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What Is Therapy Homework?

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Types of Therapy That Involve Homework

If you’ve recently started going to therapy , you may find yourself being assigned therapy homework. You may wonder what exactly it entails and what purpose it serves. Therapy homework comprises tasks or assignments that your therapist asks you to complete between sessions, says Nicole Erkfitz , DSW, LCSW, a licensed clinical social worker and executive director at AMFM Healthcare, Virginia.

Homework can be given in any form of therapy, and it may come as a worksheet, a task to complete, or a thought/piece of knowledge you are requested to keep with you throughout the week, Dr. Erkfitz explains.

This article explores the role of homework in certain forms of therapy, the benefits therapy homework can offer, and some tips to help you comply with your homework assignments.

Therapy homework can be assigned as part of any type of therapy. However, some therapists and forms of therapy may utilize it more than others.

For instance, a 2019-study notes that therapy homework is an integral part of cognitive-behavioral therapy (CBT) . According to Dr. Erkfitz, therapy homework is built into the protocol and framework of CBT, as well as dialectical behavior therapy (DBT) , which is a sub-type of CBT.

Therefore, if you’re seeing a therapist who practices CBT or DBT, chances are you’ll regularly have homework to do.

On the other hand, an example of a type of therapy that doesn’t generally involve homework is eye movement desensitization and reprocessing (EMDR) therapy. EMDR is a type of therapy that generally relies on the relationship between the therapist and client during sessions and is a modality that specifically doesn’t rely on homework, says Dr. Erkfitz.

However, she explains that if the client is feeling rejuvenated and well after their processing session, for instance, their therapist may ask them to write down a list of times that their positive cognition came up for them over the next week.

"Regardless of the type of therapy, the best kind of homework is when you don’t even realize you were assigned homework," says Erkfitz.

Benefits of Therapy Homework

Below, Dr. Erkfitz explains the benefits of therapy homework.

It Helps Your Therapist Review Your Progress

The most important part of therapy homework is the follow-up discussion at the next session. The time you spend reviewing with your therapist how the past week went, if you completed your homework, or if you didn’t and why, gives your therapist valuable feedback on your progress and insight on how they can better support you.

It Gives Your Therapist More Insight

Therapy can be tricky because by the time you are committed to showing up and putting in the work, you are already bringing a better and stronger version of yourself than what you have been experiencing in your day-to-day life that led you to seek therapy.

Homework gives your therapist an inside look into your day-to-day life, which can sometimes be hard to recap in a session. Certain homework assignments keep you thinking throughout the week about what you want to share during your sessions, giving your therapist historical data to review and address.

It Helps Empower You

The sense of empowerment you can gain from utilizing your new skills, setting new boundaries , and redirecting your own cognitive distortions is something a therapist can’t give you in the therapy session. This is something you give yourself. Therapy homework is how you come to the realization that you got this and that you can do it.

"The main benefit of therapy homework is that it builds your skills as well as the understanding that you can do this on your own," says Erkfitz.

Tips for Your Therapy Homework

Below, Dr. Erkfitz shares some tips that can help with therapy homework:

• Set aside time for your homework: Create a designated time to complete your therapy homework. The aim of therapy homework is to keep you thinking and working on your goals between sessions. Use your designated time as a sacred space to invest in yourself and pour your thoughts and emotions into your homework, just as you would in a therapy session .
• Be honest: As therapists, we are not looking for you to write down what you think we want to read or what you think you should write down. It’s important to be honest with us, and yourself, about what you are truly feeling and thinking.
• Practice your skills: Completing the worksheet or log are important, but you also have to be willing to put your skills and learnings into practice. Allow yourself to be vulnerable and open to trying new things so that you can report back to your therapist about whether what you’re trying is working for you or not.
• Remember that it’s intended to help you: Therapy homework helps you maximize the benefits of therapy and get the most value out of the process. A 2013-study notes that better homework compliance is linked to better treatment outcomes.
• Talk to your therapist if you’re struggling: Therapy homework shouldn’t feel like work. If you find that you’re doing homework as a monotonous task, talk to your therapist and let them know that your heart isn’t in it and that you’re not finding it beneficial. They can explain the importance of the tasks to you, tailor your assignments to your preferences, or change their course of treatment if need be.

"When the therapy homework starts 'hitting home' for you, that’s when you know you’re on the right track and doing the work you need to be doing," says Erkfitz.

A Word From Verywell

Similar to how school involves classwork and homework, therapy can also involve in-person sessions and homework assignments.

If your therapist has assigned you homework, try to make time to do it. Completing it honestly can help you and your therapist gain insights into your emotional processes and overall progress. Most importantly, it can help you develop coping skills and practice them, which can boost your confidence, empower you, and make your therapeutic process more effective.

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Conklin LR, Strunk DR, Cooper AA. Therapist behaviors as predictors of immediate homework engagement in cognitive therapy for depression . Cognit Ther Res . 2018;42(1):16-23. doi:10.1007/s10608-017-9873-6

Lebeau RT, Davies CD, Culver NC, Craske MG. Homework compliance counts in cognitive-behavioral therapy . Cogn Behav Ther . 2013;42(3):171-179. doi:10.1080/16506073.2013.763286

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Assigning Homework in Cognitive Behavioral Therapy

It’s certainly true that therapy outcomes depend in part on the work taking place in each session. But for this progress to reach its full impact, clients need to use what they learn in therapy during their daily lives. 

Assigning therapy “homework” can help your clients practice new skills during the week. While many types of therapy may involve some form of weekly assignment, homework is a key component of cognitive behavior therapy. 

Types of Homework

Some clients may respond well to any type of homework, while others may struggle to complete or find benefit in certain assignments. It’s important for clients to step outside of their comfort zone in some ways. For example, it’s essential to learn to challenge unwanted thoughts and increase understanding of feelings and emotions, especially for people who struggle with emotional expression. 

But there isn’t just one way to achieve these goals. Finding the right type of homework for each client can make success more likely. 

There are many different types of therapy homework. Asking your client to practice breathing exercises when they feel anxious or stressed? That’s homework. Journaling about distressing thoughts and ways to challenge them, or keeping track of cognitive distortions ? Also homework.

Some clients may do well with different assignments each week, while others may have harder times with certain types of homework. For example:

• An artistic client may not get much from written exercises. They might, however, prefer to sketch or otherwise illustrate their mood, feelings, or reactions during the week. 
• Clients who struggle with or dislike reading may feel challenged by even plain-language articles. If you plan to assign educational materials, ask in your first session whether your client prefers audio or written media. 

When you give the assignment, take a few minutes to go over it with your client. Give an example of how to complete it and make sure they understand the process. You’ll also want to explain the purpose of the assignment. Someone who doesn’t see the point of a task may be less likely to put real effort into it. If you give a self-assessment worksheet early in the therapy process, you might say, “It can help to have a clear picture of where you believe you’re at right now. Later in therapy I’ll ask you to complete another assessment and we can compare the two to review what’s changed.” 

Mental Health Apps

Some people may also find apps a useful way to develop and practice emotional wellness coping skills outside of therapy. Therapy apps can help people track their moods, emotions, or other mental health symptoms. They can provide a platform to practice CBT or other therapy skills. They can also offer structured mindfulness meditations or help clients practice other grounding techniques. 

If you’re working with a client who’s interested in therapy apps, you might try using them in treatment. Just keep in mind that not all apps offer the same benefits. Some may have limitations, such as clunky or confusing interfaces and potential privacy concerns. It’s usually a good idea to check whether there’s any research providing support for—or against—a specific app before recommending it to a client. 

Trusted mental health sources, such as the American Psychological Association or Anxiety and Depression Association of America websites, may list some popular mental health apps, though they may not specifically endorse them. These resources can be a good starting place. Other organizations, including Northwestern University’s Center for Behavioral Intervention Technologies and the Defense Department of the United States, have developed their own research-backed mental health apps. 

You can also review apps yourself. Try out scenarios or options within the app to get to know how the app works and whether it might meet your client’s needs. This will put you in a position to answer their questions and help give them tips on getting the most out of the app. 

Benefits of Homework

Some of your clients may wonder why you’re assigning homework. After all, they signed up for therapy, not school. 

When clients ask about the benefits of therapy homework, you can point out how it provides an opportunity to put things learned in session into practice outside the therapy session. This helps people get used to using the new skills in their toolbox to work through issues that come up for them in their daily lives. More importantly, it teaches them they can use these skills on their own, when a therapist or other support person isn’t actively providing coaching or encouragement. This knowledge is an important aspect of therapy success. 

A 2010 review of 23 studies on homework in therapy found evidence to suggest that clients who completed therapy homework generally had better treatment outcomes. This review did have some limitations, such as not considering the therapeutic relationship or how clients felt about homework. But other research supports these findings, leading many mental health experts to support the use of therapy homework, particularly in CBT. Homework can be one of many effective tools in making therapy more successful. 

Improving Homework Compliance

You may eventually work with a client who shows little interest in homework and doesn’t complete the assignments. You know this could impede their progress in therapy, so you’ll probably want to bring this up in session and ask why they’re having difficulty with the homework. You can also try varying the types of homework you assign or asking if your client is interested in trying out a mental health app that can offer similar benefits outside your weekly sessions. 

When you ask a client about homework non-compliance, it’s important to do it in a way that doesn’t anger them, make them feel defensive, or otherwise damage the relationship you’re working to develop. Here are some tips for having this conversation:

• Let them know homework helps them practice their skills outside of therapy. In short, it’s helping them get more out of therapy (more value for their money) and may lead to more improvement, sometimes in a shorter period of time than one weekly session would alone. 
• Bring up the possibility of other types of homework. “If you don’t want to write anything down, would you want to try listening to a guided meditation or tips to help manage upsetting emotions?” 
• Ask about it, in a non-confrontational way. You might say something like, “Is something making it difficult for you to complete the homework assignments? How can I help make the process easier for you?” 

The prospect of homework in therapy may surprise some clients, but for many people, it’s an essential element of success. Those put off by the term “homework” may view “skills practice” or similar phrasing more favorably, so don’t feel afraid to call it something else. The important part is the work itself, not what you call it.    References:

• Ackerman, C. (2017, March 20). 25 CBT techniques and worksheets for cognitive behavioral therapy. Retrieved from https://positivepsychology.com/cbt-cognitive-behavioral-therapy-techniques-worksheets
• ADAA reviewed mental health apps. (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/finding-help/mobile-apps
• Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34 (5), 429-438. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939342
• Mental health apps. (n.d.). The American Institute of Stress. Retrieved from https://www.stress.org/mental-health-apps
• Novotney, A. (2016). Should you use an app to help that client? Monitor on Psychology, 47 (10), 64. Retrieved from https://www.apa.org/monitor/2016/11/client-app
• Tang, W, & Kreindler, D. (2017). Supporting homework compliance in cognitive behavioural therapy: Essential features of mobile apps. JMIR Mental Health, 4(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481663

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• Last edited on September 9, 2020

Homework in CBT

Table of contents, why do homework in cbt, how to deliver homework, strategies to increase confidence.

Homework assignments in Cognitive Behavioural Therapy (CBT) can help your patients educate themselves further, collect thoughts, and modify their thinking.

Homework is not something that you just assign randomly. You should make sure you:

• tailor the homework to the patient
• provide a rationale for why the patient needs to do the homework
• uncover any obstacles that might prevent homework from being done (i.e. - busy work schedule, significant neurovegetative symptoms)

Types of homework

Types of homework assignments.

