Handbook of Homework Assignments in Psychotherapy (eBook)

Nikolaos Kazantzis, Ph.D., is faculty member at the School of Psychology, Massey University, Auckland, New Zealand. He has published widely on the topic of homework assignments in psychotherapy, including serving as a Guest Editor for special issues on this topic in the journals IN SESSION: Journal of Clinical Psychology (2002), Journal of Psychotherapy Integration (2006), and Cognitive and Behavioral Practice (2006). He has co-authored more than 40 articles and book chapters and has participated in national and international conferences related to his research interests. He is also a recipient of the Royal Society of New Zealand Science and Technology Award for Beginning Scientists, The Australian Association for Cognitive Behavior Therapy’s (AACBT) Tracy Goodall Early Career Award, and Massey University’s Research Medal – Early Career. Dr. Kazantzis is a licensed (registered) clinical psychologist and maintains a part-time practice in Auckland, New Zealand.  Luciano L’Abate, Ph.D., is Professor Emeritus of Psychology, Georgia State University, Georgia, Atlanta, USA where he was Director of the Family Psychology Training Program and the Family Study Center. He completed his Ph.D., at Duke University, with post-doctoral specialization at Michael Reese Hospital in Chicago. He worked in the Psychiatry Departments of Washington (St. Louis) and Emory (Atlanta) Universities Schools of Medicine before moving to Georgia State University, where he spent his entire academic career. He was in part-time private and consulting and clinical practice for 42 years. He has published (author, co-author, edited, and co-edited) 37 books, 3 are in press, as well as over 250 papers in scientific and professional journals.

