Process / Middle
Between-session work and practice
How different therapies approach the time between appointments, from structured tasks and self-monitoring to informal reflection.
Overview
Most therapy takes place in weekly or fortnightly appointments of around fifty minutes, leaving most of a person’s week outside the consulting room. Approaches differ in how they treat the time between sessions. Some use agreed tasks, often called homework or between-session practice, while others leave what happens between meetings open to the client’s own reflection.
Structured tasks and experiments
In cognitive and behavioural therapies, between-session tasks are a standard part of the method. The NHS notes that CBT commonly includes agreed activities or exercises between sessions. Examples in Beck’s cognitive therapy manual and related behavioral programmes include keeping a brief record of thoughts and situations, scheduling activities, practising mindfulness or skills, or gradually approaching a safe situation that has been avoided.
How other traditions view time between sessions
In psychodynamic and person-centred approaches, practitioners rarely set structured exercises unless a client asks for them. Even without assigned tasks, people often continue thinking about sessions, noticing dreams or emotional reactions, or trying out different ways of relating to others during the week.
A constructed example
Constructed for learning. Not a real case.
Near the end of a CBT session, a client and practitioner discuss how the client might test the belief that going to a local café alone will be overwhelming. Together they agree that the client will visit for ten minutes on a quiet morning and note what happens. At the next session the client says they did not go because the week became busy; they explore what got in the way without treating it as a failure.
What research examines
A 2010 meta-analysis by Nikolaos Kazantzis and colleagues compared cognitive and behavioural treatments with and without homework across 46 studies. The authors reported that treatments including homework were associated with better outcomes than the same treatments without homework, while noting methodological limitations across primary trials. Findings from structured CBT trials do not show that assigned homework would be helpful in non-directive or exploratory therapies.
UK and US
Between-session practice is described in similar terms in UK (NHS) and US cognitive behavioural manuals and services. No legal or regulatory difference between the UK and the US applies to this topic.
Limits and open questions
People can find the word homework off-putting or reminiscent of school, and tasks that feel imposed, overly demanding or poorly matched to a person’s energy, caring responsibilities or safety can strain the therapeutic alliance. Whether a task is agreed collaboratively matters as much as the task itself.
Sources and inspection notes
NHS. Cognitive behavioural therapy (CBT).
Supports: Describes how CBT sessions involve breaking problems down and practising changes in daily life between sessions in NHS services (UK).
Supports: Publisher bibliographic record for the 1979 manual that codified structured cognitive therapy sessions and homework tasks.
Supports: Meta-analysis comparing cognitive and behavioural therapy conditions with and without homework assignments. Bibliographic record verified through Crossref.