Therapy, self-help or online therapeutic programs for children/teens with mental, emotional or social health challenges: What happens outside the session/program is what matters most
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Many children and teens with mental, emotional, or social health challenges are engaged in some kind of therapeutic program – this might be a course of one-to-one therapy, a group program, online learning programs, or even self-help books or workbooks.
There are thousands of different therapeutic programs for young people, and these have many varied types of content. These programs might cover topics such as understanding and managing their body and physiological tension, maintaining and repairing relationships, increasing their positive and confident self-talk, identifying their values and strengths, being compassionate towards themselves, social problem solving and almost countless other ideas.
The good news is that millions of families all over the world, with all kinds of challenges and struggles – have found therapy or therapeutic intervention programs like these, life changing and useful. However, there is a significant body of research which suggests that it is not what happens in the therapeutic programs themselves which are most useful – but what happens in between sessions, lessons or modules.
This research consists of many studies which consider children/teens with emotional or mental health challenges who are attending psychological therapy sessions or group programs. They assess children/teens who have been provided with activities to practice or behaviours to undertake - before the next session – and who actually complete these, to children/teens in the exact same type of therapy program who either are not provided with ‘homework’ or who do not complete it. These studies also compare young people’s parents/caregivers who are provided with and complete homework (usually practicing new ways of relating to or supporting their children/teens) to parents/caregivers who either are not provided with or do not complete therapy homework.
These studies regularly and consistently find that higher levels of therapy homework completed – both by parents and by children/teens is linked with better therapy outcomes, as well as lower drop out and higher treatment satisfaction.
In other words, individual therapy and therapeutic programs (group or self-help) for children/teens and families are far more likely to be useful when they are accompanied by children and young people regularly practicing new skills and trying out new behaviours – and when they are accompanied by parents/caregivers also practicing new ways of supporting young people. Otherwise, therapy is likely to be minimally (or not at all) effective.
This probably doesn’t surprise you. The superiority of practicing a skill versus talking about it is true in many areas of life. Imagine a sporting coach trying to teach a young person how to play a game simply by discussion and instruction rather than getting them out there practicing and playing.
Of course, actually doing therapy tasks is much easier said than done. Questionnaires completed by therapists typically find therapy homework completion as being challenging for the families they work with - up to 60% of families regularly do not complete in between therapy session tasks set for them.
There are many reasons for this. Therapists sometimes do not set realistic tasks for homework, do not clearly explaining the benefits, and do not discuss strategies to help families support their children/teens to do therapy homework when motivation is low. In addition, parents/caregivers often have their own mental health, stress and difficult life circumstances which makes it difficult to do and help their children/teens do the therapy homework.
How to increase the homework or practice completed in therapy programs
If you are considering – or already involved in – having your child start a (group, individual or self-help) therapy program, here are some ideas to consider to help you and your family complete the in between session/module therapy tasks which will then in turn ensure the therapy or program is effective.
Before you start:
1. Identify your goals for the therapy program:
It is often helpful, to think about – before you start a self-help, group or therapy program to think about what is most important to you that you/your family achieve or get out of the program. It can be helpful to talk to someone you trust or a parenting partner about this – and to also write them down. This is a step which is often easy to skip – and may feel like it will not make a big difference – but my experience is that families and children are far more likely to complete tasks (and therefore improve during therapy programs) if they are really clear on specific goals they would like to achieve.
2. Consider whether you have the time and space in your life for a therapy program:
Therapy programs are often a big commitment. It is worth considering whether you feel be able to start them. Do you have the time and space in your life to complete homework tasks (check with your therapist /program but this might be 5-10 minutes a day) yourself as a parent/caregiver? Do you have the time and space in your life to be able to support your child/teen to complete their own therapy homework?
Most children and teens need parent/caregiver support to coach, motivate and remind themselves to do therapy homework on a daily or nearly daily basis (or for younger children – this might mean being with them while they do it).
If not, it may be appropriate to delay the therapeutic program for a few months until you can find the time and space.
3. Talk to your child/teen and potentially other members of the parenting/caregiving team about the importance of homework or home practice:
As well as thinking about this yourself, it is important to talk with the child/teen and any other members of the parenting team about this concept. You might like to use an analogy, for example, one considering the importance of practicing an instrument or learning to read, or learning to drive.
Doing therapy/this self-help/therapy program is a bit like learning an instrument/learning to drive/learning to read. Unless we practice the instrument/drive the car/practice reading outside of the lesson itself – we don’t get better at these things. With this program/therapy, we can’t just attend the session/group/read the materials – we will need to spend some time practicing skills for things to change. We will probably have to set aside time each day or every second day. Shall we talk about how we might do this/how you would like to do this?
