Between-Session Task Record
A clinician template for designing, recording and reviewing between-session tasks across a course of therapy, with prompts for rationale, obstacles, confidence rating and what was learned.
About this resource
Between-session work is where most of the change in CBT happens. Meta-analyses of homework in cognitive and behavioural therapies have found that both assigning homework and, more strongly, the degree to which clients complete it are associated with better outcomes. Yet in ordinary practice tasks are often set hastily in the last two minutes, not written down, and not reviewed at the next session, which teaches the client that they do not matter.
This template gives you a single running record for the tasks set across a course of therapy. For each task it prompts the elements that predict completion: a clear rationale linked to the session's work, a specific description of what, when, where and how often, anticipated obstacles and a plan for them, a confidence rating, and a space at the next session for what was done and what was learned. Tasks with a low confidence rating are made smaller before the session ends rather than left to fail.
The professional version includes guidance on the language to use (many clinicians avoid the word homework), on collaborative design rather than prescription, on graded task assignment for clients who are very low or avoidant, and on how to respond when tasks are repeatedly not done.
How to use it
- Design the task with the client in the last ten minutes of the session, not the last two. It should follow directly from the work of the session so that the rationale is obvious to both of you.
- Write it down on this record and give the client a copy or have them write it themselves. Specify what, when, where and how often. 'Practise the breathing exercise' is too vague; 'Practise the breathing exercise for five minutes after breakfast on weekdays' can be done and checked.
- Ask the client to rate their confidence that they will complete the task, from 0 to 10. If the rating is below about 7, ask what would make it easier and shrink the task until the rating rises. A small task done is worth more than a large one avoided.
- Anticipate obstacles together: time, forgetting, mood, other people, the task feeling pointless. Agree a plan for each one you identify.
- Review the task at the start of the next session, every time. Record what was done and what was learned. If it was not done, explore why with curiosity; the barrier is usually part of the problem you are treating.
- Look back over the record every few sessions. A pattern of tasks not done points to a problem with task design, with the formulation, or with the therapeutic relationship, and each needs a different response.
References
- Kazantzis, N., Deane, F. P., & Ronan, K. R. (2000). Homework assignments in cognitive and behavioral therapy: A meta-analysis. Clinical Psychology: Science and Practice, 7(2), 189-202.
- Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144-156.
- Beck, J. S. (2020). Cognitive Behavior Therapy: Basics and Beyond (3rd ed.). Guilford Press.