You should also decide the frequency of the homework should be assigned: should it be daily, weekly?

If your patient does not do homework, that’s OK! Explore as a team, in a non-judgmental way, to explore why the homework was not done. Here are some ways to increase adherence to homework:

• Tailor the assignments to the individual
• Provide a rationale for how and why the assignment might help
• Determine the homework collaboratively
• Try to start the homework during the session. This creates some momentum to continue doing the homework
• Set up systems to remember to do the assignments (phone reminders, sticky notes
• It is better to start with easier homework assignments and err on the side of caution
• They should be 90-100% confident they will be able to do this assignment
• Covert rehearsal - running through a thought experiment on a situation
• Change the assignment - It is far better to substitute an easier homework assignment that patients are likely to do than to have them establish a habit of not doing what they had agreed to in session
• Intellectual/emotional role play - “I’ll be the intellectual part of you; you be the emotional part. You argue as hard as you can against me so I can see all the arguments you’re using not to read your coping cards and start studying. You start.”

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15 types of therapy to know + how to find the best one for you.

Therapy is a transformative journey where you can dive into your interior world and gently unpack your story. Making the decision to engage in a deeper relationship with yourself is a positive step forward to manage your well-being and mental health effectively. Before you decide on a therapist , it could be useful first to understand some of the different types of therapies out there to choose the right one for you. 

Read on for a list of common therapeutic approaches, how they work, and how to choose the modality that will best ensure you'll feel meaningfully seen and heard. 

Psychodynamic therapy

"Psychodynamic therapy is rooted in traditional psychoanalysis, and it tends to focus on the roots of emotional suffering that is usually found in the formation years and our early experiences with our caregivers," licensed psychologist Lydiana Garcia, Ph.D., tells mbg. 

How it works:

Psychodynamic therapy works by talking in-depth about the external things that make up your life: your day, dreams, childhood, and how your past may be influencing your current behaviors. By gaining a greater understanding of your unconscious motivations and the true reasons behind your actions, you can choose how you want to react healthier.

"It strives to help clients increase self-reflection and self-examination and thus improve their ability to relate to others, make choices and create a life they would like to live," Garcia defines. 

What it's good for: 

The evidence-based talk therapy would be well suited to you if you're looking to surface repressed emotions and if you feel chronically sad and lost in life. By free-associating your thoughts out loud, your therapist can help you become aware of your patterns.

The therapy can help those with depression, anxiety, mental disorders, and stress ailments. Treatment can either be short term and last under a year or be something more long term, which could be longer than a year. 

RELATED: The Best Online Therapy Services Of 2023

Cognitive-behavioral therapy 

Cognitive-behavioral therapy (CBT) is a type of talk therapy that aims to challenge cognitive distortions present in your thinking and find better ways to cope and manage your stress through problem-solving. It's predicated on the idea that your thoughts create your reality, so you can shift them to feel better. 

"[CBT] tends to focus on changing behaviors, usually maladaptive behaviors. Some of their techniques include identifying the factors that contribute to the maladaptive behaviors to remove them, and 'learning' new ones," Garcia says. It aims to modify maladaptive behaviors such as passive-aggressiveness, withdrawal, avoidance, daydreaming, etc., by replacing them with healthier and constructive ways of coping.

CBT is a time-based intervention and can last between 12 and 20 sessions for those with depression, anxiety, somatic issues, eating disorders, substance abuse problems, relationship issues, and severe mental illnesses. A CBT therapist will teach you constructive strategies to break you out of your negative thought patterns and thus deal with your problems productively. The behavioral therapy emphasizes the use of a host of techniques to be assertive, positively manage stress, and build confidence and resilience.

Humanistic therapy

"Humanistic therapy is a psychological perspective that focuses on the whole individual, including their sense of purpose/potential and well-being. It takes into consideration what happened in someone's life but also focuses on the potential of changing it," Garcia says. 

How it works: 

Humanistic therapy parallels the gestalt, present-oriented approach. The talk therapy doesn't focus as much on past events as it does on your active participation with the current moment. Your therapist helps you empathetically validate your perspective while also offering you a safe space to reconnect to your true identity. 

If you believe your lack of self-acceptance is blocking you from having the life you want, humanistic therapy may be for you. It's a positive form of therapy that seeks to support and draw out your unique, individual nature. The humanistic approach aims to nurture you toward self-actualization with the belief that you have all of the innate wisdom you need.

This approach helps those seeking treatment for addictions, personality disorders, self-esteem, anxiety, depression, relationship issues, worthlessness, and schizophrenia. You can set your own goals and decide whether short-term or long-term therapy is right for you. 

RELATED: Online Therapy Services That Take Insurance 2023

Dialectical behavioral therapy 

"Dialectic [behavioral] therapy (DBT) is rooted in cognitive-behavioral therapy and integrates mindfulness, communication, and interpersonal skills; distress tolerance; and regulating emotions," Garcia defines. The core concept of dialectical thinking is being comfortable with the notion that two simultaneous opposing ideas can co-exist and be truthful at the same time, thus validating the contrasting emotional thoughts. 

DBT is a form of psychosocial therapy that isn't so much about talking as it is about "doing." Your therapist helps you learn how to feel OK around uncomfortable thoughts so you don't have to resort to destructive behavior, increasing your overall emotional competency and flexibility. On top of attending sessions, you'll be implementing your lessons in real life through role-play and homework assignments to cultivate skills such as mindfulness and self-soothing. 

What it's good for:

DBT is often very effective if you're suffering from suicidal thoughts, borderline personality disorder (BPD), or self-harm issues, but it can also be useful for those with less severe cases. If your emotions feel intensely outsized and hard to get under control, dialectical therapy can be very balancing.

It centers you in the here and now by leaning on mindfulness, emotional regulation, interpersonal effectiveness, acceptance of what is, and increasing your comfort to distress. Completing treatment is broken down into modules and can take anywhere between six months and over a year. 

RELATED: How To Stop People-Pleasing: 6 Steps From A Therapist

Exposure therapy

"Exposure therapy is a type of treatment that is rooted in behavioral therapy to help people confront their fears and decrease post-traumatic symptoms," Garcia says. This type of therapy is about facing your fears and has roots in cognitive-behavioral therapy. 

If you're scared or anxious about something, it's likely you may avoid whatever might be inspiring your agitation. Through therapy, your therapist will create a safe environment to expose you to the very things that you're trying to get away from, which disrupts your avoidance patterns as the new learned behaviors move you toward lessened fear.

By repeated exposure, it helps reduce phobias and your circumscribed behaviors. It can be paced through hierarchical exposure from least difficult to the most difficult fears or systematic desensitization, which combines relaxation techniques to the situation to associate calmness to the trigger. 

Exposure therapy works to relieve conditions including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) , anxiety, panic, social anxiety, and phobic disorders. Undergoing a full course of exposure therapy can be fairly quick. Depending on the depth of your fears and how you respond to the program, it can take anywhere between a few weeks and more than 20 sessions. 

Interpersonal therapy

"[Interpersonal therapy] is a type of therapy that has been shown to be effective for treating mood disorders. It focuses on becoming aware and changing interpersonal dynamics/skills that are contributing to the mood disorder," Garcia says. 

Interpersonal therapy is an attachment-focused and person-based form of psychotherapy. Your therapist works as a nonjudgmental guide to help you improve your relational problems so you can better manage your social functioning and interpersonal relationships. It can take place one-to-one or in a group setting. 

Interpersonal therapy is time-limited (up to 12 to 16 sessions) and is empirically validated to treat a variety of psychiatric disorders and other areas such as life changes, substance abuse, anxiety, postpartum depression, eating disorders, depression, grief, and difficulty starting and sustaining relationships. 

Mentalization-based therapy

Mentalizing literally means to be aware of your own mind and other people's minds. In a study published in Psychoanalytic Inquiry 1 , researchers note that mentalization-based therapy (MBT) is the process in which "we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes." As you move in the world, it's natural to focus on yourself, but it can negatively affect one's life if you're unable to identify your internal dialogue or how other people are thinking and feeling in relation to you. 

Your therapist will work with you to acknowledge your emotions to decrease impulsivity and instability in yourself and, subsequently, your relationships. Learning self-regulation and healthy emotional expression are key tenets in the framework. Your therapist functions as a secure therapeutic attachment as you gain more insight into your mental processes and explore your interpretations of behaviors around you. 

MBT was initially developed for borderline and antisocial personality disorders but can also treat substance abuse, eating disorders, and depression.

Some research (such as this paper published in World Psychiatry 2 ) notes its effectiveness for people with early abandonment issues or who didn't grow up in a securely attached household. The treatment program varies depending on your symptoms, but it usually ranges for up to 18 months. 

RELATED: The 5 Best Online Therapy Services For Teens

Mindfulness-based therapy

Mindfulness-based therapy (MBCT) intertwines cognitive-behavioral techniques together with mindfulness and breathwork to bring awareness to your present moment. The intervention focuses on observing distressing emotions nonjudgmentally and separating your sense of self from negative messages to stave off depression. 

Research published in Mindfulness 3 notes MBCT is generally in a group setting, but it's also possible to do it individually with a therapist. Your therapist will help you sit through the overwhelming, charged emotions you may feel as you develop positive thought patterns. Along with weekly sessions, there will be homework and meditation exercises to incorporate your new coping skills into your daily life. 

The study above shows MBCT may be highly effective for treating chronic unhappiness, depression, stress, anxiety, physical pain, and mood disorders. Instead of eliminating sources of pain, this approach teaches you to find relief by recognizing you can feel difficult emotions but it doesn't have to define you. The program is typically known to last for eight weeks. 

Somatic psychotherapy

"Somatic psychotherapy is a type of body-centered therapy that works great for treating trauma and similar issues. There are many different models and styles, but in general, they focus on helping people become aware of the interconnection of their body-mind-brain behavior," Garcia says. 

This type of alternative therapy works off the notion that talk therapy can only address a part of previous traumas. Somatic psychotherapy seeks to also look at your physical body and how it can hold on to stress. Therefore, the emphasis is on moving through pent-up feelings and blending together different holistic approaches to fit your specific needs. Your therapist will bring up past traumatic experiences and help you notice and feel the physical responses as you go through the uneasiness. Somatic psychotherapy teaches you concepts such as self-regulation, grounding, boundary development, and movement. 

This modality can address a wide range of psychological and physical mental health issues like stress, depression, anxiety, chronic pain, addiction, trauma, abuse, dysfunctional relationships, and sexual function.

It helps you bridge your mind and body for proper integration and may incorporate physical therapies like dance, yoga, meditation, and breathwork to help clear your mind and heal. The length of treatment varies from person to person. 

RELATED: Talkspace Vs. Betterhelp: Our Experience With Both

Marriage and family therapy

"Typically, couples' therapy involves talking through relationship challenges as a couple with a neutral party (your therapist) who is trained to help you get to the bottom of the issue," marriage therapist Linda Carroll, LMFT, previously told mbg. 

Your therapist will be there as an unbiased mediator to observe your dynamic and hear out your ongoing fights and present pain points. During the process, it's paramount that both people can be vulnerable and commit to being fully seen, no matter how uncomfortable or ugly it may seem.

As your therapist hears both of your perspectives out, they will point out any limiting beliefs and encourage active listening to push your relationship toward its fullest potential. Outside of ongoing therapy, your therapist may assign you homework in between sessions. 

