Michael A. Tompkins, PhD, ABPP
Co-Director of the San Francisco Bay Area Center for Cognitive Therapy
Self-help reading is often assigned as an extra-therapy activity and, like any homework assignment, thoughtful planning on the part of the therapist can mean the difference between a homework assignment that is completed or not. The following guidelines can improve the likelihood that clients will understand and complete self-help readings.
Never assign a self-help reading that you haven’t read first. In these busy times, it’s understandable that therapists might recommend a book to a client based on an endorsement from a colleague or another client or after only a brief review of the book. There are a number of good reasons why it is essential that therapists read the self-materials they have assigned. Not all self-help materials are helpful. Sometimes, a self-help book will reinforce a problematic view the client holds that the therapist is working very hard to correct. For example, many self-help books emphasize change when acceptance is a better strategy for many clients. This is particularly true of individuals with chronic conditions such as dysthymia in which their efforts to “feel happy” only aggravates their condition as they become self-critical when they are unable to meet this unrealistic expectation. Therapists who read self-help books before they assign them can discuss with their clients the importance of taking a balanced view toward their condition and to not set unrealistic expectations. Often, after reading self-help material, clients will have questions or will want clarification about a point. Not only is it embarrassing for the therapist to say, “Where does it say that,” and reach for the book but it decreases the likelihood that clients will take self-help readings seriously: if the therapist hasn’t taken the time to read it, how useful can it be?
Prescribe specific self-reading assignments rather than leaving to the client the decision of what to read and when. I have found prescribing specific chapters or pages in a self-help book more useful than suggesting clients read a book without any guidance as to where to begin or on what to focus. This approach is particularly helpful for anxious or indecisive clients who may need added encouragement and structure. Therapists can offer several choices of what to read and prioritize which chapters to read first, then second, and so on. It helps to write down dates and times when the reading is to be done, particularly for disorganized clients or those who have trouble following through with tasks. Clients may be more likely to read self-help materials if they believe that the readings have been individualized to their particular needs. Review with clients the table of contents of the prescribed book and discuss which chapters are relevant to them. I recommend that therapists predict that anxious clients may become anxious as they read the self-help materials, “Joyce, as you read about panic attacks you might notice yourself feeling a little anxious. This often happens to anxious clients and, in fact, it’s good practice for you because it’s important for you to become more comfortable with feeling anxious.” Then spend some time troubleshooting with clients what they might do if they become anxious so that they can continue the reading assignment.
Present the rationale for each reading assignment and tie it to the client’s treatment goals. Clients are more likely to read self-help materials if they understand the reason for doing it. Goldfried and Davison (Holt, Rinehart and Winston, 1976) noted that presenting clients with a general rationale for treatment as well as explaining the link between the client’s and therapist’s definitions of treatment goals heightens the client’s view that therapeutic tasks, such as homework, are valid and credible. A rationale for a self-help reading assignment can be quite simple, “I think reading about the nature of anxiety and panic may help to correct some misunderstandings you have about panic attacks which may decrease the likelihood you’ll have one.” After providing a rationale for the self-help reading, check with clients whether they have accepted the rationale or not. Clients who reject a homework rationale may be less open to change, perhaps because they are hopeless about anything helping; because they have clear beliefs about what will and will not help them solve their problems that the therapist has not explored, or because they don’t understand the reason for doing it.
Review the reading assignment each session. Careful inquiry about the client’s response to the self-help readings can improve adherence with future homework assignments as well as provide therapists with information that may assist treatment planning. For example, Jon, a 57-year old mechanic who had experienced a series of recent panic attacks agreed to read the first two chapters of a self-help book on panic. When his therapist asked Jon for feedback about the reading, he reported that the section on medical disorders with panic-like symptoms was particularly upsetting. Jon believed that he might be suffering from Meniere’s disease, a common disorder of the inner ear. Although Jon had been cleared medically, Jon’s therapist thought it prudent to discuss this information with Jon’s physician. Jon was then referred for an additional medical workup that confirmed an inner ear problem, although not Meniere’s disease. To check whether clients have understood what they have read, ask them to describe the main points of the readings as well as what was helpful or not helpful; ask them whether they have questions about the readings, and ask them whether they found anything to be upsetting or off putting.
A self-help book can help many clients, if they read it. The challenge of therapists is to help their clients read what they have agreed to read and thereby learn what their therapists hope they will learn. I’ve presented four guidelines that therapists can follow to get self-help reading assignments off to a good start. Try them and see what you think.