How to Supervise the Use of Homework in Cognitive Behavior Therapy: The Role of Trainee Therapist Beliefs

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1 Cognitive and Behavioral Practice 14 (2007) How to Supervise the Use of Homework in Cognitive Behavior Therapy: The Role of Trainee Therapist Beliefs Beverly Haarhoff and Nikolaos Kazantzis, Massey University Encouraging and facilitating homework completion is a core cognitive behavior therapy (CBT) skill. Consequently, it represents an important part of training practitioners. Oftentimes the process of integrating homework into therapy is rushed, poorly executed, or forgotten, and trainees are surprised to find that some patients do not complete homework. We advocate for increased therapist responsibility in accounting for homework nonadherence. Therefore, problems with the use of homework in therapy are frequently an agenda item in the supervision of trainee cognitive behavior therapists. In our experience, trainee CBT practitioners exhibit a number of interrelated automatic thoughts, assumptions, and in-session behaviors that influence their use of homework assignments. The Cognitive Behavior Therapy Homework Project has proposed a model for practice to guide the use of homework in CBT [Kazantzis, N., MacEwan, J., & Dattilio, F. M. (2005). A guiding model for practice. In: Kazantzis, N., Deane, F. P., Ronan, K. R., & L Abate, L. (Eds.), Using homework assignments in cognitive behavior therapy (pp ). New York: Routledge]. The present article will draw from those practice recommendations and discuss the role and impact of the therapeutic relationship and therapist beliefs on the use of homework assignments, with reference to the different levels of CBT conceptualization. Clinical examples from the supervision of trainees enrolled in the practicum component of the Massey University Postgraduate Diploma in Cognitive Behavior Therapy are used to illustrate supervising the use of homework assignments. OMEWORK has always been considered an integral and H essential part of cognitive therapy, commonly labeled cognitive behavior therapy (CBT; Beck, Rush, Shaw, & Emery, 1979). Homework reflects the outward focus of the approach and it is listed as one of the eight guiding principles of CBT (Blackburn & Twaddle, 1996). Furthermore, the use of homework represents 1 of 11 equally weighted competencies included in the Cognitive Therapy Scale (Young & Beck, 1980). This emphasis is supported by empirical research that consistently finds that patient completion of homework assignments in CBT is positively associated with reduced symptom severity (Beutler et al., 2004; Kazantzis, Deane, & Ronan, 2000). The perception that homework is important has also transferred to practice. The majority of CBT practitioners report using homework assignments, consider homework to be important for a range of problems (Kazantzis & Deane, 1999), and hold beliefs about its role in enhancing therapeutic outcomes (Fehm & Kazantzis, 2004; Kazantzis, Lampropoulos, & Deane, 2005). Encouraging and facilitating homework completion is a core CBT skill, and consequently, it represents an important part of training practitioners /07/ $1.00/ Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. The theoretical and empirical support for assigning homework in CBT leads most trainee cognitive behavior therapists to accept, at least in principle, that the regular and systematic assignment of homework will benefit their patients. As a consequence, trainee CBT practitioners are favorably disposed to assigning homework in therapy. However, many novice clinicians discover difficulties when they begin to design homework (i.e., the selection and discussion of tasks), assign homework (i.e., collaboration on the practical aspects of homework completion), and review homework tasks in clinical practice (Kazantzis & Lampropoulos, 2002). Oftentimes the process of integrating homework into therapy is rushed, poorly executed, or forgotten, and trainees are surprised to find that some patients do not complete homework. Therefore, problems with the use of homework in therapy are frequently an agenda item in the supervision of trainee cognitive behavior therapists. The Cognitive Behavior Therapy Homework Project posed the question, How can homework assignments be more effectively integrated in the treatment of patients? (cf. Kazantzis, 2005). Although specific recommendations for the practical use of homework have been clearly articulated since CBT s inception (i.e., Beck et al., 1979; Shelton & Levy, 1981), practitioners indicate that they do not adhere to these early practice recommendations (Kazantzis, Busch, Merrick, & Ronan, 2006; Kazantzis & Deane,

