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Recommended Homework During Psychotherapy with Couples and Individuals 

Recommended Homework During Psychotherapy with Couples and Individuals
Chapter:
Recommended Homework During Psychotherapy with Couples and Individuals
Author(s):

Arthur E. Jongsma Jr.

DOI:
10.1093/med:psych/9780199845491.003.0100
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Subscriber: null; date: 17 January 2020

The use of homework has been shown to strengthen the psychotherapy process and to improve treatment outcomes (Kazantzis, Whittington, & Dattilio, 2010). With the advent of managed care, which often requires shorter and fewer treatment sessions, therapists assign between-session homework to help maximize the effectiveness of briefer treatment. Homework is an extension of the treatment process, provides continuity, and allows the client to work between sessions on goals. Homework can also be a tool for more fully engaging the client in the treatment process. Assignments place more responsibility on the client to resolve his or her presenting problems, counteracting the expectations that some clients may experience that it is the therapist alone who can cure him or her. For some, it even may bring a sense of self-empowerment.

Another benefit of homework is that these assignments give the client the opportunity to implement and evaluate insights or coping behaviors that have been discussed in therapy sessions. Practice often heightens awareness of various issues. Furthermore, homework increases the expectation for the client to follow (p. 509) through with making changes rather than just talking about change. Exercises require participation, which creates a sense that the client is taking active steps toward change. Homework also allows the client to try new behaviors, bringing these experiences back to the next session for processing. Modifications can then be made to the client’s thoughts, feelings, or behaviors as the homework is processed in the therapy session. Additionally, using assignments that call for their participation homework increases the involvement of family members and significant others in the client’s treatment.

Three homework assignments have been adapted from The Adult Psychotherapy Homework Planner (Jongsma, 2006) for couples and three for an individual client. The three recommendations for couples focus on attending to meeting the partner’s needs and desires in the relationship, identifying changes each partner can make to improve the relationship, and teaching the importance of clarifying parenting expectations in behavioral language and rewarding a child’s rule-keeping behavior. The three recommended homework assignments for individual clients target anger management, behavioral activation for depression treatment, and exposure techniques for the treatment of phobic fear. Some assignments need the therapist to guide the client in completing the exercise while others can be completed independently by the client during the week between appointments.

How can we Meet each Other’s Needs and Desires?

Suggestions for Processing With the Client

This assignment has two parts—one to be completed by each of the partners within the relationship. It is recommended that each partner complete the homework independently and bring the results back for sharing and processing within a conjoint session. Take the opportunity to teach both partners the key concept that mutually satisfying relationships necessitate each partner being willing at times to sacrifice his or her own needs and desires and choose to meet the needs and desires of the partner. Also teach the partners that each of them should take personal responsibility for reasonable satisfaction of some needs outside of the relationship.

Meeting Each Other’s Needs

A successful and healthy intimate relationship requires that each partner invest some of his or her time and energy into satisfying the needs and desires of his or her partner. When relational needs are not being met satisfactorily, the relationship is in serious trouble and eventually may break. However, all needs cannot be met by one partner. Each must take some responsibility for satisfying needs apart from the relationship. This exercise helps you identify and clarify your needs as well as the needs of your partner.

Partner One Perspective

  1. 1. List the needs and desires that you expect the relationship to meet.

    1. a.

    2. b.

    3. c.

    4. d.

  2. 2. List your partner’s needs and desires (as you understand them) that he or she expects the relationship to meet.

    1. a.

    2. b.

    3. c.

    4. d.

  3. 3. List what you are willing to do to meet your partner’s needs and desires.

    1. a.

    2. b.

    3. c.

    4. d.

  4. 4. List what you expect your partner to do to meet your needs and desires.

    1. a.

    2. b.

    3. c.

    4. d. (p. 510)

  5. 5. How have you let your partner down in meeting his or her needs and desires?

    1. a.

    2. b.

    3. c.

    4. d.

  6. 6. How has your partner let you down in not meeting your needs and desires?

    1. a.

    2. b.

    3. c.

    4. d.

  7. 7. What could you do to get some of your needs met outside of the relationship, by yourself or with the help of others?

    1. a.

    2. b.

    3. c.

    4. d.

  8. 8. Describe three times in which you feel that you have sacrificed your own needs and desires to meet the needs and desires of your partner instead.

    1. a.

    2. b.

    3. c.

  9. 9. List at least three enjoyable and rewarding activities that you feel would help you and your partner satisfy each other’s need for social contact.

    1. a.

    2. b.

    3. c.

