Therapy sessions bring people to many new realisations. However, real learning takes place when a client attempts to apply these new ways of thinking and acting to their everyday life and to the goals they wish to accomplish. A big part of the process is the homework or exercises a therapist assigns to a client. If a client doesn’t do their homework, does this make the therapist’s job much harder?
Below you will find the testimony of 19 different therapists that are weighing in on this very real and common occurrence. Each therapist gives their two cents on whether this issue is counterproductive, ways to get around and more importantly ways to motivate their clients.
Tina Marie Del Rosario, LCSW, MSW, Adjunct Professor @ Pepperdine University
Owner of Healing Collective Therapy Group
https://healingcollectivetherapy.com
A common theme I see in people who lack motivation is the absence of self-compassion. Clients who show up faithfully are clearly displaying a form of motivation. But when it comes to doing the work, there are clients who meet resistance and acts of avoidance.
What interventions have you found to be helpful in motivating clients?
I find that starting with a psychodynamic approach is necessary. Exploring what is coming up for the client when resistance and avoidance are present is often helpful. The thoughts, attitudes and emotions attached to these feelings have come from some past experiences.
Identifying where it is coming from can help the client process said past experience(s) and recognise the lack of relevance it has to the present day. More often than not, self-critical narratives are attached to feelings of resistance.
These criticisms evoke both somatic symptoms and self-protection motivations that lead to avoidance. Becoming aware of what is coming up and how it is showing up is necessary to combat a lack of motivation. Once identified, we can then work together to process it all and begin to change the narrative.
When clients realize their lack of motivation is not coming from “laziness” or “a character flaw,” they then can begin to remove the self-critical narratives and replace them with self-compassion.
With this new internal dynamic and the absence of self-criticism, clients find it easier to begin to motivate themselves to do the work.
Ellie Borden, BA, RP, PCC
Registered Psychotherapist, Clinical Director and Clinical Supervisor.
Resistance can be a common part of any change process. Some people struggling with different challenges may appear not to want to change. Even those clients who attend therapy loyally and recognize the need for change in their lives may fail to complete their homework or take the necessary steps outside therapy to modify their behaviour.
This is a powerful moment in therapy and can give a therapist the insight necessary to recognize the deeper issues affecting someone’s motivation to take the necessary steps toward the change they seek. Often, recognizing avoidant patterns or behaviour is an opportunity to identify unresolved matters and the core elements that require healing.
Moreover, a therapist can help an individual reformat their way to change. It is important that someone’s why is emotionally driven and leads to effortless motivation. The responsibility for change is the client’s alone. However, a trained professional can give someone the objective perspective needed to get them moving in the right direction.
While a therapist can help a client become more motivated to change, ultimately, the onus is on the client to change. With that in mind, there are specific methods that therapists can use with clients to properly motivate them to make the needed changes in their lives.
What interventions have you found to be helpful in motivating clients?
One of the most widely used interventions for motivating clients is motivational interviewing. The goal of motivational interviewing is to help clients increase their intrinsic desire to change and achieve their goals in therapy. One of the techniques in motivational interviewing is bolstering the client’s sense of self-efficacy by helping them recall examples of overcoming challenges in the past. This can allow the client to see that change is achievable and that the situation may not be as hopeless as they think. Developing discrepancies is another technique in motivational interviewing.
This involves a therapist helping the client voice their thoughts, feelings, and conflicts to call attention to the discrepancy between how the client is behaving and how they would like to behave. Motivational interviewing is a great way to help clients recognize their inner strengths and develop the desire to change.
There are many reasons why a client may resist taking the proper action discussed in therapy. One is fear of failure. Some clients, particularly those who are clinically depressed, do not have much faith in themselves or their ability to succeed. Even the slightest real or perceived setback can cause them to catastrophize or engage in negative self-talk such as I am so stupid or I am a failure who can never do anything right. With such a mindset, it is no wonder many clients are unwilling to attempt the steps required for positive change, even if they may truly desire to change. This is one reason why strengthening a client’s self-efficacy is crucial.
