Growth Tasks Are Linked to Better Outcomes

Up to 50%

Across controlled CBT studies, homework was linked to up to 50% better outcomes, showing the value of helping clients follow through between sessions. [1]

Meta-analyses in cognitive and behavioral therapy consistently find that homework assignments and homework completion are associated with better treatment outcomes. [1] [2] [3] In an updated meta-analysis of homework compliance, greater compliance was significantly associated with better outcomes (r = .26). [3]

The clearest evidence here comes from CBT and related structured therapies, where between-session practice helps clients apply session learning in everyday life. [4]

Supported Growth Tasks Improve Engagement

25 studies

A systematic review found positive session-to-session effects when therapists used clear rationales, collaborative planning, review, and written summaries for between-session homework. [4]

Engagement with between-session work depends on more than assigning a task. Review evidence suggests therapists improve uptake when they explain the rationale, link the task to the client's goals, collaboratively design it, and review it next session. [4]

Earlier work in cognitive therapy for depression similarly found that concrete task design, discussion of obstacles, and written reminders are helpful homework-assignment practices. [5]

Clients Forget More Than They Retain

40-80%

Patients forget 40-80% of medical information immediately after an appointment, and written or visual supports improve recall and adherence. [6] [7]

Healthcare communication research consistently shows that people forget a substantial portion of what they hear in appointments. Ley's work found immediate recall is often only 40-60%, and Kessels later summarized evidence that 40-80% of medical information is forgotten immediately. [6] [7]

Therapy also depends on clients remembering ideas, skills, and next steps between sessions. In psychotherapy research, interventions that enhance memory for treatment have been associated with better recall and better clinical response in cognitive therapy for depression. [8]

Documentation Burden Is a Burnout Risk

5+ hrs/week

In one EHR time-motion study, documentation consumed the equivalent of 5+ hours a week in admin time, showing how much capacity can be reclaimed with a better workflow. [9] [11]

Across healthcare, documentation burden consumes a large share of clinician time. In Arndt et al., primary care physicians spent 355 minutes per day in the EHR, including 84 minutes on documentation and 157 minutes on clerical and administrative work. [9]

Reviews of documentation burden describe it as a contributor to burnout, and physician survey data show that dissatisfaction with clerical burden is associated with higher burnout risk and lower professional satisfaction. [10] [11]

The Bottom Line

The strongest evidence is that between-session work in CBT and related structured therapies is associated with better outcomes, that recall is limited without support, and that documentation burden is a real contributor to clinician strain. [1] [3] [7] [10]

InterSession is built around these evidence-informed problems: helping clinicians capture session outputs efficiently, helping clients revisit what matters, and making between-session tasks easier to follow through on.

Up to 50% better outcomes with homework [1]
40-80% medical information forgotten immediately [6] [7]
5+ hrs/week saved in admin time [9]

References

  1. 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.
  2. 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.
  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.
  4. Ryum, T., Bennion, M., & Kazantzis, N. (2023). Integrating between-session homework in psychotherapy: A systematic review of immediate in-session and intermediate outcomes. Psychotherapy, 60(3), 306-319.
  5. Detweiler-Bedell, J. B., & Whisman, M. A. (2005). A lesson in assigning homework: Therapist, client, and task characteristics in cognitive therapy for depression. Professional Psychology: Research and Practice, 36(2), 219-223.
  6. Ley, P. (1988). Communicating with patients: Improving communication, satisfaction and compliance. Croom Helm.
  7. Kessels, R. P. C. (2003). Patients' memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219-222.
  8. Harvey, A. G., Lee, J., Smith, R. L., Gumport, N. B., Hollon, S. D., Rabe-Hesketh, S., Hein, K., Dolsen, M. R., Hamen, K., Kanady, J. C., Thompson, M. A., & Abrons, D. (2016). Improving outcome for mental disorders by enhancing memory for treatment. Behaviour Research and Therapy, 81, 35-46.
  9. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W. J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine, 15(5), 419-426.
  10. Gesner, E., Gazarian, P., & Dykes, P. (2019). The burden and burnout in documenting patient care: An integrative literature review. Studies in Health Technology and Informatics, 264, 1194-1198.
  11. Shanafelt, T. D., Dyrbye, L. N., Sinsky, C., Hasan, O., Satele, D., Sloan, J., & West, C. P. (2016). Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clinic Proceedings, 91(7), 836-848.