2 326 Haarhoff & Kazantzis 1999). For instance, the Shelton and Levy recommendations focused on the assignment of homework and emphasized routine specification of when, where, how often, and how long the task should take. It is suggested that therapist self-reported nonadherence may be due to the rigidity of the practice recommendations and perceived restriction in the range of homework tasks to be assigned. It is also suggested that insufficient attention was paid to the complexities and nuances of the therapeutic relationship, which includes the cognitions and behaviors of both therapist and patient in the interpersonal interaction (Kazantzis, Dattilio, & MacEwan, 2005). Taken together with the emerging data illustrating a link between therapist competence in homework administration and therapy outcome (i.e., Bryant, Simons, & Thase, 1999), we advocate for increased therapist responsibility in accounting for homework nonadherence. In our experience, trainee CBT practitioners exhibit a number of interrelated automatic thoughts, assumptions, and in-session behaviors that influence their use of homework assignments. Common negative trainee attitudes include, Homework tasks will make the patient feel overstructured and -controlled ; Homework will increase this patient s sense of vulnerability ; and Homework assignments will be overwhelming for patients who are distressed. Another widely held belief is that the structure of CBT, of which homework assignment is an important component, inhibits spontaneity, which may result in a constriction of the therapeutic relationship. There is also some empirical support for these observations regarding therapists beliefs about the impact of homework on therapy process (Kazantzis, Lampropoulos, et al., 2005). The result of such attitudes is either to avoid assigning homework altogether, or to assign it in a manner that perpetuates this mindset. For example, rushing through instructions at the end of session, forgetting to review homework, or failing to provide a convincing rationale in designing the homework are frequent behaviors that warrant discussion in supervision. This article will focus on some of the problems presented by CBT trainees regarding the use of homework assignments. The Cognitive Behavior Therapy Homework Project has proposed a model for practice (Kazantzis, MacEwan, & Dattilio, 2005) that places greater emphasis on the importance of therapist beliefs, the facilitative qualities of the therapist, the cognitive conceptualization, and the therapeutic relationship in enhancing patient adherence with homework assignments. The present article will draw upon these three broad recommendations for practice, and will discuss the role and impact of the therapeutic relationship and therapist beliefs on the use of homework assignments, with reference to the different levels of CBT conceptualization. Clinical examples drawn from the supervision of trainees enrolled in the practicum component of the Massey University Postgraduate Diploma in Cognitive Behavior Therapy will be used to illustrate interventions used in supervising the use of homework assignments. The Three Levels of Cognitive Case Conceptualization The cognitive conceptualization is an explanatory hypothesis that helps the therapist understand the patient s psychological problems by linking the relevant predisposing, precipitating, protective, and maintaining factors. The result is a blueprint or map that guides treatment planning and facilitates the prediction of therapy-interfering and therapy-enhancing factors (Eells, 1997). A CBT conceptualization emphasizes cognition as a mediating factor and shows how the patient s presenting problems are predisposed and maintained by psychological mechanisms such as unhelpful underlying beliefs and compensatory behaviors. When conceptualizing a patient s psychological problems, trainees are required to consider three differing levels of complexity, namely: (a) the level of the immediate triggering situation, (b) the level of the diagnosis or disorder, and (c) the more complex and idiosyncratic level of the individualized conceptualization (Persons, Davidson, & Tompkins, 2000; Persons & Tompkins, 1997). Examples of situational or mini conceptualizations include the five-part model (Padesky & Mooney, 1990) and the dysfunctional thought record (J. Beck, 1995). Disorder-specific conceptualizations are vicious cycles identified as typical for particular diagnostic presentations, the most well known of these being the panic hook, where an enduring tendency to catastrophic misinterpretation of bodily symptoms is proposed (Clark, 1986). Individualized formats such as the case conceptualization diagram (J. Beck, 1995) include predisposing historical information, core beliefs, underlying assumptions, compensatory behaviors, and examples of triggering situations. The three levels of case conceptualization also have relevance for the trainee when seeking to understand his or her own reactions in therapy. Therapist Self-Practice and Self-Reflection As Supervision Interventions Trainees are encouraged not only to conceptualize the patient s nonadherence with homework assignments, but to foster an awareness of their own beliefs and reactions to nonadherence in the context of the CBT conceptual framework. If a trainee fails to develop this awareness, errors in clinical judgment can result, negatively affecting the therapeutic relationship and course of therapy (Young, Klosko, & Weishaar, 2003). Self-practice (i.e., practicing CBT techniques and interventions on oneself as therapist) and self-reflection (i.e., reflecting on the

