Therapy Homework: Why Between-Session Tasks Matter

What is therapy homework, why is it given and how can you do it more effectively? Learn the role of between-session tasks from thought records to experiments.

"My therapist asked me to keep a thought record this week. Is this school?" Many people who are new to therapy are surprised by the small tasks given at the end of a session. Yet therapy homework, especially in structured approaches, is one of the most important parts of the process. What is discussed for an hour in a session becomes real change when it is carried into everyday life during the rest of the week. In this article we look at what between-session work is, why it matters so much, its most common types and what you can do if you struggle to do it.

What Is Therapy Homework?

Therapy homework consists of tasks that the client and therapist set together so that the skills and ideas discussed in sessions are applied in everyday life between sessions. These tasks are not "graded" like school homework; they are not done right or wrong. The aim is for the client to observe, try and learn something new in their own life.

For this reason, many therapists prefer expressions such as between-session work, weekly task or practice instead of "homework". The word itself can bring back pressure and feelings of failure from school years for some people, and this can create resistance at the start. Whatever it is called, what these tasks have in common is that they ensure therapy is not limited to the session room.

Homework does not appear to the same extent in every therapy approach. In structured approaches such as cognitive behavioural therapy it is a core part of the process. It is also frequently used in schema-focused work, in acceptance and commitment therapy and in couple and family work. In more exploratory and process-focused approaches it can take less structured forms, for example "This week, notice what happens when you become aware of this feeling".

Why Is Therapy Homework So Important?

Considering the total hours in a week, a once-weekly session is a rather short period of time. The place where change actually happens is not the session room but the workplace, home, school and relationships. Between-session work builds a bridge between these two worlds.

There are several basic mechanisms that explain the importance of this work:

• Consolidating learning: A new skill, like playing a musical instrument or learning a new language, becomes lasting through repetition. A technique discussed once in a session starts to be used much more naturally when it is practised several times during the week.
• Testing in real life: A thought noticed in therapy turns into real evidence when it is tested in daily life. The thought "If I speak in the meeting, everyone will judge me" can only truly be questioned when you speak in the meeting.
• Growing awareness: Noting down your thoughts, feelings and behaviour during the day lets you see recurring patterns. Many details that cannot be recalled in a session come to light thanks to records.
• Productive sessions: Observations gathered during the week enrich the agenda of the next session and make the work more concrete.
• Growing independence: One of the long-term goals of therapy is for the client to become their own therapist in time. Homework turns the tools that can be used after therapy ends into habits right now.

Research shows that regular participation in between-session work in cognitive behavioural therapy is associated with more positive therapy outcomes. This does not mean that someone who does not do homework cannot benefit from therapy, but carrying the work into daily life can markedly support the speed and durability of the process.

A therapy session draws the map; the steps taken between sessions are what let you travel along it.

Common Types of Therapy Homework

Homework can be planned in different forms depending on the person's needs and the issue being worked on. Some of the most common are:

Thought records

When a challenging situation occurs, this involves noting down the situation at that moment, the automatic thought that came to mind, the accompanying emotion and the intensity of that emotion. At later stages, evidence for and against the thought is also written down and a more balanced alternative thought is developed. For example, when the thought "My friend didn't reply to my message, so they must be angry with me" is recorded, the person gets the chance to consider other possible explanations.

Behavioural experiments

These are small trials planned to test a belief in real life. Someone who thinks "If I ask a friend for help, they'll see me as weak" can ask for help in a low-risk situation and observe what happens. Predictions are written down before the experiment and results afterwards, and the difference between them is discussed in the session.

Graded exposure

This involves approaching anxiety-provoking situations step by step, starting with the least challenging. For example, someone who is afraid of getting into a lift could first try standing in front of the lift, then going up one floor, then longer distances. This work is carefully planned together with the therapist. You can find information about work on anxiety and panic on the anxiety and panic page.

Activity planning and monitoring

This is used especially with depressive symptoms. The person records what they do during the day and how much enjoyment or sense of achievement these activities give them. Small plans are then made to increase activities that bring enjoyment and meaning step by step. This approach is called behavioural activation.

Relaxation and mindfulness exercises

Breathing exercises, muscle relaxation exercises or short mindfulness practices help reduce physical tension and bring attention to the present moment. When repeated regularly, these exercises are easier to use in challenging moments. Like a fire drill, practice done in calm times makes it easier for the skill to switch in by itself in difficult moments, so it is important to practise not only when you feel bad but also on the days when you feel good.

Reading and writing tasks

Reading an informative text on the subject, writing yourself a compassionate letter, putting a memory from the past into writing or listing your values can also be between-session work.

Couple and family tasks

In couple and family processes, the tasks are generally relational: setting aside uninterrupted time to talk once a week, increasing expressions of appreciation toward each other or applying a time-out rule during an argument.

Why Do We Struggle to Do Homework?