ACKNOWLEDGMENTS 5
ABOUT THE EDITORS 7
CONTRIBUTORS 9
PREFACE 13
CONTENTS 17
INTRODUCTION AND HISTORICAL OVERVIEW 19
HISTORICAL OVERVIEW 19
WHAT CONSTITUTES A PSYCHOTHERAPY HOMEWORK ASSIGNMENT? 21
THEORETICAL CONSIDERATIONS 21
WHAT ARE THE ISSUES IN USING HOMEWORK IN DIFFERENT PSYCHOTHERAPIES? 24
THE PRACTITIONERS OF HOMEWORK IN PSYCHOTHERAPY 26
CONTINUING RESEARCH ON PSYCHOTHERAPY OUTCOMES 26
CONCLUSION 28
REFERENCES 28
Part I PSYCHOTHERAPY APPROACHES 34
Chapter 1 BEHAVIOR THERAPY 35
WHY HOMEWORK SHOULD BE ASSIGNED IN BEHAVIOR THERAPY 36
TYPES OF HOMEWORK ASSIGNMENTS 38
DESIGNING AND ASSIGNING HOMEWORK 39
HOMEWORK COMPLIANCE 41
HOMEWORK ASSIGNMENTS WITH CHILDREN AND TEENAGERS 45
CASE EXAMPLES 47
CONCLUSION 50
REFERENCES 50
Chapter 2 CLIENT-CENTERED THERAPY 51
ROGERS’ THEORY OF THERAPY 51
THE ACTUALIZING TENDENCY 52
THE CORE CONDITIONS 53
THE NONDIRECTIVE ATTITUDE 55
ROGERS’ THEORY OF CHANGE 56
EXAMPLES OF CLIENT-INITIATED HOMEWORK 57
MEANS AND ENDS IN THERAPY 60
CLIENT-INITIATED EXPERIMENTS AND HOMEWORK 61
SUMMARY 64
REFERENCES 64
Chapter 3 COGNITIVE THERAPY 67
OVERVIEW OF COGNITIVE THERAPY 67
THE ROLE OF HOMEWORK 69
CASE EXAMPLE 75
SUMMARY 77
REFERENCES 78
Chapter 4 EMOTION-FOCUSED EXPERIENTIAL THERAPY 80
EMOTION-FOCUSED THERAPY AND THE EMOTION COACH 80
PRINCIPLES OF EMOTION COACHING 81
STAGES OF EMOTION COACHING 82
FRAMEWORK FOR THE SYSTEMATIC USE OF HOMEWORK IN EFT 83
CASE EXAMPLES OF THE EFT APPROACH USING HOMEWORK ASSIGNMENTS 96
CONCLUSION 97
REFERENCES 97
Chapter 5 INTERPERSONAL PSYCHOTHERAPY 99
OVERVIEW OF INTERPERSONAL PSYCHOTHERAPY 99
EMPIRICAL SUPPORT FOR IPT-A ADOLESCENTS 100
THE ROLE OF HOMEWORK IN IPT-A 101
DETAILED CASE EXAMPLE 108
CONCLUSION 113
REFERENCES 113
Chapter 6 PSYCHODYNAMIC THERAPY 115
THE ROLE OF HOMEWORK IN PSYCHODYNAMIC PSYCHOTHERAPY 116
SHARON 118
SAUL 120
CONCLUSIONS 122
REFERENCES 124
Chapter 7 ACCEPTANCE AND COMMITMENT THERAPY 126
AN OVERVIEW OF ACT 126
EVIDENCE ON ACT 132
CLINICAL EXAMPLE 141
CONCLUSION 143
REFERENCES 144
Chapter 8 BRIEF STRATEGIC FAMILY THERAPY 146
SECTION I: THEORETICAL UNDERPINNINGS AND RESEARCH SUPPORT OF BSFT 146
SECTION II: RESEARCH SUPPORT FOR BSFT 151
SECTION III: NATURE OF HOMEWORK IN BSFT 153
SECTION IV: CASE STUDIES 157
CONCLUSIONS 161
REFERENCES 161
Chapter 9 PERSONAL CONSTRUCT THERAPY 163
PRINCIPLES OF PERSONAL CONSTRUCT THERAPY 163
METHODS FOR ARTICULATING PERSONAL MEANINGS 164
METHODS FOR EXTENDING CONSTRUCT SYSTEMS 170
CONCLUSION 180
REFERENCES 181
Part II CLIENT POPULATIONS 184
Chapter 10 OLDER ADULTS 185
RECOMMENDED ADAPTATIONS TO CBT FOR AN OLDER POPULATION 186
COMMON BARRIERS TO SUCCESSFUL USE OF HOMEWORK 187
STRATEGIES FOR HOMEWORK WITH OLDER ADULTS 188
CASE STUDIES 191
CONCLUSION 195
REFERENCES 195
Chapter 11 COUPLES 197
PURPOSES OF HOMEWORK IN COUPLE THERAPY 198
COMMON BARRIERS TO THE SUCCESSFUL USE OF HOMEWORK IN COUPLE THERAPY 199
TYPES OF COUPLE THERAPY HOMEWORK ASSIGNMENTS BASED ON THEORETICAL AND EMPIRICAL SUPPORT 203
THE CASE OF MURRAY AND JUNE 206
THE CASE OF CONNIE AND JIM 208
CONCLUSION 209
REFERENCES 209
Chapter 12 FAMILIES 212
HOMEWORK IN FAMILY THERAPY 214
HOMEWORK IN THE CONTEXT OF VARYING TARGETS FOR INTERVENTION 216
EMPIRICAL FINDINGS 218
BARRIERS TO THE SUCCESSFUL USE OF HOMEWORK 219
STRATEGIES FOR SUCCESSFUL HOMEWORK USE 220
USE OF HOMEWORK IN PREVENTION PROGRAMS 222
CASE EXAMPLE: THE WILLIAMS FAMILY 222
