Marta has had four sessions working on her social anxiety. At the last one you agreed that, before coming back, she would write down three situations where she felt watched: what happened, what she thought and how anxious she felt from 0 to 10. Tuesday comes, she sits down and, before you can ask, she apologises. She did it “in her head”, the sheet stayed in last week’s bag and the photo you sent her on WhatsApp is buried under forty messages. Anyone in practice knows the scene. Therapy homework is one of the best-supported tools for carrying what happens in session into the client’s life, and one of the easiest to leave half done.

This guide is for psychologists who already use between-session tasks or want to use them with more method. It covers what therapy homework assignments are, what the research says, the main types, how to set them so they get done, how to review them, what to do when a client doesn’t do them and what to record in the clinical file.

What therapy homework is

The APA Dictionary of Psychology defines homework as tasks assigned to a client to be performed between sessions of therapy, and gives reading, research or practising new behaviours, such as attending a lecture or speaking to a specific person, as examples. In practice it goes by many names: between-session tasks, therapeutic assignments, practice, exercises or, in clients’ words, “homework”.

It is the hallmark of cognitive behavioural therapy, but CBT does not own it. Homework is used in acceptance and commitment therapy, systemic and couples therapy, sex therapy, motivational interviewing and almost any brief intervention. The starting idea is the same: a session lasts an hour and a week has 168. What happens in the other 167 decides much of the outcome.

It helps to tell tasks apart from advice. “Try to rest more” is advice. “This week, switch your phone off at 11 pm and every morning note what time you fell asleep and how many times you woke up” is a task: it has a what, a when and something to bring to the next session.

Why between-session tasks work

The link between doing homework and getting better has been studied quite a lot. A meta-analysis by Brent Mausbach and colleagues, published in 2010 in Cognitive Therapy and Research, pooled 23 studies with 2,183 participants and found a significant relationship between homework compliance and treatment outcome (r = .26, a small to medium effect). The effect held whether the target was depression, anxiety or other problems. The full article is open access on PubMed Central.

Nikolaos Kazantzis, who has been studying the subject for over twenty years, published another meta-analysis in Behavior Therapy in 2016, with 17 CBT studies and 2,312 clients. His contribution was to look not only at how much homework gets done but at how well: quality, meaning whether the person really acquires the skill being practised, was also related to outcome, at the end of treatment and at follow-up. The practical takeaway is useful: filling in the sheet for the sake of it counts for less than understanding what it is for.

The NHS puts it plainly on its page on how CBT works: you will usually be asked to practise what you have learned between sessions, and doing so is important for CBT to work. It also mentions that you may be asked to record your progress in a worksheet or diary.

The clinical reasons are easy to see in the room:

  • Learning generalises: the breathing that works in the office has to work on the underground too.
  • The session works with real data rather than memories rebuilt on Tuesday morning.
  • Clients see that they can do things on their own, which feeds their sense of self-efficacy.
  • It prepares discharge: someone who has practised during treatment knows what to do when sessions end.

Types of therapy homework assignments

Almost all therapy homework falls into one of these families:

  • Self-monitoring. The client records situations, thoughts, emotions and behaviours as they happen or at the end of the day. The CBT thought record, the ABC record, the sleep diary and the binge diary are the best known.
  • Psychoeducation. Reading a short text, watching a video or going over an explanation of the problem and its treatment.
  • Skills practice. Breathing, relaxation, mindfulness, social or communication skills, problem solving.
  • Exposure. Approaching what is avoided gradually and with a plan, following a hierarchy agreed in session.
  • Behavioural activation. Scheduling pleasant or meaningful activities and rating how mood changes, very common in depression.
  • Behavioural experiments. Testing a prediction (“if I say no, she’ll be angry with me”) and writing down what actually happens.
  • Writing. Unsent letters, expressive writing, a list of values or an account of what happened.
  • Couple or family tasks. A screen-free conversation, a household agreement, an activity with the children.

