The Importance of Homework – Why Most Change in Therapy Happens Between the Sessions

Melissa ReeBlog, Psychological treatment approaches

Often people believe that when you go to see a psychologist, the majority of the ‘therapy’ happens while you are in the clinician’s room at your appointment. In actual fact, the therapy is something that largely takes place in the changes you make to your thinking and behaviour between the sessions. There are 168 hours in a week, and an average appointment is 50 minutes. Therefore, you need to be doing most of the hard yards between the sessions, so that when you get to your appointment time, you can spend this limited time touching base with the psychologist about the changes you have made since the last session, things you tried and problem solving any barriers you came up against, and then learning some new skills to take away and try before the next session.
Typical Between-Session Tasks
The kind of between-session tasks you do will depend on the kind of goals you have set for your treatment and what you’re wanting to work on in your therapy. Early on in therapy, this will often involve reading information to expand on the things you have discussed with your clinician during your session. It may also involve you keeping some sort of self-monitoring record of anything that is relevant to what you’re working on e.g., thoughts, mood, sleep patterns, eating behaviours etc. Finally, you will often be trying to make changes to your thinking and behaviour between sessions. Perhaps you will be practicing noticing and challenging negative thoughts that pop up, or ‘unhooking’ from a worry spiral, or making a change to your behaviour in order to improve your mood or test out a feared prediction. All of these are crucially important components of therapy that need to be practiced regularly between your sessions in order to achieve change.
Self-Monitoring and Records
When we ask you to keep some sort of self-monitoring record, this serves a few different purposes. Firstly, it’s a means of further assessing what is going on for you with regards to any patterns of thinking, behaviour, and emotional experience that are relevant to the difficulties you’re experiencing. Secondly, self-monitoring will prompt you to become more aware of your own patterns, and give you an opportunity to start to make changes to these – after all, you can’t change what you’re not aware of. We recognise that at time these tasks can seem arduous and perhaps a little annoying, but they are well worth the effort because they help you progress and make change.
Homework Review
One of the first things you will do in each therapy session is to review how you’ve been traveling since your last appointment and how you’ve gone with your between-session tasks.  Try to make sure you always bring your self-monitoring or homework tasks into session with you and be ready to discuss them with your psychologist – it’s much easier to do this when you have the paperwork there in front of you and don’t have to rely solely on your memory! It often helps to have a folder where you keep any handouts, self-monitoring, or other homework records that you’re working on during treatment to bring to each session and always have them handy.
Homework Setting at the End of Each Session
At the end of each therapy session, your clinician will work with you to set some ‘homework’ to complete between now and the next session, so be prepared to actively participate in this and think about what tasks might help you practice the skills and strategies you’ve learned during the session. Between-session tasks should ideally be related to whatever you’ve discussed during the therapy session, and to what you’re currently working on. It’s important to let your clinician know if you don’t understand what they’ve asked you to do or are not confident that you can manage. This gives them an opportunity to clarify things with you, and for you to collaboratively come up with a plan that feels manageable. 
Scheduling Time for Homework + Reminders
It’s really easy to walk out of a therapy session having written your next appointment in your diary and simply forget all about the between-session tasks you’d planned to work on! For this reason, we often recommend that clients set aside some time each day or week for an at-home check-in, or self-guided ‘therapy session’ where they review their homework and keep track of how they’re progressing. Many people find it helpful to pop a reminder for this in their calendar or phone, so that it doesn’t slip their mind. This way, you can steadily progress through your homework during the time between your sessions, rather than doing it all in a rush the day before your next appointment, or finishing it all right after your previous session and then forgetting to practice the tasks repeatedly.
What To Do If You Get Stuck or Forget Your Homework
If you get stuck with a homework task – that’s ok! It’s great that you’ve given it a shot, and you can always do some problem solving with your clinician at your next appointment. It’s really important that you still attend your next session anyway, and be honest with the clinician about what you have and haven’t been able to do between your sessions; that way you’re on the same page and can figure out how to move forward. The clinician can then also give you extra support, clarify the task further, and help you brainstorm how to overcome any hurdles you’ve faced.
Be Willing to Get Uncomfortable
As with any of the work that you do in therapy, change often involves doing things that feel somewhat uncomfortable, and the tasks you practice between sessions are no exception. You may often be asked to try something that pushes you out of your comfort zone like spending less time in bed to manage your insomnia, or exposing yourself to something you’re anxious about to test out your feared prediction. This is a really normal part of therapy and it’s important to be open to tolerating some short-term discomfort in order to experience improvement in the long term.
Practice, Practice, Practice
It’s important to remember that most between-session tasks are not a one off! As you go through therapy you’re gradually accumulating a set of skills and strategies to help you manage your thinking and behaviour differently, and improve your mood and overall quality of life. Just like with any skill (playing the piano, riding a bike, cooking a new recipe), you will need to repeatedly practice these strategies in order to get good benefit from them. This may mean you need to persist with a task even if it takes you a while to get the hang of it, or you don’t see the impact straight away. Repetition is key!
Now you know some more about what’s involved in between-session tasks during therapy, if you believe that you could benefit from some professional support, why not give us a call today? Our team of highly skilled and experienced Clinical Psychologists are here to help. Call us now on 6107 6828, and take the first step towards improving your mental health.

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