In Consultation


In Consultation

Taking Therapy Home: Motivating Couples to Do Their Homework

By David Treadway

November/December 2017


Q: How important is homework for couples in therapy, and how do I motivate them to do it?

A:Let me start with a case example. As they entered my office and sat on the couch, Robin and Jim looked like children dragged into the principal’s office. They hadn’t followed through on their commitment to do the therapeutic exercises between sessions I’d recommended for them. They weren’t defensive or blaming each other, just disappointed that yet again they hadn’t done their part to move therapy forward in this way.

“Listen,” I said with a smile. “You’re not the only clients who struggle to get homework done. In fact, part of the point of asking you to do homework is to help you learn to change routines and behaviors on your own. My wife and I have been doing these homework exercises for decades. They work really well to help us strengthen our relationship, and we still have long lapses where we can’t find the time to do them. So how about I offer you my carrot-and-stick approach?” They looked intrigued.

“Here’s the deal,” I continued. “If you do your homework as agreed on, I’ll give you the next session for free. That’s the carrot—and the added bonus is more success in therapy. But if you don’t, then in addition to paying for the next session, you’ll have to give an equal amount of money to my favorite charity. That’s the stick.”

Robin immediately turned to Jim and exclaimed, “A free session! We can do this!” And indeed they did. Although I don’t make a habit of offering this particular fun bribe, and was out a hefty chunk of change the next week, I was delighted, because it led them to continue following through with their homework, hence continued improvement in their relationship.

Over the years, the couples in my practice who’ve actually done homework exercises have reported communicating better and being more affectionate and more supportive of each other than couples who haven’t. Doing communication homework tasks has led to more careful listening to each other in general. Doing physical-affection exercises has led to more spontaneous gestures of affection. And changes in behavior and interactions that couples have made on their own at home have increased their sense of competence, self-esteem, and positive feelings about each other and the relationship. In fact, the implementation of homework is the single variable that predicates successful treatment in my couples therapy.

For much of my career, however, I’d been like many couples therapists who assign exercises between sessions, giving the homework more as an afterthought than as the first priority of couples therapy. I’d throw out a few ideas at the end of a session, couples frequently wouldn’t do them, and sometimes the next week I wouldn’t even remember what I’d suggested. In general, I simply wasn’t good at motivating couples to do homework. And when they didn’t do it, I was reluctant to start each session dealing with their excuses and feeling like a scold or a school principal. In many ways, I was just as resistant to dealing with homework as my clients were, and my own antipathy to pushing homework prevented me from seeing why couples have difficulty doing it—and why it’s so important.

Most couples, I discovered when I started to ask, say their difficulty in doing the homework is because of time pressure, but underneath the “we don’t have time” excuse are more difficult matters. By the time couples have arrived in my office, they’ve developed deeply ingrained habits and patterns of interaction that allow them to coexist and function together while holding deep feelings of ambivalence, hurt, distrust, and sometimes anger with each other. They’ve already made countless efforts to improve their relationship on their own, so most of them feel that they’ve been there, done that—and have failed repeatedly.

Instead of labeling a couple’s difficulties with doing homework as a problem or resistance, I now see it as an opportunity for them to explore their feelings safely, normalize difficulties with change, and help them choose homework that they can and want to do. Exploring problems with doing homework also allows me to help each partner take responsibility for his or her own behavior, rather than blaming each other.

Once I realized these benefits, I made a full commitment to encourage couples to prioritize doing homework as the core of our couples work. To make sure I’m successful in motivating them, I use the Six P’s.

Preparation. Starting with the first phone call, I convey how the work done between sessions is the key to successful couples therapy. I explain that I don’t always schedule weekly sessions because I expect that couples will be working hard to build their competence and confidence in their relationship through the assignments at home. I explicitly say that homework is the foundation of my couples therapy, and if that idea doesn’t appeal to them, I’d be happy to recommend other therapists they could work with.

Planning. I don’t simply give homework assignments: I want couples to come up with their own homework or choose from a menu of possibilities. No matter what they decide, it’s critical that the choice be collaborative. When it comes to homework, one size definitely doesn’t fit all, and the more the partners collaborate in choosing and designing their homework, the more they’ll feel ownership and investment in its success.