3 Supervising the Use of Homework 327 process) are terms coined by Bennett-Levy et al. (2001) to operationalize a form of personal therapy compatible with CBT. Trainees are required to become accustomed to the use of self-practice and self-reflection. In a small number of qualitative studies, self-practice and selfreflection have shown utility in improving therapeutic understanding, therapist skills, and therapist self-concept. Therapeutic understandings include such aspects as an increased understanding of the therapist s role, the cognitive model, change processes, and of themselves as therapist. Therapist skill refers to sensitivity and understanding in applying CBT techniques, enhanced empathy, and schema self-awareness. Both therapeutic understanding and skill are found to influence therapist self-concept, that is, self-confidence, perceived competence regarding own ability, and belief in the effectiveness of the CBT model (Bennett-Levy et al., 2001; Haarhoff & Stenhouse, 2004). The following examples drawn from clinical supervision will demonstrate the way self-practice and self-reflection can assist trainees in gaining a deeper understanding of the effect their personal belief system can have on their use of homework assignments in CBT. Case Example 1 Situational Conceptualizations of Therapist Thoughts, Emotions, and Behaviors At the simplest level a conceptualization of a problem can be drawn up as a five-part model that provides a functional analysis of the triggering situation (Padesky & Mooney, 1990). Sally was a trainee who reported continued difficulties in getting a particular patient to complete written homework such as the thought record. The patient was a woman in her 50s suffering from depression after losing her job. Sally attributed these difficulties wholeheartedly to the patient, whom she described as overwhelmed by depression and therefore unable to cope. When the therapy videotape was reviewed with Sally, the supervisor observed that she rushed through the assignment of the homework task at the end of the session in a somewhat self-depreciating and flippant manner. Collaboratively identified as a problem, Sally explored the situation by completing a five-part model, which resulted in the following data: Situation: Emotions: Cognitions: Behavior: Physical reaction: assigning homework with a patient anxiety, frustration I don t like the word homework it makes me feel like a teacher. I don t want to be mean and put pressure on her. rushed and trivialized the homework task s importance slight increase in heart rate Conceptualizing her experience in this way enabled Sally to clearly identify a pattern evident in other therapy situations. Reflecting on her background, Sally recognized that her cultural background was a factor in her negative thought patterns and resulting problematic insession behavior. Sally identified her ethnicity as Indian. She reported that her family of origin strongly emphasized respect for older people, and noted that there were firm rules that prevented her from expressing opinions or contradicting her elders under any circumstances. Sally s clinical work was with children and adolescents, and prior to the CBT practicum, she had no experience practicing psychotherapy with adults. In working with the adult patient used in this example, Sally experienced anxiety related to the thought that it was improper and disrespectful to ask the patient to complete homework when there was ambivalence or reluctance. This was an important discovery that Sally resolved to keep in the forefront of her mind when she was working with adults. Further self-reflection revealed that her beliefs sometimes prevented her from being appropriately assertive and explicit when assigning and reviewing homework with parents of her child patients. The self-practice was extended to the use of a thought record, which illuminated a raft of negative thoughts about herself as therapist and the patient. The salient automatic thoughts included She s older than me, it s uncomfortable telling her what to do ; I m no good at setting homework ; I m too soft ; and Maybe I don t explain it well enough (see Figure 1). Identifying her most prominent emotionally charged thoughts as I don t want to be mean and put too much pressure on her and I m no good at setting homework, Sally was able to systematically weigh supporting and disconfirming evidence and reach a more balanced perspective, expressed as I can check out more clearly what she considers too much and be more collaborative in setting homework and I do have some problems setting homework, but if I manage time better, I will be able to do better. Following the use of these self-practice interventions during supervision, there are several avenues that a supervisor may wish to pursue with the trainee. At the simplest level, the awareness gained using these interventions may be sufficient to facilitate a cognitive shift that will translate into behavior conducive to a more promising therapeutic outcome. In the case of Sally, she practiced taking more time to design and assign homework with her patients, explaining the exercise in greater detail, providing more opportunities for insession practice, and eliciting the patient s cognitions about the task and its utility. Through this increased discussion, Sally came to understand that her patient suffered from arthritis in her fingers, which made writing difficult. As a solution, Sally made a computerized

