Common Structural Elements

Although tailoring homework assignments to couples in sex therapy is important, there are also common structural elements that have been identified by many authors. For example, Gambescia and Weeks (2007) suggested that homework compliance is increased when the therapist and couple negotiate when the homework is to be scheduled, identify who will initiate the homework, and clearly understand what they are supposed to do within the homework. To summarize, some of the basic structural elements consist of when and how often the assignment is done, place, duration of assignment, and determining who is to do what during the activity One issue that often comes up is who is to initiate the assignment. We ask the couple to discuss this issue. They may choose to take turns and, in some cases, where one partner has been avoiding an activity, we might suggest that they take full responsibility and initiate the assignment the first week it is to be done.

Assign Relevant, Acceptable, and Appropriate Homework

The couple should view the assigned homework as relevant to their presenting problem and appropriate to meeting their goals. The therapist should discuss any emotional reaction to the homework after assigning it, rather than after the clients fail to complete it. The couple’s initial emotional reaction to a homework assignment is a good indication of their readiness to do it or their resistance to it. Whenever a couple is asked to read a particular book, watch a video, or use other resources, the therapist should ask them how they feel about each activity, as described earlier. A classic example is when the therapist suggests buying a vibrator when treating anorgasmia. This suggestion can stir powerful feelings in both partners and may need to be processed thoroughly and slowly before actually beginning the activity.

Make Sure the Homework Is Appropriate for the Couple's Age, Abilities, and Lifestyle

The homework should match the clients’ physical abilities and be considerate of their resources, including free time, schedules, and finances. Typically, the couple is asked to do the homework assignment three times during any given week. We often mention that to accomplish three assignments they must plan to schedule five with the understanding that they can cancel two because events in day-to-day living interfere. They must be ready (state of willingness) to begin the homework and have the time available to devote to its completion. The therapist should always ensure that the couple is capable of doing the homework, paying particular attention to any physical limitations based on health, age, or ability to access the required resources.

Assign Simple, Clear Homework with Specific Instructions

As stated, is always helpful for the therapist and couple to work collaboratively on designing the assignments, even though the therapist is actually directing. Give the couple the parameters of the exercise and ask them to think about how and when they would like to do it. This gives them a sense of ownership in their therapy. One couple helped the therapist to develop a series of touch exercises. The couple astutely identified using the senses of sight, hearing, taste, smell, and touch. The therapist reinforced principles of mindfulness such as a present focus and nonjudgmental thinking (Villena, Gimeno, Blazquez, Zavala, & García-Lanzas, 2018).

Start Small and Build on Successes

Begin with simple homework exercises and work toward more difficult, complex, or challenging ones as defined by the couple. Make the assignments so incremental that the couple should be successful in completing them. Giving an assignment that is too advanced will lead to avoidance, failure, and demoralization. Simply by asking the couple whether the assignment seems doable is a good indication of whether they can do so. If there is hesitation, then it needs to be processed and the exercise may need to be revised to something less challenging.

Make Assignments Single Focused and Specific

Make sure the assignment is specific and directs either behavioral or attitudinal changes. Do not allow ambiguity or veiled references made by the couple to muddy the focus of the assignment. The language used in making the assignment should be direct, clear, concise, and understandable to the couple. Get the couple to focus on only one step at a time. The first task of the therapy is to obtain a baseline of the couple’s sexual behavior by having them discuss previous sexual scenarios in detail, closely attending to when they began to feel anxious, disinterested or report dysfunction. The next step is often to proscribe or discourage certain sexual activity (especially coitus) and to prescribe sensual nongenital touch in an intimate environment. The context of the assignment is also important. Discuss the conditions under which the assignment is to take place. For instance, ensure that pets are in another room, electronic devices are turned off, and that the environment is quiet and private. For example, one couple was practicing touch exercises but reported difficulty doing so. When asked why, they said their 90-pound dog was in bed with them and they were trying to touch each other over the dog.

Ensure Understanding

Ask the couple to write down the homework or repeat it back. Make sure they both agree to do the homework and understand the purpose of the exercise before they leave the session. For high-conflict couples or those believed to have little motivation to complete the homework, create a homework contract. Review the terms of the contract with each partner and have each sign it. Make three copies, giving one to each partner and placing the third in their chart. We believe doing so is helpful and appropriate but creating a contract does not guarantee homework completion. The purpose of the contract is to have a written statement of what the couple agreed to but may fail to do. We can then shift attention away from the homework to personal or relational issues that might be preventing them from carrying out the assignment. The fact that the homework is in writing means that neither one can claim they misunderstood, misinterpreted, or simply forgot that the homework was given. While this action is not necessary with most couples, it helps promote a discussion of what contributed to not doing the homework. This can lead to focusing on the couple’s relational issues first, as well as their readiness for change and emotions about doing the homework.

Obtain an Investment

Ask clients how they feel about the assignment, what problems they might have doing it, and in some cases, how they might sabotage the exercise. When the therapist suspects the clients may avoid or not follow up with the exercise asking them how they might sabotage it can be a useful technique. Clients who are surprised by the question will probably do the homework. Others will immediately offer ideas about how the partner will fail to live up to his or her part, and some will talk about how they might sabotage themselves. Information about sabotage then leads to a discussion about how to avoid it from happening. It might help to phrase the assignment as a win-win. The assignment is a win-win because, if they are successful in doing it, they have progressed one more step; if they fail to do it, and we process the failure and learn from it, we have removed a barrier to them achieving their goal. Ask the partners what they think the exercise will offer them individually and as a couple. For example, the exercise might be designed so that each one is to do something different. For one partner, the goal may be therapeutic; for the other, is the goal may be simply pleasurable. Make sure partners feel that their role in the homework is important, enjoyable, and worthwhile.

Build in Contingency Plans and Offer Flexibility

Part of ensuring buy-in is giving the couple options in completing the assignment. Planning for the unforeseen lets the couple know their therapist understands and appreciates the complexity of their lives and, more importantly, emphasizes the process that they will become more physically or emotionally connected with each other, which is the most important outcome. Completing the prescribed assignment exactly as described is of secondary importance.

Offer Support

The therapist can tell clients to call if they have questions or experience confusion about the homework assignment as they undertake it. Most couples will not need this step, but if they do, it can almost always be handled quickly. The partners will also feel that the therapist cares about their treatment more if this offer is made. Our experience has been that very few couples call for clarification, and if they do, the phone calls are very brief. If it is obvious they need more time, then they can come back to a session earlier or not attempt the homework and stay on their regular schedule of appointments.