Clinical homework can be an iffy proposition. It can set up a teacher-student dynamic that can be counterproductive, particularly, if you, the clinician, get a little perfectionistic about homework compliance. Remember who you are working with: Many folks who come to you to work on eating issues can be pretty hard on themselves. What we want to avoid here is an all-or-nothing narrative of “failure v. success.” So, you have to be careful not to be too pedantic or obsessive about the homework you prescribe. Thus, clinical homework review must be conducted with humanistic savvy. I recommend that you focus your homework review on the following four aspects of the change process:
• Precedents
• Trends
• Changes in self-view
• Behavioral outcomes
If you just focus on the outcomes you are running the risk of invalidating the effort. If the focus of your clinical attention implicitly communicates that all that matters is whether your client is eating emotionally less often and eating less, then you are inadvertently reinforcing client’s own perfectionism and diet mentality. And that gets in the way of the change process.
Precedent review is a kind of homework review in which all you are hoping for is a precedent of change. If such a precedent can be found, you make a point to celebrate it. You don’t have to gush, but you do make a big enough deal about it to flag its importance for the client. When you do that, you create a non-perfectionistic attitude toward future homework. You are teaching the client that what matters is change – not accuracy, not precision, but change itself. And change begins with precedents. You know that whole point about how the journey of a thousand miles begins with one step? That’s what I am talking about. Yes, it’s a cliché, but it’s a cliché that makes sense, and people recognize it. So, use it. Tell the client about the journey of a thousand miles and congratulate him or her on the first couple of steps taken.
Pay special attention to any emerging trends or a change of patterns in a client’s behavior. Ask your client, “So, as you look back at the past couple of weeks since we started working on this, do you sense a trend emerging in how you use food for coping?” If the client recognizes any such trends, again, celebrate them. Make a big deal about them. But if not, reassure the client that his or her emotional eating habit has a lot of momentum behind it, and that it is entirely normal for this sort of thing to take some time. It’s the process that matters. Also, pay close attention so as to not miss out on the new patterns and trends. Think of the stories you hear from the client, and see if you can connect a few stand-alone dots of precedents into a narrative of change that is gaining speed. Even if this trend is a stretch, it’s a stretch in ego-syntonic direction, in a direction that supports change.
Ask the client how he or she has been feeling about himself or herself since he or she started working on making emotional eating more mindful. Has he or she been more at peace with himself or herself? Is the client feeling more in control? Has he or she been calmer? More balanced? More mindful? More present? And what’s it like to discover that side of himself or herself? What’s meaningful about that for the client? Has he or she had any epiphanies or realizations? Is the client more satisfied with his or her progress?
The discussion of the actual behavioral outcomes should come last. It should take the back seat to the discussions of precedents, trends and changes in self-view. In fact, it is entirely ok to not even discuss the behavioral outcomes explicitly. As a clinician, it won’t take much guesswork to see what is happening on the behavioral plane. Leave the initiative with the client: If they have something to share, to brag about, they will. And when they do, try not to overshoot and end up acting as if the outcomes don’t matter at all. Of course, they do. That’s what the client is there for. So, in dialing down the focus on outcomes, it is important not to ignore them. The rule of thumb here is to let your client bring up the issue of outcomes. At the same time, keep a close ear to what you are hearing about the outcomes. You just might need to revisit these emerging behavioral changes down the line should client’s sense of efficacy lapse for some reason. As a clinician, you are not just a catalyst of change for your client but also a historian of their progress.
Clinical homework review is not a scorecard or a weigh-in. There shouldn’t be any make-it-or-break it feel about it. There are no tests to pass or fail. Nothing to prove or disprove. Just a project of change to allow to unfold. As I see it, humanistic homework review is a collaborative creation of a change narrative. Think about it: The goal of homework is indeed change, but the goal of homework review is not change per se, instead an attempt to leverage a healthy attitude with an orientation towards methodical but patient change. So, it really helps to communicate implicitly and explicitly that change is a process and that the client, in your opinion, is always doing his or her best. This attitude of unconditional acceptance matters: If the client feels your acceptance, he or she is likely to stick around, and then you can move him or her beyond the initial intervention (to Part II and III of this work) to talk more explicitly about an unconditional view of self which will serve as a powerful long-term relapse prevention strategy. So, here’s some homework for you, the clinician: Dare to accept your client’s homework outcomes. Whatever they might be.