4 328 Haarhoff & Kazantzis Figure 1. Sally s Thought Record for Assigning Homework. template of a thought record for the patient, enabling her to complete the homework more easily. The result was successful homework completion and improved mood. Case Example 2 Individualized Conceptualizations of Therapist Beliefs There may, however, be indications that a more complex level of conceptualization, which includes both overt and covert levels of explanation, would be helpful (Persons, 1989). The example described above in the five-part model is the overt description of the problem in CBT terms, while the covert level would make some reference to underlying psychological mechanisms, such as the core beliefs and schema maintaining the cycle. An indication that a problem with homework assignment may require intervention at a deeper level is most often evidenced by the intensity of emotional arousal evoked in the trainee. As with patients, if a trainee experiences an intense emotional response in the context of homework administration, then it often indicates an influential underlying belief. Asking the trainee to rate the degree of emotion using a visual analogue scale is a quick and effective way to determine the level of emotional intensity. In the example described above, Sally reported a fairly low level of emotional intensity (30%), and the situational conceptualizations were sufficient as helpful supervision interventions. If Sally had rated her emotion as more intense (e.g., 70%), a number of different supervision interventions could have helped her identify her underlying beliefs or schema. One such method is the Therapeutic Belief System (TBS; Rudd & Joiner, 1997). The TBS is a conceptual model useful for understanding the particular types of beliefs, assumptions, and behaviors, commonly experienced by therapists and patients, that could potentially affect the course of therapy. Consistent with the cognitive model, the TBS sets out a framework to identify the therapists and patients beliefs about themselves, each other, and the course of treatment, the emotions these beliefs may trigger, and typical behavioral responses. For example, the therapist may see the patient as a hostile aggressor, helpless victim, or collaborator. These beliefs may be complemented by the trainee s own beliefs about him- or

5 Supervising the Use of Homework 329 herself, such as victim, collaborator, caretaker, or rescuer. Homework assignments can be seen by both therapist and patient as hopeless, productive, or simply maintaining the status quo, and result in a different emotional and behavioral response. In the example discussed above, it could be hypothesized that Sally perceived the patient as a helpless victim, and herself as both victim and rescuer. These beliefs could have precipitated the anxious emotional response, resulting in the avoidant behavior (i.e., rushing and trivializing the homework). Thus, the TBS can be introduced in supervision to direct the trainee to reflect upon whether they identify with any of the typical therapist beliefs and behaviors outlined in the model. Simple awareness of such patterns and cycles can be a helpful orientation to the consideration of the role of such beliefs in integrating homework assignments. Helen was a trainee who experienced a more intense emotional reaction when contemplating setting homework for a patient with vulnerability and dependence schemas. The patient was extremely disabled by her symptoms and had a long psychiatric history within the public health system. The homework assignment involved a behavioral experiment using a graded exposure designed to target the patient s social avoidance. Despite discussing the planned experiment during supervision, Helen continued to express considerable reluctance regarding assigning the exposure exercise for homework. When asked about her emotional response, she identified it as anxiety, and rated her level of anxiety as 80%. Inviting her to complete a thought record revealed the following cognitions: It won t work ; She is so controlled ; I will have to explain it and I haven t assigned a behavioral experiment before ; and I will look silly. Helen selected the thought I will look silly as the most influential thought as it accounted for the greatest proportion of her anxiety. Using the downward-arrow technique (J. Beck, 1995) to elicit the meaning behind the thought, the following pervasive underlying assumptions, beliefs, and behaviors relevant to therapy process emerged: Assumptions/ beliefs: Behavioral strategies: If I try something new I should always get it right. I should always prepare for every eventuality. Never waste time. overreliance on consultation with experts frequent reassurance seeking on treatment plan avoiding the risk of trying something new in therapy These assumptions indicated schemas relating to unrelenting and demanding standards for self, and a rather uncompromising view of the consequence of tolerating the unknown, or any degree of ambiguity. This combination of self-practice and self-reflection in supervision led to a useful discussion concerning the advantages and disadvantages of holding these beliefs. As a result, Helen planned her own behavioral experiment that involved testing a more optimistic view concerning the resilience of the patient, and taking the risk of assigning the homework without being able to feel certain of the