Another cause of a client’s resistance to change is a lack of clear goals. Some clients may struggle to articulate a vision of what desired change looks like, even if they sense that something has gone wrong. Helping the client develop a clear and realistic plan for change can give them additional motivation for following through with the often difficult and confusing work of pursuing meaningful changes in their lives.
Sarah F. O’Brien, LCSW, LCSW-C, CCATP, CTMH
Licensed Clinical Social Worker in VA & MD
Owner/Clinical Director
Thrive & Shine Counseling/ Ashland, Virginia
https://www.sarahobrienlcsw.com
Without fail, as a therapist, I will point out the discrepancy-mentioning to them how consistent they are with attending sessions, yet how inconsistent they are with completing homework. This usually sparks conversation and processing about why this may be happening for the client.
As a clinical social worker, we are trained to assess a person fully within the context of their life circumstances, something we call BioPsychoSocialSpiritual assessment. With this, I may ask and find extenuating at-home circumstances that prevent clients from being able to complete homework i.e. too busy, not setting enough boundaries at work, ignoring self-care, over-committing to things that aren’t beneficial to the client’s mental health.
What interventions have you found to be *helpful in motivating clients?
To increase client commitment to the change process, I use interventions such as:
*Psychoeducation* (explaining to them, with psychotherapy, most of ‘the work’ occurs outside of the session to achieve desired change).
*Motivational Interviewing techniques* (to prompt and explore client reasons for lack of homework follow through and their awareness, if any, about this).
*Creative homework assignments* based on the client’s interests or talents (outside-the-box stuff that doesn’t include worksheets or even writing anything down – going for a walk and looking for different types of flowers or trees–this is a mindfulness practice. Or art/expressive assignments i.e. creating a playlist, making a collage or vision board, designing a room or space in their mind– this is emotional processing, gaining a new perspective, finding a safe “place” to decompress).
*Encourage and suggest clients develop a reward system* for themselves for completing homework assignments (small gifts or tokens for completing that week’s assignment, i.e. getting special coffee, taking an hour off work early, favourite dessert they rarely have etc. And larger tokens for consistent completion – every week for a month, for example, or tracking progress or having a breakthrough from the homework – taking a weekend trip, taking a whole day off for self, purchasing non-practical or coveted item for self).
Although people willingly engage in therapy, the change process is often arduous and longer than we anticipate (or desire). People lose motivation, and it happens. Enjoyable assignments and rewards for completion are the external factors that motivate us until some positive change starts to occur. When noticeable, positive differences emerge from ‘doing the work’ outside of sessions, internal motivation often kicks in for clients and they WANT to keep doing homework BECAUSE it’s producing the change they want to see in themselves.
Candace Kotkin-De Carvalho, LSW, LCADC, CCS, CCTP
Absolute Awakenings | Morris Plains, New Jersey
https://absoluteawakenings.com/
Therapy isn’t a magic pill; clients need to work on their issues as part of the process. One strategy that may help is setting up firm boundaries. This can include scheduling regular appointments and requiring homework assignments between sessions. If a client repeatedly misses appointments or doesn’t complete required tasks, it is helpful to schedule a check-in session to discuss this issue and help the client stay on track.
There may also be times when it’s necessary to end therapy with a client who refuses to work on their issues. It can be challenging to make this decision, but it is important to do what’s best for both the client and therapist to maintain a healthy professional relationship. If you are struggling with these issues, it may be helpful to seek out support from other mental health professionals or find a trusted mentor who can provide guidance.
What interventions have you found to be helpful in motivating clients?
Reflective listening and active listening can help clients feel heard and understood, which can ultimately motivate them to do the work. Reflective listening involves paraphrasing back to the client what you have heard them say. This way, empathy, and understanding are communicated, and the client feels more motivated to continue working on their issues. Active listening involves listening through nonverbal cues, such as eye contact, nodding, and facial expressions. This approach also encourages a client to articulate their own thoughts and feelings.
