Client missing therapy homework? Here are some tips for responding when a client does not complete a homework assignment.

We all know that homework is an integral component of behavioral therapies. But despite our best efforts, helping clients to complete their homework is a hugely challenging task!
Even if you've collaborated with the client to develop a clear, specific homework assignment that will directly support their progress in therapy and around which they have a lot of buy in, even if you've worked with them to plan when and how they will complete this assignment, and even if you've provided a thoughtful and authentic rationale for why it's so important that they engage in this homework...it's still common for clients to show up to therapy with incomplete assignments or having skipped the assignment entirely.
And that's if they remember homework was assigned. Don't be surprised if clients completely forget about the assignment that you asked them to work on. After all, as therapists, we have progress notes to cue our memories around what happened in the last session and treatment plans to guide our work. Clients don't have either of those things. And if you've ever been in therapy yourself, you know just how tough it can be to remember the content of a therapy session, no matter how helpful, even minutes after walking out the door.
Given that missing homework is likely to occur, at least occasionally, in behavioral therapies, it's important to know how to respond effectively to missing assignments, particularly when your plan for the session often relies on the assumption that homework from the prior session will be complete. So, what can we do as therapists when confronted with a missing assignment?
First, consider your initial response carefully. Many of us as humans are conditioned to respond to uncomfortable social situations with the goal of reducing others' discomfort. This is entirely understandable (alienating people was probably not ideal for our ancestors' survival, so of course we evolved to care what others think of us). Sensitivity to others' reactions is probably even more likely when you're a therapist - you didn't get into this line of work to hurt or offend people!
And yet, the urge to protect others' feelings can sometimes be counterproductive when it comes to missing homework assignments. Statements like, "it's okay," "don't worry about it," or "the homework wasn't that important anyway," while understandable attempts to minimize the client's discomfort or guilt, ultimately undermine the work of the therapy. Homework assignments are important - you wouldn't have asked the client to take time out of their busy life to complete this work unless you genuinely thought it would be beneficial for their overall well-being and progress in therapy.
Don't undermine the therapy or undersell the importance of homework by minimizing when clients do not complete an assignment. Instead, consider ways of validating the challenges of completing homework while reinforcing its importance.
How can you validate the challenge of completing outside tasks while also encouraging future homework completion? You might say something like, "It sounds like you were really busy this week, and I understand how that might have made it difficult to complete this assignment. At the same time, homework is really important to your progress in therapy, so for this upcoming week, let's take some time to brainstorm together about how to increase the likelihood that you can make time for it." Is this approach likely to make your client more uncomfortable than just saying "no worries"? Probably. And yet, in therapy we are constantly working with helping our clients find ways to tolerate discomfort; therapy is not the place for shying away from difficult emotions.
Once you've offered an initial response to the news that your client forgot or chose not to complete their homework, consider asking what got in the way. This question can identify barriers to homework completion that will not only help you better understand the client's life and presentation, but will facilitate future homework completion. For example, if the client has described struggling to complete chores around the house during periods of depression, a situation in which they completely forgot about their therapy homework can offer insight into the processes that are likely impeding their success more broadly while giving you additional understanding of the challenges they face when experiencing depressive symptoms. On a practical level, if the client reports that they completely forgot that you discussed a homework assignment in the prior session, this suggests that future sessions should focus on integrating homework reminders into the client's daily life (e.g., setting a cell phone alarm, establishing specific times or activities that will trigger homework completion, etc.).
One important caveat: look out for situations in which the client's answer to what got in the way of completing homework serves as a distraction from more important content, such as a long story about various events of the week that are not especially relevant to the work of therapy. If the explanation of what got in the way appears to be functioning more as avoidance or distraction than clarification and repair, plan to redirect the discussion.
If the client remembered the assignment, but chose not to complete it, you have also gained valuable information as a therapist. What thoughts did the client's mind give them about doing the homework? What emotions showed up?
I don't have time.
This assignment will be too difficult.
I'm not sure what exactly the therapist wanted me to do.
I'm not ready for this assignment.
I don't think this will help me.
I don't think I'll be able to do it correctly/perfectly.
Nothing will change my current circumstances so homework is useless.
It's too much work to do things outside of session.
Anxiety or fear
Overwhelm
Irritation, annoyance, frustration, or anger
Embarrassment or shame
Sometimes, looking at the client's thoughts and emotions around the specific assignment or homework in general will reveal important barriers to therapy progress or shed light on the way the client is conceptualizing the therapy relationship. I would engage very differently with a client who told me the homework felt pointless because nothing will help them change their life compared to a client who told me that they assumed they wouldn't be able to do a good enough job with the homework and would be embarrassed to show the assignment to me.
