• Jensen, A., Fee, C., Miles, A. L., Beckner, V. L., Owen, D., & Persons, J. B. (in press). Congruence of patient takeaways and homework assignment content predicts homework compliance in psychotherapy. Behavior Therapy. https://doi.org/10.1016/j.beth.2019.07.005

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Homework in therapy: a case of it ain't what you do, it's the way that you do it.

Published online by Cambridge University Press:  26 August 2015

It is argued, illustrated by a case example, that homework quality and end of therapy outcomes can be positively affected when ideas of compassion and attention to individual frames of reference are considered. It is suggested that by exploring the affect experienced when completing tasks and being mindful of client learning (i.e. the zone of proximal development), engagement and emotional connection with homework increase.

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• DOI: https://doi.org/10.1017/S1754470X15000549

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Do You Need a Homework Therapist?

By Natalie Proulx

• April 5, 2018

How do you feel about homework? Do you find it helps you learn more? Is it ever enjoyable, or does it only stress you out? Why?

In “ Homework Therapists’ Job: Help Solve Math Problems, and Emotional Ones ,” Kyle Spencer writes:

On a recent Sunday, Bari Hillman, who works during the week as a clinical psychologist at a New York mental health clinic, was perched at a clear, plastic desk inside a 16-year-old’s Manhattan bedroom, her shoeless feet resting on a fluffy white rug. Dr. Hillman was helping a private school sophomore manage her outsize worry over a long-term writing project. The student had taped the project outline on the wall above the desk, at Dr. Hillman’s prodding. It was designed to serve both as a reminder that the project was due, and an empowering indicator of progress. Dr. Hillman mused about the way worry can morph into unhealthy avoidance, the cathartic power of deep breathing and the soothing nature of to-do lists. Dr. Hillman, 30, represents a new niche in the $100 billion tutoring industry. Neither a traditional tutor nor a straight-up therapist, she is an amalgam of the two. “Homework therapists,” as they are now sometimes called, administer academic help and emotional support as needed. Via Skype, email and text, and during pricey one-on-one sessions, they soothe cranky students, hoping to steer them back to the path of achievement. The service is not cheap. Parents in New York generally pay between $200 and $600 for regularly scheduled in-person sessions that range from 50 to 75 minutes. This on top of the hefty fees New York mothers and fathers already pay to help their children get ahead, or just stay on pace, from coaching for kindergarten gifted and talented tests, to subject tutoring, SAT prep and help with writing their college essays. Tutors make themselves available for last-minute interventions before midterms or when writing projects are due. They respond to texts and emails and often send their own, nudging students to finish a homework assignment or stay positive before and during a big exam. Some have teenagers create playlists on Spotify that express their feelings about homework. Others hand out blobs of scented putty, known as therapy dough, that is designed to calm. Others use meditation and mindfulness to refocus their charges on the hunt for a 4.0 and higher SAT scores.

Students: Read the entire article, then tell us:

— Do you ever feel overwhelmed by homework and studying? If so, what strategies do you have for dealing with the pressure? Are there any ideas from the article that you could use when doing homework in the future?

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The Role of Homework Engagement, Homework-Related Therapist Behaviors, and Their Association with Depressive Symptoms in Telephone-Based CBT for Depression

• Original Article
• Open access
• Published: 22 July 2020
• Volume 45 , pages 224–235, ( 2021 )

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• Elisa Haller 1 &
• Birgit Watzke 1  

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Telephone-based cognitive behavioral therapy (tel-CBT) ascribes importance to between-session learning with the support of the therapist. The study describes patient homework engagement (HE) and homework-related therapist behaviors (TBH) over the course of treatment and explores their relation to depressive symptoms during tel-CBT for patients with depression.

Audiotaped sessions (N = 197) from complete therapies of 22 patients (77% female, age: M  = 54.1, SD  = 18.8) were rated by five trained raters using two self-constructed rating scales measuring the extent of HE and TBH (scored: 0–4).

Average scores across sessions were moderate to high in both HE ( M  = 2.71, SD  = 0.74) and TBH ( M  = 2.1, SD  = 0.73). Multilevel mixed models showed a slight decrease in HE and no significant decrease in TBH over the course of treatment. Higher TBH was related to higher HE and higher HE was related to lower symptom severity.

Conclusions

Results suggest that HE is a relevant therapeutic process element related to reduced depressive symptoms in tel-CBT and that TBH is positively associated with HE. Future research is needed to determine the causal direction of the association between HE and depressive symptoms and to investigate whether TBH moderates the relationship between HE and depressive symptoms.

Trial Registration

ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.

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Mediators and Moderators of Homework–Outcome Relations in CBT for Depression: A Study of Engagement, Therapist Skill, and Client Factors

Avoid common mistakes on your manuscript.

Introduction

Therapeutic homework in terms of inter-session activity presents a central component of psychotherapy and is particularly inherent to cognitive behavioral therapy (CBT; Beck et al. 1979 ). The core principle of this treatment is to equip patients with tools to change thoughts, behaviors, emotions, and their interplay. Homework may be defined as activities carried out between sessions in order to practice skills outside of therapy and to generalize to the natural environment (Kazantzis and L’Abate 2007 ; Lambert et al. 2007 ). Rather than exclusively discussing problems in an isolated setting, patients are encouraged to address the problem in their everyday life with the intention to produce and maintain a therapeutic effect (Lambert et al. 2007 ). The theorized mechanisms of the effect of homework build upon the skills-building approach of CBT (Beck et al. 1979 ; Detweiler and Whisman, 1999 ), as therapeutic exercises provide an opportunity for the patient to gather information and practice newly gained skills. Ultimately, practicing skills outside therapy helps becoming aware of the problem and consolidating new beliefs and behaviors (Beck et al. 1979 ). Homework thus serves as a means of transferring strategies outside the therapy context and enables the patient to practice new skills in real-life situations in order to maintain therapeutic gain (Kazantzis and Ronan 2006 ).

Homework is a commonly studied process variable in CBT and has empirically been investigated primarily in association with treatment outcome. Previous research has demonstrated that a high level of homework compliance is related to improvements in depressive symptoms (e.g., Kazantzis et al. 2010 ). Meta-analyses have established correlational evidence for the homework compliance and outcome relationship (e.g., Mausbach et al. 2010 ) as well as experimental evidence for the superiority of treatments that incorporate homework over treatments without homework (Kazantzis et al. 2010 , 2016 ).

It has previously been noted that an “evidence-based” assessment of homework compliance (Dozois 2010 , p. 158) requires the consideration of qualitative aspects of homework completion throughout the course of the treatment (Dozois 2010 ; Kazantzis et al. 2010 , 2017 ). This has been neglected in previous studies on the homework-outcome relationship, which rely solely on adherence or compliance measures that focus on the proportion of completed homework or global single-item measures of whether the patient attempted the homework or not (e.g., Bryant et al. 1999 ; Aguilera et al. 2018 ). In a recent systematic review of homework adherence assessments in major depressive disorder (MDD), Kazantzis et al. ( 2017 ) found that only 2 out of 25 studies reported the measures that addressed the quality of homework completion. Furthermore, the single-item Assignment Compliance Rating Scale (ACRS; Primakoff et al. 1986 ) does not capture the depth of HE and the Homework Rating Scale (HRS; Kazantzis et al. 2004 ) is a client self-report measure, which might over- or underestimate homework compliance compared to objective measures. Studies increasingly put effort on focusing on qualitative aspects of homework completion. For this reason, the term and concept of homework engagement (HE) has been deemed relevant: it refers to the extent to which a patient has completed homework in an elaborate and clinically meaningful manner (Dozois 2010 ; Conklin and Strunk 2015 ). Furthermore, less empirical attention has been paid to underlying mechanisms going beyond patient factors, including therapist behaviors influencing HE and their relation to depressive symptoms.

