Abstract
Instructions are a common resource used by behavioral therapists to assign therapeutic homework. However, understanding how clients learn with instructions is better known in laboratory research than in clinical research. The present study aims to explore changes in the way of instructing and reviewing the client’s compliance throughout the therapeutic process. We analyzed the therapist’s verbal behavior during 211 recorded sessions corresponding to 19 cases treated by 11 behavioral therapists (53% male and 47% female). The sessions were divided into four stages according to the timing of the intervention and coded by using a previously validated coding system (SYST-INTER-INSTR). Results show that instructions become less specific towards the last stage of the intervention. However, therapists assess task compliance in the same way towards the end of the therapeutic process. The change in specificity suggests that the client’s behavior changes from being controlled by instructions to being controlled by natural contingencies. However, to make sure the clinical change remains; therapists assess and reinforce the client’s compliance until the end of the intervention. Although clinical implications of the results, some limitations (i.e., not considering the type of task instructed) should be addressed in future studies.
Highlights
Instructions are a common resource used by behavioral therapists to assign therapeutic homework
Results a) Differences between treatment stages in the way of instructing homework: In order to test the first hypothesis, Table 3 shows the descriptive statistics regarding the components of instructional blocks divided by each stage of the therapeutic process
These results demonstrate a growing trend in the use of formal instructional blocks from the initial stages of the therapeutic process to the Treatment stage, but a decrease in the final stage
Summary
Instructions are a common resource used by behavioral therapists to assign therapeutic homework. Verbal behavior is not a static element in psychological treatment; it changes throughout the therapeutic process and is dependent on the therapist’s goals (Follette, Naugle, & Callaghan, 1996; Froján, Montaño, & Calero, 2010; Rosenfarb, 1992; Ruiz, Froján, & Calero, 2013; Ruiz, Froján, & Galván, 2015; Tsai et al, 2009; Vargas et al, 2017) On this basis, it might be expected that how the therapist chooses to give instructions regarding homework and assesses the client’s compliance will change over the different stages of the intervention, reflecting how clients incorporate new strategies into their behavioral repertoire. This process is an issue that is still to be addressed in clinical psychology research
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