Keep in mind that clients don't always conceptualize remembering the existence of an assignment but failing to complete it as a choice. "I was just so busy this week" is a common explanation for not completing homework, and the experience of not having enough time likely does not feel like a choice to the client (we all have busy weeks where the thought of adding one more thing feels impossible). However, conceptualizing this as a choice can potentially be helpful for the treatment. Part of what we're working on in behavioral therapies is helping the client figure out how to live a meaningful, fulfilling life even amid all of the struggles and barriers to doing so. There is likely not going to be a perfect time to complete daily homework or a week in which nothing else important is going on. Engaging with homework even when external circumstances are not ideal is practice for engaging with helpful behaviors or responding effectively to painful emotions even when circumstances are not ideal. Pay attention to the reasons clients give for not completing homework, and you will gain understanding of the barriers that impede other effective, life-affirming behaviors for them.
After you've done had a brief initial discussion about the missing homework assignment, the best thing you can do from a behavioral perspective is take time in the current therapy session to complete the homework, if possible. If you asked the client to fill out a worksheet tracking their thoughts, emotions, and behaviors through the week, do some retrospective tracking together in session, including asking the client to write down their responses on the worksheet, just as they would if they had completed the homework throughout the week. Avoid the urge to just review written or behavioral homework verbally - this can undermine the benefits of the assignment and suggest that doing it halfway is fine. Writing down one's thoughts and emotions or rehearsing a paced breathing skill are going to result in more learning than just talking about these things, so try to replicate homework assignments as closely as possible when completing them in session. While some assignments don't lend themselves easily to exact replication in session (e.g., if the assignment was for the client to practice assertive communication with their spouse, then it will be difficult for them to accomplish that with you in an individual therapy session). However, you can usually find a way to integrate some aspect of the assignment into the session. For example, you could ask them to think back through the past week and select a specific situation when they remember wanting to be more assertive with their spouse. Then, they could role play what they might have said to their spouse with you in the session.
Completing the homework together in session sends some important messages. First, clients learn that there really isn't a way to get out of doing homework. This is especially important for assignments they may particularly want to avoid. For example, when doing a trauma therapy like Cognitive Processing Therapy or Prolonged Exposure, you never want to send the message that clients can escape discomfort by skipping homework - you would only be reinforcing avoidance. Second, at least partially completing the assignment together can often be an effective response to many of the cognitive and emotional barriers to homework completion. You believed you couldn't do this assignment correctly? Look, you're doing it! You thought you didn't have time? This only took five minutes and we got several things accomplished. You were convinced the homework wouldn't be helpful? Look how useful this was when we did it together! Third, if the client did not complete the assignment because they didn't understand what they were supposed to do, you can hopefully clarify any confusion by reviewing the assignment together in session.
I find that completing missing homework together in session also offers a helpful corrective experience to the various emotions clients may be experiencing. Particularly for those clients who feel unhelpful levels of guilt or shame about not completing an assignment or letting the therapist down, doing the assignment together offers a reparative experience that allows them to learn how they might respond effectively when they experience guilt or shame about their behavior either within or outside of therapy in the future.
Finally, a missing or incomplete homework assignment serves as another data point in understanding the client, both for yourself as the therapist and for the client's self-conceptualization. The goal here isn't to harp on a mistake or perceived failing, but to understand what this experience has revealed. What does it show you about what is getting in the way of the client meeting their goals in therapy and in life? What emotions, thoughts, and behaviors are undermining their progress? How do they cope with setbacks - give up entirely, berate themselves, persist through the difficulty, ask for help, avoiding telling others out of shame? How do they conceptualize your reaction to the news that they haven't completed the assignment and how do they respond to that conceptualization - guilt, shame, lots of apologizing, nonchalance, irritation with you? What does this experience tell you about their relationship to notions of success, failure, perfection, expectations, and responsibility? What does it tell you about the therapy relationship? Most importantly, what can you and the client do to utilize what you've learned from this experience in therapy moving forward? Ideally, a missing or incomplete assignment provides a chance to brainstorm and problem solve around future assignments in a way that will increase the likelihood of their completion.
Homework is a critical aspect of behavioral therapies, and while consistent homework completion is ideal, even situations in which clients miss or forget assignments offer opportunities for effective intervention that can ultimately benefit the therapy. Make the most of them!
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