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1. Assessing Compliance With Homework Assignments:
Review and Recommendations for Clinical Practice
䊲
Nikolaos Kazantzis
Massey University
䊲
Frank P. Deane
University of Wollongong
䊲
Kevin R. Ronan
Massey University
Despite the emphasis of homework assignments in psychotherapy research
and practice, methods to assess homework compliance have been rela-
tively neglected. This article presents a brief review of 32 studies that
described the assessment of homework compliance, and evaluated home-
work compliance in relation to treatment outcome. More than half of the
studies relied on a single source of compliance data (n ⫽ 23), eight stud-
ies involved retrospective accounts, and only four studies used the same
measure of homework compliance. The vast majority of studies focused
on the assessment of “homework compliance” without consideration of
the “quality of homework completion” or other key factors. A more com-
prehensive framework for homework compliance is discussed, and a new
Homework Rating Scale (HRS) is proposed as the first step towards as-
sisting the field in a more reliable and valid assessment of homework
compliance. © 2004 Wiley Periodicals, Inc. J Clin Psychol 60: 627–641,
2004.
Keywords: homework assignments; homework; compliance; assessment;
clinical practice
Nikolaos Kazantzis, School of Psychology (Albany Campus) and Waitemata District Health Board Cognitive
Therapy Center; Frank P. Deane, Department of Psychology and Illawarra Institute for Mental Health; Kevin R.
Ronan, School of Psychology (Palmerston North Campus).
The authors thank Michael E. Addis, Michael J. Bryant, David D. Burns, Keith S. Dobson, Irene Elkin, Mike
Startup, and Michael Tompkins for helpful discussions on the methodological issues surrounding the assess-
ment of compliance (or adherence) in psychotherapy. Preparation of this article was supported in part by
Massey University Research Award PR56786.1207 MURF to Nikolaos Kazantzis.
Correspondence concerning this article should be addressed to: Nikolaos Kazantzis, Ph.D., School of Psy-
chology, Massey University at Albany, Private Bag 102904, NSMC, Auckland, New Zealand; e-mail:
N.Kazantzis@massey.ac.nz.
JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 60(6), 627–641 (2004) © 2004 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.10239

2. Homework assignments have received emphasis as a core and crucial component of
psychotherapy for several decades (cf. Beck, Rush, Shaw, & Emery, 1979), and can be
traced back to early behavioral and cognitive treatment formulations (e.g., Herzberg,
1941; Kanfer & Phillips, 1966; Kelly, 1955). Within the Beckian approach, therapists
systematically assign homework assignments that correspond with their individualized
conceptualization of the client’s presentation, the relevant empirically supported cogni-
tive model, and its associated treatment interventions. These accounts of integrating home-
work into therapy have been extended in several recommendations for research and practice
(e.g., Detweiler & Whisman, 1999; Persons, 1989; Shelton & Levy, 1981a) as well as in
clinical discussions among prominent researcher-practitioners in the field (see the special
issue of the Journal of Clinical Psychology, Kazantzis & Lampropoulos, 2002). In addi-
tion, there is a beginning theoretical work on the use of homework as a common process
for promoting change in the range of psychotherapy approaches (see the special issue of
the Journal of Psychotherapy Integration, Kazantzis & Ronan, in press).
A long line of empirical investigations has clearly demonstrated a causal link between
the inclusion of homework assignments and improved treatment outcome (for a review,
see Kazantzis, Deane, & Ronan, 2000) as well as a correlational link between client
compliance with homework and outcome (Burns & Spangler, 2000; Kazantzis, Ronan, &
Deane, 2001). Research has sought to examine more specific aspects of the process of
integrating homework into therapy, such as the effect of matching the type and difficulty
of homework activity assigned with the client’s presenting problem (Conoley, Padula,
Payton, & Daniels, 1994; Mahrer, Nordin, & Miller, 1995) as well as the relationships
between therapist competence in assigning homework, homework compliance, and treat-
ment outcome (e.g., Bryant, Simons, & Thase, 1999; Shaw et al., 1999).