When it comes to doing their part in therapy, some clients may need additional support and guidance. This can include breaking down tasks into smaller parts, setting up time-bound goals, or providing positive reinforcement for progress made. If you give them homework assignments, check in with them at their next appointment to see how they are progressing and provide feedback or encouragement as needed.
For example, it may be overwhelming for some clients to make a major life change in one sitting, so you can help them develop a gradual plan to work toward their goals. Meanwhile, other clients may feel frustrated and unmotivated if they aren’t making enough progress or meeting their goals quickly enough. In these cases, it can be helpful to provide positive reinforcement when they make progress, such as offering verbal praise or tangible rewards.
Our behaviours are heavily affected by our thoughts, emotions, and environment. For clients who have been struggling with mental health issues for a long time, their thought patterns and coping mechanisms may be ingrained in their psyche. As a therapist, it is important to acknowledge that these behaviours may take time to change.
Often, this involves helping the client identify and understand unhealthy thought patterns and behaviours. This may involve identifying negative self-talk, challenging unhelpful beliefs, or learning coping strategies to better manage stress and anxiety. Accordingly, help the client focus on their strengths and build positive relationships with others. Acknowledging that they are working through a difficult time can provide support and motivation for them to keep going.
In addition, be mindful of your own thoughts and emotions as a therapist. For example, it is helpful to have regular supervision or check-ins with other mental health professionals so you can discuss any challenging client interactions. This will help ensure that your professional boundaries are maintained and that you provide the best support for your client.
Lauren Cook-McKay
Licensed Marriage, and Family Therapist and VP of Marketing at Divorce Answers
Although therapy is a two-way street in order to be successful, it’s also a safe space for clients to be a mess. Dealing with incomplete homework usually involved capitalizing the inaction as a window to the realisation of the issues they’re dealing with in their lives.
Paradigm shifts were emphasized as a necessity, but the inaction itself is conceptualised as evidence of a barrier to wellness so it’s leveraged for strategizing on better methods for management that are more suited to the client’s capacities. We also make sure to leave room for these strategies to be adjusted until clients are ready to fully overcome their hindrances.
What interventions have you found to be helpful in motivating clients?
The most effective intervention that improves clients’ motivations is the involvement of their support systems. Typically, the barriers they’re facing and the reasons behind them being unpacked during the session bring forth the need to have sit-down talks with their loved ones. *Practising that suggestion, they’re able to verbally communicate the impact of the reactions and behaviours of the people around them which they’ve been repressing. *This frees them from their old self-concept and ultimately minimizes their hindrances.
After defining the specifics around the sequence of events that lead to the inaction of an assignment, analyses generally reveal that *clients feel unable due to complete them mostly due to the overwhelming pressure from expectations of accomplishing the assignment and/or apprehension of the mental labour being demanded by the task, as well as the potential impacts of the self-reflections that the task aims to bring to light. These reasons stop them from their tracks and/or deplete their mental energy to commit to the whole treatment.
Lawrence Barnier
Mental Health Officer
Women’s Resources e-Information
There are a few different ways to approach this situation. One way is to try to understand why the client is not doing the work. It could be that they do not understand what is expected of them, or they may feel overwhelmed and unsure of how to get started.
In these cases, it may be helpful to provide some guidance and support to help the client get started.
Another reason why a client may not be doing the work could be that they are not interested in changing their behaviour. In these cases, the therapist may need to reassess the goals of therapy and decide if it is still appropriate to continue working with that client.
What interventions have you found to be helpful in motivating clients?
There are a number of interventions that can be helpful in motivating clients. One strategy is to set goals with the client and track their progress. This can help to provide feedback and encouragement and can help to show the client that they are making progress.
Another strategy is to provide positive reinforcement when the client demonstrates good behaviour. This can help to encourage the client and can help to build a positive relationship with the therapist.
Finally, it is important to be understanding and supportive when the client does not meet their goals. This can help to provide motivation and can show the client that the therapist is there to help them.
Claudia Luiz
Psychoanalyst
When clients “resist” in therapy, that resistance can yield more information than what the client can tell you consciously. If you focus on the resistances – why the homework isn’t getting done, why the client is stuck, why they can’t break negative patterns and integrate what they are learning – you are really getting into the zones that the client hasn’t been invited yet to explore.
