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At the end of the day all the ta ...

Posted Mar 03 2009 3:41pm

At the end of the day all the talking and insight in the world is worth nothing if it does lead to a change in behaviour and a resulting change in outcomes for a client. At some point in time what is learnt, understood or acted out in the therapy room has to generalise to the client’s everyday world.

This translation from therapy room to real life is often done using homework exercises in cognitive behavioural therapy. A frequent complaint I hear in supervision is that the client turns up but hasn’t done their homework. This often generates a sense of frustration in the therapist leading to a label of being resistant used more pejoratively that psychologically.

If a client is not doing their homework but is turning up regularly for therapy it is not in my view useful or accurate to say the client is resistant to change. It is more useful to say the client has conflicting motivations about change. Clients may avoid working in therapy because they fear it will not work and this will reinforce their hopelessness. At the same time client may avoid working in therapy because it will work and then they will have to take responsibility for themselves and get on and have a life which can be scary stuff.

The very fact that they continue to come to therapy suggests that some aspect of them believes in or wants to change. Highlighting this as a conflict and exploring the mixed motivations using a cost benefit analysis technique frequently uncovers a way forward.

Calling it homework often casts in the frame of teacher and pupil with accompany memories of school, sometimes for the worse. It also puts it into a frame that this something the client is doing for somebody else i.e. the therapist rather than for themselves. At the same time I have never been totally comfortable with other descriptions such as activity scheduling or behavioural experiments.At the end of the day I usually come back to calling it homework.

There area number of good books and articles on using homework in a cognitive behavioural framework. Leahy’s great book;

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