Although homework assignments continue to be the focus of clinical research and
practice (e.g., Abramowitz, Franklin, Zoellner, & DiBernardo, 2002; Woody & Adessky,
2002), actual methods of assessing client completion of homework, or compliance, have
been relatively neglected. An early survey of the treatment-outcome literature reported
that 95% of studies before 1980 failed to include a measure of homework compliance
even though homework featured as a core component of the treatments under investi-
gation (Shelton & Levy, 1981b). In more recent times, psychotherapy researchers have
emphasized the limitations in contemporary methods of homework compliance assess-
ment, and have called for more innovative assessment practices (Burns & Spangler, 2001;
Kazantzis et al., 2001). However, with few exceptions (e.g., Schmidt & Woolaway-
Bickel, 2000), assessment methods have remained largely unchanged in their focus on
the “quantity of homework compliance” as opposed to “quality of homework compli-
ance” over the past two decades (see early critique in Primakoff, Epstein, & Covi, 1986).
As this article will outline, the assessment of homework compliance has been a signifi-
cant shortcoming in research on this feature of psychotherapy process.
This article describes key advances as well as some continuing problems in the
assessment of homework compliance. Based on published outcome studies, this article
presents a brief review of existing assessment methods, and then extends this discussion
by presenting recommendations for clinical practice in the form of a new measure of
homework compliance.
Brief Review of Homework Compliance Measures
We restricted our review of the literature to studies that described the assessment
of homework compliance, and quantitatively evaluated compliance to treatment
628 Journal of Clinical Psychology, June 2004

3. outcome1
. More specifically, studies examining homework effects were identified using
three methods: (a) a computer search of the PsychINFO database 1980 through 2002
using the key terms behavioral practice, extratherapy, extratreatment, home practice, home-
work, and self-help assignments; (b) a manual search of the reference sections of previ-
ous reviews; and (c) a manual search of the reference sections of studies examining the
relationship between homework (or homework compliance) and therapy outcome. This
search strategy incorporated the same key terms and criteria as that used for a meta-
analysis of the homework literature (e.g., Kazantzis et al., 2000). As we were interested in
presenting a representative description of the homework compliance measures used in
psychotherapy research, those studies that reported re-analyses of previously published
datasets using the same compliance measures (e.g., Burns & Spangler, 2000; Lax, Baso-
glu, & Marks, 1992) were excluded to prevent unwarranted duplication in the review. The
final sample of studies (N ⫽ 32) is summarized in Table 1.
Source and Timing of Compliance Assessment
Table 1 shows the sample size, homework type, and compliance assessment methods
for studies included in the review.2
As the majority of the studies of homework effects
concentrated on either anxiety or depression (34% and 38%, respectively), studies were
grouped into these categories in contrast to a third “general outpatient” category for
presentation in the table.
More than half of the studies relied exclusively on a single source of compliance data
(n ⫽ 23, 72%). Of the studies using multiple sources of homework compliance data (n ⫽
9, 28%), four studies involved client and therapist data, three involved objective and
client data, and only one study involved a comparison to independent compliance assess-
ment. In terms of the timing of homework compliance assessment, 23 studies (72%)
reported that compliance assessment was conducted either session by session, daily, or in
real time. Eight studies (23%) involved retrospective accounts.
Measures of Compliance
Only four studies used the same measure of homework compliance (e.g., Abramowitz
et al., 2002; Bryant et al., 1999; Leung & Heimberg, 1996; Woody & Adessky, 2002).
These investigations used a single item rated on a scale of 0 (the patient did not attempt
the assigned homework) to 6 (the patient did more of assigned homework than was
requested) originally proposed in the review by Primakoff et al. (1986). Single-item
global ratings of homework compliance were the most consistently used format for home-
work compliance assessment (n ⫽ 12, 38% of all studies).
Three studies incorporated objective measures to assess compliance with between-
session relaxation practice. More specifically, two studies described the attachment of a
cumulative timing device within the sealed battery compartment of a commercially avail-
able portable cassette recorder (e.g., Hoelscher, Lichstein, & Rosenthal, 1984, 1986).
However, the third study used a more elaborate method involving a relaxation audiotape
1
The literature concerning the assessment of pharmacological treatments was not covered.
