Strategies for Increasing Client Completion of Treatment Assignments

Behavior therapists often give clients important assignments to do outside therapy sessions, such as recording information about each binge-eating episodes, carrying out in vivo exposure, or applying time-out in specific circumstances. Unfortunately, clients fail to perform the assignments roughly half the time (see Detweiler & Whisman, 1999; Spiegler & Guevremont, 2003). Various psychotherapists have suggested strategies for increasing treatment homework adherence (e.g., Addis & Jacobson, 2000; Coon & Gallagher-Thompson, 2002; Cox, Tisdale, & Culbert, 1988; Detweiler & Whisman, 1999; Kazantis & Lampropoulos, 2002; Larabee, 1988; Openshaw, 1998; Spiegler & Guevremont, 2003; Startup & Edmonds, 1994; and Tomkins, 2002). However, no one has ever published a comprehensive list of strategies that psychotherapists can use to increase the chances of client adherence to treatment assignments. The main purpose of this article is to fill the void. Ancillary purposes include providing information about the efficacy of adherence methods, providing a model from which one could possibly derive novel adherence strategies, and providing suggestions for how to choose among the identified strategies.