We now know from neuroscience, the three areas of the brain that can hijack conscious effort. Fear, rage, and grief. When people are afraid of feeling things, they get stuck.
Neuroscience gives us a model for what the patient may be resisting. The other emotional zones, seeking, play, and love can be engaged in this exploration. The framework gives us a way of thinking of the clients’ “stuckness” in a productive and creative way.
What interventions have you found to be helpful in motivating clients?
Joining the client in their “stuckness” with compassion and curiosity, while shifting the framework of what you are ultimately working on, avoids power struggles, or potentially shaming the client. It lets them know compassionately that we understand resistance, and that talking more about feelings can hold the key to unlocking the mystery of what is standing in the way of progress.
Elisa Tidswell
Certified Coach and Therapist, Committed to Empowering Women, Breaking
Negative Generational Cycles, and Creating Economic Justice
It’s vital that therapists understand how to keep their clients accountable to their growth. Accountability is where therapists help their clients take action that will help them grow – and action is the only place where transformation takes place. Transformation is what clients pay their therapists for.
It’s also really important that therapists get really good at accountability, otherwise, they can actually wind up demoralising their clients. After all, if clients don’t do their homework consistently they are likely to internalize it, believing that there is something wrong with them or that they are failing. This is the polar opposite of what therapists want for their clients.
What interventions have you found to be helpful in motivating clients?
So how can therapists help their clients do their homework? By cultivating an environment of curiosity and learning. Accountability is not about judgment or being ‘told off’, however, sadly this is exactly what many people believe it to be: they learned about accountability from their parents and school environments were not doing homework or handing in sub-par homework was met with shame. It’s really important for therapists to dispel this mindset and ensure their clients know that accountability is about learning.
The best approach I have found after coaching hundreds of clients to stay accountable is to include three main parts to the accountability conversation. The first is for the client to share a win: something positive that’s happened since they last met with their therapist. This could be an insight, a decision, a process (such as “I felt my feelings”), or something extrinsic, such as a pay rise. Sharing a win is important to put the client in a state of abundance and is commonly used by positive psychologists in their practice.
The second part is to consider a goal or homework that the client did do, and break it down to see why they did it. For example, what were they thinking, how were they feeling about it, how did the goal tie in with their values, what was their motivation to get it done, did they tell others about it, had they put it in their diary, and so on. The therapist and the client want to learn about what works for them so that they can double down on it.
The third part is to consider a goal or homework that the client didn’t do and then see what they can learn from why they didn’t do it. Was the goal too big and overwhelming, and actually needed to be broken down into smaller steps? Were they clear on how to get started with the homework or was their understanding fuzzy? Was the homework tied in with their vision or values? Had they put it in their diary? Did they have support from others? Was a limiting belief getting in the way? Once the therapist and client have learned more about why they didn’t do it, they can create a new goal to support them in achieving the original one.
The best action a therapist can take in supporting their clients with their homework is to let go of judgement and to a growth mindset. They have to see accountability itself as a learning exercise where they can explore what’s going on for the client, and understand what works for them.
Trish Glynn, LMHC, CRC
Licensed mental health counsellor
Owner and therapist at The Carey Center
https://careycenter.squarespace.com/
Therapy is all about meeting the client where they’re at. Of course, therapy will work best when the client is actively engaged both in and outside the therapy room. Results tend to be better and come faster. But not everyone is doing the work when they leave the appointment. There can be many reasons as well as many ways to address this. As a therapist, you want to try to figure out the “why” as that will help you determine the next best steps.
For example, maybe you’re assigning work that is “too much” or isn’t a good fit for them. Are you asking a client to journal every week when sitting down to write is a mismatch for them?
Part of therapy is figuring out why the client is stuck. That takes time and talking about it in order to understand what the individual reason and best response may be.
In some cases, we just need more details, and so we keep talking and exploring to figure it out.
What interventions have you found to be helpful in motivating clients?