Homework-Related Therapist Behaviors

Theoretical considerations and clinical recommendations of therapist behaviors related to homework (TBH) mainly build on four strategies suggested by Beck et al. ( 1979 ): (1) Homework should be described clearly and should be specific; (2) homework should be assigned with a cogent rationale; (3) patients’ reactions and should be elicited and in order to troubleshoot difficulties; (4) progress should be summarized when reviewing homework. Expert clinicians have also pointed out the value of formulating simple and feasible homework tasks and emphasized the patient involvement when developing homework assignments that are agreeable to the patient (Kazantzis et al. 2003 ; Tompkins 2002 ). Moreover, factors such as the match between the assignment and the client, as well as the wording of the homework task should be considered (Detweiler and Whisman 1999 ).

The suggested domains have also received some empirical attention. To our knowledge, four studies have focused on TBH in face-to-face treatment of MDD, which provide inconsistent findings. First, Startup and Edmonds ( 1994 ) investigated whether patient ratings of therapist behaviors promoting homework compliance were associated with therapist-rated homework compliance in a sample of 25 patients. The results did not demonstrate a significant relation between any facet of TBH (providing rationale, clear description, anticipation of problems, involving the patient) and homework compliance, which was largely attributed to ceiling effects of the patients’ ratings of TBH. Second, Bryant et al. ( 1999 ) assessed observer-rated homework compliance and TBH (reviewing previous assignment, providing rationale, clearly assigning and tailoring, seeking reactions and troubleshooting problems) in 26 depressed patients receiving cognitive therapy (CT). The study confirmed that patients that are more compliant experienced greater symptom improvement, and demonstrated a non-significant trend that suggests a relation between the overall score of the therapist homework behavior scale and homework compliance. Item-based analyses, however, demonstrated that therapist reviewing (TBH-R), but not therapist assigning behavior (TBH-A), was related to homework compliance. Third, in a sample of adolescents with depression, Jungbluth and Shirk ( 2013 ) demonstrated that providing a strong rationale and allocating more time in the beginning of treatment predicted greater homework compliance in the subsequent session, especially for initially resistant individuals. Fourth, the most recent study, conducted by Conklin et al. ( 2018 ), evaluated three classes of TBH in a sample of 66 patients with MDD undergoing CT. The authors reported that TBH-A, but not TBH-R were predictive of HE in the early sessions of CT, which stands in contrast to the findings of Bryant et al. ( 1999 ).

In consideration of the therapist’s prominent role in making use of therapeutic homework and the available inconclusive findings, the contribution of TBH to HE and their relation to depressive symptoms needs further exploration.

Homework Engagement in Telephone-Based CBT

The introduction of low-intensity CBT led to a way of delivering evidence-based treatments that is characterized by limited therapist input, technology-support, and increased use of self-help. These features are conflated in telephone-based CBT (tel-CBT). Tel-CBT puts emphasis on patients’ independent engagement with the therapeutic contents outside of therapy sessions by making systematic use of homework activities. The therapist plays an active role in structuring the treatment, providing input, and facilitating the comprehension and the use of homework. To the best of the authors’ knowledge, a limited number of studies with regard to homework in guided self-help and technology-supported treatment exists. One study investigating overall and component-specific homework compliance in an internet-based treatment with minimal therapist guidance found that overall homework compliance predicted 15% of the reductions in depressive symptoms (Kraepelien et al. 2019 ). Another study investigated TBH-R and homework completion in a telephone-delivered CBT (Aguilera et al. 2018 ). The authors found that the number of sessions in which a patient completed homework was related to a decrease in depressive symptoms at the end of treatment. This relationship disappeared when taking into account TBH-R, which, however, was positively associated with symptom reduction. These findings suggest that aspects of TBH are important factors for improved symptom outcome, but that TBH does not moderate the effect of homework compliance on improved symptom outcome (Aguilera et al. 2018 ).

Given the emphasis on patients’ contribution and self-reliance in the present treatment format, the assessment of HE might be a relevant process variable related to treatment outcome and an important therapy process that therapists can build upon. We would like to extend the current literature by using HE—a construct that is conceptually different from homework compliance and adherence—and by evaluating all sessions of the treatment (on average 9 sessions). This allows gaining a deeper understanding of the course of HE and TBH as well as the potential association between these variables and depressive symptoms.

Aim of the Current Study

The overall aim of the study is to provide insight into the occurrence and the course of HE and TBH in tel-CBT for depression. Additionally, first evidence on the relationship between HE, TBH, and depressive symptoms should be provided. Three objectives are pursued: (1) The assessment of the amount of homework, the proportion of different homework types, and the types of difficulties faced by patients when engaging with homework; (2) the description of initial status and course of HE and TBH in tel-CBT; (3) first examination of the relation between HE, TBH, and depressive symptoms over the course of the treatment.

The current study draws on data from a randomized controlled trial (RCT; Haller et al. 2019 ) investigating the effectiveness of tel-CBT compared to treatment as usual. Information on detailed study procedures and methods of the overarching RCT can be found in the study protocol (Watzke et al. 2017 ). The trial was approved by the local Ethics Committee. Inclusion criteria for the study were a PHQ-9 score of > 5 and ≤ 15, a diagnosis of mild or moderate depression according to ICD-10 (F32.0, F32.1, F33.0, F33.1), and the provision of a written informed consent. Patients were excluded, if they showed suicidality (item 9 > 0 on PHQ-9) or severe or chronic depression (F32.2, F34.1), if their physical or mental condition did not allow completion of questionnaires, if they were not proficient in the German language, or if they were in psychotherapeutic or psychological treatment at the time of intake or 3 months prior. For the main trial, 152 patients were screened for eligibility, of which 54 were included and randomized to either intervention or control group.

Data of each therapy session from patients randomized in the intervention group, i.e., those who received and completed the tel-CBT ( N  = 24), were used. We included data from all patients of which more than 80% of the therapy sessions were available and audio-recorded. The sample for the current study was necessarily reduced to N  = 22 because from two patients the majority of therapy sessions was missing due to technical failure to record. The two excluded patients did not differ from the intervention group in clinical status and sociodemographic variables with the exception that their age is in the lower range.

For the included 22 patients, three therapists who were employed at the University’s outpatient clinic were involved in providing tel-CBT. All therapists were female and 34 years old on average ( SD  = 5.9). The therapists were clinical psychologists with previous experience in treating patients with depression, and were in advanced training of CBT (current duration of training: M  = 4.3 years, SD  = 1.5). They received specific training in tel-CBT prior to the study and regular supervision by a senior clinician and researcher (BW) during the treatment provision.

Tel-CBT starts with a personal face-to-face session with the therapist and comprises 8–12 subsequent telephone sessions, which last between 30 and 40 min. The treatment program is called “Creating a balance” and is conceptualized as a guided self-help CBT delivered over the telephone. The content is based on core CBT elements—psychoeducation, behavioral activation, cognitive restructuring, and relapse prevention—within a total of eight chapters. The intervention entails a treatment manual for therapists and a workbook for patients to read and practice skills in between sessions. Each chapter is structured in a psychoeducational part with reading materials and case vignettes and a practical part with step-by-step instructions for exercises (i.e., homework). Copies of additional worksheets to complete homework are provided at the end of each chapter. Therapists were instructed to adhere closely to the treatment manual. This included agreeing upon a homework assignment in each therapy session, and reviewing the previously assigned homework at the beginning of the subsequent therapy session. The types of homework in the treatment manual were classified as: (1) Psychoeducational homework, including reading materials and case vignettes; (2) behavioral homework, including scheduling and undertaking pleasant activities; (3) cognitive homework, including replacing dysfunctional thoughts; (4) self-monitoring homework, referring to observing and monitoring thoughts and emotions; and (5) relapse prevention homework, including recognizing warning signs and establishing an emergency plan.

