Homework Assignments in Clinical Practice: Frequency of Use, Compliance and Associations with Therapeutic Outcome

Meta-Analyses confirm positive effects of therapeutic homework use and completion on treatment outcome. However, existing data in most cases is limited to retrospective estimates of homework compliance and data from controlled clinical trials in selected populations. In order to extent existing knowledge about homework use in clinical routine care, we analysed homework and therapy process variables from 1 413 therapy sessions and 79 patients treated in an outpatient psychotherapy centre. Homework was used on a regular base and with every patient; however, systematic homework assignment procedures were rare. Overall homework compliance was high; patient characteristics were not associated with compliance. However, problems in therapeutic alliance within the index session were linked to reductions in subsequent homework completion. There were no associations between frequency of homework use or compliance and symptom change; however, premature therapy termination was related to lower compliance rates. Thus, homework compliance should be considered in adaptive treatment planning.