Homework in Therapy: Part 1

Doing the work of therapy involves both the client and the therapist. I had a supervisor once time tell me he didn’t give homework assignments because patients never did them. I thought at the time “what a cop out.” What he was engaging was Low Frustration Tolerance. He didn’t have the tolerance or possibly the skill to determine what blocked the patient from doing the homework assignment. To align with client’s lack of discipline regarding their mental health is not the goal of therapy. But this therapist’s comments does bring up an important point. That the key to a client successfully completing homework assignments is a highly skilled therapist. One determined to understand what blocks the client, how to create an assignment to increase client motivation to complete it, and how to handle things if the client failed to do the assignment. Always when I give homework, I tell the client that if they have difficulty doing the assignment they’re not going to be punished by me but that there are usually legitimate reasons why people have difficulties completing assignments. What I’m doing here is taking off pressure. And that pressure is the belief that they HAVE to do the assignment. In setting up this demand for themselves, they set themselves up for or self-downing. In other words, I don’t want the client thinking; ‘I have to do this assignment but I doubt it will work for me ’cause nothing has worked for me recently.’ If we were to assess further we could see the underlying this idea of nothing working out is the belief that he must succeed and that probably he won’t because he is a loser so why try.

Another very important part of increasing the client’s motivation to do the homework is to have them practice the homework in session. I do this all a time with patients who I’m having practice disputations. And as is appropriate according to REBT I have them practice using a great deal of vigor and emotion. In fact, I coach them on how much emotion they are using so that they understand exactly what they need to put into the assignment. I also do a beginning SUDS scale and a post SUDS scale. Typically they feel better and I have increased their motivation to do the homework. As a therapist I love this moment. I love that glimmer of recognition in the patients eye’s that small glimmer of hope.

Now if they still fail to do the assignment or do it only a few times, I will change the focus and add a disputation to combat LFT. I will also give my little lecture about how beliefs are formed. I tell people a belief is not just an idea that something is true but a conviction that something is true. I also tell them that as they practice the irrational belief which naturally produces negative emotion they develop this second idea that because it feels so strongly negative the idea behind the emotion must be true. And also because they function from this belief system, self fulfilling prophecies are created which they wrongly interpret as supportive evidence. I also tell them that they have developed a neural pathway in practicing this irrational belief but neural pathways can be changed. I will continue to explore homework assignments in upcoming blogs.

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