Throughout therapy or the therapy program
1. Ask for (or create) specific tasks:
It is important to know what specific skills or tasks to work on, rather than just aiming to “think about” a general idea learnt or discussed in therapy. If you have a therapist, ask for specific skills to try in between sessions. If you are using self-help/online/group program and do not have specific skills set for you, try to create some of those yourself. They might be:
Telling someone else about an idea you learnt about
Writing out/drawing pictures associated with new ways of talking or acting
Setting a timer to say specific sentences or use new skills
Creating a poster to put up as a reminder of new therapeutic skills
Write journal entries of the main points covered in the session/lesson/module
Record a video demonstrating/presenting the new way of responding to a stressor
2. Check the homework you aim to do or have your child/teen do is achievable:
It is important to not overcommit to therapy tasks which do not fit in with your life and to also think about what strategies you can use to remember or schedule the therapy homework tasks into daily life. It might help to ask the following questions about therapy homework:
What will make this hard to complete it? How can we overcome them?
What will we do if we don’t complete the homework? What is our ‘Plan B’?
What will help us to complete the homework? How can we ensure we make it easier to do?
Do I/you understand what we are needing to do? Have we been specific in setting the task?
Can I find the time to help my child/teen complete this? How can I have the time?
On this point, you might like to consider choosing a practice schedule which relies more on increased regularity rather than longer intensity for a shorter period – i.e., suggesting 5-10 minutes per day or every second day for 4 weeks, rather than a 20-minute task once a week for 10 weeks. This often means more momentum at the start which can help get into a habit of practice.
3. Think about how you phrase or think about therapy homework:
You might like using a word or phrase which suits you and your family (e.g., therapy task, activity of the week) if “homework” makes a young person feel like it is too much like school work.
4. Check the homework you aim to do or have your child/teen do fits with your values and the goals:
Hopefully you have identified your values and goals at the start of the program. With these in mind, you can ask yourself/your child/teen: How important is this homework to you/me? You can rate the importance out of 10 (where 0 = not at all important, 10 = the most important). If it hasn’t been rated high and/or it doesn’t seem right to you, ask your therapist about it, or alter it so it fits with you.
5. Find a way of you/your child/teen being reminded of the homework:
It can be hard to remember to do new things – it is understandable that parents/caregivers and young people struggle to remember to do in between therapy session tasks. There are a number of ways you can put in place prompts, such as:
Phone reminders
Visual reminder (e.g., poster, picture, post-it note) on the bathroom mirror, the back of the bathroom door, next to the bed, on the fridge.
Build practice into the routine. For example, in the car on the way to school, after breakfast, before going to sleep, before having screen time, etc.
Add it to the family calendar
6. Ask someone to follow up on homework to keep you/your child/teen accountable:
Sometimes just having another person check in can help us be accountable to completing tasks. You might like to do this for you or your family. Be sure to specify what this will look like, to increase the likelihood that this will be helpful. For example, set up exactly when someone will follow up based on the timeframe within which you want to complete the homework. Also, plan in advance what you will share or show them. This might be a schedule that has been ticked/dated or showing a part of the homework that has a note/drawing about what was done.
Talking with your child/teen about finding the homework hard to do
If you have done all of the above, and you - your child/teen is still struggling to complete therapy tasks, it may be useful to have a conversation about this – either with another trusted person (for your own homework) or with your child. It might include:
Ask questions– which you can ask of yourself (if your own homework wasn’t completed) or your child/teen.
I noticed you/we/I had difficulties this week with the therapy homework we had agreed on/we were doing. Let’s just take a minute to see if we can understand what happened. What was hardest aspect? Was it forgotten? Was it avoided? How much did you/we/I believe it was important?
2. It is important to then follow up with empathy and compassion – for yourself and your child. Doing therapy or therapy program homework sometimes requires us – and our children/teens to make significant life changes. It is not surprising that this is hard. We should be very patient, compassionate, and kind to ourselves as we navigate being able to do this.
It makes sense that this would be hard to do. We are changing the way we usually do things, and it is hard to practice new ways. This isn’t easy. We will continue working on it together.
3. Check whether you (and also your child/teen) still believe there are good reasons/value in doing the homework or task.
If yes, it may be worth writing these down, visualizing a positive outcome, discussing them or finding another way to keep these upper most in mind. It might then be worth problem solving the homework task to make it either easier to do (smaller, briefer for example) or easier to remember to do (reminders, schedules, linking it with another task).
If no, it may be worth considering (or talking with your therapist) about an alternative homework task or seeking their (or others’) opinion about the homework task or alternatives.
Finally:
Remember, the process of therapy, or therapeutic program completion is not an easy one. Be kind and compassionate towards yourself and your family as you work out what changes are best for you.
If you have a 4 to 11 year old child with emotional, social or life challenges, and would like them to learn the skills they need to feel calm, confident and cooperative, go to calmkidcentral.com. In this program, there are videos, lessons and games for kids, and articles and lessons for parents/caregivers about how to support children with these challenges. You can also ask questions of our child psychologists and receive a response within 48 hours. Follow the link above or click on the image to the left to find out more.
