Client compliance with homework directives during counseling.

Abstract

Compliance with homework directives in counseling has often been theorized about but seldom researched. The present study investigated compliance of 61 clients, using 18 postmaster's degree counselors in a community counseling agency for adults. Compliance was investigated as a function of counselor variables, client variables, and therapy variables. Neither counselor ability nor specific counseling skills was related to client compliance. Initial severity of client problems was related to outcome but not to compliance. Clients who remained in counseling had better compliance than those who terminated early. Whether clients presented career or personal-emotional problems was unrelated to compliance. Therapy variables that predicted compliance included assignments given early in counseling, a history of compliance, and whether counselors checked their client's attitude about homework and did not stress their own status. This study suggests that variables associated with the conduct of counseling more strongly influence compliance with homework than do either counselor or client variables.Compliance has been defined in a number of different ways, but Haynes (1979) provided a succinct, workable definition: "the extent to which a person's behavior . . . coincides with medical or health advice" (pp. 2-3). Although Haynes was strictly discussing adherence or compliance with medical directives, this definition might be applied to homework directives or to suggestions given by counselors in career or personal-emotional counseling.Researchers have often theorized about compliance (and its counterpart resistance) but have infrequently investigated its presence in counseling (for reviews see Davidson, 1976;G. Martin & Worthington, 1982;Shelton & Levy, 1981). Empirical research has lagged behind theoretical work. Extant research has come from three general areas: (a) extension of findings related to health care, medical problems, and adherence to medical regimens; (b) analogue investigations into social influence theory (Corrigan, Dell, Lewis, & Schmidt, 1980;G. Martin & Worthington, 1985); and (c) behavioral and cognitive-behavioral counselors who have primarily investigated self-control problems (e.g., weight control, smoking cessation, or muscular relaxation; see Stuart, 1982). Few researchers have investigated clients in a community-based mental health setting. None has investigated compliance with directives of the private practitioner. Difficulties in Conducting Empirical Research on ComplianceLittle research has been done on compliance in career and personal-emotional counseling due to the difficulties in measuringThe data analysis and writing of this article were funded through a Virginia Commonwealth University Faculty Grant-in-Aid.Thanks are extended to the following people: Teresa Buczek and Sara Beck, who assisted in rating counselors and folders; Constance Google, who assisted in data analysis; Stephen Robbins, who read and commented on an earlier draft of the article; and the practicum counselors who provided d...

Reflecting on homework in psychotherapy: What can we conclude from research and experience?

“…The suggestion is that written homework serves as a public statement of the client's intention to comply with the assignment while also serving as a memory prompt (see empirical support in Cox, Tisdelle, & Culbert, 1988). Tompkins also underscores the importance of soliciting feedback from clients regarding their acceptance of the rationale, understanding of the content, and willingness to undertake the task as discussed (see empirical support in Worthington, 1986).…”

Assessing compliance with homework assignments: Review and recommendations for clinical practice

“…Research has sought to relate severity and type of presenting problem to homework compliance, without success (e.g., Bryant et al, 1999;Leung & Heimberg, 1996;Worthington, 1986). Similarly, willingness to engage in therapy and acceptance of a rationale for cognitive-behavioral therapy have not been linked with homework compliance (e.g., Addis & Jacobson, 2000;Burns & NolenHoeksema, 1991).…”

“…In two studies of therapist competency in delivering cognitive-behavior therapy for depression, therapists' competency in the review of homework assignments was correlated with homework compliance (e.g., Bryant et al, 1999;Shaw et al, 1999; also see Worthington, 1986). However, a study by Startup and Edmonds (1994) did not find any evidence to suggest that therapist adherence to the homework administration procedures was associated with compliance.…”

Modifying therapeutic homework for patients with personality disorders

“…Allowing patients to select among homework activities that are equal to their abilities can further increase commitment, responsibility, and adherence. Offering the patient a choice of ways and times to complete the assignments can have similar effects (Beck, et al, 1979;Kazantzis & Deane, 1999;Worthington, 1986).…”