2
The only data sources that required some judgment in creating Table 1 were the estimates of homework
compliance based on therapist ratings of client records (e.g., thought diary, activity scheduling). In these instances,
the data source was classified as a therapist rating of compliance because therapists were required to assess
client compliance from records originally obtained for self-monitoring purposes (i.e., to provide “objective”
data about the client’s problems).
Assessing Homework Compliance 629

4. Table 1
Detail on Homework Compliance Assessment Methods in Homework Research
Homework Compliance Assessment
Study
Sample
Sizea
Average
Ageb
Homework
Type Source Frequency Instrument
Average
Ratec
DEPRESSIONd
Addis & Jacobson (2000) 150 37.9 ns Therapist Sessions 1–3 Single item 3-point scale 0.43
Sessions 4–6 Single item 3-point scale 0.54
Bryant et al. (1999) 14 37.4 ns Independent Session-by-session Single item 7-point scale 4.01
Burns & Nolen-Hoeksema (1992) 175 36.1 ns Client Retrospective Single item 5-point scale 3.28
Therapist Retrospective Single item 5-point scale 3.47
Burns & Nolen-Hoeksema (1991) 159 36.6 ns Client Retrospective Single item 5-point scale –
Therapist Retrospective Single item 5-point scale –
Fennell & Teasdale (1987) 34 – Bibliotherapye
Independent Session-by-session Client record –
Harmon et al. (1980) 8 – Thought record Therapist Daily Client record –
Kornblith et al. (1983) 22 – ns Therapist Session-by-session – 55% of time
Neimeyer & Feixas (1990) 59 46.5 ns Therapist Session-by-session – –
Persons et al. (1988) 35 37.5 ns Therapist Retrospective Single dichotomous rating –
Startup & Edmonds (1994) 20 41.8 ns Therapist Session-by-session Single item 7-point scale 4.59
Thompson & Gallagher (1984) 40 67 ns Client Retrospective Self-report –
Zettle & Hayes (1987) 12 41.5 ns – – – –
ANXIETYf
Abramowitz et al. (2002) 28 35.2 ns Therapist Retrospective Single item 7-point scale 3.56 exposure
3.30 monitoring
Barlow et al. (1984) 28 40 ns Therapist Session-by-session Client record 2.46 times/week
Edelman & Chambless (1993) 48 – ns – – – –
630
Journal
of
Clinical
Psychology,
June
2004

5. Edelman & Chambless (1995) 52 – ns Therapist Session-by-session – –
Hoelscher et al. (1984) 20 36.7 Relaxation Objective Real time Electronic device 68.2 min/week
Client Daily Client record 105.2 min/week
Jannoun et al. (1980) 26 32 Exposure Therapist Daily Client record –
Jannoun et al. (1982) 16 36 Relaxation Therapist Daily Client record –
Leung & Heimberg (1996) 67 35.8 ns Therapist Session-by-session Single item 7-point scale –
Marks et al. (1988) 24 – Exposure Therapist Session-by-session Client record –
Solyom et al. (1981) 40 32 Exposure Therapist Daily Client record –
Woody & Adessky (2002) 53 33 ns Therapist Session-by-session Single item 7-point scale 4.64 start of tx
4.25 end of tx
GENERAL OUTPATIENTg
Blanchard, Nicholson, Radnitz, et al. (1991) 46 39.2 Biofeedback Therapist Daily Client record –
Retrospective Interview –
Blanchard, Nicholson, Taylor, et al. (1991) 27 33.6 Relaxation Independent Retrospective Interview –
Gasman (1992) 76 – Videoh
Client Retrospective 2 items in questionnaire 49% complied
Hawton et al. (1992) 36 41 Exposure Therapist At Session 3 Single item 5-point scale –
Hoelscher et al. (1986) 34 51.1 Relaxation Objective Real time Electronic device 100 min/week
Client Daily Client record 120 min/week
Holtzworth-Munroe et al. (1989) 32 41.4 ns Therapist Session-by-session Single item 9-point scale –
Client Session-by-session Single item 9-point scale –
Ingram & Salzberg (1990) 15 31.9 Assertioni
Independent Session-by-session Client record 12.1 times/week
Kazdin & Mascitelli (1982) 64 30.4 Exposure Client Session-by-session Single item 7-point scale –
Therapist Session-by-session Interview 94.1% complied
Taylor et al. (1983) 23 – Relaxation Objective Real time Electronic device 4.6 times/week
Client Daily Client record 5.9 times/week
Note. ns ⫽ No single type of homework activity in treatment. a
Sample size involved in analysis of the homework-related effect. b
Average age of homework group where experimental methodology is employed
and overall sample value not reported. c
Values mean scores on rating scales except where otherwise stated. d
n ⫽ 12. e
Reading the memo by Beck and Greenberg (1974). f
n ⫽ 11. g
n ⫽ 9. h
Videotape of therapy
session. i
Six assertive techniques from Smith (1975) and a seventh involving expression of positive feelings.