Repeat these questions for the Partner Two Perspective

Positive and Negative Contributions to the Relationship: Mine and Yours

Suggestions for Processing with the Client

Copy this exercise and give one to each partner. Ask each partner to complete the exercise independently and to bring it to a subsequent conjoint session. Review each partner’s list and attempt to clarify the language and to put the changes requested in positive terms. Clients generally indicate what they would like not to happen rather than what they would like to happen. Ask each client for a commitment to work on making the changes that are called for in his or her own behavior.

When conflicts predominate in a relationship, an exaggerated focus gets placed on the negative aspects of the partner. Defenses keep us from evaluating our own contributions to the conflict and from noticing the positive things that the partner does to enhance the relationship. We become so focused on the negative aspects and primarily see the partner as the cause of the failure of the relationship. This assignment attempts to put things in perspective by asking each partner to take an honest look at himself or herself as well as evaluating the partner’s contribution to conflict. Additional balance is sought by attempting to have each partner list the positive things that are brought to the relationship by each partner.

Partner List

Complete each of the following four lists. In the first list, itemize those things that you do that contribute positively to the relationship. In the second list, itemize those things that your partner does that enhance the relationship. Third, list the things that you need to do to improve the relationship and make it stronger. Finally (and this is always the easiest part), list the things that you believe your partner needs to do to make the relationship better.

  1. 1. What I do to enhance the relationship:

    1. a.

    2. b.

    3. c.

    4. d.

    5. e.

  2. 2. What does my partner do to enhance the relationship?

    1. a.

    2. b.

    3. c.

    4. d.

    5. e. (p. 511)

  3. 3. Things I need to do to improve the relationship:

    1. a.

    2. b.

    3. c.

    4. d.

    5. e.

  4. 4. What does my partner need to do to make the relationship better?

    1. a.

    2. b.

    3. c.

    4. d.

    5. e.

Repeat these questions for Partner Two List.

Using Reinforcement Principles in Parenting

Suggestions for Processing with the Client

Parents find it difficult to express expectations in behaviorally specific language—so do therapists. We must patiently try to shape parents’ behavior as we process the rules that they develop. Also, be careful to bring to light unspoken rules that are left unlisted, but actually are very important for harmony in the household. Use counseling sessions to review lists and to model or role play positive reinforcement of rule-keeping behavior. Watch out for negative consequences for rule breaking that are not “tied to the crime” and are too protracted.

Parenting Methods

Rules are best kept when there are as few as possible; they are stated clearly and in a positive direction; obedience is recognized by reward; and disobedience is either ignored (if a minor violation) or met with a consequence that is swiftly administered, brief, not harsh, focuses on the offensive behavior and not on the child, and is somehow related to the broken rule. This exercise helps you think about what your rules are for your child and what the consequences for his or her obedience and disobedience are.

Think about, discuss, and then write out the three most important rules of the household for your child. Write them concisely and clearly so there is no misunderstanding as to what is expected from the child. Also, be sure to write them in observable terms and in a positive direction. For example:

Example A

Bad rule: Johnny must stop causing so much trouble with his sister.Better rule: Johnny must keep his hands off his sister, talk to her softly and politely, and allow her to finish her TV program before asking to change the channel to his preference.

Example B

Bad rule: Johnny must take his schoolwork more seriously and be more responsible about homework assignments.Better rule: Johnny must attend all his classes promptly and regularly, complete and hand in each assignment on time, keep the rules of the classroom, reserve at least 1 hour per night for quiet study, and obtain no grade below C–.

Example C

Bad rule: Johnny must not explode in anger whenever he is told he may not do some activity or must stop some activity he is doing.Better rule: When Johnny is told what he may or may not do, he must accept the parental or teacher limits calmly and respectfully, carrying out the request within 30 seconds or less.

Three Most Important Rules

  1. 1. _______________

  2. 2. _______________

  3. 3. _______________

(p. 512) When rules are kept or reasonably obeyed, it is easy to take this behavior for granted and not acknowledge it. But when the goal is to build self-esteem, increase compliance, and reduce conflict with authority, then it is advisable to focus positive attention on obedience or compliance. Find ways to reward obedient behavior whenever and wherever it occurs. Rewards do not have to be elaborate, expensive, or even concrete. The reward can be as simple as “Thanks, I appreciate that” or an affectionate pat on the back. At times, it may be appropriate to stop and talk about how pleasant it is for everyone when rules are kept, respect is shown, and conflict is at a minimum. Finally, some rewards may be more concrete such as a small gift, a favorite meal, a special outing, a privilege granted, or an appreciative note left on his or her pillow.

Now list four ways that you could show positive recognition to your child for keeping the rules.

