April 5, 2007
I often tell therapists and patients that the way people get better is to make small changes in their thinking and behavior every day. That's why it's important for patients to do homework - just talking to a therapist for an hour a week is unlikely to be of much help to most people with psychiatric disorders. Homework frequently involves having patients change their distorted thinking so they see reality more clearly, doing "experiments" to change their behavior in small ways to see what happens, and implementing solutions to problems they've discussed in session. I set up homework assignments very carefully and make sure patients are overwhelmingly likely to do them. When an Australian graduate student contacted me a few weeks ago about the role of homework in cognitive therapy, I told him that I think the reason some patients fail to do homework is because of mistakes their therapist makes. They assign homework that is too difficult, they don't explain homework well enough, they don't emphasize the importance of homework, they don't review the homework at the next session, they don't provide a coherent enough rationale, or they don't spend enough time identifying and helping patients respond to thoughts or practical difficulties that will interfere with doing the homework. Occasionally I've found that patients have beliefs (about themselves, about other people, about experiencing negative emotion, and/or about getting better) that make it very difficult for them to fully engage in treatment, and certainly, to extend the work of treatment (homework) between sessions. For thoughts about what to do in cases like these, and for more information about homework in Cognitive Therapy, see Cognitive Therapy for Challenging Problems (Chapter 9), or Using Homework Assignments in Cognitive Behavior Therapy.