Better Therapy Homework: Research Brief

Therapist Behaviors as Predictors of Immediate Homework Engagement in Cognitive Therapy for Depression
Cognitive Therapy Research, 2018

Patients’ level of engagement with therapy homework, particularly in the first few sessions of therapy, is predictive of improvements in their symptoms both overall and from one session to the next. (Conklin et al., 2018) However, research on the subject is limited and therapists receive scant training in effective use of homework with their patients. 

Previous research and expert opinion has found that review of the previous session’s homework was particularly predictive of compliance and improvement.

This study shows that rather than spend a long time reviewing previous homework challenges, clinicians should allocate more time to assigning future homework, emphasize practicing of new skills and ensure that the homework related to those skills is specific and understandable. 

Improved engagement in therapy homework is thought to be influenced by therapists’ explanation of rationale for assignments, tailoring of assignments to the patients’ problems, and troubleshooting possible problems that might affect compliance. 

Skills assigned for homework should be practiced first in session, and patients would benefit from written instructions for each assignment rather than verbal instructions alone. The sooner a patient is engaged in homework, the greater the likelihood of completion throughout the therapeutic process. 

Highlights from the Study

“Clinicians have thus far had to largely rely on expert advice and clinical intuition to determine what elements of the homework process are important to emphasize to increase the likelihood that patients complete homework.” (page 9)

“Therapist efforts to assign homework was the numerically strongest predictor of homework engagement.” (page 9)

“Homework engagement could be enhanced when therapists emphasize key elements of the homework assignment process in early sessions.” (page 10)

At Feeling Good Institute, therapists are committed to continuous improvement and refinement of their therapy skills through weekly training of dozens of professional skills, including better use of homework for improved therapy outcomes.   

Learn about the essential skills for effective cognitive behavior therapy and how we set therapists up for success.

Research Brief Author: Maor Katz, MD

Citation: Conklin LR, Strunk DR, Cooper AA (2018). Therapist Behaviors as Predictors of Immediate Homework Engagement in Cognitive Therapy for Depression. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839503/#R21