  1. 1. _______________

  2. 2. _______________

  3. 3. _______________

  4. 4. _______________

Obviously, rules are not going to be kept 100% of the time by any child. The difficult task for a parent is to decide how to respond to disobedience most effectively and reasonably. Two cardinal rules for punishment: First, do not react when and if your anger is not well controlled; postpone action but make it known that you are doing so. Second, keep your focus on the child’s behavior that is out of bounds and do not disparage, name-call, swear at, or belittle the child; give consequences with an attitude of respect.

Consequences should be given as soon as reasonably possible after the disobedience—long delays before consequences reduce effectiveness significantly. Consequences should be brief and tied to the offensive behavior, if possible. Long and extended consequences breed resentment, cause hardship for the enforcers of the consequences, and are not any more effective than something more pointed and brief. Finally, be sure to be consistent in giving consequences; both parents have to work together. Misbehavior should not be overlooked one time and addressed the next nor should it be overlooked by one parent and punished by the other.

Now list two possible consequences for each of the Three Most Important Rules that you listed previously.

  1. 1a.

  2. 1b.

  3. 2a.

  4. 2b.

  5. 3a.

  6. 3b.

Alternatives to Destructive Anger

Suggestions for Processing with the Client

Clients often feel they responded to a frustrating situation in the only way possible. They fail to realize that they have choices and control over their behavior. You may want to review the alternatives to rage listed in the first section of the assignment to help the client understand the alternatives he or she could apply when dealing with frustration or anger. Review the client’s journal material and suggest additional constructive ways to respond to frustrating or hurtful situations that prompt his or her mismanaged anger.

Anger Response Alternatives

Destructive anger can take many forms. Anger can be expressed in rage that is out of control, either verbally or physically. We also can express anger by snapping at someone or being unkindly critical. A third form that anger may take is that of cold, icy withdrawal that punishes the other person by shutting the person out, shunning the person, or refusing to acknowledge the person’s attempts to relate to us. All of these reactions and many more can be destructive to the relationship and to our own feelings of self-esteem. Destructive (p. 513) expressions of anger often generate later feelings of guilt and shame.

This exercise is designed to briefly identify some constructive alternatives to destructive anger by giving a brief description of the positive alternative. The goal is for you to consider these alternatives as you seek to replace destructive anger with more constructive behaviors. You will be asked to keep a journal of situations in your daily life that provoked anger and then note how one or more of these constructive alternatives may have been applied to the situations.

Constructive Alternatives

  1. a. Assertiveness. Speaking forthrightly in a manner that is very respectful of the other person’s needs and rights and does not attack anyone so as to make him or her defensive.

  2. b. Tune out/cool down. Recognize that the situation has become volatile and nonproductive and suggest withdrawal from the situation to give each party a chance to cool down and collect his or her thoughts and regain personal control.

  3. c. Relaxation. Learn and implement relaxation skills to reduce stress and tension through the use of words that cue relaxation, deep breathing that releases tension, imagining relaxing scenes, or deep muscle relaxation procedures.

  4. d. Diversion. When anger is felt to be building, find diversionary activities that stop the buildup and focus the mind on more enjoyable experiences.

  5. e. Physical exercise. When anger and tension levels rise, physical exercise can be a wonderful way to release tension and expel energy as an alternative to losing control or exploding in rage.

  6. f. Problem-solving skills. Identify or clarify the problem, brainstorm possible solutions, review the pros and cons of each alternative solution, select the best alternative for implementation, evaluate the outcome as to mutual satisfaction, and finally, adjust the solution if necessary to increase mutual satisfaction.

  7. g. Self-talk. Take time to talk to yourself in calming, reasoned, and constructive sentences that move you toward anger control and away from hurtful expressions of anger.

  8. h. “I” messages. Speak to the target of your anger, describing your feelings and needs rather than attacking, labeling, or describing the other person’s behavior, motivations, or goals. Begin your sentences with “I feel … “ or “I need…. “

  9. i. Other. Describe your own or your counselor’s alternative to rage.

    • _______________

    • _______________

    • _______________

    • _______________

Application to Daily Life

In the columns that follow, describe the date and time, the situation that prompted the angry response, the destructive response, and the alternative constructive response that might have been used. In the final row, instead of writing a full description of the alternative, you may simply enter the alphabetical indicator of the constructive alternative, A through I.

Recommended Homework During Psychotherapy with Couples and Individuals

Repeat recording situations in this format as often as necessary.