Assessing
Homework
Compliance
631

6. superimposed with 60-Hz sounds at regular intervals, a microphone, an event counter,
and playback device that recorded the number of 60-HZ sounds occurring between ther-
apy (Taylor, Agras, Schneider, & Allen, 1983). Although these objective measures were
intended to be more accurate in their measurement of compliance, they were able only to
estimate the amount of time clients spent playing audiotapes, and provided no informa-
tion on the quality of the learning experience for clients. As Hoelscher et al. (1984) noted,
clients may have suspected that the equipment incorporated a hidden measurement device
and simply left the audiotape player running.
Rate of Compliance
The inconsistency in the measurement of homework compliance is reflected in the data
these measures have produced. Of those studies reporting the rate of compliance (n ⫽
13), one study reported that 49% of the sample “made video homework a regular part of
therapy” (Gasman, 1992, p. 94), one study reported that 94% of the sample “had prac-
ticed [homework] after each of the sessions” (Kazdin & Mascitelli, 1982, p. 253), and
one reported that self-report data indicated that clients had “accurately completed the
[homework] assignments” 55% of the time (Kornblith, Rehm, O’Hara, & Lamparski,
1983, p. 519). Studies that obtained a weekly estimate of compliance (n ⫽ 3) reported
average rates ranging from 2.5 times per week to 12 times per week (Barlow, O’Brien, &
Last, 1984; Ingram & Salzberg, 1990; Taylor et al., 1983). Studies that obtained a weekly
estimate of time spent on homework per week (n ⫽ 2) reported rates ranging from 68 min
per week to 120 min per week (Hoelscher et al., 1984, 1986). Studies that used the same
single-item rating scale either reported an average rate of compliance overall (i.e., Bryant
et al., 1999), average rates of compliance for different homework assignments (i.e.,
Abramowitz et al., 2002), rates of compliance for all homework assignments at the begin-
ning and the end of treatment (i.e., Woody & Adessky, 2002), or did not report the rate of
compliance (i.e., Leung & Heimberg, 1996). Consequently, the diversity of assessment
methods and the resultant data restricts any meaningful interpretation of compliance rates
across studies.
Summary and Conclusions from the Review
With one exception (i.e., Schmidt & Woolaway-Bickel, 2000), all studies in this review
focused on the assessment of quantity (or extent) of homework compliance rather than
the quality of learning. This is surprising given that proponents of homework have tra-
ditionally emphasized that partial homework completion, and even noncompletion, can
often provide the therapist with useful information for the conceptualization and treat-
ment plan (Beck et al., 1979). At the same time, only a small handful of studies used the
same measure of homework compliance, making any comparisons between studies decid-
edly problematic. Therefore, our first conclusion was that the assessment of homework
compliance has been a significant shortcoming in psychotherapy research. Lack of stan-
dardization in the measurement of compliance, reliance on single-item global measures,
and the confounded constructs of quantity and quality suggest that there is a need for a
new measure that takes account of these limitations.