The client has a reason for what they do or doesn’t do – and therapy is about finding that out. Progress can come from discussing things the client has maybe never talked about with anyone before.
Also, it can be helpful to seek out some emotionally compelling reasons for change. If you can come up with some really meaningful “why” that speaks to the client, that can create a shift. Logic is often useless. We often know why we should do things. Yet, we don’t. But emotion can get us moving. What interventions have you found to be helpful in motivating clients?
A lot depends on client preference. As a therapist, it’s important to build rapport and get to know who is in front of you. That’s the ideal way to figure out what will work best for them. Because something can be incredibly effective, but if it’s not a good fit for a particular person, it won’t matter. Often, an eclectic approach is best. We are all so very different. One of the most important elements in therapy is the relationship. That matters more than any particular intervention. That’s why people go to therapy to talk to someone – a self-help book, for example, can list out some
interventions, but nothing compares to the human relationship, the rapport, the empathy, and the positive regard, which occurs in the therapy room. You can’t buy that off a shelf. Elaborate on any details you find helpful for explaining the mindset of the client and how it changes.
Therapy involves understanding the current mindset of the client. We want to understand if it’s fixed, or more growth-oriented, for example. We want to consider how their mindset both helps and hinders them. It’s usually a fixed mindset that gets us into trouble. We think we can’t change and our circumstances, too, can’t change. We will give up more easily and ignore helpful feedback. With a growth mindset, we know we are a work in progress. We are more open to accepting challenges. We are more able to seek them out.
Changing from fixed to growth involves challenging current thoughts. For instance, you can get stuck making a lot of false assumptions. You can begin to question your thoughts. Is that true? How do I know? What else might be happening here? Am I being too black and white, and missing the grey areas?
We have to notice where our mindset is now. Then we begin questioning it. We begin really getting deliberate about looking at our thoughts. For most of us, we don’t really spend much time if any thinking about our thoughts. It can help to start pausing to consider what thoughts are in your mind. And then we can start examining them and challenging them. And that’s when we can begin to create a shift. We can’t change what we don’t look at and understand.
Janelle Marshall, LPC
Marshall Gray Counseling Services
https://www.marshallgraycounseling.com
How do you navigate clients who faithfully come to therapy, but don’t do the work?
I check in with the client and help process any challenges that are interfering with their ability to do the work. Sometimes the perception of the client not “doing the work” is an indicator of emotional trauma or blockage that needs to be processed.
What interventions have you found to be helpful in motivating clients?
Journaling is one of my favourite interventions to share with clients. I find it helpful for clients to visualize their therapeutic goals and their thoughts on how their lives will reflect the efforts attempted. Habit tracking is a tool that helps take motivation a step further with clients that are committed to the therapeutic process. I have a collection of reflective habit tracker journals that serve as a guide to help user align their actions with their desired goals.
As a solution-focused therapist, I help prepare my clients to embrace the evolution of their mindset throughout our journey together. It’s also understood that the client’s anticipated mindset change is contingent upon their willingness to commit to the work assigned in and out of the session.
Miriam Manela
The Thrive Group
The best motivation for clients is first and foremost for the therapist to let go of having a NEED to change their client, to let go of convincing their client to change and to simply allow the client to do what they have been doing and nothing different.
What interventions have you found to be helpful in motivating clients?
I usually tell clients, without any judgment, but just to give them an awareness that typically when the follow-up program is kept then results are significantly faster. If there is no follow-up done, that is okay, I just like them to be aware that therapy can take quite a bit longer then.
The third technique I use in therapy to motivate clients to change from within themselves is to create intentions. Rather than giving the client something they need to do, I would make an intention with them, which they could say once a day to give themselves the awareness of their challenge. Or if not, they may only use their intention once a week when they come to me for a session.
An intention would sound something like, I noticed that when someone questions my authority, I get very agitated. or I noticed that when my child comes home from school, or my boss walks into my office I feel flustered, overwhelmed, frustrated or anxious, etc. So without needing to tell the client to do any specific exercise at home, we’ve instead created together an intention to repeat every day to give themselves awareness. I may have them create a reminder on their phone with it or post a sticky note in their bedroom or bathroom.