Measures and Assessment

Global Homework Engagement Scale (GHES). We developed an instrument measuring global HE independent of the type of homework assigned. The previously established homework engagement scale (HES) for CT by Conklin and Strunk ( 2015 ) served as a basis for the instrument. GHES consists of seven items regarding quantitative and qualitative aspects of homework completion. Each item is described in detail and is assessed on a 5-point Likert scale, varying from 0 ( not at all ) to 4 ( considerably ). Each of the five item manifestations contains a verbal anchoring tailored to the respective item in order to determine specific criteria connected to the rater’s decision, helping to ensure a uniform understanding of each item’s characteristics. The seven items cover the following aspects of HE: (1) Extent to which patients engaged with homework tasks; (2) whether and to which extent patients carried out homework as agreed upon; (3) whether and to which extent patients applied learnt strategies in difficult times; (4) the intensity of HE; (5) whether and to which extent patients faced difficulties when carrying out homework; (6) whether and to which extent patients could benefit from completed homework tasks; (7) estimated time that patients spent on HE. Additionally, and similarly to HES by Conklin and Strunk ( 2015 ), the scale contains two items which serve as a homework log. In the first log-item, homework that was reportedly completed from the previous session were written down by the raters. For the second log-item, research assistants recorded homework assignments for the next session before the rating procedure started. This procedure ensured that raters were informed about which previously assigned homework the discussion in a session is referring to. For the global GHES score, an average score of items 1 to 7 is calculated with higher scores indicating more HE.

Scale for Therapeutic Homework Assignment and Review (StHAR). An instrument to assess TBH was constructed for the purpose of this study. The instrument consists of eight items covering the process of assigning the upcoming homework (TBH-A) and the process of reviewing previously assigned homework (TBH-R). All items are assessed on a 5-point Likert scale, varying from 0 ( not at all ) to 4 ( considerably ). Each item is described in detail and contains a verbal anchoring for each item manifestation. The five items covering TBH-A build the subscale StH-A and comprise: (1) providing a rationale for the homework; (2) tailoring the homework to the individual situation; (3) addressing potential challenges of completing the homework; (4) specifying the homework; (5) ensuring comprehension of the homework. The subscale StH-R includes three items relating to TBH-R: (1) extent of discussing previous homework; (2) drawing conclusions of the homework; and (3) using homework to strengthen self-efficacy expectation of patient. The global StHAR score is calculated with an average score of all items, with StH-A items used from the previous session and StH-R items used from the subsequent session. Higher scores indicate a larger extent of TBH. Items from both scales are displayed in Table  1 . The German versions of the scales can be retrieved upon request from the corresponding author.

Patient Health Questionnaire (PHQ - 9) . Depressive symptoms were assessed at the beginning of each session using the German version of the PHQ-9 (Löwe et al. 2002 ). Nine items regarding primary and secondary depression symptoms are assessed on a 4-point Likert scale and build a sum score between 0 and 27. Therapists went through each item of the PHQ-9 right at the beginning of each session as part of the symptom monitoring. Patients had a copy of the PHQ-9 in front of them, answering whether the symptom was available 0 ( none of the days ) to 3 ( almost every day ). Although originally developed as a self-report measure, telephone administration of the PHQ-9 seems to be a reliable and valid procedure to assess depression (Pinto-Meza et al. 2005 ).

Ratings of Tel-CBT Sessions

Audio recordings were available for all therapy sessions of the included 22 treatments. All available recordings of per protocol therapy sessions were included in the dataset. We did not include the initial face-to-face appointment, as this was not relevant for the assessed process variables. From 210 tel-CBT sessions that had taken place within this sample, we were able to rate 194 sessions (92.4%). We had to exclude sessions that deviated from the treatment manual ( n  = 4) or where audio recordings were not available or unusable due to technical failure to record the session, or due to poor quality of the recording ( n  = 12), respectively. Deviation of the treatment manual is defined as a session that did not target the planned content. This was the case, when therapists had to react to a crisis situation of the patient. The mean duration of one telephone session was 43 min ( SD  = 9.6).

Raters and Rater Training

HE and TBH were rated by five independent raters (one Doctoral candidate and four Master-level students in clinical psychology). All raters were blind to treatment outcome of the patients. During a period of 4 weeks, raters received 54 hours of training in the employed treatment manual and the use of the rating instruments. Training consisted of discussing the content of the treatment manual, particularly homework types in the tel-CBT. Furthermore, defining adequate and competent therapist behaviors regarding assignment and review of homework were discussed. Following the training phase, three successive trial ratings were completed by the raters. Each trial rating was discussed and in case of disagreement, the wording of the items were refined until consensus was reached. Prior to the rating phase, three therapy sessions from two excluded cases were randomly selected and rated by all five raters in order to examine initial inter-rater reliability (IRR). Calculation of intra-class correlation coefficients (ICC) in a two-way random model ICC (2,2) (Shrout and Fleiss, 1979 ) revealed an average ICC (2,2) of .91 and a median ICC (2,2) of .93 across all raters and all items of GHES, and an average ICC (2,2) of .81 and a median ICC (2,2) of .88 across all raters and all items of StHAR. This result indicated that IRR was high, and that formal ratings could start subsequently.

Rating Procedure

All items were rated on a 5-point Likert scale in order to determine the estimated extent of patient`s HE as well as the extent of TBH. Raters were encouraged to take notes while listening to the audio file and rate all items at the end of the session. Of the 197 eligible audio recordings, each rater was randomly assigned between 32 and 38 sessions for the main rating. Session allocation was stratified by therapist, patient, and treatment phase (phase I: sessions 1–4; phase II: sessions 5–9). A subsample of therapy sessions was double-coded in order to establish IRR. 40% of the total amount of sessions were drawn to carry out double-ratings resulting in a total of 57 to 62 sessions rated per rater. Each rater was paired with every other rater an approximately equal number of times. For the double-rated sessions, the average score of the rater pair for each item was used in the final analyses.

Statistical Analysis

As GHES and StHAR are newly developed rating instruments, analyses of the psychometric properties were conducted before turning to the research questions under investigation. We calculated Pearson`s r for corrected item-total-correlations and coefficient omega (ω) to measure internal consistency of both scales. IRR was assessed by calculating ICC in a two-way random model (ICC 2,2 ) (Shrout and Fleiss 1979 ) testing for absolute agreement between two raters and within one rater, respectively.

In order to meet research objective one, the types of homework assigned as well as types of difficulties faced when completing homework are reported. Moreover, descriptive statistics (means and standard deviations) of the individual items and the total scores of the scales GHES and StHAR (including subscales StH-A and StH-R) are presented. For research objective two, multilevel mixed models (MLM) were applied to examine between- and within-patient variability of HE and TBH over the course of treatment in a nested data set. In two-level models HE and TBH assessed at each of the nine telephone sessions (level 1) are modelled within each of the 22 individuals (level 2). The inter-individual variability in terms of initial status and growth of HE and TBH are modelled at level 2. For research objective three, MLM was analysed with depressive symptoms measured with PHQ-9 defined as criterion on level 1. Depressive symptoms were assessed in each session. HE of the same session, and TBH (consisting of TBH-A of the previous session and TBH-R of the current session), were gradually introduced as time-varying predictors of the session-specific symptom severity. In total, five stepwise built multilevel models were calculated. First, the null or unconditional model was created, including the intercept and the random term (null-model). Second, the null-model was expanded by adding a random slope for time (model 1). Third, one time-varying predictor (HE) was introduced into the random intercept random slope model (model 2). Lastly, random intercept and random slope models with two time-varying predictors (HE and TBH; model 3) and an interaction term between HE and TB (model 4) were created. A separate model that included HE as criterion and TBH as predictor was analysed.

All models were estimated using restricted maximum likelihood (RML). In order to compare the appropriateness of the specified models, AIC, BIC and log-likelihood values were used. Analyses were performed using R software (version 6.3.0; R Core Team 2014 ), the lme4 package (Bates et al. 2015 ) and the psych package (Revelle, 2019 ).

Descriptive Statistics of Sample

Baseline sociodemographic and clinical characteristics of the N  = 22 included patients are displayed in Table  2 . The majority of the sample was female and on average 56 years old ( SD  = 18.1). Symptom severity ranged from mild to moderately severe levels of depression (6 ≤ PHQ-9 ≤ 20) at the beginning of treatment resulting in a moderately depressed status on average.