Identify and Schedule Pleasant Activities

Suggestions for Processing with the Client

The client’s depression may interfere with his or her ability to recall pleasant activities and he or she may censor many of these activities, feeling he or she does not have the energy for them. Encourage him or her to brainstorm (p. 514) freely. If it is necessary, this assignment can be done within the counseling session rather than relying on the reduced motivation of the depressed client to fulfill the requirements of the assignment. Perhaps the brainstorming and scheduling need to be done within the session and the homework is that of implementing the activity and recording its impact. It is recommended that the client monitor his or her mood before, during, and after the event to focus him or her on the positive effect that the event has on mood. Review and reinforce the client’s success in improving his or her mood using the satisfying activities.

Pleasurable Activities

People who are depressed almost always withdraw from participation in activities that they once found satisfying, rewarding, pleasurable, or just plain fun. It is very important to break this cycle of withdrawal and to begin reinvesting in the activities of life, the relationships around you, and the things you do well. A starting point for this task of reinvestment or reinvolvement is to create an inventory of all those things that you found to be pleasant events in the past.

  1. 1. On the lines that follow, write down a description in only a few words of those activities that you found pleasurable and pleasant in the past. These enjoyable activities should include (1) positive social interactions (e.g., spending time with a good friend), (2) useful or productive activities (e.g., caring for your child, doing a job well), and (3) intrinsically pleasant activities (e.g., a meal at your favorite restaurant, listening to favorite music, taking a warm bath). During this brainstorming session, allow yourself to freely recall any pleasant and enjoyable activities without censoring them based on whether you think you have the energy for them or whether they are feasible. You may want to ask significant others to give input to your list, but please remember that this is your list of personal pleasant activities and must reflect events that you find enjoyable.

  2. 2. Now select from your list of pleasant events seven that you believe are most likely for you to engage in. In the seven lines, list those activities and then to the right of the activity, write a few words that describe what was positive about the activity or why you found it pleasant or enjoyable.

  3. 3. On the following lines, schedule one pleasant activity per day to which you are committed. Include the time of the day and with whom you might share the activity. (p. 515)

  4. 4. On the following lines, record the activity engaged in and the degree of satisfaction on a scale of 1 (low) to 10 (high) that was felt during and after the engagement with the pleasant event. Also record the effect that the pleasant event had on your mood using a scale of 1 (no positive effect) to 10 (strong uplifting effect on mood).

Positive Social Interactions

Intrinsically Pleasant

Useful Activities Activities

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

_______________

Most Likely Activities

Why Pleasant?

1) _______________

_______________

2) _______________

_______________

3) _______________

________________

4) _______________

_______________

5) _______________

_______________

6) _______________

_______________

7) _______________

_______________

Activity

When and with Whom

Day 1 ____________

_______________________

Day 2 ____________

_______________________

Day 3 ____________

_______________________

Day 4 ____________

_______________________

Day 5 ____________

_______________________

Day 6 ____________

_______________________

Day 7 ____________

_______________________

Activity

Satisfaction

Effect on Mood

Day 1 ______

_______________

______________

Day 2 ______

_______________

______________

Day 3 ______

_______________

______________

Day 4 ______

_______________

______________

Day 5 ______

_______________

______________

Day 6 ______

_______________

______________

Day 7 ______

_______________

______________

Gradually Reducing your Phobic Fear

Suggestions for Processing with the Client

Graduated exposure to a feared object or situation has proven to be a very successful approach to extinguishing a fear response. This assignment focuses the client on the phobic stimulus and its effect on his or her life. Then, the client must develop a gradual hierarchy of exposure steps to the feared stimulus. You probably will have to be directly involved in constructing this hierarchy with the client. As preparation for beginning the in vivo exposure to the feared stimulus, it is recommended that you teach the client some behavioral and cognitive anxiety-reduction skills, such as deep breathing, progressive relaxation, positive imagery, confidence-building self-talk, and so on. Monitor and reinforce his or her implementation of these skills as the exposure program progresses. Urge the patient to increase exposure as anxiety diminishes to the current step.

Overcoming Fears

Fears that are so strong that they control our behavior need to be faced and overcome. This exercise helps you do just that: Identify what your fear is; describe how it affects you; develop a plan to face it systematically; and, finally, actually take steps to face your fear and win.

  1. 1. It is important to clearly identify what you fear and how it affects you emotionally (e.g., feel nervous and tense), behaviorally (such as avoid contact and/or do not talk about the feared stimulus), and physically (for instance, heart pounds, forehead and palms sweat, stomachache, nausea). Describe what the feared object or situation is and then tell how it affects you.

    To overcome a fear, it must be faced in a gradual but systematic fashion. We call this exposure. When you practice exposure in the proper way, fear steadily diminishes until it does not control your behavior or affect you physically. The key to the process is to develop a plan for gradually increasing exposure to the feared object or situation. Once the plan is developed, you then expose yourself one step at a time to the feared object or situation. You do not take the next step in the gradual exposure plan until you are quite comfortable with the current level of exposure.