Just remembering their awareness helps them remember what to do to calm down, on their own.
Danielle Bagus, MSW, LSW
Therapist
Relief Mental Health
When a client seeks out therapy, and faithfully attends without fail but once in session we are going over the same issues over and over again and I have found they are not doing the work on themselves outside of the therapy sessions, I attempt to look for a support system that may help them.
This might be a significant other, a parent, a sibling, a friend, etc. I ask who is in their close circle and who they trust to help hold them accountable. I will also hold them accountable but sometimes encouragement coming from a loved one or someone they don’t want to let down will mean more.
I also have found that the homework might not necessarily match up with their skill set or what they are willing to put in at that time. Therefore, as their therapist, it’s my responsibility to find a new method or way to connect with the client and help them be successful.
One size does not fit all when it comes to therapy. Therapists need to have lots of tools in their toolkit to meet the needs of the client and ultimately to meet the client where they are in the process of therapy.
What interventions have you found to be helpful in motivating clients?
I think this can really depend on the client and what they need out of therapy. I find that Cognitive Behavioral Therapy (CBT) works the best to motivate my clients to continue to do the work outside of therapy. CBT helps people with such a wide range of mental health issues and ultimately helps with really digging deep to find new ways of thinking, coping and behaving in certain situations.
Clients seek therapy for many different reasons. Some want to change their mindset, some wish to seek outside advice or help on a specific situation or topic (divorce, relationship, school-based issues, family issues, etc.), and some come because they have been diagnosed with a mental illness (bipolar, depression, schizophrenia, eating disorder, OCD) and need help maintaining a healthy mindset, some clients want an outside person to just listen, the list goes on. As a therapist, you are there to be an impartial, nonjudgmental resource for the client. You are there to help them realize different ways of doing things and different ways of thinking.
The client takes the first step in seeking out therapy but also needs to be the one doing the work and willing to change what they have always done with the guidance of their therapist. It’s important for the therapist to always ask what the client wants out of therapy or a specific session. Sometimes the client doesn’t know but I think our clients are more self-aware than they realize. If you can ask the right questions, they ultimately will tell you what they need, want or expect to get out of therapy in general or even a specific session.
Kellie Brown, LMHC, NCC, MCAP, (she, her)
Licensed Mental Health Counselor (LMHC)
Owner of Quiet Water Counseling in Florida
https://www.QuietWaterCounseling.com
Often, when a client comes regularly to therapy but does not want to do work outside of sessions it comes down to the client being afraid of making changes in their lives. People get so used to doing things one way it is very hard to change directions and try something new.
What interventions have you found to be helpful in motivating clients?
So instead of setting clients up for failure by giving them a huge homework assignment that is very likely overwhelming and they probably won’t do, I give them very small tasks to accomplish.
So instead of giving a client the homework assignment of going to an Alcoholics Anonymous meeting or joining a gym, I ask clients to research AA meetings or research local gyms. The next week I might ask them to just drive to the location of the meeting, or drive to the gym location, but tell them they don’t have to go in, I just want them to physically see where it is located.
Giving smaller homework assignments tends to help break down a huge change into something more manageable.
Elizabeth Mateer, MS, MA, LMHCA *(she/her/they)
Director, Divergent Wellbeing https://www.divergentwellbeing.com
Lead with curiosity. Asking why didn’t you do X this week as we talked about automatically leads to defensiveness and shuts down motivation to discuss what happened. Something like After our conversation last week, you seemed excited to work on using that coping skill. I’m curious about what the barrier was when you thought about applying it this week. This framing allows the client to explore the *process* of doing the work, rather than the content of I didn’t do it.
Don’t let it go. As therapists, we tend to feel compassion and understanding towards our client’s challenges. While this is an important skill in many aspects of therapy, it can sometimes be tempting to let it go when our clients are consistently not doing the work outside of therapy. This is not only avoidant ourselves, but it doesn’t serve our clients by teaching them to take accountability for their well-being. We can still be compassionate while being direct.
