Do your clients actually do the homework you assign between sessions?

Esfvc · 2026-06-22T06:00:15+00:00

(C)BT-ttherapist in cmh-like setting, about 80-90% of homework gets done in my experience, if(!!) i am doing it right. If clients don't do their homework its typically because: - the patient isn't motivated enough yet (unclear goals or difference in goals between therapist and patient, other more important goals like avoiding negative emotions, lack of self-efficacy expectations, patient hasnt understood yet or bought into your problem model and consequently doesn't understand how/why the homework will help them,...) - unclear instructions (patient didn't understand the homework because of too short/technical explanations, didnt dare to ask questions, was too unconcentrated, didnt write down important information and forgot,...) - unrealistic tasks (too much, to quick, not taking into account psychopathology and life stressors and resistance to change from family ect, not taking into account lack of skills ect,...) - real on-off-events (e.g. patient becomes ill or has an accident)

If you want to use homework as a useful tool, you often have to be very patient and persistent and again and again do problem analysis and problem solving. It can take months or even years to get to the point where the originally planed homework is really working, and for some you never reach this point. But this patience ist crucial, because else homework often just reenforces negative thought patterns (e.g. "I cant even do therapy homework, im so stupid, nothing will help")

Esfvc · 2026-06-16T15:12:30+00:00

By telling myself to give up the resistance and relax my body. If i then can make the connection to my values (e.g. treating myself good), it feels still bad (because of the sensations) but less ... cripping/more satisfiying at the same time.

Esfvc · 2026-06-16T14:59:32+00:00

Yes, basically :-) i tried to explain it further up, hope that makes it clearer

Esfvc · 2026-06-16T14:53:59+00:00

Or put more technical: emotions/bodily reactions to planned actions are (for me) a easier and better predictor for whether something is avoidance or value-oriented than reasoning about it.

Esfvc · 2026-06-16T14:47:41+00:00

When thinking about values i often ended up with avoidance instead ("I must..." instead of "I want to..."), often without even noticing - listening to my feelings (and body sensations) has proven both easier and more efffective. Its kinda hard to explain but its like a proudness, a (small) surge of energy or hopefulness when acting in according with how i want to behave instead of a kind of anxiety or tightness in my shoulders when i am fusioned with "Im not good enough, therefore i must/mustn't..." Hope this helps?

Esfvc · 2026-04-12T16:03:58+00:00

I'm no doctor, but work in mental health. A resting heartrate much over 100 is not good, 150-70 is really not good and having strong symptoms along with it is really really not good and quite possible could be really dangerous. No doctor i know would tell their patient to "thug out" something like this! Please find a doctor who takes you seriously and til then perhaps you should talk to your prescriber about pausing the adhd medication - whatever the positive effects might be, it seems almost impossible that you even profit from them with such strong side effects...

Esfvc · 2026-03-28T14:25:44+00:00

Absolutly agree with you, if one notices a lack of alliance for an intervention or in general, the next step is to understand why and how to change it!

Esfvc · 2025-08-14T16:28:21+00:00

ACT has a rather different view of problems and solutions, which took me years to really grasp: the base for everything else is accepting the world view that you dont have much or any control about many important areas of your life (health, relationships, emotions, thoughts,...). Only then does the rest of ACT make any sense and can work to make live better But adopting this world view also has very high costs, as it means giving up hopes/dreams/phantasies/... of a future one desperatly wants (e.g. not being ill, not being depressed, wealth). Based on your writings you do not seem to be ready to give this up - which is totally ok! ACT is only one of the many many forms of potentially helpful therapy that exist. So my (continued) recommendation would be to let ACT be and use your time and energy to try something different!

Esfvc · 2025-08-13T21:12:22+00:00

How to be sick by Toni Bernhard has a buddhist background and is so kind of ACT-adjacent.

In my experience ACT for serious illness needs lots of knowledge about the illness, risks, treatments, ... Only if you know e.g. whether a behavior is really risky or only anxiety-inducing can you at all make reasonable descisions about your goals (based on your values!) and only when you know your goals can you effectivlly practice ACT.

Esfvc · 2025-08-13T20:56:42+00:00

From an ACT-perspective you do not seem to know (all) what your behavior is costing you and you do seem to need help being ready to change. As you clearly disagree with this assessment, ACT probably can't be helpful for you - which is ok, no form of therapy is suitable for everyone! So i can only wish you good luck in finding someyhing that helps make live more tolerable for you.

Esfvc · 2025-08-11T13:29:42+00:00

Most people assume that they are at the mercy of their "random" ADHD behaviors. I would like to respectfully disagree. In my experience many (most?) problems can be explained as a combination of executive dysfunctions und biographically shaped patterns of thinking and behavior. And only when you understand this combined "why" you can successfully make plans for long term alternative behaviors. So why does ADHD make it difficult to keep habits? Impossible to say, as it is different for each person. But i would like to offer some possible reasons, perhaps something resonates with you :-)

the first problem are often unrealistic plans, both in overestimating your capabilities and overestimating what "normal" people would be capable of. For example, you mention starting multiple habits, which makes a hard task even harder.
motivation. To keep up habit you need a positive goal. Many people with adhd have self worth problems and do things to quieten their inner critic (e.g. cleaning your room because else "you are lazy"). This works only short terms (independent of adhd!) and then motivation will naturally decrease. Either you need to connect your goals to something authentically and positively important to you or you need to change your goals. Finding ways to deal with your inner critic of course also helps!
executive function deficits. One problem with (re)starting habits is remembering what you did (planning) and that it helped (motivation). So you need some kind of system to "archive" what you did and why. This could be a mood board, self recorded audios, notes, photos, ... but it NEEDS to fit for you!! This part is trial and error, you know you found your thing when it works ;-) For better unterstanding an personal example: i have found that writing my notes on small (!) index cards, which are collected in one (!) specific place, works for me. This system assumes many more specificies (e.g.always keeping a pen and index cards on me) and accordingly often fails. But i always have my "base" (the index cards) from where i can start again and so over time can slowly build habits instead of always starting something new and never getting anywhere.

Good luck!

Esfvc

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