Psychometric Properties of GHES and StHAR

With regard to psychometric properties of the scales, corrected item-total correlations ranged from .46 to .78 for GHES and from .39 to .61 for StHAR. Internal consistency of GHES was excellent across treatment (ω = .87), with values ranging from .79 to .91 across sessions. Internal consistency for StHAR was good across treatment (ω = .80) with values ranging from .63 to .87 across sessions. Internal consistency for StH-A was .73 and .68 for StH-R. We calculated ICC using a two-way random effects model (ICC 2,2 ) (Shrout and Fleiss, 1979 ) to estimate IRR. For GHES, ICCs (2,2) across all rater dyads ranged from .41 to .81, resulting in a moderate average ICC (2,2) of .68 as well as a moderate median ICC (2,2) of .70. For StHAR, ICCs (2,2) across rater dyads ranged between .45 and .83 resulting in a moderate average ICC of .64 and a moderate median IRR of .64. Due to the good psychometric properties of StHAR, the global StHAR score was used instead of the subscales StH-A and StH-R in further analyses.

Descriptive Statistics of Homework, HE, and TBH

Across all telephone sessions and patients, 411 homework activities were assigned in total, resulting in approximately two defined homework tasks per session and per patient on average. The majority of the homework was classified as psychoeducational ( n  = 142; 35%) and behavioral ( n  = 138; 31%), followed by cognitive ( n  = 76; 18%), self-monitoring ( n  = 36; 9%), and relapse prevention ( n  = 29; 7%) homework. In total, 380 (92.5%) of the homework activities were completed. Across all patients and therapy sessions HE was on average M  = 2.71 ( SD  = 0.74), which translates into moderate to high HE when using the item anchors. Difficulties in completing homework assignments were reported in 75% of the sessions, with the extent of difficulties showing an average of M  = 1.53 ( SD  = 1.10). Using the item anchors, this value translates to small to moderate difficulties. Most commonly assessed types of difficulties encountered by patients were negative events that impeded homework completion (34.1%), depressive symptoms (29.7%), and lack of strategies and options to complete homework (13.7%). Lack of time (8.2%), homework being too difficult (8.2%), and other homework-related aspects (6.0%) were further reported difficulties in completing the task. HE and TBH showed a small significant association across sessions, with a mean correlation of r  = .28 ( p  < .05). Descriptive information on HE and TBH per session are presented in Table  3 .

Course of HE and TBH and Their Association

With regard to variation in HE among patients and across treatment, we first ran an unconditional or null model with HE as criterion. The average HE across patients and treatment is 2.70 ( SE  = 0.09). Calculations of ICC using the within- and between-patient variance shows that 25% of the variance in initial status of HE are attributed to differences among patients. Entering time as predictor (model 1), the unconditional growth model demonstrates that patients start on average with high HE ( M  = 3.00, SE  = 0.13) and show a small reduction in HE during the course of treatment (− 0.05, p  = .011). With regard to TBH, 14.8% of variance can be attributed to differences between patients. The initial status of TBH is 2.32 ( SE  = 0.13) and shows a similarly small, but statistically non-significant reduction during the course of the treatment (− 0.04, p  = .307). The models regarding course of HE and TBH are displayed in Table  4 .

In order to explore the association between HE and TBH, stepwise multilevel models were built with HE as criterion in a separate model. TBH consisting of TBH-A from the previous session and TBH-R from the following session was entered as a time-varying predictor of HE in the subsequent session. TBH was significantly and positively related to HE over the course of treatment (0.24, SE  = 0.07, p  = .032). Results are displayed in Table  5 .

Association Between HE, TBH, and Depressive Symptoms

For the association between HE, TBH, and depressive symptoms, we first ran an unconditional or null model, which demonstrated a within-patient variability in depressive symptoms of 38% (data not shown), indicating a nested structure of the data. After modelling the time slope (model 1), time-varying predictor 1 was entered at level 1 (model 2). Time-varying predictor 1 was HE of the current session, since ratings refer to the interval between two sessions. Higher scores on HE were associated with lower depressive symptoms over the course of treatment (− 0.83, SD  = 0.35, p  = .015). Comparison of model 1 and model 2 returned better fit indices for model 2 (log-likelihood for model 1 = - 451.37 and for model 2 = − 448.05, p  = .009; AIC for model 1 = 910.74 and for model 2 = 906.10; BIC for model 1 = 923.3 and for model 2 = 921.8;) for the random intercept random slope model with HE as predictor (smaller values indicate better fit). Next, the second time-varying predictor—TBH from the previous session—was introduced into the model at level 1. TBH was not significantly related to depressive symptoms (0.23, SD  = 0.30, p  = .437). Compared to model 2, model 3 did not show improved model fit (log-likelihood for model 2 = − 444.69 and for model 3 = − 444.24, p  = .346; AIC for model 2 = 903.4, and for model 3 = 904.5; BIC for model 2 = 925.4 and for model 3 = 929.6), indicating the model with HE as predictor fits the data better. The last model (model 4) included an interaction between the two time-varying predictors, however the model did not converge. Results of the random intercept model (model 1), the random intercept and random slope model with one predictor (model 2), and the random intercept random slope model with two predictors (model 3) are presented in Table  6 .

The present study describes types and amount of homework assigned and depicts rather high levels of HE in tel-CBT. Results of our study further show that HE decreases slightly throughout the course of therapy and that TBH is related to HE over the course of therapy. Ultimately, results reveal that higher scores on HE are associated with lower levels of depressive symptoms, but that TBH and depressive symptoms are not associated.

The study demonstrates that homework assignments and engagement with homework play a central role in tel-CBT – as could be expected from the guided self-help approach. This is indicated by the overall amount of assigned homework across therapy and patients, the proportion of homework completed by patients, and the patients’ rather high HE throughout the course of the treatment. As expected, we found that homework was overall assigned in most of the therapy sessions. The fact that on average two homework assignments were prepared in each session confirms that contents were employed and implemented as scheduled by tel-CBT. This treatment format lays special emphasis on this kind of intersession activity.

When modelling the status and course of HE and TBH, both variables showed more within-patient variability compared to between-patient variability over the course of the treatment, as indicated by the ICC calculations of variance components and the slopes of the variables in the models. Inter-individual differences explained rather small proportions of the variance (25% in HE, 15% in TBH), which might indicate that both variables are dynamic rather than stable patient characteristics. The overall high HE across patients might be explained by sociodemographic and clinical patient characteristics. The average age of our sample was rather high and the vast majority of patients reported having had previous depressive episodes and psychotherapy experience. It is likely that patients with a history of depression and of undergoing treatment are trying particularly hard to make the most out of therapy. Moreover, older patients might show a sense of self-responsibility when it comes to carrying out therapeutic homework. Contrary to the belief that adult patients may have reservations regarding homework due to their age, there is evidence that adult patients have positive attitudes towards homework, with the vast majority of patients not perceiving themselves too old for homework (Fehm and Mrose 2008 ). HE declined slightly over the course of treatment and visual inspection of the individual courses of HE showed that drops in HE happened in some patients in single sessions. These variations are expected to be due to specific external factors that have an influence on the patient's HE at a given session. For example, further explorative analyses might scrutinize which external factors regarding homework (such as difficulties completing the homework task; lack of resources or time in a given week) and session content might be responsible for situations with a drop in HE. In view of previous suggestions that homework compliance might not be linear across treatment of social anxiety disorder (Leung and Heimberg 1996 ), future studies might employ statistical models that are suitable to detect various patterns of HE. For example, latent growth analysis, which requires much larger samples than the one used in our study, would allow to detect differences in latent factors between groups of patients, and to relate different HE patterns to treatment outcome (Collins and Sayer 2001 ).

