Therapeutic homework: the use of behavioral assignments in office counseling.

Office counseling provides an intensive, short-term opportunity for patients to learn new response patterns and coping skills. Progress is enhanced to the extent that patients experiment with and practice new approaches in real-life situations outside the physician's office. Particularly in a family medicine context, with its associated time constraints, it is important for patients' between-session experience to be orchestrated carefully to solidify or act upon learning from brief counseling sessions. Behavioral assignments and other therapeutic homework are essential tools for the family physician to take advantage of between-session opportunities for patients to learn and change. Examples of therapeutic homework include self-monitoring, lists, narrative accounts, questionnaires, action assignments, and published patient education material. This paper provides theoretical background about therapeutic homework and presents guidelines that should increase the likelihood that behavioral assignments will be understood and carried out in an effective way.