What to do between therapy sessions

What the research on the week between says

Most of the evidence concerns homework in cognitive behavioural therapy (CBT), where the therapist assigns a specific task. Three findings are worth knowing, and each comes with a limit.

• A 2010 meta-analysis (Mausbach and colleagues) pooled 23 studies with 2,183 participants. Completing homework was associated with better outcomes, with a correlation of r = .26. The size of the link changed with how completion was measured.
• A 2016 meta-analysis (Kazantzis and colleagues) pooled 17 CBT studies with 2,312 clients. How much homework people did and how well they did it were both related to outcome. The estimate for quality rests on only 3 studies, so the authors call it tentative.
• Earlier controlled comparisons, as summarised in a Psychology Today column, found that clients given homework did better than about 70% of those given none. That is a secondary summary; we have not re-read the underlying paper.

Two cautions follow. An association is not a cause: people who feel better may also find homework easier to do. And these are CBT studies. Psychodynamic therapy seldom sets tasks, and the searches behind this article found no comparable trials of what people do on their own between psychodynamic sessions. So the sensible reading is modest: between-session effort seems to matter in CBT, and it is reasonable, though not proven, to expect some benefit elsewhere.

One more finding speaks to writing in particular. A 2006 meta-analysis of 146 randomized studies (Frattaroli) found that writing about personal experiences had a positive but small average effect, r = .075, with several factors changing it. Writing helps a little on average. It is not a treatment.

A routine that does not become a second job

Pick the smallest version that you will actually do.

Within a day of the session: five minutes. Write three lines: what stayed with you, what you disagreed with or did not follow, and what you did not say. The third line is often the most useful one. It marks where the next session may need to start.

During the week: log moments, not days. A moment is a short entry with four parts: where you were, who was there, the first feeling, and what you did next. Take a type of situation familiar to many people: you are asked for something at work, you say yes before you have decided, and by evening you resent it. The entry is not "I was stressed." It is "asked in a meeting, felt a tightening, said yes in two seconds." A pattern is visible only in specifics.

If your therapist set a task, do it or say why not. Skipping it is information too. "I could not make myself do it" is a good thing to bring.

The day before: choose one thing to bring. One sentence is enough. Choose between the item you most want to discuss and the item you are avoiding. If they differ, bring the second.

Leave room for rest. Not every feeling needs processing before the next session. A week can also be a week of ordinary life.

What to write down and bring

Bring the notes or just read the key line aloud. You do not need to hand over a diary. If you are not sure whether your therapist wants notes, ask at the start of a session.

Using the notes in the session

Notes help only if they reach the room. Two habits make that likely.

First, say the note aloud in the first five minutes, before the session drifts to whatever is most pressing. "Last week you said something about my brother, and I disagreed all week" is a complete opening. Therapists differ in how much they want to steer, so if yours prefers to begin elsewhere, offer the note when there is a pause.

Second, give a note one chance to be wrong. A moment you logged as significant may turn out, when you say it aloud, to be about something else. That change is not a failure of the note. It is the work. Many people discover that the line they nearly left out was the one that mattered.

Traps to avoid

• Turning the log into rumination. A note is a record, not a verdict. If you find yourself reading old entries to prove a point to yourself, stop and close the notebook.
• Writing for an audience. Notes composed to impress your therapist, or to make yourself look reasonable, lose their use. Short and unpolished is better.
• Trying to solve it before the session. A problem you cannot solve alone is part of what the session is for. Bring it unsolved.
• Measuring progress by how much you did. The research above links effort to outcome on average. It does not say that a week with no notes is a wasted week.
• Comparing your week with someone else's routine. The right amount is the amount you will do again.

When the gap is long

Some gaps are longer than a week: a holiday, a waiting list, a month between appointments. The same routine scales. Keep the three-line entry after any session, keep the moment log, and add a short weekly note on what has changed in your mood or in the pattern you are working on. When the next appointment arrives, read the weekly notes first and choose what to bring. If a gap includes a hard period, do not wait for the appointment: contact your therapist or a service your region provides.

Where TwentyThird fits

TwentyThird is a written space between appointments. A member talks with Oneli, an AI agent grounded in psychodynamic thinking, and it keeps track of what repeats in what they say. That can make the third line of your notes easier to see across weeks. It is an AI, it does not do therapy, and today psychologist supervision is in early access: no human is alerted if something alarming is written. See how Oneli works and what TwentyThird is not.

What this does not replace

Notes and routines do not replace the person you see. If something in your week frightened you or felt unmanageable, tell your therapist at the next session, or contact them sooner if they allow that. If you are in danger, contact local emergency services now. In the EU, call 112. For more on remembering sessions, see how to remember what you said in therapy.