Homework Instructions and Compliance Assessing in the Therapeutic Process: An Analysis of Therapists’ Verbal Behavior

Abstract

Instructions are a common resource used by behavioral therapists to assign therapeutic homework. However, understanding how clients learn with instructions is better known in laboratory research than in clinical research. The present study aims to explore changes in the way of instructing and reviewing the client’s compliance throughout the therapeutic process. We analyzed the therapist’s verbal behavior during 211 recorded sessions corresponding to 19 cases treated by 11 behavioral therapists (53% male and 47% female). The sessions were divided into four stages according to the timing of the intervention and coded by using a previously validated coding system (SYST-INTER-INSTR). Results show that instructions become less specific towards the last stage of the intervention. However, therapists assess task compliance in the same way towards the end of the therapeutic process. The change in specificity suggests that the client’s behavior changes from being controlled by instructions to being controlled by natural contingencies. However, to make sure the clinical change remains; therapists assess and reinforce the client’s compliance until the end of the intervention. Although clinical implications of the results, some limitations (i.e., not considering the type of task instructed) should be addressed in future studies.