The second session with Elisa -15 years old- was going very well until, shortly before finishing, I took out a self-registration and explained to her the importance of filling it out until our next session, the following week. This is what the psychologists We call it “homework«I see her looking at me perplexed, 'So, on top of that, you're giving me homework!'»
I calmly explain to her that they are not homework and the reasons why they are not necessary, but Elisa has not listened to reason for a while now: “If I don’t do my schoolwork, I’ll do yours.” Three months later, Elisa is the one who explains to other patients during group therapy how “beneficial homework is” and how it has helped her progress.
What tasks are usually assigned in therapy?
First of all, let me clarify that Not all psychologists have the same psychotherapeutic orientation and therefore what may be important for some may no longer be so for others. Thus, from the perspective of the cognitive-behavioral orientationwhich is what I move around in, homework is a fundamental part since with them we work so that the cognitive-behavioral changes achieved during the session are internalized and stabilized until reaching the next session, achieving that the patient acquires greater autonomy with respect to his psychologist.
Furthermore, depending on whether these tasks have been carried out or not, whether they have been done halfway, whether they are incorrect, etc. In the following session, the degree of involvement and commitment of the patient with respect to his own process can be assessed, but they also provide elements to the psychologist to see whether he himself has to change the course of the therapy or introduce changes.
When are homework assignments given?
At the same time, the psychologist, whether providing face-to-face therapy or online therapy, when designing the intervention, also defines the homework. These are given at each session, at the end, and with progressive difficulty. At first they will be relatively easy and quick to do and, as they approach the end, they will require a greater reflective process.
The effectiveness of therapy lies in the alliance between the therapist and patient, in the mutual commitment to wait, understand and transform, thus finding the path to emotional well-being.
Maria Jesus, clinical psychologist
There is an intermediate stage in which The therapist and patient can choose the home therapy together. as long as the objectives of the therapy are not lost sight of. Ideally, in the last sessions, the patient himself should design and carry out the tasks that he considers most convenient and that only require psychologist supervision because it means that your confidence and security will have increased.
Are there different types of tasks?
There are two fundamental models:
1) Permanent. Characteristic examples are:
- Self-registrations to control negative thoughts, with evidence in favor, evidence against and generation of an alternative thought, for example. It is important to do these self-registrations from the first session and introducing variables such as the emotion felt when the automatic thought occurred and its intensity (0-10), the behavior carried out, the physical and emotional consequences, whether something else could have been done… Each of the variables is introduced progressively.
- Bibliotherapy. It is important that the patient not only reads the books we have recommended, but also writes down everything he or she agrees or disagrees with, or has questions about and needs to ask.
- Cinema therapy. It is important that the patient watches the film we have recommended in an active way, similar to bibliotherapy.
- Breathing and relaxation techniques that we have worked on in the session and that can be practiced in different situations, filling out graphs about the levels of relaxation or the difficulty in breathing in said situations.
- Assertive techniques learned in the session, for example, through role-playing, and which can be used to deal with certain personal communication situations that we find difficult.
These are tasks that are only useful for specific sessions, for example, to expand or deepen the list of therapy objectives, to make a list of negative thoughts, etc. so that, for example, cognitive restructuring of the thoughts that appear on the list can be applied.
At the end of therapy, it is important that homework focuses on psychoeducation about warning signs and it may be useful for the patient to review all previous homework and learn how to react to difficulties. If there are any questions, the psychologist is still available for support.
If they are so useful, why are some patients reluctant to do homework?
First of all, this is an overly categorical statement; it cannot be said that all patients do not do all things. Homework assignments throughout therapy because we would be cognitively distorting what is happening.
The reality is that, on occasion, some patients do not do some homework and it is not because they do not want to do it – although there may be some, obviously – because they leave the consultation convinced about the effectiveness of the tasks, so they leave. What happens then?
- Poor management of time and resourcesAmong them, the most frequent one is “I can do this in two minutes” and, if possible, two minutes before the session – there are some who even do it in the waiting room – which means that the benefit that is expected to be obtained disappears.
- Not knowing what it is really forOne of the most common reasons is that psychologists move quickly and, perhaps, we should put more care and time into explaining the homework properly and the patient to notice it correctly, since many become overconfident.
- Excessive difficultyThe task must be personalized to maximize its effectiveness.
- Perfectionism. Although perfection does not exist, some patients have a high dysfunctional cognition about the need to be perfect and, therefore, it would be necessary to design tasks with errors for them.
- Therapist. Although it may seem like a paradox, it is. Accepting that the patient does not do the task repeatedly is not good for the therapy. Therefore, the psychotherapist You should think about what goes through your mind or what your limiting beliefs are when you have to give a homework assignment.
Guidelines for when homework has not been done
It is quite possible that we arrive at the next session and, despite the fact that an initial portion of time should be devoted to following up on homework, the patient prefers to talk about a topic that is causing him great concern. Perhaps because something has happened that he does not know how to deal with, or he even makes conscious efforts to divert attention from his homework.
However, already In the first session, patient and therapist should have agreed on a structure for the session. consisting of an initial time reserved for reviewing the tasks from the previous session because, probably, all the content of the present session revolves around these tasks that should be internalized. All of this does not mean that we cannot talk about this topic that is of such concern to the patient, obviously.
If the patient has not done homework:
- We are not going to give you a “sermon” about the importance of doing them.. After all, it is a consultation, not a nursery. They are patients and not children who we, psychologists/professors, have to scold because they have not done their homework. What we want is for our patients to become self-sufficient, autonomous, self-confident and secure people, and that is why we must start from the beginning.
- We can't get angryIf you have not implemented what we have suggested, for your own good, you must have your reasons.
- We won't blame him. Not at all. We will not even blame you for a responsibility that is ours; we should have explained ourselves better, more calmly, more slowly…
- We are not going to ignore youIf a person does not do what we told them, does exactly the opposite or does what we told them but makes changes, they are telling us how they want their therapy to be, and we should pay a lot of attention to it…
What are the benefits of homework during therapy with a psychologist?
- Reduce your dependence on your therapist. Homework assignments allow you to see that, with everything you have learned, once your entire therapy process is over, you no longer need a psychologist. You will be more independent and autonomous.
- Reduce therapy timeThe more compliant a patient is with tasks, the less time the therapy will take, since the things that he or she currently does in the consultation can be generalized to any context, with less cost in money and time.
- Transfer what you have learned in the consultation to other contexts, in situations where it is more useful to apply what has been learned, in order to maintain the results in the long term.
- Improve the ability of self-knowledgebeing more aware of how one thinks, feels and acts in certain situations.
If a psychotherapy works and is effective it is because it comes from a collaborative work between the psychologist and the patientAs I always tell my patients, this is a 50/50 job, do you accept?
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