The Unexpected Progress: Working In Between Sessions

The magic of the therapy session is enhanced by continued engagement in between sessions. Evidence shows that therapeutic growth and benefits are increased and maintained long-term when you practice your therapy learning during your daily routine ³.

Table of Contents

• What is the Purpose of In Between Session Work?
• How Do I Incorporate Work In Between Sessions?
• How Do I Develop Therapeutic Awareness?
• What are the Challenges of this Work?
• A Case Study: Courtney
• Final Thoughts

Albeit strange at first, it is worthwhile exploring how to work with skills, reflections, insights, and therapeutic awareness. Once you begin to include these in your day-to-day activities it will become easier as time goes on.

You are creating new habits and routines when you include these elements. There are also increased opportunities for you to reflect on your growth and bring back questions or insights to your therapist to explore in the next session.

Table of Contents

• What is the Purpose of In Between Session Work?
• How Do I Incorporate Work In Between Sessions?
• How Do I Develop Therapeutic Awareness?
• What are the Challenges of this Work?
• A Case Study: Courtney
• Final Thoughts

What is the Purpose of In Between Session Work?

New therapeutic thoughts or perceptions regarding your experiences, needs time to settle within you. The time between sessions offers this opportunity. You need to notice new insights and connect them to daily life to consolidate and internalise your session work ⁵.

Therapy teaches new ways of thinking, feeling, and acting, which need practice to become natural ². Intentionally using these new skills in between sessions will grow comfort with them - and even reveal questions to discuss with your therapist.

Therapy helps you develop sensitivity and awareness of your thought patterns, triggers, habits, behavioural responses, and emotional regulation ⁴. To truly appreciate this, pay attention to your experiences beyond the therapy room. Using mood trackers, journalling, and other observations help identify further patterns and inner understanding.

Working between sessions builds momentum and continuity (Tambling et al., 2021). Bringing what you explore in the room into daily life keeps your growth moving forward without pause. There is increased productivity in sessions because you can contribute reflections, questions, and feedback. The continuity of this process will help ensure that the changes you see become long-lasting.

How Do I Incorporate Work In Between Sessions?

There are a variety of ways that you can incorporate your therapeutic work into your daily life. Not all of these ways will work for you - you may need to try a few to find which ones integrate smoothly and make the best impact.

Formal Assignments

Some therapists use directed and structured homework assignments, as a concrete way to ensure that you engage with the work outside of the room ⁴. It provides focus and a starting point for your explorations. Discussing the results of your assignment with your therapist allows you to dig into deeper layers in the next session. Assignments could include worksheets, readings, exercises, or journal prompts.

Informal Opportunities

You may be faced with multiple opportunities to practice these skills outside of the session. This could be in a stressful moment, important conversations, or stepping back to gain a different perspective. These opportunities will constantly arise; you can develop your awareness to catch them and engage with them.

Journalling

Writing down your thoughts helps you pause, reflect, and increase awareness. Fully immersing in journalling gives you space to reflect on using therapeutic skills, their effectiveness, any challenges, and their value in your life. Your journal should work for you - there's no right way to do it. Written, drawn, or voice recorded, it's a space for honest, judgment-free expression.

How Do I Develop Therapeutic Awareness?

There have been multiple mentions of 'therapeutic awareness', but what exactly is this and more importantly, how do you develop it?

Observation Skills

Your observational skills will develop as you become more aware of your experiences, triggers, thoughts, and responses. Remember that this involves non-judgement; you are simply increasing awareness of patterns and behaviours.

Pattern Tracking

When you are observing yourself, you might notice themes or patterns developing. These are good reflections to take to your therapist and explore in a session. Your awareness makes it easier to develop strategies to support you. Tracking these patterns in writing lets you monitor their progress and your responses to different strategies.

Being Mindful

Developing mindfulness skills enhances therapeutic awareness as the practice helps you become acutely aware of your experiences and responses ¹.

Mindfulness practices can easily be incorporated into your daily routine, for example when brushing your teeth: notice the flavour of the toothpaste, the feeling of the bristles on your teeth, what you are thinking, etc. These small practices help you strengthen skills to use during moments of emotional dysregulation.

What are the Challenges of this Work?

As wonderful as in-between session work sounds, we have to be realistic - it takes effort. Which means you may have challenges to manage it. Being aware of such challenges can help you to find solutions that work for you.

Time Management

Finding time for reflection can be tricky - especially when you are still getting used to it ³. It may help to reflect on your time limitations and boundaries; find ways to fit between-session work into your existing. A handy way of doing this is to pair your therapeutic work with an already scheduled activity. For example, you could use your drive to work to reflect on the previous day's patterns.

Resistance and Avoidance

Resistance and avoidance are challenges that stand in the way of easy engagement; however, they can rather be seen as starting points. Being curious about your resistance or avoidance can spark reflections both in and outside the session. Make a note of these feelings and instead of simply pushing through or giving in to them, make them a part of your reflections.

A Case Study: Courtney

Courtney* worked hard during sessions but didn't engage in any in-between session work. Therapy was helpful, but progress was slower than we both hoped. Each session, she arrived highly distressed, as if the only place she could regulate and practise her skills was in the room with me.

We broached the topic of her starting a journal to help her regulate and track her mood and thoughts throughout the week. I gave her a few journal prompts based on our sessions. Eventually she managed to direct her own journalling and reflection.

She began coming to sessions better regulated, bringing questions and ideas for handling future dysregulation. Courtney not only spent more time engaging in therapy, but she also gained a sense of ownership and control over her journey.

*This is an amalgam case of several clients. Names have been changed to protect confidentiality.

Final Thoughts

Between-session work offers you a brand-new way of engaging in therapy. Developing your own autonomy and routine reflection routine will help you use support strategies in ways that fit your life and make a real impact ⁵.

A therapeutic journey is a valuable one, one that can be enhanced by bringing it fully into your everyday life. Although it takes a little more effort - you are worth it.

Amy de Wet

Educational Psychologist

PS0159417

References

1. Cornish, M. (2024, April 30). New research: Homework review improves therapy outcomes. Eleos Health. Link ↑
2. Kazantzis, N., & Ronan, K. R. (2006). Can between-session (homework) activities be considered a common factor in psychotherapy? Journal of Psychotherapy Integration, 16(2), 115-127. Link ↑
3. Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34(5), 429-438. Link ↑
4. Primakoff, L., Epstein, N., & Covi, L. (1986). Homework compliance: An uncontrolled variable in cognitive therapy outcome research. Behaviour Therapy, 17(4), 433-446. Link ↑
5. Ryum, T., Bennion, M., & Kazantzis, N. (2023). Integrating between-session homework in psychotherapy: A systematic review. Psychotherapy, 60(2), 123-145. Link ↑

Disclaimer: This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.