What interventions have you found to be helpful in motivating clients?
Meet them where they are at. Clients know when they aren’t doing what they said they would, and yet, they are still showing up. That says a lot about the relationship and trust you’ve already built with them. Highlighting any progress you see, regardless of how small, is an effective way to motivate clients to continue moving forward. Sometimes these clients just move at a slower pace than others we see coming into therapy ready to take action, and that’s OK.
Self-reflect on what we are asking from them and if it is too much. Sometimes as therapists we see the potential a client has and give homework assignments that are beyond what is realistic in the present moment, especially if we have seen our clients for a long time and have an idea of what they are capable of. Is there a way to break down the work into smaller, more achievable pieces? For some clients, if a task seems too aspirational or unrealistic, they won’t attempt it at all. Smaller steps towards progress are better than no progress at all.
Steve Carleton, LCSW, CACIII
Gallus Detox
Navigating clients who come to therapy but don’t complete their homework can be difficult and often requires a tailored approach.
What interventions have you found to be helpful in motivating clients?
The first step is to create an honest dialogue with the client about why they are not completing the assigned tasks. It could be that the tasks are too challenging or time-consuming, or that they don’t understand what is expected of them. It is important to understand the underlying reasons behind the lack of motivation and build a plan together that works for both parties.
The next step is to offer alternative homework assignments that are tailored to each individual client’s needs. This could include reading an article or book related to the problem being discussed in therapy, journaling about their thoughts and feelings, writing a letter to their future self, or attending a workshop or class related to the topic. It might even be more helpful to ask your client what they would like to work on or what they would find most helpful. This will help to make the homework assignments more meaningful and will give them a sense of ownership over their progress.
The last step is for the therapist to provide ongoing support and accountability for their client’s progress. Check-ins at the end of each session are a great way to ensure that homework is being completed, and providing regular feedback can help the client stay motivated. Above all else, try to create an environment of understanding and acceptance that encourages your client to be open and honest about their progress. With patience and dedication, you can help your clients reach their goals.
Nirmala Bijraj, LMHC, NCC, She/Her/Hers*
Aligned Self, LLC
How do you navigate clients who faithfully come to therapy, but don’t do the work?
I explore with them why they don’t do the homework, what about getting it done, and doing it, makes it difficult.
What interventions have you found to be helpful in motivating clients?
I usually start with the least possibly intrusive change. We explore the change they want to make, identify the first step and then explore how to incorporate that change with the least amount of barriers and effort possible to start to build a new habit.
I’ve found if we start with something that feels like the least amount of effort, takes the least amount of time, and is the least intrusive on their life and schedule, then the client is most likely to do it.
For example, a client wants to work out in the mornings: *(this is a real scenario that I’ve worked with clients on with these steps). We start with building the habit of getting into gym clothes first thing in the morning when they wake up, the goal is to start the habit, we don’t focus on how many times they work out or if they work out at all, just starting the first part of the process.
Then a week or two later or more depending on the client, we would add a 10-20 minute workout, something that they can actually make the time to do, 5 minutes if that’s all the time they have to start with, again the least amount of effort that will help them start building the habit. And then continue to build on that habit until they’re where they want to be with that goal.
Lindsey Ferris, MS, LMFTA
Individual & Couples Psychotherapist
https://www.talkhealthrive.com
If I notice that clients are coming regularly and sticking with therapy, but I’m not seeing progress or an effort to do out-of-session homework. I will bring this up directly to the client to ask them what they are seeing and how they are experiencing therapy. If they are seeing the changes and growth, they want to see, then I’ll have them elaborate on this so I can understand from their perspective what growth and change look like.
Oftentimes it takes checking in with my client to learn that they in fact are feeling the benefits and see growth in themselves in different ways than what I may be looking for, and it is a good idea to level set vs. assume that “work” isn’t being done or growth isn’t happening.
What interventions have you found to be helpful in motivating clients?