If you work from CBT, our guide to CBT techniques explains how each one fits into treatment.

How to set therapy homework clients actually do

Most homework that doesn’t get done fails before the client leaves the room. Setting it well takes a few minutes of the session, and it is worth keeping them for the end rather than handing out the task at the door.

Design the therapy homework with the client

An imposed task feels like school homework. An agreed task is the client’s own experiment. Ask what they think would help them move forward, offer options and let them choose the format: paper, phone, voice notes to themselves. The more it is theirs, the more likely they are to do it.

Explain what it is for

“Write down your thoughts” motivates nobody. “If you write it down in the moment, on Tuesday we can see what happens just before the anxiety goes up, and that is what we are going to change” does. The link to the goal of therapy should be clear in one or two sentences.

Pin down what, when, where and how much

The more specific, the better: “three times this week, when you get home from work, ten minutes of breathing on the sofa”. Tying the task to an existing routine (after dinner, on getting home) works better than relying on memory.

Start small

A task done 100% beats an ambitious one dropped on Wednesday. The first tasks should be almost certain to go well, because the client is also learning that homework is worth it. There will be time to raise the difficulty.

Rehearse it in session

Fill in the first line of the record together or do five minutes of the exercise in the room. Questions come up while you are still there to answer them.

Anticipate obstacles

Ask what could stop them doing it and what they will do then. A trip, the children, a night shift. A task with a plan B has a much better chance of making it to Tuesday.

Put therapy homework in writing, somewhere easy to find

What is said at the end of a session is forgotten on the way downstairs. The written instructions, the record sheet or the reading material need to be somewhere the client finds without looking. A sheet in a bag gets lost and a file in a chat gets buried; a space of their own, where it is always at hand, prevents half of the “I couldn’t find it”.

Reviewing homework at the next session

If homework is not reviewed, clients quickly learn that it doesn’t matter. The review goes at the start of the session, not in the last five minutes, and should take as long as it needs.

  • Ask what they did and what they learned, not just whether they did it.
  • Acknowledge effort, partial effort included. Two records out of three are much more than zero.
  • Use what they bring as session material: the week’s thought record is the best starting point for the work.
  • Adjust the next task to what happened: easier, harder or different.

The review is also where you see the quality Kazantzis talks about: whether the client has understood the exercise or done it mechanically.

When a client doesn’t do the homework

Undone homework is clinical information, not a failure of the client or the therapist. The useful question is not “why didn’t you do it?”, which sounds like a telling-off, but “what got in the way?”. The most common answers have a fix:

  • They didn’t understand it. Explain it again, with an example done in session.
  • It was too much. Split it or reduce the frequency.
  • They didn’t see the point. Go back to what it is for and whether it fits what the client wants.
  • Avoidance is the problem. In anxiety, exposure tasks trigger exactly what is being treated. Step down the hierarchy.
  • Perfectionism or shame. Some clients don’t bring it because they didn’t do it “right”. Make clear that a half-finished record is useful.
  • Forgetting or lost material. Reminders help here, and so does keeping the material in the same place.

If homework keeps slipping week after week, there is usually something underneath: the alliance, the client’s life circumstances or the fit of the treatment itself. Our article on therapy adherence and dropout covers how to spot it early.

Therapy homework examples by presenting problem

A few therapy homework examples that work well as a starting point and should be adapted to each client:

  • Anxiety: a worry log with time and intensity; postponing worry to a 15-minute “worry time”; one step of the exposure hierarchy.
  • Depression: an activity schedule with one pleasant and one mastery activity a day, rating mood before and after.
  • Insomnia: a sleep diary for two weeks, a fixed wake-up time and getting out of bed if sleep hasn’t come within twenty minutes.
  • Couples: twenty minutes a week of phone-free conversation; noting one thing the other did well each day.
  • Children and teenagers: short, visual tasks with parents involved; a sticker chart works better than a sheet of text.
  • Online therapy: shared material needs to be available outside the video call, somewhere the client can go back to.