It's helpful for all couples during any stage. There's value in seeing couples' therapy as relationship maintenance to learn how to improve communication, navigate life changes, and see each other more clearly. Carroll notes most people go to couples' therapy when the relationship is on life support and they're looking for repair, but "a healthy relationship is a skill set. Most of us don't learn these skills growing up, so we just expect love to carry us through. But it isn't enough. That said, love combined with skills usually is enough." The length of couples' therapy ranges but can typically take a few months or years to work through issues. 

Group therapy 

"Group therapy is therapy delivered in a small-group setting. Group therapy is incredibly helpful to connect you with others who are experiencing similar challenges. It can be done on its own or also in combination with individual therapy," says licensed psychologist Lisette Sanchez, Ph.D.

"There are different types of therapy groups. Most groups require a prior meeting with the therapist(s) facilitating the group. Groups may have a set duration, four to 12 weeks, or may have ongoing availability," Sanchez further explains. A therapist will lead discussions as the group chimes in with perspective and experiences. Engaging in group therapy can be incredibly cathartic as you share your personal stories and develop new skills to relate to others.

Group therapy treats many mental illnesses and has a lot of efficacy around family problems, attention deficit hyperactivity disorder (ADHD) , depression, anxiety, panic disorders, eating disorders, phobias, post-traumatic stress disorders (PTSD), and substance abuse. It can be affirming to be around people who are going through similar afflictions, so you don't feel alone. If you're looking for interpersonal support, a sense of belonging, and a sounding board to better understand yourself, group therapy may be for you. 

Eye movement desensitization and reprocessing therapy 

Research suggests that eye movement desensitization and reprocessing psychotherapy 4 (EMDR) is an empirically validated treatment for trauma in processing negative life experiences. It facilitates the processing of unprocessed and otherwise inaccessible memories. (You can read more about EMDR here .)

EMDR works in phases and specifically looks at childhood events rather than present stressors. Your clinician will develop a treatment plan by learning about your history and the level of your emotional distress.

Then they will teach you stress reduction techniques so you can feel equipped down the road to sit with disturbing images related to your memories and undergo bilateral stimulation, which can be eye movements or taps. It works by feeling those tough emotions and installing positive beliefs over negative beliefs. 

Clinical applications show it may help with psychological problems such as stress-induced physical disorders, post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (CPTSD), complicated grief, dissociation, substance abuse, eating disorders, panic, and anxiety. EMDR is a time-based intervention and depending on the traumatic memories you're looking to address, it can take between three and 12 sessions or more. 

RELATED: Betterhelp Review, From Someone Who's Been In Therapy For Years

Internal family system

A 2011 case study 5 defines internal family system (IFS) as a form of therapy that works to regulate shame and facilitate a whole relationship with yourself through internal compassion. Research published in the  Encyclopedia of Couple and Family Therapy 6 posits that the natural state of the mind contains multiple, subpersonalities that "contain valuable qualities and abilities but are forced from their naturally vulnerable states by traumas or attachment injuries. Some are forced into protective roles, and others are locked away inside the mind such that people no longer have access to them." The goal is to become comfortable with those inner parts and integrate them. 

Your therapist will help you understand your subpersonalities and assist you in creating a cohesive relationship with those autonomous parts to move toward a cohesive, unchanging core self. One study from the Journal of Clinical Psychology 7 notes that while psychotherapy is usually about changing unwanted behaviors, emotions, or thoughts, IFS instead fosters radical acceptance of all parts, no matter how destructive or shameful. 

It can treat a variety of conditions including depression, anxiety, phobias, panic, post-trauma stress disorder (PTSD), substance abuse, eating disorders, and physical health conditions. The length varies depending on your specific concerns and your acclimation to the model. 

Family therapy

The Mayo Clinic defines family therapy as a type of psychotherapy that addresses underlying issues that affect the psychological health of the family. It helps improve communication by understanding dynamic relationships within the family system and tackle conflicts in a manageable way. 

Your therapist will teach you tools to resolve problems effectively while identifying issues with family roles and behavior patterns that may contribute to those issues. It can corral the entire family together to support each other beneficially. 

It's useful in bringing several members of the family together to explore thoughts, emotions, and conflict in a safe setting. Family therapy is often short-term and can generally take 12 sessions. It depends on your therapist's recommendations and your family situation. Some common problem areas are communication, economic hardship, anger, addiction, depression, medical issues, and tragedy. 

Art therapy

Art therapy 8 uses the creative process of art-making as an avenue for self-expression to examine your emotions and inner experiences. Through the process, it aims to enhance mental well-being and gain greater insight into who you are as an individual.

By using creative expression, your therapist will help encourage exploration into your creative sides and often interpret the creative results. There are many artistic mediums you can use in art therapy such as coloring, drawing, painting, photography, doodling, collaging, sculpting, music, dance, pottery, and more. 

Research published in the journal Procedia 9 notes people living with mental illnesses often use art and drawings as a way to visually communicate and unload their emotions. If it's hard for you to name and verbally express your feelings, art therapy can help you meaningfully engage your mind, understand yourself better, and share thoughts—to help resolve ongoing conflicts in your life.

Art therapy has been used to treat anxiety, learning disabilities, depression, emotional difficulties, stress, brain injuries, psychological symptoms, psychosocial issues, stress, substance abuse, and more. 

RELATED: Here's How To Actually Use "Therapy Speak"

How do you know which therapy is right for you? 

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"The right therapy for you will be a combination of what you are wanting to work on, what the therapist specializes in, and the relationship you develop with your therapist. My biggest recommendation is that after you find several therapists that meet your criteria, schedule a consultation or a couple of sessions to get to know them and see if you feel the connection," Garcia says. She also notes that developing a safe relationship with your therapist is the most important thing to keep in mind on your search. "If you cannot connect with a therapist, they can have the best skills, but the therapy may not be that helpful." 

"There are many therapeutic modalities. There are many benefits to each, and it is about finding the right fit. Overall, the biggest predictor of success in therapy is the client-therapist relationship ," Sanchez affirms. It is best to find someone who you feel comfortable with and who you feel connected to."

What's more, depending on your unique identity and the nuances of your background, it can be imperative to talk to prospective therapists about how they handle cultural sensitivities like sexuality, race, gender, religion, privilege, and how that may intersect with your personal belief and value systems. Garcia points out: "For communities that have been marginalized, it is important to look for therapists that are for liberation and that are not upholding supremacy standards."  

The bottom line.

There are so many different therapeutic approaches to choose from, including these 15 popular modalities. However, the most important thing is finding the method that works best for you. "Sometimes, it takes time to explore and learn about what you might like. If it is not working for you, I recommend you have a conversation with your therapist. Explain the concerns you have, they may be able to offer additional guidance," Sanchez says. 

If one therapeutic approach doesn't work for you, take it as an invitation to try another type to see if that resonates. It's crucial you feel OK expressing yourself freely and honestly. Once you find the right therapist to manage your anxieties and challenge your emotional issues with, commit to then seeing the process through. 

• https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4467231/
• https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2816926/
• https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5107193/
• https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3951033/
• https://pubmed.ncbi.nlm.nih.gov/21847894/
• https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-49425-8_199
• https://pubmed.ncbi.nlm.nih.gov/23813465/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124538/
• https://www.sciencedirect.com/science/article/pii/S1877042811022312?via%3Dihub

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Empowering Progress: Effective Therapy Homework for Depression

The role of therapy homework.

Therapy homework plays a vital role in the treatment of depression, providing individuals with an opportunity to actively engage in their healing process. By completing assignments outside of therapy sessions, individuals can reinforce the concepts learned in therapy, apply new skills, and make progress towards their treatment goals. In this section, we will explore the importance of therapy homework and how it can specifically help with depression.

Understanding the Importance of Homework in Therapy

Homework assignments serve as an extension of therapy and allow individuals to continue their progress beyond the confines of the therapy room. It provides an opportunity for individuals to practice and integrate new insights, coping strategies, and techniques into their daily lives. Through regular engagement with therapy homework, individuals can reinforce the therapeutic work, develop new habits, and enhance their overall well-being.

Therapy homework offers several benefits for individuals with depression. It allows for increased self-awareness, as individuals are encouraged to reflect on their thoughts, emotions, and behaviors. This self-reflection promotes a deeper understanding of oneself and the factors contributing to their depression, enabling individuals to identify patterns and make positive changes.

Additionally, therapy homework empowers individuals by giving them a sense of control and agency in their recovery journey. It fosters a sense of ownership and responsibility for one’s mental health, promoting active participation and engagement in the therapeutic process.

How Therapy Homework Can Help with Depression

Therapy homework can be particularly effective in addressing various aspects of depression. It can help individuals challenge negative thought patterns and develop more adaptive and positive thinking. Cognitive Behavioral Therapy (CBT) worksheets, for example, provide structured exercises to identify and reframe negative thoughts. These worksheets, along with journaling and thought records, allow individuals to track their thoughts and emotions, identify cognitive distortions, and develop healthier thinking patterns.

Behavioral activation exercises are another valuable component of therapy homework for depression. They involve engaging in activities that provide a sense of accomplishment, pleasure, or mastery, even when motivation is low. By gradually increasing participation in enjoyable and fulfilling activities, individuals can combat the inertia often associated with depression and experience an improvement in mood.

By consistently engaging in therapy homework, individuals with depression can experience a sense of progress, growth, and empowerment. However, it’s essential to collaborate with a therapist to develop a personalized homework plan that aligns with individual goals, needs, and preferences. This collaboration ensures that the homework assignments are tailored to the specific challenges and circumstances faced by each individual.

In the following sections, we will explore different types of therapy homework for depression and provide tips for developing a personalized homework plan that maximizes the benefits of therapy.

Types of Therapy Homework for Depression

When it comes to managing depression through therapy,  various types of homework assignments  can be incorporated to enhance the therapeutic process. These assignments aim to reinforce the skills and techniques learned in therapy sessions and provide individuals with opportunities for self-reflection and growth. Here are three common types of therapy homework for depression:

Cognitive Behavioral Therapy (CBT) Worksheets

Cognitive Behavioral Therapy (CBT) is a widely used approach for treating depression. CBT worksheets are valuable homework tools that help individuals identify and challenge negative thought patterns and beliefs. These worksheets typically involve exercises such as identifying automatic negative thoughts, examining evidence for and against these thoughts, and developing more balanced and realistic thinking patterns. CBT worksheets can be used to address distorted thinking commonly associated with depression, such as overgeneralization, personalization, and catastrophizing.

Journaling and Thought Records

Journaling and thought records are effective homework assignments for promoting self-awareness and monitoring thoughts and emotions related to depression. By encouraging individuals to write down their thoughts and feelings, these assignments provide an opportunity to identify negative thinking patterns and emotions that contribute to depressive symptoms. Thought records, in particular, involve documenting a specific negative thought, examining evidence for and against it, and generating alternative, more positive thoughts. Journaling and thought records can be powerful tools for increasing self-reflection and challenging negative self-perceptions.

Behavior Activation Exercises

Behavior activation is a key component of therapy for depression . Homework assignments focused on behavior activation aim to increase engagement in pleasurable and meaningful activities, even when motivation is low. These assignments may involve creating a schedule of daily activities, setting achievable goals, and gradually increasing involvement in enjoyable activities. By actively participating in positive experiences, individuals with depression can counteract the cycle of withdrawal and isolation often associated with the condition.

