Between-Session Work
What if homework helped you learn, rather than becoming another test you could fail?
A quick note on this page. CBT often includes practice between sessions, and doing it is linked with better outcomes. This page sets out how to make between-session work accessible, and why an unfinished task is information about the task and circumstances before it is information about motivation.
The short version
Practice between sessions can help CBT work in everyday life, and doing it is linked with better outcomes. But the task has to fit your capacity, format and circumstances. If something wasn’t done, that is information about the task first, not a verdict on your commitment.
You might recognise this
Illustrative statements drawn together from common experiences. They are not quotes from individual people.
- “I dreaded the start of every session, because of the homework review.”
- “I did it, but in my head, not on paper. Did that count?”
- “I couldn’t do it during the flare, and I didn’t want to admit it.”
- “Doing it together in the session was the only way it ever happened.”
- “When we changed the format, I suddenly found it useful.”
Why CBT uses between-session work
CBT is designed to help people practise new ways of thinking and responding in their actual lives, not only in the therapy room. Between-session tasks, often called homework, are how that practice happens: trying an experiment, noticing a pattern, scheduling an activity, practising a skill.
There is evidence that this matters. A 2016 meta-analysis of 17 studies found that clients who did more between-session work tended to have better outcomes. Kazantzis et al., 2016
What that finding does and doesn’t show
The meta-analysis shows an association: people who did more homework did better. It doesn’t show that homework caused the difference. For disabled people, this matters. Someone with more energy, fewer symptoms and more support may both do more homework and improve more, for reasons that have little to do with motivation. A therapy that rewards homework completion could, without intending to, reward the people whose lives are already easier.
That is not an argument against between-session work. It is an argument for making it accessible enough that capacity is not the hidden variable.
Before agreeing a task
Questions to ask together
- Does it serve your goal, not just the therapy’s plan?
- Is the format accessible: spoken, typed, recorded, visual, or on paper?
- What will it cost in energy, pain or time?
- Does it need support from someone else?
- What happens on a flare day? Is “nothing” an acceptable version?
- Could part of it be done together in the session?
- How will we review it without blame?
A menu, not a worksheet
- noticing something, without recording anything;
- talking it through at the start of the next session;
- an audio or video note, if speaking is easy for you that day;
- a typed note or a message to yourself;
- supported notes, written with someone else;
- a tick, colour or symbol on a simple chart;
- a short version done together in the session;
- one small task, or no task at all this week.
None of these is automatically accessible. A voice note may suit one person and be impossible for another. The question is what works for you, and it can change from week to week.
When a task wasn’t done
Unfinished homework is sometimes read as a sign of low commitment or avoidance, particularly in rushed or target-driven services. Occasionally that is part of the picture. But before interpreting motivation, look at the task and the circumstances. A client may have:
- forgotten, which may reflect memory, executive function or fatigue;
- disagreed with the task, but not felt able to say so;
- lacked privacy to do it;
- been overwhelmed, or in a flare;
- found the format unusable;
- learned, by trying, that the task didn’t fit.
Each of these improves the formulation. Non-completion is information, not failure.
A moment in the session
An illustrative exchange, written for teaching. It is not a real session.
Where to slow down
- The client apologises for unfinished tasks, or seems to dread the review.
- Homework is the same format every week, regardless of how it has gone.
- Completion rates are being used to judge commitment or eligibility for further sessions.
- The client is doing the homework at real cost to their health.
For therapists
- Have I asked what format would work, rather than assuming paper?
- Do I explore non-completion before interpreting it?
- Would I count a task done in the client’s head as done?
- Am I unintentionally rewarding the clients with the most capacity?
A different experience
Some disabled clients find homework the most valuable part of CBT, and like the structure of a task to do between sessions. For them, keeping it, perhaps in an accessible format, may be exactly right.
Evidence and status
- Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it, not that it does not exist.
- Research: the Kazantzis et al. meta-analysis linking homework compliance with outcome.
- Our synthesis: the point that capacity may confound that association for disabled clients, and the adaptations here. We have not located studies testing accessible homework formats with disabled clients.
A question worth carrying: what would make this task possible for me this week, not just in theory?
Where this connects
Learning between sessions, in a format that fits your life.
Within the CBT section
- CBT Through a Disability Lens – the hub.
- Why CBT Can Fail Neurodivergent Clients – executive function and format.
- Pain, Fatigue and Fluctuating Capacity – homework on flare days.
Across the site
- Frequently Asked Questions – asking for adjustments.
- Humanistic Therapy & Accessibility – access as part of the therapy.
- Power & Professional Authority – who decides what counts as compliance.
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