Integrating Between‐Session Interventions (Homework) in Therapy: The Importance of the Therapeutic Relationship and Cognitive Case Conceptualization

Abstract

Between-session interventions, or homework, are crucial to a range of psychological therapies, including cognitive behavior therapy (CBT). Therapeutic interventions often involve experiencing emotions and situations, or examining strongly held views about their problems, that clients can find distressing. Hence, the clinician faces a particular challenge in collaborating with the client to carry out these interventions between sessions. In this article, we convey how this process in CBT requires not only a consideration of the theoretically meaningful determinants of adherence behavior but also a sophisticated cognitive case conceptualization. Using case material, we illustrate the interplay between in-session design, planning, and review of between-session interventions and the conceptualization. We also include a distinction between generic elements of the therapeutic relationship and CBT-specific elements. The case material also attends to the person of the therapist, and his or her own cognitive and emotional reactions occurring throughout the process of discussing between-session interventions.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

“…CBT treatment adopts a formulation-based approach rather than a diagnosis-based approach [ 54 , 104 ]; as such, a diagnosis is not necessary for support to be given. Formulation involves exploring the predisposing, precipitating, perpetuating, and protective factors connected to a psychological problem, and then building these factors into a causal model [ 105 ].…”

“…The development of coping skills is a central component in CBT-based practices, and such skills can help clients reduce distress that can trigger problematic maintenance cycles [ 54 , 100 , 104 , 184 ]. For example, a core exercise in the treatment of anxiety is the development of relaxation skills, and a meta-analysis of 27 RCTs found a medium to large effect size for relaxation training on anxiety ( d =0.57, 95% CI 0.52-0.68) [ 117 ].…”

Natural language processing for cognitive therapy: Extracting schemas from thought records

“…These are comprehensive outlines of the patient’s problems as first drafted during the intake conversation between patient and therapist. They are continually refined throughout therapy, often on the basis of homework assignments [ 54 ]. With the possibility of automatically interpreting thought record data, it may be possible to sketch a first CCC before therapy by collecting and analyzing thought records over the period of time the patient spends on a waiting list and to then collaboratively update this CCC with the therapist as new thought records are completed during therapy.…”

Case conceptualization research in cognitive behavior therapy: A state of the science review

“…Comprehensive case conceptualization is not intended to capture a client's entire life, or the “entire person,” but to identify psychopathology through the identification of cognitive and behavioral strengths and weaknesses (Bieling & Kuyken, ; Kuyken et al., ). The case conceptualization is also fluid and draws on client information from each session and the experiences of the client resulting from the activities between sessions, and it could be based on any moment that the client interacts with the therapist (e.g., Cronin, Lawrence, Taylor, Norton, & Kazantzis, ). In this way, the case conceptualization is technically never “complete”; it is an evolving hypothesis that both informs and is informed by therapy (Kuyken et al., ).…”

“…any moment that the client interacts with the therapist (e.g., Cronin, Lawrence, Taylor, Norton, & Kazantzis, 2015). In this way, the case conceptualization is technically never "complete"; it is an evolving hypothesis that both informs and is informed by therapy (Kuyken et al, 2009).…”