Many clients struggle from time to time to do between-session work. This is very common and understandable. Behind the difficulty there are usually these reasons:

• Lack of time and energy: A busy work pace, childcare, long commutes and everyday tiredness make it hard to make room for a new habit.
• A vague task: A general task such as "Pay attention to your anxiety this week" is easily forgotten because it is not clear when and how to do it.
• A task that is too big: If it feels as though a very challenging step has to be taken all at once, a person may prefer not to start at all.
• Avoidance: Especially with anxiety-provoking subjects, the homework requires facing precisely the feeling that is being avoided. Putting it off is therefore a natural response that reduces anxiety in the short term.
• Perfectionism: Thoughts such as "What if I do it wrong?" or "If I can't do it perfectly, I won't do it at all" can prevent starting.
• Associations from school years: The word homework can recall experiences of being criticised or failing.
• Loss of meaning: If why the task matters has not been discussed enough, a person may not find the motivation to do it.

Let's say someone who is anxious about presenting at work set themselves the homework of speaking up once in a meeting this week. All week they thought about speaking in each meeting but kept putting it off, saying "next time". This is not a failure but valuable information: it shows how avoidance works and offers an opportunity at the next session to break the task into smaller steps. For more information on the mechanisms behind putting things off, you can look at the article on the habit of procrastination.

Ways to Make Between-Session Work Easier

The suggestions below can help you fit homework into your daily life more easily:

1. Set the task together. You do not have to accept a task that does not suit you or whose meaning you cannot see. At the end of the session, talk with your therapist about the purpose of the task and whether it suits you.
2. Keep it concrete and small. Instead of "Work on your anxiety", set a clear task such as "On Tuesday and Thursday evenings, after dinner, do a five-minute breathing exercise".
3. Set a time and place. Link the task to a habit that already exists in your day: after your morning coffee, on the way home from work or before going to bed.
4. Use reminders. Setting a reminder on your phone or sticking a small note on the fridge can make things easier.
5. Think about obstacles in advance. Ask in the session "What could stop me doing this task?" and make a plan in advance for possible obstacles.
6. Do it good enough, not perfectly. A half-finished thought record can contain information just as valuable as a completely filled-in one.
7. Come and talk even when you couldn't do it. Not having done the homework is not a reason to cancel the session. Talking about why you couldn't do it often opens the door to a very productive session.
8. Be kind to yourself. Missing a week does not mean the process has broken down. It is always possible to start again the following week.

When Should You Seek Professional Support?

The techniques described in this article are most beneficial when used as part of a therapy process. It can be helpful to try some exercises on your own, but you may consider working with a specialist in the following situations:

• If anxiety, low mood or stress has lasted a few weeks and is affecting your daily life,
• If the methods you try on your own are not enough or you do not know where to start,
• If the situations you avoid are increasing and narrowing your life,
• If you experience panic attacks or intense physical anxiety symptoms; the article on panic attack symptoms can give you background information.

It is important that some work, such as exposure, is planned with a specialist, because an attempt made at the wrong time or too quickly can increase anxiety.

If you are having thoughts of harming yourself or ending your life, do not try to cope with this kind of work on your own; in an emergency call 112 (emergency services) or go to your nearest emergency department.

How Is Homework Handled in Therapy?

In cognitive behavioural therapy, each session generally begins with a review of the previous week's work. The therapist asks with curiosity how the task went, what the client noticed and where they struggled. This review is not a "check" but a process of learning together. If the task could not be done, the reasons are examined without blame; often this examination gives important information about the client's avoidance patterns or beliefs about themselves.

At the end of the session, a new task linked to what was discussed that day is set together. A well-planned task generally has these features: it is directly related to the client's goals, it is clear and doable, it is a challenge the client can manage and it is understood why it is being done. To make sure the client can do the task successfully, the therapist may ask, "How confident are you that you can do this task?"; if confidence is low, the task is made smaller.

In schema-focused work, between-session work is planned in a way that helps the client notice their core beliefs and emotional needs. Examples of this kind of work include noting the feeling and reaction noticed when a schema is triggered, reading a short reminder card written to yourself from the healthy adult perspective or trying to express your needs in small steps.

When working with children, tasks are gamified and carried out with the support of parents. Activities such as colouring in a feelings thermometer, having a weekly "feelings chat" in the family or creating a calm-down corner help the child take what they learn in the session home.

Frequently Asked Questions

If I don't do my therapy homework, will therapy not work?

Not doing homework does not mean therapy will not work at all. But between-session work supports carrying what is learned into daily life and making it lasting. If you struggle to do it, talking to your therapist about it lets the task be made more suitable for you.

Is homework given in every therapy?

No. Homework is a core part of the process especially in structured approaches such as cognitive behavioural therapy. In other approaches it may be used in less structured forms or not at all. This depends on the method being used and your needs.

How much time should I set aside for my homework?

This varies with the type of task. Many tasks are limited to a few minutes a day; others are planned to be done once or twice a week. What matters is not the length of time but regularity and the task suiting your daily life.

How is homework shared in online therapy?

In online sessions, the client can read out their records during the session or, paying attention to confidentiality, share them with their therapist by a secure route agreed in advance. Records kept on paper can also be conveyed verbally without being shown to the camera during the session.

• #CBT
• #between-session work
• #thought record
• #therapy process

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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