Between Sessions: 8 Self-Therapy Practices That Actually Work

You leave therapy feeling lighter, clearer, maybe even hopeful. The insights land. The emotions shift. You feel genuinely different.

Then Tuesday happens. By Wednesday, you're back in familiar patterns—snapping at your partner, spiralling into anxiety at 2am, or numb-scrolling through your phone for three hours because you can't muster the energy for anything else.

By the time your next session rolls around, you've lost the thread. "What did we talk about last time?" you ask sheepishly. The week between sessions feels like a therapeutic black hole where progress goes to die.

Here's the truth: therapy isn't just what happens in the room with your therapist. It's what happens between sessions that determines how deep and lasting the change will be.

Your therapist gives you tools, insights, and frameworks. But you're the one living your life 24/7. The real work—integrating insights, practising new skills, noticing patterns—happens when you're alone.

Let me give you eight evidence-based practices you can use between sessions to deepen your therapeutic work, maintain momentum, and actually make the changes you're seeking.

TL;DR:

• Therapy sessions plant seeds; between-session work helps them grow
• You don't need hours—10-15 minutes of intentional practice daily makes a difference
• Different practices suit different goals (insight, emotion regulation, behaviour change)
• Consistency matters more than intensity
• These aren't "extra" work—they're how therapy actually works
• If you struggle with homework, that's okay—start small and build capacity

Why Between-Session Work Matters

Research consistently shows that clients who engage in between-session work progress faster and maintain gains longer than those who don't.

A 2019 study in Psychotherapy Research found that homework completion predicted therapy outcomes more strongly than almost any other factor—including therapeutic alliance or therapist experience.

Why? Because:

1. Therapy is 50 minutes a week. Life is 10,080 minutes. The ratio is tiny. If change only happens during sessions, progress will be glacially slow.

2. Insight without action doesn't create lasting change. You can understand why you do something and still keep doing it. Behaviour change requires practice.

3. Your brain needs repetition to rewire. Neuroplasticity—the brain's ability to form new neural pathways—requires repeated practice. One session per week isn't enough repetition.

4. Between-session work builds agency. Therapy can feel like something done to you or for you. Self-practice shifts that: you're actively participating in your own transformation.

That said: if executive function challenges, depression, or ADHD make homework difficult, that's not failure. Start absurdly small. One minute of practice. One sentence of journaling. Something is better than nothing.

The 8 Practices

1. Reflective Journaling (Insight Work)

Best for: Processing emotions, noticing patterns, making sense of experiences

Journaling isn't just writing about your day. Therapeutic journaling is structured reflection designed to deepen insight.

How to do it:

Prompt-Based Journaling: Use specific prompts from therapy or general ones like:

• What emotion am I avoiding right now?
• What would my best friend say about this situation?
• What need is underneath this behaviour?
• If this pattern had a voice, what would it say?

Stream of Consciousness: Set a timer for 10 minutes. Write without stopping, censoring, or editing. Let whatever's underneath the surface spill out. You're not writing for an audience—you're externalising internal noise.

Pattern Spotting: After a triggering event, write:

• What happened (facts)
• What I felt
• What I thought
• What I did
• What I notice about this pattern

Over time, patterns emerge. You start recognising: "Ah, this is the part where I shut down," or "This is my go-to defence mechanism."

Research support: A 2020 meta-analysis found that expressive writing significantly reduced symptoms of anxiety, depression, and PTSD. Even 15 minutes of writing 3-4 times per week produced measurable improvements.

Tips:

• Don't worry about grammar or coherence
• You can destroy the pages afterwards if privacy is a concern
• Voice memos work too if writing feels inaccessible

2. Thought Records (Cognitive Work)

Best for: Challenging unhelpful thinking patterns, managing anxiety, building rational perspective

If you're doing CBT (Cognitive Behavioural Therapy), thought records are foundational.

