Behavioral Health Minute

March 2008 - Behavioral homework for patients

The short summary
We may have brilliant, good-hearted conversations in the office about people changing their lives, but the money lies more in how people put energy into changing their lives out there in the world after they leave.  This is a process that we can be aware of and support.

The modestly longer reflection

I was thinking the other day that I would like to write a one-page handout for pts about how to be successful with life changes.  Smoking, drinking, emotional regulation, relationship enhancement, mood changes… I see real differences in people who are or are not successful.  The people in my practice who are not successful are those who suffer and who sit somewhere waiting and hoping that something will happen to make things better.  The people in my practice who are successful are those who suffer but a) have an awareness of where they want to be going, and b) take concrete steps to get there.

For me, this underscores the pivotal importance of what people do when they are not with me.  This is home-work.  I really want to encourage people to invest energy in experimenting with living their lives differently, away from the office.

Some ways that I frequently approach this:

• Questions that invite pts to create homework tasks.  “How do you see yourself following up on this conversation in the next couple of weeks?”  “What do you think you could put some energy into that would help you to move forward a little?”  “What is your sense about what you could be doing to pick up on what we have been talking about?”
• Concrete suggestions for homework tasks, like
• Tasks that grow out of the conversation.  “You said you are thinking about asking your sister about her recollections about growing up with your dad… sounds good to me… would you see yourself doing this?
• Journaling.  “Spend a few minutes each evening writing down anything that passes through your mind, unedited, then look it over to see what you can learn.”
• Self-observation.  “Notice… and jot down some notes… about times when the problem that we are talking about is not quite so bad, and then think about what you could learn about what you do to bring these times about.”
• And the elegantly-simple but sometimes powerful task of just doing something different each day.

Follow-up

Experiment with ways that you can encourage people to take action following up on your office visit after they leave.

Fred Craigie, PhD