Our study provides empirical support for the association between HE and depressive symptoms throughout the course of tel-CBT in mildly to moderately depressed patients. Using MLM with repeated measures of predictors and outcome, we found a medium-sized association between HE shown between sessions and depressive symptoms in the subsequent session. In other words, when HE increases by one unit in an interval of two sessions, patient's symptomatology decreases an average of 0.8 units on the PHQ-9 in the subsequent session. Overall, this result goes in line with meta-analytic evidence of the relation between homework compliance and treatment outcome showing a weighted mean effect size on therapy outcome of r  = .22 for homework compliance and r  = .36 for the employment of homework in therapy (Kazantzis et al. 2000 ). Moreover, the result corresponds to one previous study focusing on a similar conceptualization of HE, which found an immediate effect of HE on symptom outcome in the subsequent session (Conklin and Strunk 2015 ). In our study, TBH was not associated with depressive symptoms in the subsequent session. However, our results indicate that TBH was significantly related to HE over the course of treatment, which corresponds to results of a previous study that found TBH to significantly predict subsequent HE (Conklin et al. 2018 ). Explanations for these findings could be that some clinically beneficial TBH might have been less present in the overall therapists’ behaviors and therefore exerted an effect on HE but not on depressive symptoms. Even though the homework procedure in our study tended to be therapist-initiated, the patients took an active part in tel-CBT, as the majority of the session time was spent on reviewing patients’ experiences with the previous homework and discussing future homework It needs to be stressed that therapists were not trained in specific assignment and review procedures. This means that some aspects of assigning homework that received clinical and empirical support in previous work, were not implemented in our study. For example, it is recommended to write down homework tasks and instructions (Cox et al. 1988 ) in order to assure higher homework compliance. Moreover, a recent study provides preliminary support for the importance of designing homework tasks that are congruent with what the patient perceived helpful in the session (Jensen et al. 2020 ). Since therapists were instructed to adhere to the homework assignments as scheduled, they were not entirely free to consider whether the homework type scheduled for a specific session was appropriate for the patients’ current problem or situation. It is likely that therapists—despite strictly assigning the activity types as scheduled in the treatment manual—adequately adapted the different homework types to the patient's individual situation and promoted patient's willingness and ability to engage with homework outside the therapy session. Our results further suggest that the specific type of homework might not be the only relevant factor for higher HE, as long as therapists assign and review homework in an elaborate, comprehensible, and convincing manner. Lastly, it is important to consider that the association between TBH and HE might run in the opposite direction in that patients’ higher HE and reporting thereof might have influenced the therapists’ reactions to the patients’ reports.

The present results need to be interpreted in due consideration of several limitations: First, the predictor variables were assessed using two self-constructed rating scales, which have not been validated prior to the study. We did not use standardized or validated instruments to assess HE and TBH, because no process rating instrument targeting the particular conceptualization of these variables exists. We aimed at expanding on the previously reported Homework Engagement Scale (HES) by Conklin and Strunk ( 2015 ) by adding indicators such as intensity of HE or difficulties faced when engaging with homework. Despite good psychometric properties for both scales with regard to internal consistency and moderate to good properties regarding IRR, the validity of GHES might be constrained: Even though GHES is an objective observer-based rating instrument with a precise rating manual, the items do not always allow a direct observation of facets relevant to HE. The appraisal of each item relies on the patient expressing his or her thoughts and experiences with the homework process. However, these narratives might not cover all areas of interest in the rating instrument. For example, the rating on the difficulty-item is indirectly inferred from the narratives of the patient about how engaging with homework went. If the patient did in fact face difficulties affecting HE, but not explicitly mention these when talking about how homework activity went, the measurement of difficulties faced in this situation might not be representative of HE. The rating therefore relates to the raters’ appraisal of whether a patient had faced challenges that might have affected HE, rather than the patients’ subjective feelings or the true influence of experienced difficulties on HE. Objective and observer-based assessments of HE might be supplemented by patients’ reports of difficulties faced as well as by patient ratings on the profoundness with which patients engaged in homework activities as well as the perceived benefits of homework in future research. Second, the StHAR did not specifically target competence or quality of assigning and reviewing homework. Future studies might develop and employ rating instruments that clearly differentiate the extent of TBH shown by the therapist from the competency of these therapeutic actions. Moreover, patient ratings of whether therapists assigned and reviewed the homework in a skilful manner in the patients’ views might add to a better understanding of clinically meaningful TBH.

Third, our methodology and our analytic strategy do not allow for any causal inferences regarding HE and depressive symptoms, despite multiple assessments of HE in session intervals and the depressive symptoms assessed at the beginning of each session. Reverse causation cannot be excluded, since patients might have reported about homework more elaborately and positively in the sessions due to an improved mood. Moreover, depressive symptoms were assessed retrospectively for the time period since the last therapy session. Fourth, the study sample was rather small. Therefore, additional exploratory statistical models for our third research question (e.g., including interaction terms) could not be converged in our models. Lastly, selection bias might have occurred as the majority of the patients self-referred to the overarching clinical trial, potentially leading to the inclusion of generally motivated patients who showed rather small variability in HE and therefore also did not require the therapist to intervene in a way that promotes HE or improves depressive symptoms.

Even though our results should be regarded as preliminary evidence, the findings add to the body of literature due to several strengths. A more comprehensive concept of the extent of homework compliance was used in the present study, going beyond commonly used quantitative measures of homework completion or single-item compliance measures. Several differences between HE and previous operationalizations of homework compliance exist. HE incorporates facets of the quality and the intensity of patient's engagement with the homework tasks, the estimated benefit for the patient of undertaking homework, the estimated transference of acquired skills to the patients’ daily lives, as well as the difficulties experienced by the patient when completing homework. Another strength of the study is the conceptualization of TBH, which incorporates multiple facets regarding preparing and reviewing homework, informed by clinical recommendations. These aspects were derived from listening to and rating complete therapy sessions with high reliability, as indicated by the IRR analyses. Moreover, observer-based ratings of both HE and TBH might provide more objective estimations of HE and discussion of tasks in the therapy session compared to client or therapist reports (Mausbach et al. 2010 ). Lastly, our study provides insight into the course of HE and TBH throughout the entire treatment, which helps generating hypotheses regarding the nature of HE and its relation to TBH and depressive symptoms.

The study provides evidence that homework is implemented by therapists and patients in tel-CBT. Engagement with homework and therapists’ actions to assign and discuss homework varies across treatment in this sample. However, on average a slight decrease of HE throughout the treatment was observed and patients, who show high HE, experience lower depressive symptoms on average. Future studies with designs allowing to determine the direction of causality and with  reliable and more economic ways of retrieving information regarding HE in the patients’ natural environments (e.g., using ecological momentary assessment) are warranted. This approach would allow for recording patients’ HE close to occurrence and provide information regarding reasons for low HE as well as facilitators for completing homework without recall bias. TBH was not related to depressive symptoms but showed an association with HE. Future studies might examine whether TBH moderates the HE-symptom improvement relationship and whether specific homework types require specific therapist skills to assign and review in a meaningful way.

Data Availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Haller, E., Watzke, B. The Role of Homework Engagement, Homework-Related Therapist Behaviors, and Their Association with Depressive Symptoms in Telephone-Based CBT for Depression. Cogn Ther Res 45 , 224–235 (2021). https://doi.org/10.1007/s10608-020-10136-x

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Why Therapists Set Homework

Homework!? Really!?

I happen to be a therapist who likes to set homework. Not all therapists do (it may not be appropriate to the therapeutic approach or goals for therapy) and it certainly doesn’t fit with every therapist’s approach or training, but for me it’s a win-win.

Partly because I enjoy the look on the kids faces when I say, “I’m going to give you some homework to do”…

Partly because I miss lecturing and setting assignments…

But mainly because it’s the best way to achieve real and lasting change.

Allow me to explain.

Creating Lasting Change

When you come to a therapist and you want to work on; reducing your anxiety, or managing your mood, or improving your relationship etc, you are going to be talking about making changes.

And while we humans are pretty adaptable as a species, we kind of suck as individuals when it comes to making changes. Our brains are just not wired for it. They’re wired to keep us safe, and change isn’t safe because it brings uncertainty (which our brains really don’t like).

So, if you’re trying to change a lifelong pattern of; negative self-talk, self-sacrificing or picking the wrong partners etc, your brain is going to resist the change.

It just is.

Try it. Pick up your phone and switch apps with your non-dominant hand (after you’re finished reading this of course!). Or hold the phone to your other ear next time you make a call. Write with that non-dominant hand, leave the toilet paper fold coming from underneath instead of over the top or change the way you tie your shoelaces. Your brain will NOT like it!

And this is why we need to practice.

Practice Makes Change (doesn’t have to be perfect!)

We need to repeat the new way of answering the phone, or the new way of tying the shoelaces, over and over and over again until our brains start to realise that nothing bad happens when we do it this way and it can calm down.

