Magazine article Family Therapy Networker

IN CONSULTATION: When Clients Don't Do Their Homework

Magazine article Family Therapy Networker

IN CONSULTATION: When Clients Don't Do Their Homework

Article excerpt

Q: How do I get clients to do homework assignments?

A: Please don't call them homework assignments. That evokes memories of tasks handed out in school, which often seemed like busywork. The best way to ensure clients' cooperation is to make the assignments relevant for them. Task assignments are designed to bring about changes in the presenting problem. We try to make sure they are relevant to clients by having a mutually agreed upon definition of the problem being addressed and then collaboratively designing tasks that relate to it. In fact, when the tasks derive from a collaborative relationship, they often don't feel like tasks at all.

There are several ways to design tasks collaboratively. We present multiple possibilities and suggestions and then try to anticipate clients' responses to potential tasks by telling stories about other clients who performed a task assignment similar to the one we think might help them. If clients shake their heads adamantly during such a story, we understand that this may not be the best task for them. Likewise, if clients are smiling or nodding, we get a sense we are probably on the right track.

Steffanie once saw a family who had been referred by their pediatrician because their 10-year-old son had been having escalating temper tantrums since his surgery for severe colitis. The family had never been to therapy, but they settled in quickly and readily discussed their son's colitis and temper tantrums. Steffanie reassured them about the likelihood of solving the problem and proceeded to give examples of tasks that had worked for other families. The father began to shift in his chair and sigh as

Steffanie spoke about these interventions. After observing this, Steffanie turned to the father and said, "I think I'm off target in some way. I notice you seem uncomfortable when I start to talk about things that might help."

The father said, "You're telling us things we can do to stop the tantrums. We thought that if we brought him here, you could work with him and stop the tantrums." Steffanie and the family talked about psychotherapy with kids and discussed the fact that Steffanie preferred to work by involving the family in making changes because they were really the experts on their kids and would be around when most of the tantrums occurred. Both parents seemed relieved and the mother confided that they felt responsible for missing the warning signs of their son's illness and were scared to "do anything wrong again." They had come to mistrust their judgment and think "the professionals know better." Newly empowered to take control of the situation, the family worked with Steffanie on setting clearer limits and developing other strategies for dealing with the tantrums.

Assignments have to be road tested. Do they work for the clients? Were there unpredicted glitches? For us this is the stuff of treatment--the feedback we receive from the assignment often determines the direction of the session. For instance, Bill told a couple having fights about money about another couple he had worked with who had committed to weekly budget "summits" in which they would make joint decisions about household expenditures. The couple agreed to do the task, but when they returned, they reported that it hadn't worked. …

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