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.

6 replies
  1. Kath Mansfield
    Kath Mansfield says:

    Thankyou for the reminder about homework. In addition to what you have written, I have found that having trust and an excellent rapport with my clients is also essential when encouraging (especially) the initial attempts at ‘homework’ (or as I sometimes call it ‘practice’). Working with individuals with a first epsiode of psychosis and it has become very clear that without trust and rapport even the best worded attempts to explain homework, carefully constructing and targetting the homework, emphasising its importance and reviewing it will not necessarily promote its completion with this population. It is my reflection that it is often the fact that I have taken the time to develop trust and rapport with my clients that they then agree to try the homework and actively contribute to its formulation. Once they develop an understanding of its benefits they are usually keen to continue.

  2. CT Today
    CT Today says:

    Judith S. Beck says:

    I’m so pleased you brought up the therapeutic alliance. In order to get patients to do work either in or out of session, a good alliance is essential.

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  4. Frances Ludmer
    Frances Ludmer says:

    I like the model of having homework for an individual because it allows a person to connect to self and internalize thinking with more depth. Also, such thoughts correlate with other therapies, and that has proved to be helpful. However, it is also an imperative to be conscientious of timing as homework adds to a person’s schedule, and it might not always be available. Nevertheless, through a collaborative efforts, something excellent may take place.

    • Sarah Licata
      Sarah Licata says:

      Hi David – To contact Dr. Beck from our website, click Contact in the top menu, fill out the email enquiry form and choose “To contact Dr. Judith Beck.”


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