    For example, if your fear is that of driving alone on the expressway during heavy traffic, you could design a plan as follows.

    Step 1: Drive on the expressway for 5 minutes at a time of light traffic with a supportive person to give reassurance.

    Step 2: Drive on the expressway for 5 minutes at a time of light traffic, alone.

    Step 3: Drive on the expressway for 10 minutes at a time of light traffic, alone.

    Step 4: Drive on the expressway for 15 minutes at a time of light traffic, alone. (p. 516)

    Step 5: Drive on the expressway for 5 minutes at a time of heavy traffic, alone.

    Step 6: Drive on the expressway for 15 minutes at a time of heavy traffic, alone.

    Each next step is taken only after the fear is low or gone in the current step.

  2. 2. Now create a gradual exposure program to overcome your feared object or situation. The steps can increase the time you spend with the feared object or situation, increase your closeness to it, increase the size of the object, or a combination of these things. Use as many steps as you need. Your therapist is available to help you construct this plan, if necessary.

    1. Step 1. _________________________________

      _________________________________________

      _________________________________________

    2. Step 2. _________________________________

      _________________________________________

      _________________________________________

    3. Step 3. _________________________________

      _________________________________________

      _________________________________________

    4. Step 4. _________________________________

      _________________________________________

      _________________________________________

    5. Step 5. _________________________________

      _________________________________________

      _________________________________________

    6. Step 6. _________________________________

      _________________________________________

      _________________________________________

    Now it’s time for a gradual but steady exposure to your feared object or situation. Stay relaxed. Your therapist may teach you some deep breathing, muscle relaxation, and positive self-talk techniques that you can use to keep yourself relaxed. For each attempt at exposure, record the coping technique you used and rate your degree of fear on a scale of 1 to 100, with 100 representing total panic, the sweats, and heart-pounding shakes. The rating of 1 represents total calm, complete confidence, peace of mind, looseness, and relaxed feeling. When your rating is reduced to 10 or lower on a consistent basis for the exposure to a particular step, then it’s time to consider moving on to the next step.

Feared Object or Situation

Reaction to Feared Object or Situation

__________________

Emotional reaction: _____

___________________

___________________

___________________

Behavioral reaction: _____

___________________

___________________

____________________

Physical reaction: _____

Exposure Steps

Coping Technique and Fear Rating

Step 1. ____________

1st attempt: ____________

_________________

2nd attempt: ____________

_________________

3rd attempt: ____________

Step 2. ____________

1st attempt: ____________

_________________

2nd attempt: ____________

_________________

3rd attempt: ____________

Step 3. ____________

1st attempt: ____________

_________________

2nd attempt: ____________

_________________

3rd attempt: ____________

Step 4. ____________

1st attempt: ____________

_________________

2nd attempt: ____________

_________________

3rd attempt: ____________

Step 5. ____________

1st attempt: ____________

_________________

2nd attempt: ____________

_________________

3rd attempt: ____________

Step 6. ____________

1st attempt: ____________

_________________

2nd attempt: ____________

_________________

3rd attempt: ____________

References and Readings

Bevilacqua, L. J., & Dattilio, F. M. (2010). Family therapy homework planner (2nd ed.). Hoboken, NJ: Wiley.Find this resource:

    Finley, J. R., & Lenz, B. S. (2009). Addiction treatment homework planner (4th ed.). Hoboken, NJ: Wiley.Find this resource:

      Jongsma, A. E. (2006). Adult psychotherapy homework planner (2nd ed.). Hoboken, NJ: Wiley.Find this resource:

        Jongsma, A. E., Peterson, L. M., & McInnis, W. P. (2006). Adolescent psychotherapy homework planner (2nd ed.). Hoboken, NJ: Wiley.Find this resource:

          Jongsma, A. E., Peterson, L. M., & McInnis, W. P. (2006). Child psychotherapy homework planner (2nd ed.). Hoboken, NJ: Wiley.Find this resource:

            Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144–156. (p. 517) Find this resource:

              Schultheis, G. M., Alexander O’Hanlon, S., & O’Hanlon, B. (2010). Couples therapy homework planner (2nd ed.). Hoboken, NJ: Wiley.Find this resource:

                Related Topics

                Chapter 50, “Improving Completion of Therapeutic Homework”

                Chapter 99, “Recommended Self-Help Books, Autobiographies, and Films”

                Chapter 101, “Recommended Self-Help Internet Resources for Patients”