By incorporating these types of therapy homework into the treatment plan, individuals with depression can actively engage in their own healing process. It is important for therapists to collaborate with their clients, identifying specific goals and areas of focus, to tailor the homework assignments to each individual’s needs and preferences. Consistency, tracking progress, and seeking support are essential for making therapy homework a meaningful and effective part of the journey towards overcoming depression.

For more information on therapy homework assignments and ideas for other areas of focus, visit our articles on  therapy homework assignments  and  therapy homework ideas .

Developing a Personalized Homework Plan

To make the most out of therapy homework for depression, it’s essential to collaborate with your therapist and develop a personalized plan. This plan should be tailored to your specific needs, goals, and areas of focus. By working together with your therapist, you can create a realistic and manageable homework plan that complements your therapy sessions.

Collaborating with Your Therapist

The first step in developing a personalized homework plan is to collaborate with your therapist. Through open and honest communication, express your goals, challenges, and preferences. Your therapist will use their expertise to guide you in selecting appropriate homework assignments that align with your therapy objectives.

Your therapist may suggest specific therapy techniques or resources that can be incorporated into your homework plan. These may include  cognitive behavioral therapy (CBT) worksheets ,  journaling ,  thought records ,  behavior activation exercises , or other relevant tools. By discussing your preferences and comfort level, you can ensure that the chosen homework assignments resonate with you.

Identifying Goals and Areas of Focus

During therapy sessions, you and your therapist will identify specific goals and areas of focus. These goals may include developing coping skills, challenging negative thought patterns, improving self-esteem, or enhancing communication skills. By identifying these goals, you can create homework assignments that directly address the areas you want to work on.

For example, if one of your goals is to challenge negative thought patterns, your therapist may suggest completing CBT worksheets that help you identify and reframe negative thoughts. By integrating these worksheets into your homework plan, you can reinforce the skills learned during therapy sessions and continue working on them independently.

Creating a Realistic and Manageable Plan

When creating your homework plan, it’s crucial to ensure that it is realistic and manageable. Your therapist will help you set realistic expectations and establish a schedule that fits your lifestyle. It’s important to strike a balance between challenging yourself and avoiding overwhelming tasks.

By breaking down larger goals into smaller, achievable tasks, you can maintain motivation and progress steadily. Your therapist may also suggest incorporating self-care activities, relaxation exercises, or mindfulness practices into your homework plan to foster emotional well-being and resilience.

To help you stay organized and track your progress, consider using a journal or a digital tool specifically designed for therapy homework. These tools can help you monitor your assignments, record your thoughts and emotions, and reflect on your progress over time.

Remember, the success of your therapy homework plan depends on your consistency, commitment, and willingness to actively engage in the process. By collaborating with your therapist, identifying goals, and creating a realistic plan, you can maximize the benefits of therapy homework for depression.

Tips for Effective Therapy Homework

To make the most out of therapy homework and enhance the effectiveness of your treatment for depression , it’s important to keep a few key tips in mind. These tips will help you stay on track and maximize the benefits of your therapy sessions.

Consistency and Commitment

Consistency is key when it comes to therapy homework. Make a commitment to regularly engage in your assigned exercises or activities. Set aside dedicated time each day or week to work on your homework. Treat it as a priority and integrate it into your routine. By being consistent and committed, you’ll reinforce the therapeutic progress and build momentum towards achieving your goals.

Tracking Progress and Making Adjustments

Keep track of your progress as you engage in therapy homework. Maintain a record of your experiences, observations, and any changes you notice. This tracking will help you identify patterns and trends, providing valuable insights into your journey. It can be helpful to use a journal or a tracking app to record your thoughts and progress. Regularly review your records with your therapist to assess your growth, make adjustments, and refine your homework plan if necessary.

Seeking Support and Accountability

Seek support and accountability to stay motivated and committed to your therapy homework. Share your goals and progress with a trusted friend, family member, or support group. Consider joining a therapy or coaching community where you can connect with others who are also working on their mental health. Engaging in discussions, sharing experiences, and receiving encouragement from others can provide a sense of support and accountability that keeps you motivated and engaged.

Remember, therapy homework is an integral part of the treatment process for depression. By following these tips for effective therapy homework, you can enhance your progress and experience the full benefits of your therapeutic journey. Stay consistent, track your progress, and seek support to make the most out of your therapy experience.

For more information and resources on therapy homework for various topics, visit our  therapy homework assignments  page.

Overcoming Challenges with Therapy Homework

While therapy homework can be an effective tool for managing depression, it’s important to acknowledge and address the challenges that may arise during the process. Here are some common challenges individuals may encounter when completing therapy homework and strategies for overcoming them.

Addressing Resistance and Motivation Issues

Resistance and lack of motivation can hinder progress when it comes to therapy homework. It’s not uncommon to feel resistant or unmotivated, especially when dealing with the symptoms of depression. However, it’s important to remember that therapy homework plays a significant role in your overall treatment and recovery.

To address resistance and motivation issues, consider the following strategies:

• Explore the underlying reasons : Reflect on why you may be resistant or lacking motivation. Are there specific barriers or fears that need to be addressed? Share your concerns with your therapist to gain a deeper understanding and explore possible solutions.
• Break tasks into smaller steps : Overwhelming tasks can lead to resistance. Break down your therapy homework into smaller, more manageable steps. This can help make the tasks feel less daunting and increase motivation.
• Find intrinsic motivation : Connect with the deeper reasons behind why you want to engage in therapy homework. Remind yourself of the potential benefits, such as improved coping skills or increased self-awareness. Focusing on these intrinsic motivations can help reignite your motivation.

Dealing with Time Constraints

Finding time to complete therapy homework can be challenging, especially when juggling other responsibilities and commitments. However, dedicating time to your therapy homework is essential for making progress in your treatment.

To overcome time constraints, consider the following strategies:

• Prioritize and schedule : Prioritize your therapy homework by scheduling specific times in your daily or weekly routine dedicated solely to completing the tasks. Treat these scheduled times as non-negotiable commitments to yourself and your well-being.
• Break tasks into shorter sessions : If the length of the tasks feels overwhelming, break them into shorter sessions spread out over several days. This can help you fit therapy homework into your schedule more easily.
• Utilize downtime : Identify pockets of time throughout your day that can be used to complete smaller tasks. For example, you can work on journaling exercises during your morning commute or listen to guided meditation during your lunch break.

Modifying Homework to Fit Individual Needs

Therapy homework is not one-size-fits-all, and it’s important to tailor it to your individual needs and preferences. If you find that certain exercises or assignments are not resonating with you or are not producing the desired outcomes, it may be necessary to modify them.

Consider the following strategies for modifying therapy homework:

• Communicate with your therapist : Discuss any challenges or concerns you have with your therapist. They can help modify the homework assignments to better suit your needs and provide alternative options if necessary.
• Explore alternative techniques or activities : If a particular exercise is not effective for you, discuss alternative techniques or activities with your therapist. They may be able to suggest different approaches that align better with your preferences and goals.
• Experiment and adapt : Be open to experimenting with different approaches and techniques. Therapy homework is a collaborative process, and it may take some trial and error to find what works best for you. With the guidance of your therapist, adapt and modify the homework assignments to suit your unique circumstances.

By addressing resistance and motivation issues, managing time constraints, and modifying therapy homework to fit your individual needs, you can overcome challenges and make the most of your treatment. Remember to communicate openly with your therapist, as they are there to support you in your journey toward healing and recovery.

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Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps

1 Discipline of Psychiatry, Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada

David Kreindler

2 Division of Youth Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

3 Centre for Mobile Computing in Mental Health, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Cognitive behavioral therapy (CBT) is one of the most effective psychotherapy modalities used to treat depression and anxiety disorders. Homework is an integral component of CBT, but homework compliance in CBT remains problematic in real-life practice. The popularization of the mobile phone with app capabilities (smartphone) presents a unique opportunity to enhance CBT homework compliance; however, there are no guidelines for designing mobile phone apps created for this purpose. Existing literature suggests 6 essential features of an optimal mobile app for maximizing CBT homework compliance: (1) therapy congruency, (2) fostering learning, (3) guiding therapy, (4) connection building, (5) emphasis on completion, and (6) population specificity. We expect that a well-designed mobile app incorporating these features should result in improved homework compliance and better outcomes for its users.

Homework Non-Compliance in CBT

Cognitive behavioral therapy (CBT) is an evidence-based psychotherapy that has gained significant acceptance and influence in the treatment of depressive and anxiety disorders and is recommended as a first-line treatment for both of these [ 1 , 2 ]. It has also been shown to be as effective as medications in the treatment of a number of psychiatric illnesses [ 3 - 6 ]. Homework is an important component of CBT; in the context of CBT, homework can be defined as “specific, structured, therapeutic activities that are routinely discussed in session, to be completed between sessions” [ 7 ]. Completion of homework assignments was emphasized in the conception of CBT by its creator, Aaron Beck [ 8 ]. Many types of homework are prescribed by CBT practitioners, including symptom logs, self-reflective journals, and specific structured activities like exposure and response prevention for obsessions and compulsions. These can be divided into the following 3 main categories: (1) psychoeducational homework, (2) self-assessment homework, and (3) modality-specific homework. Psychoeducation is an important component in the early stage of therapy. Reading materials are usually provided to educate the client on the symptomatology of the diagnosed illness, its etiology, as well as other treatment-relevant information. Self-assessment strategies, including monitoring one’s mood using thought records, teach the patients to recognize the interconnection between one’s feelings, thoughts, and behaviors [ 8 ]. For example, depressed patients may be asked to identify thinking errors in daily life and document the negative influences these maladaptive thinking patterns can produce on their behaviors. Various psychiatric disorders may require different types of modality-specific homework. For example, exposure to images of spiders is a treatment method specific to arachnophobia, an example of a “specific phobia” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [ 9 ]. Homework is strategically created by the therapist to correct and lessen the patient’s psychopathology. The purpose of these exercises is to allow the patients to practice and reinforce the skills learned in therapy sessions in real life.

Homework non-compliance is one of the top cited reasons for therapy failure in CBT [ 10 ] and has remained a persistent problem in the clinical practice. Surveys of practitioners have suggested rates of non-adherence in adult clients of approximately 20% to 50% [ 10 , 11 ] while adherence rates in adolescents have been reported to be approximately 50% [ 12 ]. Many barriers to homework compliance have been identified in the literature; to facilitate discussions, they can be divided into internal and external factors. Internal factors originate from a client’s own psychological environment while external ones are created by external influences. Internal factors that have been identified include lack of motivation to change the situation when experiencing negative feelings, the inability to identify automatic thoughts, disregard for the importance or relevance of the homework, and the need to see immediate results [ 12 - 14 ]. Various external factors have also been identified, including the effort associated with pen-and-paper homework formats, the inconvenience of completing homework because of the amount of time consumed, not understanding of the purpose of the homework, lack of instruction, and failure to anticipate potential difficulties in completing the homework [ 14 - 16 ]. There is strong evidence suggesting that homework compliance is integral to the efficacy of CBT in a variety of psychiatric illnesses. In the treatment of depression with CBT, homework compliance has been correlated with significant clinical improvement and shown to predict decreases in both subjective and objective measures of depressive symptoms [ 17 - 23 ]. Similarly, homework compliance is correlated with short-term and long-term improvement of symptoms in anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), hoarding, panic disorder, and post-traumatic stress disorder (PTSD) [ 17 , 24 - 32 ]. Fewer studies have been done on homework compliance in other psychiatric conditions, but better homework compliance has been correlated with significant reductions in pathological behaviors in psychotic disorders [ 33 , 34 ], cocaine dependence [ 35 , 36 ], and smoking [ 37 ]. Two meta-analyses further support the notion that greater homework adherence is associated with better treatment outcomes in depression, anxiety-related disorders, and substance use [ 38 , 39 ].