This is especially true if we’re talking about new ways of dealing with things like big emotions or panic attacks. I don’t care how good your therapist is, even if you spent the entire hour of your weekly session practicing your breathing or grounding techniques, there’s another 167 hours every week where you’re NOT practicing that skill and the old behaviours can creep back in.

Think of it this way.

If you can’t swim and someone throws you in the deep end of the pool, you might learn to keep your head above water, but you’re certainly not going to be a confident swimmer. And if you find yourself in open water, it’s probably not going to go terribly well for you.

We learn in the shallow end so we can practice the skills we need to be comfortable in the deep end. And just like kids practice blowing bubbles in the bathtub, completing your homework tasks in between sessions, is all about getting your brain and your body comfortable with these new skills, so when the time comes you won’t sink!

Danielle Graber Clinical Psychologist, Director & Homework Giver

Why Do Some Therapists and Coaches Assign Homework In Between Sessions?

Caitlin harper.

When you start therapy or coaching, you probably expect to be doing most of the work in-session, working directly with your amazing coach or therapist. But what happens when the session ends?

If you’re just starting your therapy or coaching journey, it might surprise you to find that many therapists and coaches assign homework in between sessions, and it’s even an integral part of certain types of therapy, like cognitive behavioral therapy, or CBT. 

“It’s important to learn and fully understand the skills we explore during sessions and it is equally important to know how to apply those skills in your real life situations,” says Irene Chin, a therapist and MyWellbeing community member. “When I assign ‘homework’ it is to foster positive change in your life slowly but surely. However, the amount of homework can be tweaked to best fit your needs.”

If your school graduation days are behind you, you might think your homework days are long gone as well. But in this new stage of your learning and development, that might not be the case! Here are a few of our therapists and coaches on why they might assign homework in between sessions and what it might look like for you.

Why do coaches and therapists assign homework in between sessions?

Many times, therapists and coaches will assign homework so that you can practice the skills you explored during your session in the “real world.”

“While we work together on developing insight during our sessions, it’s between sessions when you have the opportunity to put these insights into practice in your life,” says Christine Carville. “Being able to take home specific tools to use in tough situations or emotionally charged moments allows for you to experience the learning and gain confidence. It’s like learning a language—you can go to class once or twice a week but it takes using the language on a daily basis to become fluent and confident. In a lot of ways, therapy is learning the language of emotional intelligence and in-vivo experience is vital.”

Some therapists and coaches find that assignments or other exercises to practice in between sessions can help clients gain a sense of continuity and growth as their therapy or coaching journey progresses.

“I have found that often people leave sessions feeling elated, unburdened, and with an increased sense of comfort and clarity,” says Sky Koltun. “Sometimes this experience can feel difficult to hold onto between sessions. I am always prepared to work with people to create a sense of continuity between sessions or come up with ways to hold or continue to cultivate what they feel they have gained from the work we do in the session. I have often recommended books, writing/journaling exercises, breathing, and meditation techniques, and help clients to create their own practices.”

Therapists and coaches who do assign homework sometimes believe that most of the work actually happens outside the session where you can apply what you learn when you worked together.

“I do assign work in any form that works best for you,” says Hannah Evans. “I can provide handouts and worksheets, book recommendations, journal prompts, behavior change activities to engage in, etc. Both you and I will discuss how the homework or activity went, exploring your thoughts, feelings, and interpretations to progress towards your therapy goals. There are 168 hours in a week and change will not occur in the one hour we meet each week. Therefore, most of the work for therapy happens outside of session where you apply the skills learned in session.”

In many situations, what you put into it is what you get out of it, and therapy and coaching are often no different. The more work you do outside of your sessions, the better your results can be.

“I always tell clients that coming to therapy and/or coaching is a bit like buying a gym membership: it's great that you have committed to bettering yourself, but you have to be patient and you have to be ready to put in consistent work to see results,” says William Hasek. “If you are only engaging in self-reflection for one hour a week with me, I don't think that will be of great benefit to you—just like you won't see many benefits if you only go to the gym one hour a week. You have to put in the time and energy outside of our sessions to experience the benefits.” 

But all of our coaches and therapists agree on one thing, and that is that you and your therapist or coach will work together to find what works best for you.

“I don't like to simply ‘assign’ activities for you to do outside of session because I want you to be active in creating solutions and committing to action, says William. “We will develop these activities collaboratively so you have a voice in the changes you are undertaking.”

What are some types of homework therapists or coaches might assign?

While homework can be worksheets or journaling, you might be surprised how varied and creative your “assignments” can be!

“Sometimes the homework can look like ‘Try to take note of what is happening before and after your anxiety sets in,’” says Evelina Rodriguez. “Other times I may offer an article, book, or activity to continue processing over the course of time between sessions.”

The homework doesn’t always look like “work” either.

“If you are struggling with burnout, I would encourage you to think about one simple yet pleasurable activity such as listening to  soothing music and schedule this specific event at a certain time of day,” says Catherine Kim.

In fact, homework often looks a lot like “real life,” which is kind of the point.

“Homework helps to reinforce skills discussed and practiced in session,” says Fanteema Barnes. “Assignments can range from completing worksheets, practicing mindfulness techniques, socializing, going on a date, reflecting on what we discussed in session, giving yourself compliments daily, engaging in a hobby, reading an article, purchasing a self-help book, watching a video or TED talk, or even having a conversation with a loved one.”

Leora Mandel gives a few more creative homework examples: 

• Free-form journal entries or letter writing 
• Planned pleasant events, such as attending a concert, cooking a favorite meal, making time to listen to a podcast, or paint
• Executing a plan brainstormed by you and I, such as beginning a new habit, reaching out to a person, beginning an application, or making a list
• Recording events to identify patterns—what time of day do negative thought spirals occur, and how often? Are there any recurring triggers? 
• Exercises with instructions involving the learning of a tool, such as a distress tolerance skill, and reflection of your experience practicing it

And your homework doesn’t have to stay the same—as you progress through your therapy or coaches journey, your assignments might change as you do.

“At the start of treatment, homework mostly consists of reflecting on behaviors, examining thoughts, and understanding relational and coping patterns,” says Shari Norton. “Toward the middle of treatment, homework may consist of practicing skills between sessions and through activities such as journaling. As treatment comes to an end, homework becomes less frequent, and consists of reflecting on changes that occurred from the start of sessions.

Again, your therapist or coach will work with you to determine the best course of action for you at that particular time in your life.

“Some people find the process of additional homework to be stress-inducing, adding yet another thing to their already piled-high list, and if this is the case then I might just ask the client to take a mental picture of something that happened to bring into the next session, maybe something around a triggering event, a dream, or just a thought that they keep ruminating about,” says Andrea Yuen-Sing Chan. “For others, homework helps to ease the transitions between sessions and to make the person feel as if they are doing something. In this case, because it can reduce anxiety and is also therapeutically useful, I will ask for journal entries, or to practice behavioral interventions and then to notate them in a journal. Occasionally I suggest a book or article that might be helpful to the client.”

Does every therapist or coach assign homework in between sessions?

If the idea of homework isn’t appealing to you, that’s totally fine too—not all coaches and therapists are into it either.

“I do not assign homework,” says Shaina Ferguson. “I believe that each of us have different ways of processing what may come up in therapy. You may find yourself reflecting upon the content of sessions outside of sessions and may want to journal or process through art or movement. You may choose to bring writing or other forms of expression into therapy and that is welcomed, but no formal homework will be assigned.”

Some therapists and coaches won’t assign you homework, but you’re more than welcome to develop exercises yourself and share them with your coach or therapist in-session.

“I believe that therapy has to be client-centered and based on your personal experience, not out of a book or on a worksheet,” says Autumn Potter. “I may ask you to take notice of certain experiences outside of a session or ask you to collect specific art materials. That being said, I also have clients who have come up with their own homework, such as ‘this week I am going to refrain from using Instagram.’ I believe that the directive coming from the client holds significantly more power than something I would assign.”

Homework doesn’t always fit with the kind of care you’re receiving, and that’s okay. But self-reflection is usually encouraged!

“I find that assigning homework does not fit well with my style of work which is more focused on expression of, and reflection on, feelings and thoughts within a supportive therapy relationship in order to build a level of insight that I feel can ultimately produce meaningful changes,” says Michael Nettis-Benstock. “At the same time, I feel that our work doesn’t stop at the end of the session and I always encourage you to reflect on what we discuss in our sessions throughout the week, but not in a way that feels like an assignment.”