CASE EXAMPLE: THE KLEIN FAMILY 225
SUMMARY AND CONCLUSIONS 227
REFERENCES 228
Part III SPECIFIC PROBLEMS 233
Chapter 13 BORDERLINE PERSONALITY DISORDER 234
BIOSOCIAL THEORY OF BORDERLINE PERSONALITY DISORDER 234
COMMON BARRIERS TO THE EFFECTIVE USE OF HOMEWORK WITH BPD PATIENTS 242
STRATEGIES TO OVERCOME BARRIERS TO EFFECTIVE HOMEWORK IN DBT 245
RESEARCH ON HOMEWORK IN DBT 246
CASE ILLUSTRATIONS 246
SUMMARY 250
REFERENCES 250
Chapter 14 CHRONIC DEPRESSION 253
DEFINITION OF CHRONIC DEPRESSION 253
ADDRESSING BARRIERS TO THE SUCCESSFUL USE OF HOMEWORK 254
GOOD COGNITIVE THERAPY HOMEWORK ASSIGNMENTS FOR CHRONIC DEPRESSION 257
CASE EXAMPLE 1 259
CASE EXAMPLE 2 (CBASP) 263
SUMMARY 264
REFERENCES 267
Chapter 15 CHRONIC PAIN 269
CASE ONE: JOSEPHINE 270
CASE TWO: BETSY 271
TREATMENT COMPONENTS, COMMENTS, AND APPROPRIATE HOMEWORK 273
BARRIERS TO HOMEWORK 276
OTHER BARRIERS 280
REFERENCES 281
Chapter 16 EATING DISORDERS 285
TYPES OF EATING DISORDERS 285
TREATMENT 285
HOMEWORK ASSIGNMENTS IN CBT FOR BN AND BED 287
STRATEGIES TO ENCOURAGE HOMEWORK COMPLETION 289
BARRIERS TO THE SUCCESSFUL USE OF HOMEWORK 292
TWO CASE STUDIES 295
CONCLUSION 300
REFERENCES 300
Chapter 17 LOW SELF-ESTEEM 303
A COGNITIVE MODEL OF LOW SELF-ESTEEM 304
COGNITIVE THERAPY FOR LOW SELF-ESTEEM 308
THE ROLE OF HOMEWORK IN TREATING LOW SELF-ESTEEM 309
PRACTICAL ISSUES 317
CONCLUSION 318
REFERENCES 319
Chapter 18 OBSESSIONS AND COMPULSIONS 321
COGNITIVE-BEHAVIORAL MODEL OF OCD 322
COGNITIVE-BEHAVIORAL TREATMENT OF OCD 323
PROBLEMS ENCOUNTERED IN ASSIGNING HOMEWORK 326
COGNITIVE AND BEHAVIORAL HOMEWORK EXERCISES FOR OCD 330
CASE ILLUSTRATION OF OBSESSIONAL RUMINATION 334
CONCLUSION 338
REFERENCES 338
Chapter 19 PSYCHOSIS 341
PSYCHOSIS AND PSYCHOTHERAPY 341
HOMEWORK IN COGNITIVE THERAPY 342
EFFECTS OF COMPLIANCE AND NON-COMPLIANCE 346
CLIENT MOTIVATION 346
INCREASING HOMEWORK TASK COMPLETION 347
CASE EXAMPLE 349
CONCLUSION 353
REFERENCES 353
Chapter 20 SEXUAL DYSFUNCTION 356
A BRIEF HISTORICAL PERSPECTIVE 356
THEORETICAL FOUNDATIONS 357
THE ROLE OF HOMEWORK IN TREATING SEXUAL DYSFUNCTIONS 359
HOMEWORK ASSIGNMENTS FOR SPECIFIC SEXUAL PROBLEMS 365
CONCLUSION 370
REFERENCES 371
Chapter 21 SUBSTANCE ABUSE 374
EMPIRICALLY SUPPORTED STRATEGIES FOR THE EFFECTIVE USE OF HOMEWORK 374
OVERVIEW OF COMMON BARRIERS 385
CASE STUDIES 386
SUMMARY 390
REFERENCES 391
Chapter 22 TRAUMATIC BRAIN INJURY 394
SPECIAL CONSIDERATIONS RELATING TO REHABILITATION FOLLOWING TBI 395
INTERVENTIONS FOR PSYCHOLOGICAL DIFFICULTIES AFTER TBI PSYCHOTHERAPY 399
COGNITIVE REHABILITATION 400
CASE STUDY 1 401
CASE STUDY 2 403
REFERENCES 404
Part IV DIRECTIONS FOR RESEARCH, PRACTICE, AND PREVENTION 409
Chapter 23 DIRECTIONS FOR RESEARCH ON HOMEWORK 410
A CRITICAL APPRAISAL OF EMPIRICAL FOUNDATIONS 410
IS HOMEWORK A COMMON FACTOR OR A UNIQUE INTERVENTION? 413
HOMEWORK (BETWEEN-SESSION ACTIVITY) AND PSYCHOTHERAPY OUTCOME 415
SUMMARY 420
HOMEWORK COMPLIANCE AND OUTCOME 421
FUTURE RESEARCH DIRECTIONS 423
REFERENCES 424
Chapter 24 DIRECTIONS FOR THE INTEGRATION OF HOMEWORK IN PRACTICE 427
WHAT DO WE MEAN BY PSYCHOTHERAPY "HOMEWORK"? 428
TO PRESCRIBE OR NOT TO PRESCRIBE? 428
WHY USE HOMEWORK IN PSYCHOTHERAPY? 430
GUIDELINES OR PRINCIPLES FOR THE EFFECTIVE USE OF HOMEWORK IN PSYCHOTHERAPY PRACTICE 435
CONCLUSIONS AND FUTURE DIRECTIONS 443
REFERENCES 445
INDEX 460

