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Themenschwerpunkt

Therapeutische Hausaufgaben in der klinischen Praxis: Einsatz, Erledigung und Beziehungen zum Therapieverlauf

Published Online:February 28, 2015https://doi.org/10.1024/1661-4747/a000106

Abstract

Zusammenfassung.Meta-Analysen belegen positive Effekte des Einsatzes und der Erledigung therapeutischer Hausaufgaben auf das Therapieergebnis. Gleichzeitig ist die Aussagekraft der vorhandenen Studien eingeschränkt durch den starken Bezug auf retrospektive Urteile und Daten aus kontrollierten klinischen Studien an selegierten Patientengruppen. Zum konkreten Einsatz und den Effekten von Hausaufgabenvereinbarungen in der klinischen Praxis liegen nur wenige Daten vor. Vor diesem Hintergrund wurden therapie- und hausaufgabenrelevante Daten aus insgesamt 1’413 Therapiesitzungen von 79 Patienten einer psychotherapeutischen Ambulanz ausgewertet. Es zeigte sich, dass Hausaufgaben in der Ambulanz regelmäßig und bei allen Patienten, jedoch nur selten systematisch vereinbart wurden. Die Hausaufgabenerledigung konnte als überwiegend gut eingeschätzt werden, wobei kein Einfluss von Patientenvariablen auf die Compliance festgestellt wurde. Dafür gingen Probleme in der therapeutischen Beziehung während der Sitzung häufiger mit einer nachfolgend eingeschränkten Hausaufgabenerledigung einher. Hausaufgabenvergabe und Erledigung standen nicht in Beziehung zur symptomatischen Veränderung während der Therapie; allerdings konnten niedrigere Compliance-Raten bei Therapien, die abgebrochen wurden, beobachtet werden. Entsprechend sollte die Hausaufgabenerledigung durch den Patienten in die adaptive Therapieplanung einbezogen werden.


Homework Assignments in Clinical Practice: Frequency of Use, Compliance and Associations with Therapeutic Outcome

Abstract.Meta-Analyses confirm positive effects of therapeutic homework use and completion on treatment outcome. However, existing data in most cases is limited to retrospective estimates of homework compliance and data from controlled clinical trials in selected populations. In order to extent existing knowledge about homework use in clinical routine care, we analysed homework and therapy process variables from 1 413 therapy sessions and 79 patients treated in an outpatient psychotherapy centre. Homework was used on a regular base and with every patient; however, systematic homework assignment procedures were rare. Overall homework compliance was high; patient characteristics were not associated with compliance. However, problems in therapeutic alliance within the index session were linked to reductions in subsequent homework completion. There were no associations between frequency of homework use or compliance and symptom change; however, premature therapy termination was related to lower compliance rates. Thus, homework compliance should be considered in adaptive treatment planning.

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