Why therapy gives you homework, and what to do when you have not done it

Many people do not expect to be set tasks by a therapist. You turn up to talk, and you leave with a worksheet, or an instruction to notice something, or a small thing to try before next week. Then the week gets busy, and you arrive with nothing done and a low, guilty feeling. This post is for that moment.

The short version

• Between-session tasks are a normal part of cognitive behavioural therapy (CBT), and in controlled studies that compared the same therapy with and without it, the version with homework did better on average.
• The tasks are practice, not a test. Nobody is marking you.
• Not doing them happens a lot in my experience, and it is useful information for your therapist, not a failure.
• Say so early and plainly. A good therapist will work with you to change the task rather than judge you for it.

What the homework is for

A therapy session is short, and the rest of your week is long. Many of the habits that keep anxiety going, such as avoiding and checking, happen between sessions rather than during them. So the work has to reach that part of the week.

That is really all homework means. It might be writing down a worry and what actually happened. It might be doing one small thing you usually avoid. It might be noticing when your body tightens and what came just before. The NHS page on CBT says you will usually be asked to practise what you have learned between sessions, and that it is important to do this for CBT to work.

What the research says

One key review is a 2010 meta-analysis by Kazantzis and colleagues, covering 46 studies. When they looked only at controlled studies comparing the same therapy with and without homework, the pooled result modestly favoured homework. The authors concluded that homework assignments enhance therapy outcomes.

A second review, in 2016, asked whether people who did more of their homework did better. It covered 17 studies with 2,312 clients. Doing more of the set homework was linked to better outcomes, both at the end of treatment and at follow-up. Far fewer studies measured how well people did the tasks, so that part is thinner.

Two cautions, because I would rather you had the fair version. First, that second finding is a link, and the review cannot tell you which way it runs. Doing the tasks may help, or feeling better may make the tasks easier, or both. Second, this research is mostly about CBT and closely related approaches. I would not stretch it to every kind of therapy.

Why it slips

In more than fifteen years of practice I have seen the same reasons come up, and many have little to do with motivation.

The task did not fit

A small study of 41 people in CBT, covering 541 sessions, found that homework was more likely to be done when the task matched what the person had taken away from the session. That is an association, not proof. It is one small study from private practices, so I hold it lightly. It fits what I see, though. A task handed over at the end of a session, unrelated to the part that mattered to you, is easy to drop.

It started to feel like a test

Some people hear "homework" and their school self arrives, along with grades and being found out. If that is you, the task has become about performance, and worry about performing can feed anxiety. The fix is not more willpower. It is telling your therapist the task feels like an exam.

It was too big

"Do the thing you have been avoiding every day" sounds reasonable in the session. On a Tuesday night it can feel impossible. A task you cannot picture yourself doing is usually too big, and shrinking it is something you and your therapist can work on together.

What to say when you have not done it

Say it near the start of the session, before the therapist asks. Something like:

"I did not do the task. Can we work out why before we move on?"

You do not need to apologise, and you do not need a good reason. If it helps, choose from these:

• "It felt too big."
• "I could not see how it linked to what we talked about."
• "It felt like a test and I froze."
• "I forgot, and I think that might mean something."
• "It made me feel worse and I stopped."

That last one matters. If a task is making you feel worse rather than just uncomfortable, say so straight away. Some discomfort is part of practising something difficult. Feeling flooded or unsafe is not, and a task can be paused or changed. If that happens between sessions, stop the task, look after yourself, and tell your therapist as soon as you can. If you feel at risk of harm, use the crisis contacts at the end of this post.

What a good therapist does with it

They get curious rather than disappointed. What got in the way? Was it time, mood, the wording, or the size? They may shrink the task, rewrite it, link it more closely to something you said, or swap it for something you would actually do. Sometimes the answer is that the whole approach needs a rethink, and that is a useful thing to find out early rather than halfway through treatment.

A therapist who makes you feel told off is not doing this well. That is worth raising too. It fits with what I have written elsewhere about when therapy does not seem to be working.

A note on session length

The research above asks whether homework helps and whether doing it matters. It does not ask how long a session should run, so it has nothing to say on that either way. Session length is its own question. brightloaf's sessions are built around 20 minutes: a short session, then the rest of the week, which is where the practice happens.

A small way to begin

If you have skipped a task and feel bad about it, pick the smallest version you can picture. Two minutes, one line in a notebook, one thing noticed. Do that, and tell your therapist how it went, including if it did not.

This article is general information and is not a substitute for personal medical advice. If you are struggling, or you are in crisis or at risk of harm, contact your GP, call 999 or NHS 111, or a crisis line such as Samaritans on 116 123. brightloaf is not a crisis service.