I ask couples to place the same priority on doing homework that they place on showing up for an appointment with me—which can be a big challenge in the hurly-burly of everyday life. Even small assignments, like a communication exercise that only takes 15 minutes per week, are hard for people to follow through with. So it’s essential for each partner to make a commitment to prioritize the effort. In fact, having each partner take responsibility for his or her actions is at the core of almost all successful couples therapy, and this is a good way to get that momentum started.

Practicing. For homework to succeed, it’s critical for couples to practice in the room with me so they can experience how to do a task with coaching from me. Then I’ll often step out of the room to have them practice on their own to solidify their sense of ownership and competence without me.

When working with intimacy and sexuality issues, for example, I help couples practice an exercise called “Loving Fingers—Hurt and Angry Feelings.” Couples take turns giving each other a light shoulder massage while I encourage them to internally experience their negative, hurt, resistant, angry, distrusting feelings. This helps them learn to touch each other lovingly while acknowledging that they have a mess of mixed feelings. I might cap that session by stepping out of the room so they can give each other a hug and experience the power of touch while also allowing themselves to have difficult, uncomfortable feelings. Of course, some couples or one partner may feel unready to do this, but that allows me to address the importance of being able to say no and to adjust the pace of our work.

Processing. We always start the next session by deciding and discussing what aspects of the homework worked and what didn’t. Having each partner held accountable for his or her own actions around homework breaks patterns, reveals resistance, and short-circuits the blame game. If one partner is compliant and the other isn’t, I can bring affectionate curiosity—not judgment or blame—to the feelings blocking them from fully participating. Often this allows the therapy to go deeper into the underlying pain and vulnerability that lies beneath the surface for the couple.

Sometimes a couple reports that they did their homework but didn’t like it or it didn’t help. That’s always a welcome opportunity to explore with greater depth and refinement what they believe would help that they’d be ready to try. Again, creating successful homework is a collaborative creation by the couple and the therapist as a team.

Pushing. I’m as persistent as a dog chewing on a bone when helping couples do homework. I ask them to write down the homework task, or I send them an email restating it. I ask them to call or write to me if they have questions or if it’s not happening. With couples who really struggle to follow through with homework, like Robin and Jim, sometimes I’ll even offer an incentive and/or a penalty to get them started. I’ve also gone so far as to recommend that the couple take a break from treatment until they’re able to do agreed-upon homework.

Perpetuating. I’m about to celebrate my 50th wedding anniversary. Over the years, my dear wife and I, her relentless therapist husband, have been practicing many of the homework assignments I routinely give my clients. But do we practice what I preach about making them our first priority? No. We often lapse and disregard our relationship practices, even though we know they’re highly effective. So we often have to rededicate ourselves to the work. The simple truth is that with all self-discipline practices, like meditation and physical exercise, homework practices are difficult to sustain. Thus, toward the end of successful therapy, when couples are doing well with their homework, we space out sessions progressively, with the understanding that they need to keep up their homework between our intermittent sessions. In many instances, that leads to twice-a-year or once-a-year sessions before we consider the therapy complete. Couples prepare for the possibility that they’ll lapse and discuss how they’ll get back on track. They accept that it’ll always take maintenance.

- - - - -

Clients often have a hard time with the core truth of what it takes to be a successful couple: hard work that never ends. It’s not always about the therapeutic breakthroughs, the dramatic insights, the tenderness of amends and forgiveness. Just like cultivating a successful garden, you can’t enjoy the fruits of your labor without putting in the effort of weeding and nourishing the soil, day in and day out, decade after decade. But rather than brush this truth aside, we therapists can help couples accept and practice this, with the aim of continuously nourishing their relationship long after therapy ends.

***

David Treadway, PhD, is a therapist who’s been giving workshops and trainings around the country for more than 30 years. He’s the coauthor of Home before Dark: A Family Portrait of Cancer and Healing and author of three other books. Contact:dctcrow@aol.com.

Tell us what you think about this article by emailing letters@psychnetworker.org. Want to earn CE hours for reading it? Visit our website and take the Networker CE Quiz.

Want to submit an In Consultation piece for an upcoming issue? Please see Submission Guidelines on our website.

Photo © Katarzyna Bialasiewicz | Dreamstime



Previous: Clinician's Digest
Next: Case Study

Read 1431 times
Comments - (existing users please login first)
Your email address will not be published. Required fields are marked *

*
*
*