The Utility of Technology in Enhancing CBT Homework

Despite its demonstrated efficacy, access to CBT (as well as other forms of psychotherapy) remains difficult due to the limited number of practicing psychotherapists and the cost of therapy sessions [ 40 ]. With the rise of mass-market mobile communication devices such as the iPhone or other kinds of mobile devices with app capabilities (smartphones), new solutions are being sought that will use these devices to provide therapy to patients in a more cost-effective manner. Mobile phones with app capabilities are portable devices that combine features of a cellphone and a hand-held computer with the ability to wirelessly access the Internet. Over time, ownership of mobile phones in North America has grown [ 41 , 42 ] and progressively lower prices have further reduced barriers to their use and ownership [ 43 , 44 ]. As more and more people acquire mobile phones, the acceptance of and the demand for mobile health solutions have been on the rise [ 45 ]. Boschen (2008), in a review predating the popularization of the modern mobile phone, identified the unique features of the mobile telephone that made it a potentially suitable vehicle for adjunctive therapeutic applications: portability, acceptability, low initial cost, low maintenance cost, social penetration and ubiquity, “always on,” “always connected,” programmability, audio and video output, keypad and audio input, user-friendliness, and ease of use [ 46 ]. Over the last decade, modern mobile phones have supplanted the previous generation of mobile telephones; progressive increases in their computing power, ongoing advances in the software that they run and interact with (eg, JAVA, HTML5, etc.), common feature sets across different operating systems such as Google Inc.'s Android or Apple Inc.'s iOS, and adoption of common hardware elements across manufacturers (eg, touch screens, high-resolution cameras, etc) have enabled the development of platform-independent apps for mobile phones, or at least apps on different platforms with comparable functionality (eg, apps written for Apple's HealthKit or the apps written for Microsoft's HealthVault).

The popularization of the smartphone presents a unique opportunity to enhance CBT homework compliance using adjunctive therapeutic applications such that well-designed mobile software may be able to diminish barriers to CBT [ 40 ] by making CBT therapists' work more cost-effective. However, there are no guidelines and no existing research that directly address the design of mobile phone apps for this purpose. Given this gap in the literature, we searched MEDLINE (1946 to April 2015) and PsycINFO (1806 to April 2015) for all articles related to “cognitive behavioral therapy”, “homework”, “mobile applications” and “treatment compliance or adherence”, and reviewed articles related to (1) mobile technologies that address homework completion, (2) essential features of therapy, or (3) barriers to homework completion in CBT. In this article, we propose a collection of essential features for mobile phone-based apps that will optimally support homework compliance in CBT.

A Proposed List of Essential Features for Mobile Apps That Optimally Support CBT Homework Compliance

In order to be effective for patients and acceptable to therapists, an optimal mobile phone app to support CBT homework compliance should conform to the CBT model of homework while addressing barriers to homework compliance. Tompkins (2002) provides a comprehensive guideline on the appropriate ways to provide CBT homework such that homework should be meaningful, relevant to the central goals of therapy, salient to focus of the session, agreeable to both therapist and client, appropriate to sociocultural context, practiced in session to improve skill, doable, begin small, have a clear rationale, include written instructions, and include a backup plan with homework obstacles [ 47 ]. In addition, the therapist providing the homework needs to be curious, collaborative, reinforce all pro-homework behavior and successful homework completion, and emphasize completion over outcome [ 47 ]. By combining Tompkins' guidelines with the need to reduce barriers to homework compliance (as described above), we obtained the following list of 6 essential features that should be incorporated into mobile apps to maximize homework compliance: (1) congruency to therapy, (2) fostering learning, (3) guiding therapy, (4) building connections, (5) emphasizing completion, and (6) population specificity.

Congruency to Therapy

Any intervention in therapy needs to be relevant to the central goals of the therapy and salient to the focus of the therapeutic session. A mobile app is no exception; apps have to deliver useful content and be congruent to the therapy being delivered. There are different types of homework in CBT, including (1) psychoeducational homework; (2) self-assessment homework; and (3) modality-specific homework. Which types are assigned will depend on the nature of the illness being treated, the stage of treatment, and the specific target [ 48 ]. An effective app supporting homework compliance will need to be able to adjust its focus as the therapy progresses. Self-monitoring and psychoeducation are major components in the early stage of therapy. Thought records can be used in depression and anxiety while other disorders may require more specific tasks, such as initiating conversation with strangers in the treatment of SAD. Therefore, the treatment modules delivered via mobile phones should meet the specific needs of therapy at each stage of therapy, while also providing psychoeducation resources and self-monitoring capabilities.

Psychoeducational Homework

While there are large amounts of health-related information on the Internet, the majority of information is not easily accessible to the users [ 49 ]. Mobile apps can enhance psychoeducation by delivering clear and concise psychoeducational information linked to the topics being covered in therapy. As psychoeducation is seen as a major component of mobile intervention [ 50 ], it has been incorporated into several mobile apps, some of which have been shown to be efficacious in treating various psychiatric conditions, including stress [ 51 ], anxiety and depression [ 52 ], eating disorders [ 53 ], PTSD [ 54 ], and obsessive compulsive disorder (OCD) [ 55 ]. For example, Mayo Clinic Anxiety Coach is a mobile phone app “designed to deliver CBT for anxiety disorders, including OCD” [ 55 ]. The app contains a psychoeducational module that teaches the user on “the use of the application, the cognitive-behavioral conceptualization of anxiety, descriptions of each anxiety disorder, explanations of CBT, and guidance for assessing other forms of treatment” [ 55 ]. The benefits of delivering psychoeducation via a mobile phone app are obvious: the psychoeducational information becomes portable and is easily accessed by the patient. Furthermore, the information is also curated and validated by proper healthcare authorities, which builds trust and reduces the potential for misinformation that can result from patient-directed Internet searches. However, psychoeducation on its own is not optimal. Mobile interventions that also incorporate symptom-tracking and self-help interventions have resulted in greater improvement when used for depression and anxiety symptoms than those that deliver only online psychoeducation [ 50 ].

Self-Assessment Homework

In contrast to conventional, paper-based homework, mobile apps can support in-the-moment self-assessments by prompting the user to record self-report data about the user’s current state [ 56 ]. While information collected retrospectively using paper records can be adversely affected by recall biases [ 57 ], mobile apps enable the patient to document his or her thoughts and feelings as they occur, resulting in increased accuracy of the data [ 58 ]. Such self-assessment features are found in many mobile apps that have been shown to significantly improve symptoms in chronic pain [ 59 , 60 ], eating disorders [ 61 ], GAD [ 62 ], and OCD [ 55 ]. Continuing with the previous example, the Mayo Clinic Anxiety Coach offers a self-assessment module that “measures the frequency of anxiety symptoms” with a self-report Likert-type scale [ 55 ]. The app tracks users’ progress over time based on the self-assessment data; users reported liking the record of daily symptom severity scores that the application provides.

Modality-Specific Homework

Evidence suggests that a variety of modality-specific homework assignments on mobile apps are effective, including relaxation practices, cognitive therapy, imaginal exposure in GAD and PTSD [ 54 , 57 ], multimedia solutions for skill learning and problem solving in children with disruptive behavior or anxiety disorders [ 63 ], relaxation and cognitive therapy in GAD [ 62 ], or self-monitoring via text messages (short message service, SMS) to therapists in bulimia nervosa [ 61 ]. Mayo Clinic Anxiety Coach, for example, has a treatment module for OCD that “guides patients through the use of exposure therapy” [ 55 ]; patients can use this to build their own fear hierarchies according to their unique diagnoses. Users reported liking the app because it contains modality-specific homework that can be tailored to their own needs. Novel formats, such as virtual reality apps to create immersive environments, have been experimented with as a tool for facilitating exposure in the treatment of anxiety disorders with mostly positive feedback [ 64 - 66 ]. Apps that provide elements of biofeedback (such as heart rate monitoring via colorimetry of users' faces using the mobile phone's camera), have recently begun to be deployed. So-called ”serious games,“ (ie, games developed for treatment purposes), are also showing promise in symptom improvement in certain cases [ 51 , 67 , 68 ].

Fostering Learning

Doing CBT homework properly requires time and effort. As noted above, any sense of inconvenience while doing the homework may hamper a patient’s motivation to complete the homework. While patients may appreciate the importance of doing homework, they often find the length of time spent and the lack of clear instructions discouraging, resulting in poor engagement rates [ 49 , 52 ]. Therefore, it makes sense that the tasks should be simple, short in duration to begin with, and include detailed instructions [ 47 ], since homework completion rates have been shown to be correlated with patients’ knowing exactly what to do [ 33 , 69 ]. Many apps incorporate text messaging-based services or personalized feedback to encourage dynamic interactions between the therapist and the client [ 59 ]. However, the types of homework delivered by these apps are fixed. An app that adapts the contents to the user’s progress in learning homework tasks would be more engaging and effective since therapy should be a flexible process by nature. Ideally, the app would monitor and analyze the user’s progress and adjust the homework's content and difficulty level accordingly. While the effectiveness of this type of app has not been studied, a similar app has been described in the literature for treating GAD [ 62 ]. This app, used in conjunction with group CBT, collected regular symptom rating self-reports from patients to track anxiety. Based on patients’ ratings, the app would respond with encouraging comments and invite patients to practice relaxation techniques or prompt the patient to complete specific built-in cognitive therapy modules if their anxiety exceeded a threshold rating. Despite the simple algorithm used to trigger interventions, use of the app with group CBT was found to be superior to group CBT alone.

Guiding Therapy

Therapists have a number of important roles to play in guiding and motivating clients to complete homework. First, the therapist needs to address the rationale of the prescribed homework and work with the client in the development of the treatment plan [ 47 ]. Failure to do this has been identified as a barrier to homework compliance. Second, the therapist should allow the patient to practice the homework tasks during the therapy sessions [ 47 ] in order to build confidence and minimize internal barriers, such as the failing to identify automatic thoughts. Lastly, the therapist has to be collaborative, regularly reviewing homework progress and troubleshooting with the patients [ 47 , 70 ]; this can be done during or in between homework assignments, either in-person or remotely (ie, via voice or text messaging) [ 60 , 71 ].

Reviewing and troubleshooting homework has been seen as a natural opportunity for apps to augment the role of therapists. Individualized guidance and feedback on homework is found in many Internet-based or mobile apps that have been shown to be effective in treating conditions such as PTSD [ 72 ], OCD [ 55 ], chronic pain [ 59 , 60 ], depression and suicide ideation [ 71 ], and situational stress [ 73 ]. Moreover, providing a rationale for homework, ensuring understanding of homework tasks, reviewing homework, and troubleshooting with a therapist have each individually been identified as predictors of homework compliance in CBT [ 74 , 75 ]. However, despite incorporating a variety of features including self-monitoring, psychoeducation, scheduled reminders, and graphical feedback [ 52 ], automated apps with minimal therapist guidance have demonstrated elevated homework non-completion rates of up to 40%, which is less than ideal.