Not everyone loves the word homework and your therapist or coach might call it something else entirely

“Part of the co-created coaching process depends on ‘fieldwork’ or homework in between sessions where clients are accountable for making real-world progress on short- and long-term goals,” says Ilysse Rimalovski.

“Oftentimes I assign small tasks in between sessions,” says Jordyn Norman. “I feel this is a good way to be able to measure progress.”

“I will at times assign what I like to call ‘projects’ in between sessions,” says Pam Skop. “The reason that I do this is that the real work happens outside of therapy. I generally meet with clients once a week for forty-five minutes and a lot can be discussed at that time, but it is what they do with that once they leave my office that leads to lasting changes. We will discuss the ‘project’ at the next session and use it as a learning tool to move forward.”

“Any ideas for tasks between sessions arise from our conversations during the session,” says Alena Gerst. “As you reveal to me what you feel you are lacking, we find ways to begin to slowly and intentionally integrate what you are searching for into your life. I call these tasks ‘Marching Orders’ (referring to the book The Artist's Way by Julia Cameron). Occasionally, these ‘assignments’ may feel challenging as you come to terms with what is true for you. But usually they are designed to unlock creativity, joy, and delight.”

“As a former teacher, I know that the word ‘homework’ might make some cringe, so I prefer to call it ‘practice,’” says Alison Abrams. “Time between sessions is priceless. It provides you with more time to extend the learning you do in our sessions into the real world.”

“There definitely will be times when I may make recommendations for ‘homework’ (or as I like to refer to it, ‘a challenge’) depending on what we're working through or if I think it could be relevant or helpful,” says Faith Bowen. “I typically don't do this every session—unless that is something you'd like.”

“I believe that I'm not here to help you grow just during the sessions but I want the growth and change to be sustainable in the long run,” says Kimberly Weimer. “I typically will cater your 'homeplay' (homework) around self-care tasks that you are interested in. This might include meditation, journaling, a gratitude practice, breathwork, yoga or some form of exercise. I will encourage readings, podcasts, and activities that fit with your struggles and goals.”

“For example if you have OCD you will have exposure exercise,” says Kimberly. “If you struggle with anxiety or depression you might have a thought journal and mindfulness exercises. If you are struggling with self-esteem or imposter syndromes you will likely be assigned affirmations and self love exercises. Homeplay is not mandatory but encouraged. I want you to have the skills to maintain the ‘new you’ long term and continue in your growth process even after we are no longer working together."

In the end, your therapist or coach is going to do what is right for you

“Our activities depend on your goals, what motivates you, and what has worked in the past,” says Krissi Franzen. “Most of our assignments involve being curious and experimenting, whether it's with coping strategies, grounding techniques, or practicing communication skills. If you're freaked out by homework, don't fret! If it's not a strategy that is successful for you, let's find things that do work!”

Mainly, you and your therapist or coach will work together to figure out what’s best. Be sure to share what’s working and not working for you so can find the best way forward for you.

“This is a conversation that we will have together!” says Em Kane. “If you're someone who enjoys being given homework and tasks for outside of sessions I can make that a component of our work. For others though this just adds stress, so it isn't necessary!”

Your therapist or coach is there to support you so you can get the care you deserve. Through your collaborative relationship, you can discuss how they can best facilitate your therapy or coaching journey. If you’re ready to get started, find your perfect match now. Still not sure if you might benefit from therapy or coaching? Our quiz might help.

“For some clients, homework is enjoyed, embraced and needed, however, not all clients like this,” says Christina Viera. “As a result, it is our job (client and therapist) to discover what works best for you, so that you can get the most out of therapy.”

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Recommended reading, can yoga help our mental health, everything you want to know about dialectical behavior therapy (dbt), the geography of self.

About the author

Caitlin is an organizational change strategist, advisor, writer, and the founder of Commcoterie, a change management communication consultancy. She helps leaders and the consultants who work with them communicate change for long-lasting impact. Caitlin is a frequent speaker, workshop facilitator, panelist, and podcast guest on topics such as organizational change, internal communication strategy, DEIBA, leadership and learning, management and coaching, women in the workplace, mental health and wellness at work, and company culture. Find out more, including how to work with her, at www.commcoterie.com .

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Empowering Recovery: Transformative Therapy Homework Assignments

The power of therapy homework.

Therapy homework is an integral part of the therapeutic process that extends the benefits of therapy beyond the therapy room. It involves assignments and activities that clients are encouraged to complete between therapy sessions to facilitate healing, growth, and recovery. By actively engaging in therapy homework, individuals can take ownership of their progress and empower themselves on their journey towards well-being.

What is Therapy Homework?

Therapy homework refers to the tasks, exercises, and activities assigned by therapists to their clients with the aim of reinforcing and extending the benefits of therapy. These assignments are tailored to address specific therapeutic goals and objectives, focusing on areas such as self-reflection, skill-building, and behavioral changes. Therapy homework can take various forms, including journaling, self-reflection exercises, mindfulness practices, and behavioral experiments.

Therapy homework serves as a bridge between therapy sessions, allowing individuals to apply the insights gained in therapy to their daily lives. It encourages active participation and engagement in the therapeutic process, enabling clients to develop a deeper understanding of themselves, their emotions, and their thought patterns. Through regular completion of therapy homework, individuals can cultivate new coping strategies, enhance self-awareness, and promote personal growth.

How Therapy Homework Can Support Recovery

Therapy homework plays a crucial role in supporting recovery by reinforcing the therapeutic work done during sessions. Here are some ways in which therapy homework can contribute to the recovery process:

• Continuity of Learning:  Therapy homework provides a continuous learning experience, allowing clients to build upon the insights gained during therapy sessions. It helps reinforce new skills, coping strategies, and perspectives, facilitating lasting change and growth.
• Application of Skills:  By engaging in therapy homework, individuals have the opportunity to apply the skills and techniques learned in therapy to real-life situations. This practical application helps strengthen and solidify new behaviors and thought patterns.
• Increased Self-Awareness:  Therapy homework encourages self-reflection and introspection, fostering a deeper understanding of one’s emotions, behaviors, and patterns of thinking. This increased self-awareness can lead to greater insight and personal growth.
• Empowerment:  Active participation in therapy homework empowers individuals to take charge of their own healing process. It allows them to be proactive in their recovery journey, develop a sense of agency, and take ownership of their progress.
• Consolidation of Progress:  Regular completion of therapy homework reinforces the progress made in therapy sessions. It helps maintain momentum, prevents relapse, and supports long-term recovery.

Therapy homework is a collaborative process between the therapist and the client. It involves setting realistic goals, tailoring assignments to suit individual preferences and needs, and providing ongoing support and feedback. By embracing therapy homework, individuals can enhance their therapeutic experience, accelerate their progress, and empower themselves on their path to recovery . To explore specific examples of therapy homework assignments, check out our articles on  therapy homework for anxiety  and  therapy homework for depression .

Types of Therapy Homework Assignments

Therapy homework assignments play a vital role in supporting the therapeutic process and helping individuals make progress towards their goals. There are several types of therapy homework assignments that therapists can assign to their clients. Here, we will explore three common types:  journaling and self-reflection exercises ,  behavioral and habit-forming assignments , and  mindfulness and meditation practices .

Journaling and Self-Reflection Exercises

Journaling and self-reflection exercises are powerful tools for promoting self-awareness and personal growth. Through the act of writing, individuals can explore their thoughts, emotions, and experiences in a structured manner. Journaling can help individuals gain insights into their patterns of thinking, identify triggers, and reflect on their progress.

Therapists may assign specific journaling prompts or provide worksheets to guide clients in their self-reflection journey. These exercises can focus on various topics, such as exploring emotions, identifying cognitive distortions, practicing gratitude, or tracking behaviors. Journaling can also be used as a platform for  therapy homework for self-expression  and  therapy homework for creativity .

Behavioral and Habit-Forming Assignments

Behavioral and habit-forming assignments are designed to help individuals make positive changes in their behavior and develop healthier habits. These assignments are often action-oriented and require individuals to practice new skills or engage in specific activities outside of therapy sessions.