There also are limitations with the way in which homework compliance measures
have been utilized to evaluate therapy process. Homework compliance was most com-
monly assessed using one source of data, with only a small proportion of studies directly
comparing two or more sources of data. Contemporary reviews of psychotherapy research
632 Journal of Clinical Psychology, June 2004

7. emphasize the importance of incorporating both client and therapist perspectives when
studying therapy processes (Orlinsky, Rønnestad, & Willitzki, 2004), and the meta-
analysis of the homework research provided evidence to suggest that homework effects
were moderated by the source of compliance data (Kazantzis et al., 2000). In addition, a
sizable proportion of studies used retrospective accounts of homework compliance obtained
at posttreatment or during follow-up assessments. Retrospective ratings are clearly prob-
lematic, as clients who have experienced improvement in symptoms may inadvertently
inflate the extent to which they complied with homework. Alternatively, measuring com-
pliance retrospectively may miss the early, rapid recovery that has been hypothesized to
occur in response to homework completion (e.g., Persons, Burns, & Perloff, 1988). The
Kazantzis et al. (2000) meta-analysis provided further evidence to suggest that the timing
of compliance data moderates homework effects. Therefore, our second conclusion was
that future research studies should consider the value of assessing homework compliance
from multiple sources and assess compliance regularly throughout therapy as a means of
adjusting the course of therapy for the individual client. Such data on homework com-
pletion from the beginning stages of therapy would have valuable implications for both
research and practice (see discussion in Lambert et al., 2003).
Recommendations for Clinical Practice
Many of the studies included in the previous review do not necessarily provide the level
of detail necessary for guiding clinical practice. For example, it is difficult to know what
a practitioner could conclude from the 12 studies examining homework compliance within
treatments for depression. The information reported in Table 1 is unlikely to be helpful
for deciding how to proceed with a depressed client who has learned how to schedule
activities to increase his or her sense of pleasure and mastery, but who is unable or
unwilling to attempt completion of a thought record.
The theoretical basis for using homework assignments rests firmly on the behavioral
principle of generalization, but there is no theoretical model that considers the features of
the individual client, therapist factors, and features of the homework assignment as a
means of maximizing client learning through the completion of homework. Numerous
practice recommendations have appeared in the literature (e.g., Persons, Davidson, &
Tompkins, 2001), but these have typically echoed the clinical guidelines outlined in early
psychotherapy texts outlining the use of homework in therapy (e.g., Beck et al., 1979). A
theoretical model that considers client, therapist, and task characteristics would serve as
a firm foundation upon which to develop more extensive methods of homework compli-
ance assessment.
In an attempt to assist the field in understanding the construct of homework compli-
ance, Detweiler and Whisman (1999) proposed a “heuristic” or framework based on
findings from the research literature. Within the Detweiler and Whisman framework,
various client factors (e.g., collaborative involvement in setting homework, having clear
rationale for homework completion, obtaining enjoyment from task), therapist factors
(e.g., persuasiveness/enthusiasm, specificity in therapists’ administration of task), and
task characteristics (e.g., difficulty level, written reminders) were hypothesized to be
necessary precursors to client compliance with homework activities. Prior attempts to
explain homework compliance have focused almost exclusively on therapist behaviors
in reviewing, designing, and assigning homework (e.g., Shelton & Levy, 1981b) or have
not intended to provide a guiding theory for research and practice (e.g., Carich, 1990;
Halligan, 1995).
Assessing Homework Compliance 633

8. Therefore, our recommendations for practice will follow the Detweiler and Whisman
(1999) framework as a guiding foundation. These recommendations are then reflected in
the items in our new homework compliance measure for use in clinical practice.
Homework Rating Scale
As the first step towards assisting the field in the development of more reliable and valid
measures of homework compliance, we offer a Homework Rating Scale (HRS) as a tool
for clinical practice (see Appendix). Although the HRS may later demonstrate utility as a
measure for studying psychotherapy process, the absence of existing psychometric data
limits our recommendations for its use to the clinical practice setting. The HRS is a
12-item, client self-report measure designed to measure client, therapist, and task char-
acteristics associated with client compliance with homework assignments. Unlike exist-
ing measures discussed in this review, it separates the construct of compliance into two
components, quantity and quality, asking clients to rate these on a 5-point scale. The
theoretical and empirical rationale for the remaining items in the HRS is outlined below,
together with comments regarding the clinical utility of client responses.