Building Connections

The effects of technology should not interfere with but rather encourage a patient’s ability to build meaningful connections with others [ 76 ]. The therapeutic alliance between the therapist and the client is the strongest predictor of therapeutic outcome [ 77 ] and has been suggested to predict level of homework compliance as well [ 78 ]. While there is no evidence so far to suggest that technology-based interventions have an adverse effect on the therapeutic alliance [ 79 , 80 ], this conclusion should not be generalized to novel technologies as their impact on therapeutic alliance has not been well studied [ 81 ].

An arguably more significant innovation attributable to technology has been its potential to allow patients to form online communities, which have been identified as useful for stigma reduction and constructive peer support systems [ 82 ]. Online or virtual communities provide patients with a greater ability to connect with others in similar situations or with similar conditions than would be possible physically. Internet-delivered CBT that includes a moderated discussion forum has been shown to significantly improve depression symptoms [ 83 ]. Furthermore, professional moderation of online communities increases users’ trust of the service [ 84 ]. Therefore, including social platforms and online forums in a mobile app may provide additional advantages over conventional approaches by allowing easier access to social support, fostering collaboration when completing homework, and enabling communication with therapists.

Emphasizing Completion

A patient’s need to see immediate symptomatic improvement is an impediment to homework compliance since the perception of slow progress can be discouraging to the user [ 35 ]. To address this issue, it is important for both therapists and mobile apps to emphasize homework completion over outcome [ 47 ]. While a therapist can urge the client to finish uncompleted homework during the therapy session to reinforce its importance [ 47 , 85 ], there is little a therapist can do in between therapy sessions to remind clients to complete homework. In contrast, a mobile app can, for example, provide ongoing graphical feedback on progress between sessions to motivate users [ 52 , 86 ], or employ automatic text message reminders, which have been demonstrated to significantly improve treatment adherence in medical illnesses [ 87 ]. These features have previously been incorporated into some technology-based apps for homework adherence when treating stress, depression, anxiety, and PTSD [ 52 , 54 , 88 ] with significant symptom improvement reported in one paper [ 71 ].

Population Specificity

Homework apps should, where relevant or useful, explicitly be designed taking into account the specific characteristics of its target audience, including culture, gender, literacy, or educational levels (including learning or cognitive disabilities). One example of how culture-specific design features can be incorporated can be found in Journal to the West, a mobile app for stress management designed for the Chinese international students in the United States, which incorporates cultural features into its game design [ 89 ]. In this game, breathing activity is associated with the concept of “Qi” (natural energy) in accordance with Chinese traditions; the name of the game itself references to a famous Chinese novel and the gaming environment features inkwash and watercolor schemes of the East Asian style, making the experience feel more “natural” as reported by the users. A different approach to tailoring design is taken by the computer-based games described by Kiluk et al [ 68 ] that combine CBT techniques and multi-touch interface to teach the concepts of social collaboration and conversation to children with autism spectrum disorders. In these games, the touch screen surface offers simulated activities where children who have difficulties with peer engagement can collaborate to accomplish tasks. Children in this study demonstrated improvement in the ability to provide social solutions and better understanding of the concepts of collaboration. Although the population-specific design is intuitively appealing, the degree to which it can enhance homework compliance has yet to be investigated.

Other Considerations

There are several additional issues specific to mobile apps that should be carefully considered when developing mobile apps for homework compliance. Because of screen sizes, input modes, the nature of electronic media, etc, standard CBT homework may need to be translated or modified to convert it into a format optimal for delivery via a mobile phone [ 47 ]. The inclusion of text messaging features remains controversial, in part because of concerns about client-therapist boundary issues outside the therapy sessions [ 90 ]. One potential solution is to use automated text messaging services to replace direct communication between the therapist and the client so the therapist can't be bombarded by abusive messages [ 52 , 61 , 91 , 92 ]. Privacy and security issues are also real concerns for the users of technology [ 93 ], although no privacy breaches related to text messaging or data security have been reported in studies on mobile apps so far [ 88 , 94 - 98 ]. Designers of mobile apps should ensure that any sensitive health-related or personal data is stored securely, whether on the mobile device or on a server.

Finally, while this paper focused on “essential” features of apps, this should not be misunderstood as an attempt to itemize all elements necessary for designing a successful piece of software. Good software design depends on many important elements that are beyond the scope of this paper, such as a well-designed user interface [ 99 ] that is cognitively efficient relative to its intended purpose [ 100 ] and which makes effective use of underlying hardware.

The popularization and proliferation of the mobile phone presents a distinct opportunity to enhance the success rate of CBT by addressing the pervasive issue of poor homework compliance. A variety of barriers exist in traditional, paper-based CBT homework that can significantly hamper clients’ motivation to complete homework as directed. The 6 essential features identified in this paper can each potentially enhance homework compliance. Therapy congruency focuses the features of the app on the central goal of therapy and fostering learning eases engagement in therapy by reducing barriers. Apps should help the therapist guide the client through therapy and not hinder the therapeutic process or interfere with patient’s building connections with others. It is crucial that homework completion be emphasized by the app, not just homework attempting. Population-specific issues should also be considered depending on the characteristics of targeted users.

As an example of how this applies in practice, “Mental Health Telemetry-Anxiety Disorders” (MHT-ANX) is a new mobile app developed by the Centre for Mobile Computing in Mental Health at Sunnybrook Health Sciences Centre in Toronto that helps patients monitor their anxiety symptoms using longitudinal self-report. The symptom log is therapy congruent to the practice of CBT since it promotes patients' awareness of their anxiety symptoms and the symptoms’ intensity. The simplicity of the app makes it easy for patients to learn to use, consistent with the need for fostering learning and increasing compliance. The MHT-ANX app was designed to share patient data with their clinicians, helping clinicians guide patients through therapy and more readily engage in discussion about symptom records, thus potentially enhancing the therapeutic relationship. Homework completion is emphasized both by automated text message reminders that the system sends and by questions presented by MHT-ANX that focus on how homework was done. While there are few population-specific design issues obvious at first glance in MHT-ANX, the focus groups conducted as part of our design process highlighted that our target group preferred greater privacy in our app rather than ease of sharing results via social media, and prioritized ease-of-use. While not yet formally assessed, reports from staff and early users suggest that MHT-ANX has been helpful for some patients with promoting homework compliance.

Limitations and Future Challenges

The feature list we have compiled is grounded in current technology; as technology evolves, this list may need to be revised. For example, as artificial intelligence [ 101 ] or emotional sensing [ 102 ] develops further, we would expect that software should be able to dynamically modify its approach to the user in response to users' evolving emotional states.

This paper presents our opinion on this topic, supported by a survey of associated literature. Our original intention was to write a review of the literature on essential features of apps supporting CBT homework compliance, but there was no literature to review. The essential features that are the focus of this article are summaries of key characteristics of mobile apps that are thought to improve homework compliance in CBT, but randomized trials assessing the impact of these apps on homework compliance have not yet been done. We would anticipate synergistic effects when homework-compliance apps are used in CBT (eg, if measures of progress collected from an app were used as feedback during therapy sessions to enhance motivation for doing further CBT work), but the actual impact and efficacy of therapy-oriented mobile apps cannot be predicted without proper investigation.

Abbreviations

Conflicts of Interest: None declared.

Types of Homework in CBT

Cindy brown.

• November 5, 2021
• No Comments

What is Homework in Psychotherapy

Psychotherapy homework is often allocated to patients as part of their therapy. Homework activities are incorporated in this way to practice techniques taught in therapy, to enable people to adapt the skills they have gained in therapy to real-life circumstances, and to strengthen the particular issues experienced in therapy. For example, in one therapy session, a patient with social skills deficits might practice and rehearse acceptable social skills, and be expected to complete homework assignments before the next session applying those newly acquired skills (e.g., going to a social engagement or greeting five people each day). In this article, we will talk about Homework Types in CBT . 

Thought and Behavior Rating Scales

Such homework is essential in the treatment of patients with cognitive distortions. These tests, which provide clinical information and are for self-report (self-rating) scales, also work as a self-report criterion to observe the patient’s mood changes during post-session homework or sessions. The use of such scales helps provide feedback from the patient during or towards the end of therapy. Beck Depression Inventory and Beck Anxiety Inventory are among the scales frequently used in this type of homework. The Beck Depression Inventory can work either as a group or as an individual by grading oneself or verbally, while the Beck Anxiety Inventory can be administered individually by grading one’s self.

Self-Monitoring

In the self-monitoring homework, patients keep records of their cognitive and behavioral status related to their main problems. This homework technique helps the therapist to get a clearer idea about the nature of the patient’s problem. This may also be useful for patients whose symptoms have spread throughout the day, have become habitual, and have difficulty describing these symptoms. However, therapists should be aware that self-monitoring in anxious patients can provoke anxiety. During this activity, the therapist asks the patient to concentrate on automatic thoughts and beliefs during the interaction with the family members.

Event Planning Phases

With this technique, patients first make a list of what they have to do. Then select one of them to determine which steps they should take to achieve this. . The therapist should ensure that these steps are large enough for the patient to cope with. After identifying the steps, the patient can rehearse the subject and write down the possible difficulties he may face. And think about what he can do about these steps. In this process, the therapist tells the patient: “Start the practice from the first step and ignore the other steps. Focus on what you’ve accomplished, not the things you have to do waiting for you.”

Confrontation

For the CBT to be effective, the client should apply confrontation exercises as an assignment at home, on the street, or in public transport. The confrontation treatment evaluation consists of three stages; explaining the rational treatment-making the graded confrontation list and determining the reaction prevention rules. 

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19 Best Narrative Therapy Techniques & Worksheets [+PDF]

It is likely that the life story you tell yourself and others changes depending on who is asking, your mood, and whether you feel like you are still at the beginning, in the middle, or at the end of your most salient story.

But when was the last time you paused to consider the stories you tell?

“What is your story?”

Narrative therapy capitalizes on this question and our storytelling tendencies. The goal is to uncover opportunities for growth and development, find meaning, and understand ourselves better.

We use stories to inform others, connect over shared experiences, say when we feel wronged, and even to sort out our thoughts and feelings. Stories organize our thoughts, help us find meaning and purpose, and establish our identity in a confusing and sometimes lonely world. Thus, it is important to realize what stories we are telling ourselves, and others, when we talk about our lives.

If you’ve never heard of narrative therapy before, you’re not alone!

This therapy is a specific and less common method of guiding clients towards healing and personal development. It’s revolves around the stories we tell ourselves and others.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What is narrative therapy a definition, 5 commonly used narrative therapy techniques, 3 more narrative therapy exercises and interventions, examples of questions to ask your clients, narrative therapy treatment plan, best books on narrative therapy, youtube videos for further exploration, a handy powerpoint to use, a take-home message.

Narrative therapy is a form of therapy that aims to separate the individual from the problem, allowing the individual to externalize their issues rather than internalize them.

It relies on the individual’s own skills and sense of purpose to guide them through difficult times (Narrative Therapy, 2017).

This form of therapy was developed in the 1980s by Michael White and David Epston (About Narrative Therapy, n.d.).

They believed that separating a person from their problematic or destructive behavior was a vital part of treatment (Michael White (1948-2008), 2015).

For example, when treating someone who had run afoul of the law, they would encourage the individual to see themselves as a person who made mistakes, rather than as an inherently “bad” felon. White and Epston grounded this new therapeutic model in three main ideas.

1. Narrative therapy is respectful.

This therapy respects the agency and dignity of every client. It requires each client to be treated as an individual who is not deficient, not defective, or not “enough” in any way.

