What predicts therapy outcomes
Decades of psychotherapy research have identified the factors that most consistently predict positive outcomes. Therapeutic alliance, the quality of the relationship between client and clinician, is consistently near the top. But so is something less often discussed: what clients do between sessions.
Between-session engagement, whether clients apply what they learn, reflect on what happened, and arrive prepared to build on it, is one of the stronger predictors of lasting change. The session plants something. The between-session period is where it either takes root or does not.
The forgetting problem
Research on memory suggests that without active review, a significant portion of what is discussed in a conversation is forgotten within 24 to 48 hours. In therapy, this means that insights from Tuesday's session can be genuinely hard to access by Thursday, let alone the following week.
Writing briefly after a session, even a few sentences noting what felt important, substantially increases retention. It also gives you something to build from at the next session rather than starting from scratch.
This is not about doing more therapy at home. It is about not letting the work disappear. The between-session period is not filler, it is where the real integration happens.
What the research on homework completion shows
Multiple meta-analyses have found that clients who complete between-session assignments make measurably better progress than those who do not, across different therapeutic modalities, not just CBT. The effect is not trivial. In some studies it is comparable in size to the effect of the therapeutic relationship itself.
Practical things that help
- Write something after each session. Even one sentence noting what you want to hold onto. Do it before the day ends.
- Complete assigned homework, however imperfectly. A partial attempt is more useful than none. Bring the resistance to the next session if you cannot complete it.
- Track your mood briefly. A daily number takes under a minute and gives both you and your clinician a much more accurate picture than weekly recall.
- Notice what comes up during the week. Not everything needs to be processed immediately. Writing it down means you can bring it to the session rather than forgetting it happened.
- Arrive with something to say. You do not need an agenda. You need one or two things you noticed that feel worth exploring.
What your clinician can do
Between-session engagement is not only a client responsibility. Clinicians who assign structured work, review what clients share, and build each session on the previous one create a continuity that amplifies outcomes. The session becomes part of a longer arc, not an isolated weekly event.
Betterjournal supports the work between sessions
Private journaling, daily check-ins, and clinician-assigned homework. Always free for clients in Canada.
Learn more for clients