How to record homework in the clinical file

Between-session tasks are part of treatment and should be documented like the rest. In each session note, this is usually enough:

  • Which task was set, with what goal and how often.
  • The material given (record sheet, reading, video of a technique).
  • How the review went: level of completion, what they learned and what difficulties came up.
  • Adjustments for the following week.

That way you can follow how the case evolves and, if it passes to a colleague or goes to supervision, it is clear what has been tried and what worked. Our page on digital clinical records for psychologists explains how to keep it all organised in one place.

Therapy homework with My Psico Agenda

My Psico Agenda doesn’t decide what homework to set or mark it for you. It helps with the practical side, which is where most homework gets lost:

  • In each client’s record, under “Patient files”, you upload the material: a PDF, an image, a Word document or a video. Everything you upload starts hidden and only you can see it.
  • When you want them to have it, tap “Hidden” and it becomes “Visible”. The client finds it in their own space, in the “Documents” tab, with “View” (for PDFs and images) and “Download” buttons. They sign in with their code and PIN, from a phone or a computer.
  • As soon as they open it, the record shows “Seen” with the date, so on Tuesday you know whether they looked at it before you ask.
  • Signed consent forms are visible in their space as soon as they are signed.
  • In the clinical history you write each session note, with the task set and how the review went.
  • With “Recurring therapy”, each client’s regular slot stays booked every week, every two weeks or once a month, so the homework review always has its place. WhatsApp reminders go out 24 hours before with buttons to confirm or cancel.

The app doesn’t do video calls: if you see clients online, you add the link of the tool you use to the appointment. There is a summary of everything on the software for psychologists page. Individual plans start at €4.99/month + VAT (Semilla plan, up to 25 patients) and centre plans at €99.99/month + VAT. File storage depends on the plan. No lock-in: cancel whenever you like.

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Keep each client’s material out of the chat and in one place. Create your account and try 1 month free, no card needed · See pricing

Frequently asked questions

The questions about therapy homework that come up most often in practice and in supervision.

What is therapy homework?

It is the activities a client does between sessions to practise what was worked on in therapy: self-monitoring records, reading, breathing or relaxation exercises, gradual exposure, behavioural experiments or writing tasks. It helps carry what is learned into daily life and gives the session real data from the week.

Does homework really improve therapy outcomes?

Yes. A meta-analysis by Mausbach and colleagues (2010), with 23 studies and 2,183 participants, found a significant relationship between doing homework and improving, of small to medium size. Kazantzis and colleagues (2016) added that quality also counts: learning the skill, not just filling in the sheet.

How many assignments should I set each week?

One or two well-chosen tasks are usually enough. A small task the client completes is better than three they drop halfway through the week. Raise the difficulty once the first ones go well.

What should I do if my client never does the homework?

Ask what got in the way, without blame. The usual reasons are that they didn’t understand it, it was too much, they didn’t see the point, the avoidance that comes with the problem, perfectionism or losing the material. Adjust the task to the reason and review the alliance if the pattern repeats week after week.

Should I call it “homework” or something else?

For many adults the word “homework” brings back school and puts them off. “Practice”, “exercise” or “this week’s task” often work better. What matters is that the client sees it as their own and not as an imposed obligation.

How can I share material with a client so it doesn’t get lost?

Ideally it should always be in the same place, where the client can go back to it whenever they want. In My Psico Agenda you upload the file to their record, switch it from “Hidden” to “Visible” and they have it in their space, in the “Documents” tab. When they open it, the record shows “Seen” with the date.

Does therapy homework work with children?

Yes, with adaptations: shorter, visual tasks with parents or guardians involved. A sticker chart or a record with drawings works better than a sheet of text, and it should be reviewed with the child at the start of the session, just as with an adult.