Individuals who engage in narrative therapy are brave people who recognize issues they would like to address in their lives.

2. Narrative therapy is non-blaming.

In this form of therapy, clients are never blamed for their problems, and they are encouraged not to blame others as well. Problems emerge in everyone’s lives due to a variety of factors; in narrative therapy, there is no point in assigning fault to anyone or anything.

Narrative therapy separates people from their problems, viewing them as whole and functional individuals who engage in thought patterns or behavior that they would like to change.

3. Narrative therapy views the client as the expert.

In narrative therapy, the therapist does not occupy a higher social or academic space than the client. It is understood that the client is the expert in their own life, and both parties are expected to go forth with this understanding.

Only the client knows their own life intimately and has the skills and knowledge to change their behavior and address their issues (Morgan, 2000).

These three ideas lay the foundation for the therapeutic relationship and the function of narrative therapy. The foundation of this therapeutic process has this understanding and asks clients to take a perspective that may feel foreign. It can be difficult to place a firm separation between people and the problems they are having.

Key Concepts and Approach

Making the distinction between “an individual with problems” and a “problematic individual” is vital in narrative therapy. White and Epston theorized that subscribing to a harmful or adverse self-identity could have profound negative impacts on a person’s functionality and quality of life .

“The problem is the problem, the person is not the problem.”

Michael White and David Epston

To this end, there are a few main themes or principles of narrative therapy:

• Reality is socially constructed, which means that our interactions and dialogue with others impacts the way we experience reality.
• Reality is influenced by and communicated through language, which suggests that people who speak different languages may have radically different interpretations of the same experiences.
• Having a narrative that can be understood helps us organize and maintain our reality. In other words, stories and narratives help us to make sense of our experiences.
• There is no “objective reality” or absolute truth; what is true for us may not be the same for another person, or even for ourselves at another point in time (Standish, 2013).

These principles tie into the postmodernist school of thought, which views reality as a shifting, changing, and deeply personal concept. In postmodernism, there is no objective truth—the truth is what each one of us makes it, influenced by social norms and ideas.

Unlike modern thought that held the following tenets as sacred, postmodern thought holds skepticism over grand narratives, the individual, the idea of neutral language, and universal truth.

Thus, the main premise behind narrative therapy is understanding individuals within this postmodern context. If there is no universal truth, then people need to create truths that help them construct a reality that serves themselves and others. Narrative therapy offers those story-shaping skills.

It’s amazing how much easier solving or negating a problem can be, when you stop seeing the problem as an integral part of who you are, and instead, as simply a problem.

The five techniques here are the most common tools used in narrative therapy.

1. Telling One’s Story (Putting Together a Narrative)

As a therapist or other mental health professional, your job in narrative therapy is to help your client find their voice and tell their story in their own words. According to the philosophy behind narrative therapy, storytelling is how we make meaning and find purpose in our own experience (Standish, 2013).

Helping your client develop their story gives them an opportunity to discover meaning, find healing, and establish or re-establish an identity, all integral factors for success in therapy.

This technique is also known as “re-authoring” or “re-storying,” as clients explore their experiences to find alterations to their story or make a whole new one. The same events can tell a hundred different stories since we all interpret experiences differently and find different senses of meaning (Dulwich Centre, n.d.).

2. Externalization Technique

The externalization technique leads your client toward viewing their problems or behaviors as external, instead of an unchangeable part of themselves. This is a technique that is easier to describe than to embrace, but it can have huge positive impacts on self-identity and confidence .

The general idea of this technique is that it is easier to change a behavior you do, than to change a core personality characteristic.

For example, if you are quick to anger or you consider yourself an angry person, then you must fundamentally change something about yourself to address the problem; however, if you are a person who acts aggressively and angers easily, then you need to alter the situations and behaviors surrounding the problem.

It might seem like an insignificant distinction, but there is a profound difference between the mindset of someone who labels themselves as a “problem” person and someone who engages in problematic behavior.

It may be challenging for the client to absorb this strange idea at first. One first step is to encourage your client not to place too much importance on their diagnosis or self-assigned labels. Let them know how empowering it can be to separate themselves from their problems, and allowing themselves a greater degree of control  in their identity (Bishop, 2011).

3. Deconstruction Technique

Our problems can feel overwhelming, confusing, or unsolvable, but they are never truly unsolvable (Bishop, 2011).

Deconstructing makes the issue more specific and reduces overgeneralizing; it also clarifies what the core issue or issues actually are.

As an example of the deconstruction technique, imagine two people in a long-term relationship who are having trouble. One partner is feeling frustrated with a partner who never shares her feelings, thoughts, or ideas with him. Based on this short description, there is no clear idea of what the problem is, let alone what the solution might be.

A therapist might deconstruct the problem with this client by asking them to be more specific about what is bothering them, rather than accepting a statement such as, “my spouse doesn’t get me anymore.”

This might lead to a better idea of what is troubling the client, such as general themes of feeling lonely or missing romantic intimacy. Maybe the client has construed a narrative where they are the victim of this helpless relationship, rather than someone with a problem coping with loneliness and communicating this vulnerability with their partner.

Deconstructing the problem helps people understand what the root of problems (in this case, someone is feeling lonely and vulnerable) and what this means to them (in this case, like their partner doesn’t want them anymore or is not willing to commit to the relationship like they are).

This technique is an excellent way to help the client dig into the problem and understand the foundation of the stressful event or pattern in their life.

4. Unique Outcomes Technique

This technique is complex but vital for the storytelling aspect of narrative therapy.

The unique outcomes technique involves changing one’s own storyline. In narrative therapy, the client aims to construct a storyline to their experiences that offers meaning, or gives them a positive and functional identity. This is not as misguided as “thinking positive,” but rather, a specific technique for clients to develop life-affirming stories.

We are not limited to just one storyline, though. There are many potential storylines we can subscribe to, some more helpful than others.

Like a book that switches viewpoints from one character to another, our life has multiple threads of narrative with different perspectives, areas of focus, and points of interest. The unique outcomes technique focuses on a different storyline or storylines than the one holding the source of your problems.

Using this technique might sound like avoiding the problem, but it’s actually just reimagining the problem. What seems like a problem or issue from one perspective can be nothing but an unassuming or insignificant detail in another

(Bishop, 2011).

As a therapist, you can introduce this technique by encouraging client(s) to pursue new storylines.

5. Existentialism

You might have a particular association with the term “ existentialism ” that makes its presence here seem odd, but there is likely more to existentialism than you think.

Existentialism is not a bleak and hopeless view on a world without meaning.

In general, existentialists believe in a world with no inherent meaning; if there is no given meaning, then people can create their own meaning. In this way, existentialism and narrative therapy go hand in hand. Narrative therapy encourages individuals to find their meaning and purpose rather than search for an absolute truth that does not necessarily resonate for themselves.

If your client is an avid reader, you might consider suggesting some existentialist works as well, such as those by Jean-Paul Sartre, Albert Camus, or Martin Heidegger.

The visual below helps summarize what narrative therapy is, and how it can be used.

You can download the printable version of the infographic here .

While narrative therapy is more of a dialogue between the therapist and client, there are some exercises and activities to supplement the regular therapy sessions. A few of these are described below.

1. Statement of Position Map

• Characteristics and naming or labeling of the problem
• Mapping the effects of the problem throughout each domain of life it touches (home, work, school, relationships, etc.)
• Evaluation of the effects of the problem in these domains
• Values that come up when thinking about why these effects are undesirable

This map is intended to be filled out in concert with a therapist, but it can be explored if it is difficult to find a narrative therapist.

Generally, the dialogue between a therapist and client will delve into these four areas. The therapist can ask questions and probe for deeper inquiry, while the client discusses the problem they are having and seeks insight in any of the four main areas listed above. There is power in the act of naming the problem and slowly shifting the idea that we are a passive viewer of our lives.

Finally, it is vital for the client to understand why this problem bothers them on a deeper level. What values are being infringed upon or obstructed by this problem? Why does the client feel negative about the problem? For example, what does the “stressful dinner party” bring up for them? Perhaps feelings of social anxiety and “otherness” that feel isolating? These are questions that this exercise can help to answer.

For a much more comprehensive look at this exercise, you can read these workshop notes from Michael White on using the statement position maps.

You can also access a PowerPoint in which a similar exercise is covered here .

2. My Life Story

This exercise is all about your story, and all you need is the printout and a pen or pencil.

The intention of the My Life Story exercise is to separate yourself from your past and gain a broader perspective on your life. It aims to create an outline of your life that does not revolve too intensly around memories as much as moments of intensity or growth.

First, you write the title of the book that is your life. Maybe it is simply “Monica’s Life Story,” or something more reflective of the themes you see in your life, like “Monica: A Story of Perseverance.”

In the next section, come up with at least seven chapter titles, each one representing a significant stage or event in your life. Once you have the chapter title, come up with one sentence that sums up the chapter. For example, your chapter title could be “Awkward and Uncertain” and the description may read “My teenage years were dominated by a sense of uncertainty and confusion in a family of seven.”

Next, you will consider your final chapter and add a description of your life in the future. What will you do in the future? Where will you go, and who will you be? This is where you get to flex your predictive muscles.

Finally, the last step is to add to your chapters as necessary to put together a comprehensive story of your life.

This exercise will help you to organize your thoughts and beliefs about your life and weave together a story that makes sense to you. The idea is not to get too deep into any specific memories, but instead to recognize that what is in your past is truly the past. It shaped you, but it does not have to define you. Your past made you the reflective and wiser person of today.

You can download this worksheet  here .

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3. Expressive Arts

This intervention can be especially useful for children, but adults may find relief and meaning in it as well.

We all have different methods of telling our stories, and using the arts to do so has been a staple of humanity for countless generations. To take advantage of this expressive and creative way to tell your stories, explore the different methods at your disposal.

• Meditate . Guided relaxation or individual meditation can be an effective way to explore a problem.
• Journal. Journaling has many potential benefits. Consider a specific set of question s (e.g., How does the problem affect you? How did the problem take hold in your life?) or simply write a description of yourself or your story from the point of view of the problem. This can be difficult but can lead to a greater understanding of the problem and how it influences the domains of your life.
• Draw. If you’re more interested in depictions of the problem’s impact on your experience, you can use your skills to draw or paint the effects of the problem. You can create a symbolic drawing, map the effects of the problem, or create a cartoon that represents the problem in your life. If drawing sounds intimidating, you can even doodle abstract shapes with the colors of the emotions you feel, and keywords that express your reflection in that moment.
• Movement. You can use the simple medium of movement and mindfulness to create and express your story. Begin by moving in your usual way, then allow the problem to influence your movement. Practice mindful observation to see what changes when you let the problem take hold. Next, develop a transitional movement that begins to shake the problem’s hold on you. Finally, transition into a “liberation movement” to metaphorically and physically explore how to escape the problem.
• Visualization. Use visualization techniques to consider how your life might be in a week, a month, a year, or a few years, both with this problem continuing and in a timeline where you embrace a new direction. Share your experience with a partner or therapist, or reflect in your journal to explore the ways in which this exercise helped you find meaning or new possibilities for your life (Freeman, 2013).

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Narrative therapy is a dialogue in which both you and your client converse to learn about your story. As you may imagine, it requires many questions on the part of the therapist.

“Every time we ask a question, we’re generating a possible version of a life.”

