Cognitive-behavioral therapy is more efficacious when between-session 'homework' tasks are included. Although the evidence for the effectiveness of homework appears compelling, only limited research is available to guide day-to-day practice. Recently, the search for strategies to enhance homework compliance (or engagement) has centered on practitioner competence in developing collaborative and empirical therapeutic relationships. Rather than viewing practitioner competence as a "trait", newer measures are better equipped to capture the fluctuations in competence from session-to-session, as well as the relationship between therapist competence and patient compliance, and their combined effects on positive treatment outcomes.
This presentation will use meta-analytic methods to review the empirical data demonstrating the causal and correlational effects of CBT homework assignments in enhancing positive treatment outcomes. Positive results have been obtained in the treatment of major depressive disorder, social anxiety disorder, panic disorder, and generalized anxiety disorder. Data supporting the development of therapeutic relationships characterized by strong patient and therapist involvement in the therapeutic work (collaboration) of identifying and evaluating the patients' belief system (empiricism) will also be covered. A recent study in the treatment of major depressive disorder suggests that therapist competence in following a compliance enhancement protocol, which focused on collaborative empiricism, enhanced treatment outcomes. In conclusion, the results of these studies suggest that patient engagement with homework assignments is an important determinant of positive CBT outcomes, but practitioner competence may enhance the effect when the patient-therapist relationship is characterized by collaborative empiricism.