Does therapy homework really help?

When I found myself on a therapist’s couch in 2017, I kept waiting for the real work to begin. I had started therapy because I wanted to “fix” my life — my anxiety, my relationships — and wanted someone who was wiser than me to tell me how to do that. My natural orientation toward uncomfortable feelings is to take action, because that’s easier than wading through them. I feared I’d drown in all those tough emotions if I fully stepped into their swirling waters.

My therapist would kindly tap the brakes every time I had that pleading “What should I do?” look in my eyes. I wanted things to change, and immediately. Thankfully, this therapist was more interested in guiding me toward my own thoughts and patterns and understanding where they came from.

These early therapy days came to mind when a reader, who asked to remain anonymous, asked this question: “Is a therapist just a safe space to talk about your problems, or can you expect to make goals and be given ‘homework’ or guidance on how to achieve better mental health? I am wondering if a life coach is a more appropriate option than a therapist for affecting change in my life.”

At the end of the day, that’s why 99% of us go to therapy: to affect change in our lives. But how can that change be set in motion with the help of a professional?

My dog ate my therapy homework

I’m going to tackle the question of homework first.

The short answer is yes — homework is totally a thing in therapy. In fact, most therapists invite clients to complete certain tasks between therapy sessions, said Jesse Owen, a counseling psychology professor at the University of Denver who studies the process and outcomes of psychotherapy.

“The real work of therapy, other than the courage to be vulnerable in sessions, is to do something to change your life outside of the 50 minutes we spend together each week,” Owen told me.

And it can have real payoffs: Research suggests that incorporating homework into psychotherapy enhances its effectiveness, and that clients who consistently follow through with assignments tend to have better mental health outcomes.

The homework you receive will depend on your therapist’s approach. For example, clinicians who use Cognitive Behavioral Therapy (CBT) — which focuses on changing the way you think — may ask you to keep track of your thoughts, feelings and behaviors that arise in situations that are stressful or upsetting. Then, in the therapy room, you and the therapist can come up with more helpful ways to respond in those situations in the future. CBT is arguably the most homework-heavy kind of therapy, Owen said.

Others might suggest workbooks that you can do together, always with the gentle caveat that it’s up to you to complete the work.

Ann Kelley, a psychologist in Austin, Texas, and the co-host of Therapist Uncensored, a podcast (that I love!) about attachment and relational science, said her homework is all about broadening her clients’ awareness of themselves and those around them.

Let’s say that you’re someone who is afraid of conflict and has a hard time voicing your opinions and needs in intimate relationships. Kelley might ask you to try to speak more directly with your partner that week. Later, you and Kelley could discuss what you noticed in those moments (like: “I was scared to death to do that!” or “It actually felt really good to tell my partner how I really felt”).

With certain couples, Kelley might ask them to go home, look each other in the eyes, hold their gaze and ask each other important questions. Often, people are shocked that they can’t make sustained eye contact with their partner without getting really anxious. If your therapist has a more psychodynamic approach, you would probably explore why you have that reaction. (Quick note: For some neurodivergent folks, we know this exercise might not be helpful and appreciate your readership.)

“It’s all about getting new information about yourself,” Kelley said, “about being in a place of deep curiosity instead of knowing.”

People can (often unintentionally) approach therapy in a passive way, Kelley said. They show up for an hour each week after not thinking about or applying what they discussed with their therapist the week prior. Homework is one way to ensure you’re getting the most out of therapy because it shifts what you learned from an intellectual understanding to lived experience.

If your therapist hasn’t given you homework and that’s something you’d like, Kelley recommends asking your therapist for ways you can deepen what you learned in between sessions.

A different kind of conversation

Our reader also asked whether they can expect “guidance” in therapy, which I interpreted as “advice.”

Usually when we’re really opening up, it’s to a best friend who, with permission (hopefully), can offer some advice. Therapy is a much different dynamic.

The job of a psychotherapist is to guide people toward self-awareness, but most are trained to avoid advice-giving, Owen said. There are a few reasons for this. People are more likely to metabolize insights they themselves discovered in the caverns of their unconscious, though a therapist may have been holding the flashlight. “Generally, advice doesn’t do as much as [asking] open-ended questions and exploring the deeper meaning of things,” Owen said. Therapists also don’t want to give bad advice, or dictate what a client should do because of power differentials in the therapy relationship.

If a client asks for advice, a therapist might share more general thoughts or encourage a client to think about what patterns are contributing to the problem.

“As much as we would like people to take advice — eat healthy, sleep, drink less — people don’t listen unless they’re really in touch with their own motivations for mental health,” Kelley said. “Our job is to help people want to make important shifts, not tell them how to do it.”

As a future therapist myself, I’m reflecting on what kind of feedback I’ve found most helpful in therapy.

The therapists I’ve worked with have never explicitly told me what to do — like when I’ve asked whether I should leave a relationship or a career — but did reflect back to me insights I’d been forming with their help.

Once, after describing a series of distressing conflicts with an ex-partner, my therapist flat out said, “I don’t like this for you.” I didn’t like it either, but I wasn’t ready to fully admit that to myself. When my therapist acknowledged that how I was being treated (as I was describing it) wasn’t OK, it opened the door for me to do the same.

This worked for me only because I’d been seeing this therapist for a while and I trusted her. But it should also be noted that this comment really did influence the way I saw my relationship — one reason therapists tread with caution when offering such commentary.

Put me in, coach

Lastly, this reader would like to know whether working with a life coach might be a better option.

Both therapists and life coaches offer support and guidance, but there are notable differences:

• A life coach helps you improve certain skills, like problem-solving and organization, and holds you accountable for reaching future goals.
• Therapists are trained in more in-depth psychological exploration and can help you get to the root of patterns that are holding you back.
• Unlike therapists who are held accountable by a licensing board, life coaching is not regulated by the government, and there’s not much empirical research yet on its effectiveness, Owen said.

Still, there are many great life coaches out there. Kelley refers clients to coaches when they need help building skills in a specific area, like finding a particular job, or working on time management for people living with ADHD.

“If you’re self-aware and need a confidence boost or help with goal setting, a life coach can be a good fit,” wrote health journalist Kaitlin Vogel in this Psych Central piece I recommend if you’d like more information on life coaching.

See you next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

See previous editions here. To view this newsletter in your browser, click here.

More perspectives on today’s topic & other resources

Psychoanalyst and psychologist Nancy McWilliams talks about what actually works in therapy in this episode of Therapist Uncensored.

Ready to start your therapy journey? The Times put together a comprehensive list of low-cost mental health resources in Los Angeles and Orange counties, including therapy, support groups and meditation classes.

How to help people in psychosis — from Times contributor Erica Crompton, who’s experienced it firsthand.

Other interesting stuff

“What if the cure for our current mental health crisis is not more mental health care?” asks UCLA professor Danielle Carr in this thought-provoking New York Times op-ed. She makes the point that the medicalization of the problem puts the focus on the individual at the expense of reforming systems and structures that created it in the first place.

Renowned addiction expert Gabor Maté talks about the effect that toxic culture has on our minds and bodies in this great interview on the Higher Practice podcast. Maté’s new book, “The Myth of Normal,” came out earlier this month.

Women are doing more paid work, but the bulk of household labor still falls to them — and research shows it takes a toll on psychological well-being.