Client Factors
A series of client factors have been suggested to be important in determining client
completion of homework assignments. While any homework assignment should be dis-
cussed so that the client has a clear understanding and involvement in setting the home-
work activity, there may be several reasons why this is not always achieved. Some authors
have noted that practical obstacles in the client’s environment can sometimes interfere
with homework completion despite attempts to identify them in-session (Beck et al.,
1979; Shelton & Levy, 1981b). The homework activity also may be more difficult than
the client and therapist anticipated, and may extend beyond the client’s ability or skill
level (Beck et al., 1979). It also is suggested that clients will be more likely to enjoy
activities that they are involved in designing (Detweiler & Whisman, 1999; Wankel,
1993).
Perhaps most importantly, the client may present with attitudes, rules, or beliefs
about the homework activity which may (or may not) be characteristic of their presenting
problems, but still serve to interfere with the opportunity to learn from homework assign-
ments. These features of the client’s presentation may be related to the severity of the
presenting problems, personal responsibility for change, or the efficacy of the treatment
being offered (Shelton & Levy, 1981b). For example, the client also may exhibit a belief
(or schema) structure that promotes noncompletion of homework such as unrelenting
standards, fear of failure, or increased sense of social desirability (Persons, 1989). These
cognitive features may occur independently or in combination with negative beliefs about
the future, the world, and other people—including the therapist (Burns & Auerbach,
1992; Goisman, 1985).
Even though these client factors are grounded in theory and clinical experience, there
is limited empirical support in the existing literature. Research has sought to relate sever-
ity and type of presenting problem to homework compliance, without success (e.g., Bry-
ant et al., 1999; Leung & Heimberg, 1996; Worthington, 1986). Similarly, willingness to
engage in therapy and acceptance of a rationale for cognitive-behavioral therapy have not
been linked with homework compliance (e.g., Addis & Jacobson, 2000; Burns & Nolen-
Hoeksema, 1991). Given the limitations of the homework compliance measures in this
634 Journal of Clinical Psychology, June 2004

9. area of research, it is simply possible that the source, timing, or methods of compliance
assessment were insufficiently sensitive to detect the relationship between client factors
and completion of homework assignments.
Nonetheless, practitioners can attend to these factors when integrating homework as-
signments into therapy through in-session discussion with clients. We have designed five
items on the HRS to target client factors.These items ask the client to rate the extent to which
practical obstacles interfered with the assignment (Item 4), how well they understood what
was involved (Item 5), how well they understood the rationale for the assignment (Item 6),
their perceived involvement in planning the assignment (Item 7), and how much they en-
joyedtheassignment(Item10).Wehavefounditusefultoaskclientstocompletetheseitems
on a semiregular basis in the waiting room before a therapy session, to be discussed as part
of reviewing homework.3
Aside from saving time, client responses on these items often
function as a way of prioritizing the barriers to the effective use of homework in therapy.
Finally, we would like to highlight the client’s age as an important factor. The pop-
ulation of older adults is growing worldwide, and the empirical support for homework
effects within cognitive-behavioral therapies for older adults is emerging (e.g., Coon &
Thompson, 2003). We suggest that practitioners consider the appropriateness of their use
of homework and revise measures such as the HRS accordingly. Although a detailed
consideration of the special issues in assessing homework compliance for different age
groups is beyond the scope of this article, discussion of these clinical issues has been
published elsewhere (see Kazantzis, Pachana, & Secker, 2003).
Therapist Factors
Aseries of therapist factors also have been suggested to be important in predicting whether
a client will complete a given homework assignment. Homework should be reviewed and
summarized at the beginning of every session, be presented with a rationale that is under-
stood by the client, and be tailored to the client’s specific problems (Beck et al., 1979). At
the same time, therapists should problem solve difficulties that could or did prevent
learning from homework assignment completion. To maximize this problem-solving pro-
cess and ensure the assignment is practically possible given the demands on the client’s
time, therapists can work towards a high degree of specificity in setting up the homework.
That is, therapists can collaboratively work with the client to decide when, where, how
often, and how long the homework assignment is likely to take (Shelton & Levy, 1981b).