For example, a therapist may assign tasks related to assertiveness training, stress management techniques, anger management strategies, or goal setting exercises. These assignments encourage individuals to actively apply the concepts discussed in therapy to their daily lives. By practicing new behaviors and breaking old patterns, individuals can work towards their therapeutic goals.

Mindfulness and Meditation Practices

Mindfulness and meditation practices are widely recognized for their ability to promote relaxation, reduce stress, and increase self-awareness. Therapists may assign mindfulness exercises and meditation practices as part of therapy homework to help individuals cultivate mindfulness in their daily lives.

These assignments can include guided meditations, breathing exercises, body scans, or mindful awareness activities. By incorporating mindfulness into their routine, individuals can learn to observe their thoughts and emotions without judgment, cultivate present-moment awareness, and develop a greater sense of calm and clarity.

By incorporating a variety of therapy homework assignments, therapists can cater to the unique needs of each individual and provide a well-rounded approach to therapy. It’s important for therapists to assess client goals and preferences when assigning homework, ensuring that the assignments are relevant, engaging, and align with the client’s therapeutic journey. For more therapy homework ideas, check out our article on  therapy homework ideas .

Customizing Assignments for Individual Needs

To ensure the effectiveness of therapy homework assignments, it is essential to  customize  them according to the  individual needs  of each client. This personalized approach allows therapists to address specific goals and objectives, tailoring the assignments to suit the client’s preferences and circumstances.

Assessing Client Goals and Objectives

Before creating therapy homework assignments, therapists must first  assess  their clients’ goals and objectives. By understanding what clients hope to achieve through therapy, therapists can design assignments that align with their desired outcomes. For example, if a client’s goal is to improve their communication skills, therapy homework assignments may focus on practicing active listening, assertiveness, or conflict resolution. By linking the assignments directly to the client’s goals, the therapeutic process becomes more targeted and effective.

Tailoring Assignments to Suit Individual Preferences

Each client is unique, and their preferences and learning styles should be taken into consideration when designing therapy homework assignments. Some clients may prefer written exercises and journaling, while others may be more receptive to artistic or creative expression . By tailoring the assignments to suit individual preferences, therapists can increase engagement and motivation, leading to a more productive therapeutic experience.

For example, a client who enjoys writing may find value in self-reflection exercises or the use of  writing and narrative therapy techniques . On the other hand, a client who is more visually oriented might benefit from artistic assignments or creative expression through art therapy. By incorporating activities that resonate with the client’s preferences, therapy homework becomes more enjoyable and meaningful.

By customizing therapy homework assignments, therapists can optimize the therapeutic process and enhance client outcomes. It ensures that assignments are directly aligned with the client’s goals and objectives, promoting a sense of ownership and motivation in their recovery journey. Additionally, tailoring assignments to suit individual preferences increases engagement and enjoyment, fostering a positive therapeutic alliance.

Remember to explore a variety of therapy homework ideas to meet the diverse needs of your clients. Whether it’s therapy homework for self-esteem, mindfulness, relaxation, or any other topic, the key is to create assignments that are relevant, meaningful, and effective. By providing personalized and tailored assignments, therapists can empower their clients in their recovery process.

Incorporating Creativity in Therapy Assignments

To enhance the therapeutic process and encourage self-expression, incorporating  creativity  into therapy assignments can be highly beneficial. Creative activities provide clients with a unique outlet for exploring their emotions, thoughts, and experiences. In this section, we will explore two popular approaches:  art therapy and creative expression  as well as  writing and narrative therapy techniques .

Art Therapy and Creative Expression

Art therapy involves using various artistic mediums to facilitate self-expression, reflection, and healing. Through painting, drawing, sculpting, or collage-making, clients can tap into their creativity and communicate their inner world visually. Art therapy can be particularly effective for individuals who struggle with verbal expression or find it challenging to articulate their emotions.

Engaging in art therapy allows clients to explore their thoughts and feelings in a non-threatening and non-judgmental manner. The creative process itself can be therapeutic, providing a sense of control, empowerment, and catharsis. Art therapists often guide clients in interpreting their artwork, helping them uncover deeper insights and gain a better understanding of themselves.

Integrating creative expression into therapy assignments can offer clients an opportunity to engage with their emotions in a different way. For example, a therapist might suggest creating a collage that represents their goals, dreams, or emotions. This visual representation can serve as a powerful tool for self-reflection and exploration. To learn more about incorporating art therapy into your practice, explore our article on  therapy homework for creative expression .

Writing and Narrative Therapy Techniques

Writing can be a powerful therapeutic tool that allows clients to explore their thoughts, emotions, and experiences. Narrative therapy techniques, such as journaling, letter writing, or storytelling, can help clients gain insight, process challenging events, and reframe their narratives.

Journaling is a widely used form of therapy homework that involves writing down thoughts, feelings, and experiences in a journal or diary. This practice provides an opportunity for self-reflection, self-expression, and problem-solving. Clients can explore their innermost thoughts, identify patterns, and track progress over time. To discover various journaling exercises for therapy, refer to our article on  therapy homework for journaling .

Another approach is letter writing, where clients address letters to themselves, others, or even abstract concepts like their fears or past traumas. This process can be cathartic and empowering, allowing clients to express emotions that may be difficult to articulate in person. Writing a letter can help clients gain closure, find forgiveness , or express gratitude. It provides a safe space for processing emotions and can be revisited as a source of reflection and growth.

By incorporating these creative techniques into therapy assignments, therapists can encourage clients to explore their inner worlds and gain new perspectives. It’s important to remember that creativity is a personal experience, and different clients may resonate with different forms of expression. As a therapist, offering a range of options and tailoring assignments to suit individual preferences can enhance the therapeutic process.

Maximizing the Benefits of Therapy Homework

To ensure the effectiveness of  therapy homework assignments , it’s important to implement strategies that maximize their benefits. By setting realistic expectations, providing ongoing support and feedback, and fostering collaboration between the therapist and client, therapy homework can become a powerful tool for transformation and growth.

Setting Realistic Expectations

When assigning therapy homework, it’s crucial to set realistic expectations for the client. This involves discussing the purpose, goals, and anticipated outcomes of the assignments. By clearly communicating the objectives and potential benefits, clients can better understand the value of their efforts and remain motivated throughout the process.

It’s important to emphasize that therapy homework is not a quick fix but rather a gradual process. Encourage clients to approach their assignments with patience and self-compassion , understanding that progress takes time. By managing expectations, clients are more likely to stay committed and experience the full benefits of therapy homework.

Providing Ongoing Support and Feedback

Support and feedback from the therapist play a crucial role in maximizing the benefits of therapy homework. Regular check-ins and discussions about the assignments allow clients to seek clarification, express concerns, and receive guidance. This ongoing support helps clients stay engaged and motivated, knowing that their therapist is there to provide assistance and encouragement.

Additionally, providing constructive feedback on completed assignments is essential for growth and improvement. Acknowledge the effort and progress made by the client, while also providing suggestions and insights to enhance their understanding and application of the concepts discussed in therapy. This feedback loop strengthens the therapeutic relationship and boosts the client’s confidence in their ability to succeed.

Collaboration Between Therapist and Client

Collaboration between the therapist and client is key to optimizing the benefits of therapy homework . By involving the client in the assignment selection process, therapists can tailor the tasks to suit the client’s individual needs, preferences, and therapeutic goals. This collaborative approach fosters a sense of ownership and empowerment, motivating clients to actively engage in their recovery journey.

Regular communication between therapy sessions is crucial for maintaining this collaboration. Clients should feel comfortable reaching out to their therapist for guidance, clarification, or support related to their assignments. This open line of communication ensures that the therapy homework remains aligned with the client’s evolving needs and allows for adjustments when necessary.

By setting realistic expectations, providing ongoing support and feedback, and fostering collaboration, therapists can help clients maximize the benefits of therapy homework. This approach not only enhances the effectiveness of the assignments but also empowers clients to take an active role in their own recovery journey. To explore a wide range of therapy homework ideas and resources, visit our article on  therapy homework ideas .

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