David Epston

The list of questions below is intended to go with the statement of position maps, but these questions can be useful outside of this exercise too:

• It sounds as though [problem] is part of your life now.
• How long have you been noticing this [problem]?
• What effect does the [problem] have on your life?
• How does the [problem] impact on your energy for daily tasks?
• Does [problem] have an impact on your relationship with other family members?
• What effects does [problem] have on your child’s life?
• What do you think about the effects [problem] is having on your life?
• Are you accepting what [problem] is doing?
• Are these effects acceptable to you or not?
• Why is this? Why are you taking this position on what [problem] is doing?
• How would you prefer things to be?
• If you were to stay connected to what you have just said about what you prefer, what next steps could you take?

The website www.integratedfamilytherapy.com also provides excellent examples of questions to ask your client as you move through their story:

• Enabling Openings Can you describe the last time you managed to get free of the problem for a couple of minutes? What was the first thing you noticed in those few minutes? What was the next thing?
• Linking Openings with Preferred Experience Would you like more minutes like these in your life?
• Moving from Openings to Alternative Story Development. What was each of you thinking/feeling/doing/wishing/imagining during those few minutes?
• Broadening the Viewpoint. What might your friend have noticed about you if she had met up with you in those few minutes?
• Exploring Landscapes of Action. How did you achieve that? How did Tim help you with that?
• Exploring Landscapes of Consciousness.  What have you learned about what you can manage from those few minutes?
• Linking with the Exceptions in the Past. Tell me about times when you have managed to achieve a similar few minutes in the past?
• Linking Exceptions from the Past with the Present. When you think about those times in the past when you have achieved this, how might this alter your view of the problem now?
• Linking Exceptions from the Past with the Future. Thinking about this now, what do you expect to do next?

Developing a treatment plan for narrative therapy is a personal and intensive activity in any therapeutic relationship, and there are guidelines for how to incorporate an effective plan.

This PDF provides a profile of a treatment plan, including goals and guidelines for each stage and theories that can apply to the client’s treatment.

The co-founder of narrative therapy, Michael White, offers an additional resource for therapists using narrative therapy.

According to White, there are three main processes in treatment:

1) Externalization of the problem, which mirrors the steps of the position mapping exercise:

• Developing a particular, experience-near definition of the problem;
• Mapping the effects of the problem;
• Evaluating the effects of the problem;
• and justifying the evaluation.

2) Re-authoring conversations by:

• Helping the client include neglected aspects of themselves;
• and shifting the problem-centered narrative.

3) Remembering conversations that actively engage the client in the process of:

• Renewing their relationships;
• Removing the relationships that no longer serve them;
• and finding meaning in their story that is no longer problem-saturated as much as resilient-rich.

If you’re as much of a bookworm as I am, you’ll want a list of suggested reading to complement this piece. You’re in luck!

These three books are some of the highest rated books on narrative therapy and offer a solid foundation in the practice of narrative techniques.

1. Maps of Narrative Practice – Michael White

This book from one of the developers of narrative therapy takes the reader through the five main areas of narrative therapy, according to White: re-authoring conversations, remembering conversations, scaffolding conversations, definitional ceremony, and externalizing conversations.

In addition, the book maps out the therapeutic process, complete with implications for treatment and skills training exercises for the reader.

Find the book on Amazon .

2. What is narrative therapy? : An easy-to-read introduction – Alice Morgan

This best-seller provides a simple and easy to understand introduction to the main tenets of narrative therapy.

In this book, you will find information on externalization, remembering, therapeutic letter writing, journaling, and reflection in the context of narrative therapy.

Morgan’s book is especially useful for therapists and other mental health professionals who wish to add narrative techniques and exercises to their practice.

3. Narrative Therapy: The Social Construction of Preferred Realities – Gene Combs and Jill Freedman

This book is best saved for those who want to dive headfirst into the philosophical underpinnings of narrative therapy.

Casual readers interested in learning more about narrative therapy may want to try one of the first two books; students, teachers, and practitioners will find this book challenging, informative, and invaluable to their studies.

Included in this book are example transcripts and descriptions of therapy sessions in which the principles and interventions of narrative therapy are applied.

1. This quick, 5-minute video can give you an idea of how some of the techniques of narrative therapy can be applied in real counseling sessions, specifically with children and families. As Dr. Madigan quotes in this video, “we speak ourselves into meaning.”

We need to speak in ways that serve us.

3. Finally, for a fun and engaging exploration of narrative therapy for in couples counseling, click the link below. It leads to a video involving puppets and outlining some of the main techniques and principles involved in narrative couples therapy.

Around four minutes in, a breakthrough moment occurs when the therapist puppet says, “so you’re feeling anxious because you don’t know what direction this is going to take you.” This is an example of deconstructive questioning, and how it helps uncover the deeper vulnerability of any “problem.”

If you’re more a reader or if you like to go at your own pace, check out this slideshow on narrative therapy.

It’s intended for students learning about narrative therapy in an academic setting. Some of the languages may seem specific and jargon abounds, but there is some great information in here for any readers curious about the philosophy, principles, and theories behind narrative therapy.

Follow this link to view the slideshow.

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How do you tell your story? What are the chapters of your life? Do you like the story you tell, or would you prefer to change your story? These and many other questions can be answered in narrative therapy.

“There is no greater agony than bearing an untold story inside you.”

Maya Angelou

If you’re an individual curious about narrative therapy, I hope your curiosity is piqued and that you have a foundation now for further learning.

If you’re a therapist or other mental health professional interested in applying narrative therapy in your work, I hope this piece can give you a starting point for you.

As always, please leave us your thoughts in the comment section. Have you tried narrative therapy? If so, what did you think? Did you find it useful? What techniques in particular capture your interest?

Thanks for reading and happy storytelling!

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• About Narrative Therapy. (n.d.). Narrative Therapy Centre of Toronto. Retrieved from http://www.narrativetherapycentre.com/narrative.html
• Bishop, W. H. (2011, May 16). Narrative therapy summary. Thoughts From a Therapist. Retrieved from http://www.thoughtsfromatherapist.com/2011/05/16/narrative-therapy-summary/
• Dulwich Centre. (n.d.). What is narrative therapy? Dulwich Centre. Retrieved from http://dulwichcentre.com.au/what-is-narrative-therapy/
• Freeman, J. (2013, June 5). Expressive arts workshop materials. Narrative Approaches. Retrieved from http://www.narrativeapproaches.com/expressive-arts-workshop-materials/
• Michael White (1948-2008). (2015, July 24). GoodTherapy. Retrieved from http://www.goodtherapy.org/famous-psychologists/michael-white.html
• Morgan, A. (2000). What is narrative therapy? An easy-to-read introduction. Adelaide, SA: Dulwich Centre Publications. https://www.amazon.com/dp/0957792905/
• Narrative Therapy. (2017). Good Therapy. Retrieved from http://www.goodtherapy.org/learn-about-therapy/types/narrative-therapy
• Standish, K. (2013, November 28). Introduction to narrative therapy [Slideshow]. Retrieved from https://www.slideshare.net/kevins299/lecture-8-narrative-therapy

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What our readers think.

Wow, this is really invalidating. It’s always so telling when mental health providers focus on “behavior change” when sometimes behaviors aren’t the issue. It’s also telling that the author assumes that mentioning children and family is not triggering to clients. What if the issue is that there is not a possibility of children or family?

Why is the assumption that telling one’s story is the issue? For many of us, we are aware of and can express our stories; that’s not the issue.

Yikes for those of us who have already had terrible and invalidating experiences with therapy.

I’m genuinely sorry to hear that the content has resonated with you this way. It’s crucial to acknowledge that everyone’s experience with mental health is unique, and what works for one person might not be suitable for another. The intention is never to invalidate anyone’s feelings or experiences. Instead, the aim is to provide diverse tools and perspectives that might be helpful to some.

Your point about the assumptions regarding family and storytelling is well-taken, and it highlights the importance of a more inclusive and sensitive approach that considers the varied backgrounds and experiences of all individuals.

If there are specific topics or resources you feel would be more beneficial or sensitive to your experiences, we’re open to suggestions.

Warm regards, Julia | Community Manager

As a mental health therapist I understand exactly what you are saying. Narrative Therapy may never be a good therapy for you and many others. It seems to me that it can be effective after the patient feels securely validated, assigns appropriate responsibility to the source of their pain, establishes safety, regains their ability to exercise choices and options, and feels a sense of value and worth. Then the patient may choose to pursue Narrative Therapy as a way to further recover from what happened to them by becoming the main character in their own life. This can be an empowering experience that allows them to validate themselves, secure their identity, strengthen their self-esteem and regard their past, present and future based on their own terms. For example, a Chapter 1 title something like: “JKL is born for themselves, not to please their parents.” A clinician needs to use sound clinical judgment about the readiness for this therapy, as is true for other therapies. Treating trauma and deep wounds is a sensitive process and takes wisdom along with skill.

Existentialism has little to do with White and Epston’s developments — please be more cautious about representing Narrative Practice. There are some more subtle inaccuracies here as well (deconstruction isn’t well represented, re-authoring and re-membering are hardly mentioned, not to mention outsider witness conversations and the abscent but implicit, to name several, but not all), but the problem I’m citing really needs to be addressed.

I always enjoy relearning the techniques of Narrative Therapy but could use a guideline that focuses on Addiction. I am a co-occurring therapist that works with Addiction and Mental Health and use externalization a lot. It would be great if you had a specific worksheet/questionnaire that addresses addiction specifically.

Thanks so much for your insight!

Kind Regards, Diane Music

Dear Diane,

Thank you for reaching out and expressing your interest in resources specifically designed for the context of addiction. It’s wonderful to hear you’re applying Narrative Therapy techniques in your work!

Although we presently lack resources specifically tailored to your case, we recommend adapting the principles of Narrative Therapy to suit the unique needs of your clients battling addiction:

– Externalizing the Problem: As you’re already doing, this can be particularly beneficial in addiction therapy. It helps the client see their addiction as a separate entity rather than an inherent part of themselves. They can then examine how ‘the addiction’ influences their life and choices. – Deconstructing Dominant Narratives: Encourage clients to explore societal and personal beliefs about addiction. Challenge these narratives and help clients construct their own, empowering narratives. – Highlighting Unique Outcomes: Help your clients identify times when they successfully resisted the ‘pull’ of addiction. These ‘unique outcomes’ can help them see their own strength and capacity for change. – Letter Writing: This can be a powerful tool for clients to communicate with their ‘addiction,’ express their feelings, or articulate their hopes for the future. – Mapping the Influence: Create a visual map of how addiction influences different areas of their life. This can be a powerful tool for externalization and for identifying areas to work on.

We hope to have more specialized resources available soon. Until then, we believe the techniques mentioned above, when applied with sensitivity and creativity, can be highly effective in a narrative approach to addiction therapy.

Thank you for the impactful work you’re doing!

Best Regards, Julia | Community Manager

“Expressive Arts. This intervention can be especially useful for children, but adults may find relief and meaning in it as well.” As an expressive arts therapist, I found this comment to be confusing and somewhat misinformed. Firstly, the “expressive arts” are not an intervention, but are a collective of psychotherapeutic techniques and disciplines. There is also an insinuation that the expressive arts (or, more accurately, “expressive arts therapy”) are mostly for children, while adults, secondarily, “may find relief and meaning in it as well.” I have worked primarily with adults as an expressive therapist. The misconception that expressive therapy is mostly for children is a bias that many of us must contend with from those who do not understand that we are trained psychotherapists who work with adults. Thank you.

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