Several studies have sought to examine therapist factors in relation to homework
compliance, but the results have been mixed. In two studies of therapist competency in
delivering cognitive-behavior therapy for depression, therapists’competency in the review
of homework assignments was correlated with homework compliance (e.g., Bryant et al.,
1999; Shaw et al., 1999; also see Worthington, 1986). However, a study by Startup and
Edmonds (1994) did not find any evidence to suggest that therapist adherence to the
homework administration procedures was associated with compliance. Similarly, a study
by Burns and Nolen-Hoeksema (1992) did not produce a significant relationship between
therapist empathy and compliance.Again, the limitations in homework compliance assess-
ment together with the limitation of low statistical power in this research (see Kazantzis,
3
Although we use this measure on a semiregular basis in our clinical work, we have not yet gathered sufficient
data for preliminary psychometric analysis of the HRS. The limited data have been collected solely for clinical
purposes, and our clients have not provided informed consent for its use in publications or research. As noted
in the final summary and conclusion of this article, the HRS will form the focus of psychometric evaluation in
our programmatic research.
Assessing Homework Compliance 635

10. 2000) are likely explanations for the inconsistencies in these results. In the counseling
literature, however, there is promising evidence to suggest that activities are more likely
to be completed between sessions when they match with client goals for treatment (Cono-
ley et al., 1994).
Both in designing and reviewing homework, we have found it helpful to ask clients
for their views on the degree to which the homework assignment was specific and matched
their therapy goals. Consequently, we have designed two items on the HRS to target two
key areas of therapist competence. These items ask clients to rate the extent to which the
guidelines for the homework assignment were specific (Item 8) and matched their goals
for therapy (Item 9). Responses on these items can often reveal gaps in the planning or
“setup” for the learning assignment, both in terms of the practical considerations for its
completion and clients’ view of its relevance.
Task Characteristics
Finally, the difficulty of the homework task has been suggested to be important in pre-
dicting whether a client will complete a given homework assignment. This assertion is
centered on the importance of ensuring that the difficulty level of the assignment is
tailored and matched to the ability of the client, and has preliminary empirical support
(Conoley et al., 1994; Worthington, 1986).
In reviewing homework, we have found it consistently helpful to ask clients how
difficult they found the assignment. Following the discussion on difficulty, we also have
found it helpful to ask clients for their view on whether the particular assignment has
promoted any learning or progress towards their therapy goals. As a result, we designed
the three remaining items on the HRS to target this and other task factors. These items ask
the client to rate how difficult the assignment was (Item 3), the extent to which the
homework helped them gain control over their problems (Item 11), and whether it helped
with progress in therapy (Item 12). Client responses to these questions, either on the HRS
or in verbal discussion, also provide the therapist with an indication on the extent to
which a client is ready to progress to new skills or components of the treatment.
Summary and Conclusion
The issue of how best to assess homework compliance remains an empirical question.
Taking into account the theoretical and empirical evidence to date, we have compiled a
new measure for homework compliance assessment that clinicians can use in their every-
day practice. The HRS is more extensive than existing measures of homework compli-
ance, both in terms of the number of items and measurement of several theoretically
based dimensions of clients’ compliance with learning activities completed as homework
assignments. The measure itself will be undergoing examination in our own program-
matic research and used on a semiregular basis in our own practices.
In terms of research, one avenue worth exploring is the extent to which the degree of
therapist competence in assigning homework (i.e., collaborating with the client, specifi-
cation of when, where, how often, and how long) is linked with client learning through
homework completion. For example, does a client’s mastery of a homework activity
relate to the quality of planning, increased specificity, and the explicit linking of home-
work activities to treatment goals? Furthermore, does a sense of mastery or progress
through the completion of homework assignments early in therapy predict subsequent
outcome? Answers to such questions will clarify the role of homework assignments in
promoting positive therapy outcomes for clients.
636 Journal of Clinical Psychology, June 2004

11. Appendix
Assessing Homework Compliance 637

12. References
References marked with an asterisk were included in the review.
*Abramowitz, J.S., Franklin, M.E., Zoellner, L.A., & DiBernardo, C.L. (2002). Treatment compli-
ance and outcome in obsessive-compulsive disorder. Behavior Modification, 26, 447–463.
*Addis, M.E., & Jacobson, N.S. (2000). A closer look at the treatment rationale and homework
compliance in cognitive behavioral therapy for depression. Cognitive Therapy and Research,
24, 313–326.
*Barlow, D.H., O’Brien, G.T., & Last, C.G. (1984). Couples treatment of agoraphobia. Behavior
Therapy, 15, 41–58.
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