Improving Compliance with Homework

Since others haven't contributed yet, I'll contribute a few ideas.

There are a few things I try to do in developing "homework" in order to improve the odds of the client following through on it:

• Develop homework collaboratively rather than assigning it unilaterally.
• Use homework consistently every session.
• Make sure the homework is clearly related to the client's goals.
• Ask the client if they have any objections to the homework and ask them if they see anything which would stop them from doing it.
• Review the homework towards the beginning of the next session and make use of it in the session. Make sure the client notices how they benefit from doing the homework.

There are a few questions that I often ask the client when non-compliance is a problem:

• "What's your recollection of what you were going to do for today's session?"
• "As you remember it, what was the point to [the assignment]?"
• "Think of a time during the week when you thought of doing [the assignment] and ended up not doing it... What feelings do you remember? What thoughts do you remember running through your head?"
• "Is [the goal] still something you want to work towards?"
• "Does [the assignment] still make sense to you?"
• "Do you have any objections to [the assignment]?"
• "Do you want to give this another try or would you like us to come up with another option?"
• "What could we do to make it easier for you to follow through on this?"

If non-compliance becomes a persistent problem, I check to make sure I'm doing good basic Cognitive Therapy:

• Are we working collaboratively towards clear goals which the client values? Does the client recognize that the reason to follow through on tasks between sessions is to achieve their goals sooner, not to benefit the therapist? (Heck, I'm in private practice. The less homework they do, the longer therapy will take, and the more money I'll collect. The point is to benefit them, not me.)
• Have I been getting feedback from the client on a regular basis? Have I been asking explicitly for negative feedback? Have I been taking their feedback seriously?
• Am I working collaboratively with the client to overcome the problems with compliance? Have we pinpointed the thoughts that lead to non-compliance? Have we tried modifying the assignment to make it easier for them to follow through on?

These simple suggestions certainly don't eliminate problems with compliance but I find that they are often quite helpful. Does anyone else have suggestions or comments?

Replies:

Simply Reviewing Previous Homework Substantially Improves Compliance with Subsequent Homework, by Jim Pretzer, 12/19/99

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