outcome. Helen did her experiment, and in this instance, the homework was successfully completed by the patient. The increased awareness of her underlying belief structure resulted in an increased toleration of a greater degree of ambiguity in therapy. Helen has continued to allow herself and her patients the opportunity to learn from mistakes, and has experimented with reducing her reassurance seeking. Case Example 3 Individualized Conceptualizations of Therapist Schema A schema refers broadly to mental structures that integrate and give meaning to events (A. T. Beck, Freeman, & Davis, 2004). Schemas can be positive, negative, or neutral. In the context of CBT as a treatment for psychological disorders, there is a focus on dysfunctional schemas that are often associated with specific diagnostic presentations (e.g., schemas concerning personal vulnerability are common in the anxiety disorders). A schema is generally defined as a pervasive theme of cognitions, emotions, physiological sensations regarding oneself and relationships with others (Young et al., 2003). Therapists schemas are triggered in specific therapyrelated contexts and do not usually signal mental health problems. Therapists schemas are influenced by the following factors: training experiences such as supervision and stage of training, clinical experience, peer group, therapy model, and personal experience. Once identified, a therapist s schema can be used in supervision as a starting point to begin discussing some of the trainee s potential therapy-interfering beliefs. The completion of structured questionnaires can be used to identify schemas, core beliefs, and underlying assumptions among trainees. Some examples of helpful questionnaires are the Dysfunctional Attitude Scale (Weissman & Beck, 1978), the Personality Belief Questionnaire (A. T. Beck & Beck, 1991), the Young Schema Questionnaire (Young & Brown, 2001), and the Therapists Schema Questionnaire (Leahy, 2001). Leahy s Therapists Schema Questionnaire is a relatively straightforward screening technique to identify therapist schemas that could affect the therapeutic relationship. It consists of 46 assumptions that relate to 14 of the most common therapist schemas.

6 330 Haarhoff & Kazantzis Consistent with the examples proposed by Leahy (2001), we have found that certain schemas are particularly common in CBT trainees, such as demanding standards, excessive self-sacrifice, and special superior person. Trainees who identify with the demanding standards schema have a somewhat obsessive, perfectionist, and controlling approach to therapy. These therapists usually have high expectations for patient homework adherence, and may not appreciate that nonadherence of homework is often part of the learning process. Therapists with demanding standards may hold an expectation that there is a right way to complete a homework assignment, leading to a sense of frustration when the assignment produces unexpected results. This stance may indicate insecurity and a belief that if things deviate from the predicted structure the job is not being done properly, and the trainee will be exposed as a fraud. The activation of this schema was clearly demonstrated by Helen when she expressed the fear that she would look silly if the exposure experiment did not work out. It is not surprising that many trainees identify with the excessive self-sacrifice schema, which is the most frequently observed schema in both novice and experienced therapists (Young et al., 2003). Leahy (2001) suggests that these therapists tend to overemphasize the importance of their relationships with patients. They may fear abandonment or feel guilty that they are better off than the patient. As a result, the trainee may engage in therapy-defeating behaviors, such as going overboard to ensure the homework assignment fits with the various demands on the patient s time, experiencing difficulty with appropriate assertiveness when discussing persistent patient nonadherence, and a tendency to avoid techniques such as exposure for fear of upsetting the patient. Sally was influenced by this schema, as shown by her fear that she would be seen as too controlling or demanding. Trainees identifying with special superior person schema see the therapy situation as an opportunity to achieve excellent results and have grandiose expectations for their own performance. There may be a tendency to idealize the patient or, conversely, devalue or distance self from patients who do not improve or comply with homework. The prominence of the special superior person schema in CBT trainees appears to contradict the other two prominent schemas with its connotations of entitlement and narcissism. This apparent contradiction can be understood in terms of the schema processes or coping styles that evolve in response to the threat of schema activation (see Young et al., 2003). The presence of the schema special superior person can be conceptualized as an overcompensation in response to demanding standards and excessive self-sacrifice, which have thematic connotations of being not good enough. The clinical practicum places the trainee in a position where their use of homework assignments is scrutinized in supervision through the rating of videotaped therapy sessions on the Cognitive Therapy Scale (CTS; Young & Beck, 1980). Feeling superior and special may be, in some instances, a way of coping with the feelings of inferiority generated by the experience of having their use of homework evaluated in this way. In addition to acknowledging general schema responses experienced by most trainees, the supervisor should assist the trainee to become aware of his or her idiosyncratic beliefs and coping styles likely to be triggered by certain patients. The supervisor should encourage the trainee to pay particular attention to schema overlapping, in which the therapist s schema and the patient s schema overlap, resulting in the therapist overidentifying with the patient (Young et al., 2003). The following example demonstrates the result of schema overlapping and the effect this had on homework assignment. Mike was a trainee providing CBT to a patient with a diagnosis of social phobia and some indication of vulnerability schema. The problem had been long standing and avoidance had become the patient s primary coping strategy. The patient was engaged in a number of healthy activities such as healthy eating (thinking about his diet and making salads) and brain gym (crossword puzzles), but avoided most social and occupational situations that produced anxiety, resulting in a very limited lifestyle, with many empty hours in the day. The patient felt frustrated by his lifestyle, but felt paralyzed by his core beliefs I am different and defective and other people are critical, judgmental, and ultimately cruelly rejecting. The patient had a developmental history that included a considerable amount of schoolyard bullying. Mike had seen the patient for about 14 sessions before starting structured CBT supervision. During this time he had developed a strong therapeutic relationship with the patient, who was positively engaged in the therapeutic process. The activity schedule was chosen as an intervention to combat avoidance. In this instance, Mike had taken great pains to explain the task to the patient and similarly a very long time was spent on reviewing the homework and praising the patient for healthy eating, brain gym, and writing in his journal. These activities were labeled by Mike as accomplishments and were not considered as possible strategies to avoid distressing situations. The patient repeatedly expressed the view that healthy eating, brain gym, and writing were not challenging and therefore did not constitute much of an achievement. Nonetheless, Mike responded to the patient s self-criticism with reassurance and more praise for what the patient had accomplished. As there had been little change in the patient s pattern of avoidance, the supervisor highlighted the fact that the homework assignment had revealed a tendency to fill time with

7 Supervising the Use of Homework 331 passive and trivial activities, a fact the patient had already recognized. Acknowledging the progress Mike had made in developing a healthy therapeutic relationship, the supervisor suggested that exploring the patient s perception of challenge might prove beneficial, and developing a hierarchy of challenging activities could be collaboratively developed and introduced into the activity schedule. Mike became quite defensive and appeared somewhat irritated with the suggestion offered by the supervisor. Noting this change in emotional response (Mike was usually extremely open and receptive to feedback), the supervisor asked Mike to reflect on his beliefs about himself and others, and identify compensatory behaviors which might be the result. In preparation for his next supervision session, Mike was asked to reflect on these beliefs and behaviors in the context of his general delivery of CBT, and the context of the specific homework assignment. At the next supervision session Mike presented the following beliefs and behaviors: Core beliefs: Behavioral strategies: I am different and possibly defective. Others are critical. frequent attempts to emphasize his difference persistent efforts to preempt rejection Mike was interested to note that his beliefs about self and others mirrored those of his patient, and that he too had been severely bullied at a particular period in his childhood (see Figure 2). Mike acknowledged identifying with the patient s distress and noted that he might be at risk of taking on the savior role and overemphasizing the patient s vulnerability. He resolved to trust the strength of the therapeutic relationship and allow the patient to take some risks. Conclusions The clinical examples discussed above illustrate some of the ways in which therapist beliefs can influence how they handle homework assignments. We have offered some practical suggestions for tackling these issues in supervision in a manner that is grounded in the CBT model and three levels of conceptualization. Using self-practice and self-reflection enables the trainee to develop self-awareness in relation to the theory and an understanding of the practical implications of applying their increased selfawareness in a real-life clinical situation. Identifying and working with therapist beliefs in supervision enables the CBT trainee to experience the effect of his or her beliefs on the therapeutic relationship in all Figure 2. Interaction Between Patient and Therapist Behaviors, Emotions, and Cognitions.

