Integrating between-session homework

This chapter defines and illustrates the use of between-session homework (BSH) in individual psychotherapy. Whereas previous reviews have demonstrated a positive association between client compliance with BSH and distal treatment outcomes, this chapter pays particular attention to therapist behaviors that may promote client engagement with BSH assessed as immediate (in-session) and intermediate (session-to-session) outcomes, and moderators of these effects. For the systematic review, 25 studies with 1,304 clients and 118 therapists were identified, mostly on cognitive–behavioral therapy and exposure-based treatments with depression and anxiety disorders. A box-score approach was utilized to summarize findings. Results for immediate outcomes were mixed but neutral. Results for intermediate outcomes were positive. Therapist behaviors that may promote client engagement with BSH include presenting a convincing rationale; being flexible in collaboratively designing, planning, and reviewing homework tasks in accordance with the clients’ goals; aligning BSH with the clients’ takeaways from the session; and providing a written summary of homework and rationale. The chapter concludes with research limitations, diversity considerations, training implications, and therapeutic practices.