If I find that clients are resistant to homework, or not making progress towards their therapeutic goals, I will address this directly and ask them what is getting in the way of doing homework and impacting their ability to engage fully in their therapy process. This can often lead to areas that need to be addressed first, before other priorities, so that any therapy-interfering behaviour can be resolved and progress can continue.
I find that often addressing directly with clients what I am observing in therapy interfering with behaviour or lack of compliance to homework can lead to thought-provoking insight and dialogue and instigate a change in how the client sees the way they show up for therapy. Once it is out on the table as a barrier to therapy compliance, the client and I can have an open dialogue about when either of us sees it coming up in the room to work towards behaviours and changes that they want to see. When a client has insight into patterns that may be blocking them from growth, it can be a true aha moment that changes the engagement and adherence to therapeutic homework and growth.
William Schroeder
Licensed Counselor and Owner of Just Mind LLC
Every therapist has clients like this and it’s a helpful thing to not beat around the bush about. If you notice someone is saying they are motivated and then not doing the work, the meat of the therapy is digging into what’s getting in the way.
What interventions have you found to be helpful in motivating clients?
Motivational interviewing could be one way to approach this. On a scale of 1-10, how motivated are you to see X change? If it’s low, then that’s helpful to know and you might need a new target. If it’s high and there isn’t follow through, then you need to see what ideas they have that might help them have success and assess their perception of those as well.
Sometimes trauma can get in the way and it can help to make sure this is properly assessed. There are a number of trauma screens but trauma can be a big barrier to change if it’s not dealt with. Things like EMDR can be helpful in treating PTSD, for instance. 100% of single-trauma incidents and 77% of multiple-trauma survivors no longer met the diagnostic criteria for PTSD after 6 fifty-minute EMDR sessions.
It also can be helpful to assess ADHD to see if that’s possibly a complicating factor. The World Health Organization has simple test clinicians or clients can use to see if they might meet criteria.”
Alexandra Alex Cromer, LPC
Thrive Works
https://thriveworks.com/richmond-therapy/
A great tactic to navigate this is to have an honest conversation on their progress and introduce them to your theoretical framework/how you judge and measure client success.
What interventions have you found to be helpful in motivating clients?
The Transtheoretical Model of Change is my personal favourite, and it takes into account client motivation and any barriers that might be keeping them from making continued progress.
Another tactic is to discuss one of the main goals of therapy with a client; making the client more effective in their daily lives. Through this lens, we can invite the client into a bidirectional conversation in which we discuss progress and change as well as ways in which they believe your time together in therapy is effective.
I tend to favour a lot of motivational interviewing techniques as well as cognitive challenging skills to help motivate clients. If a client is faithfully attending sessions but is not doing the work, we could ask them a cognitively challenging question to get them to explore and identify their current patterns and routines and the efficacy of these.
Motivational interviewing techniques are similar in this way, in that they require work and active reflection on the part of the client in order to answer the questions. The most effective techniques to motivate clients are the ones which require the clients to do active work and are not closed-ended questions. The more you can allow a client to engage in self-reflection, the research shows client motivation and propensity to change increase.
One of the biggest frustrations that therapists experience is a client who is seemingly not putting in the work or reportedly making progress and change. It’s very common for a therapist to assume that a client is unwilling to change and is purposefully resistant to the process. Often, this is not the case and the client’s stagnation can be better explained through a theoretical lens. For example, using the Transtheoretical Model of Change, we can identify that client’s barrier to progress come in the form of fear of failure, anxiety, and perceived low self-esteem, rather than willful ignorance.
Honest, direct conversations with clients allow them to see themselves through your perspective, and vice versa. Typically, research shows that clients who have a high sense of self-efficacy have a higher propensity to engage in change-making behaviours. Therapists can increase client self-efficacy by continuing to engage clients in self-reflection.
Wrapping up
The bottom line is that when clients do their homework things progress quicker, but when clients DON’T do their homework, we get new insights into resistance and what is actually going on inside. Thank you to all the fantastic therapists that contributed to this article. With great insight comes improved well-being.
Dennis Relojo-Howell is the founder of Psychreg.