Chapter 15 CHRONIC PAIN (p. 263-264)

Malcolm H. Johnson

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers tend to continue to reduce activities to avoid pain and to look to others for physical treatments such as medications or procedures to resolve the physical injury they assume still exists, rather than expecting their own efforts to provide resolution. Furthermore, chronic pain sufferers that do attempt to self-manage their pain tend to use passive strategies such as resting, taking medication and using hot/cold packs that are associated with higher levels of pain-related disability (Blyth, March, Nicholas, and Cousins, 2005).

In fact, the evidence increasingly shows that self-management approaches based on components of cognitive-behavior therapy, including those that are incorporated into multidisciplinary pain management programs, offer the best prospect of return to satisfactory functioning for the chronic pain sufferer (Morley, Eccleston, &,Williams., 1999), and that maintained or increased activity is often part of the rehabilitation process (Von Korff et al., 2005).

However, in spite of this evidence for treatment success in the short term, the treatment of chronic pain patients is plagued by relatively high relapse rates (Turk &, Rudy, 1991), with a major contribution to relapse being failure to generalize behaviors learned during treatment to the environment outside the treatment setting or to maintain behaviors following treatment. The potential for the effective use of homework to improve generalization and maintenance is clear in spite of the dearth of direct evidence for the ef.cacy of homework in chronic pain treatment. The few studies that have assessed the usefulness of homework for chronic pain treatment have mostly looked at single modes of treatment, such as relaxation training for treating chronic headache (e.g., Blanchard et al., 1991). For the most part the .ndings of these studies have been equivocal, although several have shown a trend for homework to make a useful contribution.

Although there is not much .rm evidence for the ef.cacy of homework for psychological treatment of chronic pain, formanyof the most signi.cant components such as relaxation and exercise/reactivation, home practice, following initial in-session instruction and coaching, is the treatment. Thus, for chronic pain treatment, whether one considers the encouragement to complete treatment activities outside the treatment setting as homework or the treatment itself, the encouragement and awareness of strategies to maximize the prospect of patients maintaining treatment activities is an essential part of effective treatment.

This chapter will .rst present two cases to highlight some of the issues presented by the chronic pain patient. Some of the components of chronic pain treatment and the homework that might be incorporated into them will then be reviewed. Finally, some of the barriers to homework in chronic pain and strategies to manage them will be discussed.

CASE ONE: JOSEPHINE

Josephine is a 43-year-old woman who has experienced pain for almost three years. She has been referred to a pain treatment center by her employer and the employer’s compensation agency. The problem commenced shortly after she obtained a new job. She applied for this position as her husband was forced to close down the family bricklaying business following an injury. This left the family short of income and struggling to pay the mortgage.