8 332 Haarhoff & Kazantzis aspects of therapy, including homework assignment and review. The emphasis on structure in CBT training through the use of the CTS can sometimes fragment therapy into discrete components in the mind of a novice clinician trying to get it right and tick all the boxes. We have noted that supervisor ratings of trainees use of homework assignments on the CTS, a rating that appears toward the end of the scale, can sometimes contribute to the view of homework as an add-on or adjunctive component to the overall therapy. Orientating the trainee to the role of his or her own beliefs about therapy opens the door to considering more adaptive beliefs about homework and its utility. As discussed in Kazantzis, MacEwan, et al. (2005), adaptive beliefs that have particular resonance with some of the recurrent problems discussed in supervision are that Homework is therapy, and not an auxiliary or complementary component of CBT ; Homework noncompletion is common and part of the learning process ; and Homework noncompletion should be conceptualized from the perspective of the patient and the therapist. References Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press. Beck, A. T., & Beck, J. S. (1991). The Personality Belief Questionnaire. Unpublished assessment instrument, The Beck Institute for Cognitive Therapy and Research, Bala Cynwyd, PA. Beck, A. T., Freeman, A., Davis, D. D., & Associates (2004). Cognitive therapy of personality disorders (2nd ed.) New York: The Guilford Press. Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press. 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Overcoming resistance in cognitive therapy. New York: The Guilford Press. Padesky, C. A., & Mooney, K. (1990). Clinical tip: Presenting the cognitive model to patients. International Cognitive Therapy Newsletter, 6, 1 2. Persons, J. B. (1989). Cognitive therapy in practice: A case formulation approach. New York: Norton. Persons, J. B., Davidson, J., & Tompkins, M. A. (2000). Essential components of cognitive-behavior therapy for depression. Washington, DC: American Psychological Association. Persons, J. B., & Tompkins, M. A. (1997). Cognitive-behavioral case formulation. In T. D. Eells (Ed.), Handbook of case formulation New York: The Guilford Press. Rudd, M., & Joiner, T. (1997). Countertransference and the therapeutic relationship: A cognitive perspective. Journal of Cognitive Psychotherapy: An International Quarterly, 11, Shelton, J. L., & Levy, R. L. (1981). Behavioral assignments and treatment compliance: A handbook of clinical strategies. Champaign, IL: Research Press. Weissman, A. N., & Beck, A. T. (1978). Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Paper presented at the meeting of the American Educational Research Association, Toronto, Ontario, Canada. Young, J., & Beck, A. T. (1980). Cognitive Therapy Scale: Rating manual. (Available from the Beck Institute for Cognitive Therapy and Research, GSB Building, One Belmont Avenue, Suite 700, Bala Cynwyd, PA ). Young, J. E., & Brown, G. (2001). Young Schema Questionnaire, Special Edition New York: Schema Therapy Institute. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner s guide. New York: The Guilford Press. Address correspondence to Beverly Haarhoff and Nikolaos Kazantzis, Ph.D., School of Psychology, Massey University, Private Bag , Albany, Auckland, New Zealand; N.Kazantzis@massey.ac.nz. Received: February 28, 2006 Accepted: August 25, 2006 Available online 17 July 2007