How to do it:

When you notice a strong emotion, pause and write down:

1. Situation: What triggered this?
2. Automatic thought: What went through my mind?
3. Emotion: What am I feeling? (Rate intensity 0-10)
4. Evidence for the thought: What supports this thought?
5. Evidence against the thought: What contradicts it?
6. Alternative thought: What's a more balanced perspective?
7. Outcome: How do I feel now? (Rate 0-10)

Example:

• Situation: Friend didn't reply to my text for 6 hours
• Automatic thought: "They're angry with me. I've done something wrong."
• Emotion: Anxiety (8/10)
• Evidence for: They usually reply faster; they seemed quiet last time we met
• Evidence against: They mentioned being busy at work; they've been slow to reply before and it wasn't about me
• Alternative thought: "They're probably busy. If something's wrong, they'll tell me."
• Outcome: Anxiety (4/10)

Research support: Thought records are a core CBT technique with decades of evidence. They reduce anxiety, depression, and negative thinking patterns.

Tips:

• Do this immediately after an emotional spike, whilst the thoughts are fresh
• You don't have to fully believe the alternative thought—just entertain it
• Apps like MindShift or CBT Thought Diary can streamline the process

3. Grounding Techniques (Nervous System Regulation)

Best for: Anxiety, panic, dissociation, trauma responses, overwhelm

When your nervous system is dysregulated—fight/flight/freeze mode—rational thinking and emotional processing are offline. You need to calm your body first.

5-4-3-2-1 Technique:

• Name 5 things you can see
• 4 things you can touch (and touch them)
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

This pulls you out of internal overwhelm and anchors you in present external reality.

Bilateral Stimulation:

• Butterfly hug: cross your arms over your chest and alternate tapping your shoulders (left, right, left, right)
• Walk whilst focusing on alternating feet
• Tap your knees alternately

Bilateral movement activates both brain hemispheres and calms the nervous system (same mechanism as EMDR).

Cold Water Immersion: Splash cold water on your face, hold ice cubes, or take a cold shower. The "dive reflex" rapidly activates your parasympathetic nervous system (calming mode).

Research support: Grounding techniques are evidence-based for PTSD, anxiety, and dissociation. A 2021 study found that regular grounding practice reduced anxiety by 40% over four weeks.

Tips:

• Practice grounding when you're calm, so it's accessible when you're not
• Keep grounding tools handy: ice pack in freezer, grounding cards in wallet, list on phone

4. Self-Compassion Practice (Shame Reduction)

Best for: Self-criticism, perfectionism, shame, low self-esteem

Therapy often surfaces painful insights: "I push people away," "I'm terrified of failure," "I don't trust anyone." It's easy to turn those insights into self-attack: "What's wrong with me? Why am I like this?"

Self-compassion interrupts that pattern.

Kristin Neff's Self-Compassion Break:

When you notice self-criticism, pause and say (internally or aloud):

1. "This is a moment of suffering." (Mindfulness—acknowledging pain)
2. "Suffering is part of being human." (Common humanity—you're not alone)
3. "May I be kind to myself in this moment." (Self-kindness—offering care, not judgment)

You can add: "May I give myself the compassion I need."

Self-Compassionate Reframing: When you catch yourself thinking: "I'm such an idiot for doing that," pause and ask:

• What would I say to a friend in this situation?
• Can I speak to myself the way I'd speak to someone I care about?

Then reframe: "I made a mistake. I'm learning. That's what humans do."

Research support: Self-compassion reduces anxiety, depression, and shame whilst increasing resilience and wellbeing. A 2022 study found that brief daily self-compassion practice (5-10 minutes) over three weeks significantly reduced self-criticism and improved mood.

Tips:

• This will feel awkward initially—that's normal
• You don't have to "believe" it at first; practice anyway
• Physical gestures help: hand on heart, self-hug

5. Mindful Awareness (Present-Moment Practice)

Best for: Rumination, worry, dissociation, chronic stress

Therapy explores past patterns and future concerns. But healing happens in the present.

Body Scan: Lie down or sit comfortably. Slowly bring attention to each part of your body, from toes to head. Notice sensations without judgment: warmth, tingling, tension, numbness. Just observe.

Mindful Daily Activities: Choose one routine activity (washing dishes, brushing teeth, walking to the bus). Do it with full attention:

• What do you see, hear, smell, feel?
• Can you stay present for the entire activity without mental drift?

Noting Practice: When thoughts arise, mentally note: "Thinking." When emotions arise: "Feeling." When physical sensations arise: "Sensation." You're not suppressing—just noticing and naming.

Research support: Mindfulness reduces anxiety, depression, and rumination. Even micro-practices (2-3 minutes) produce measurable benefits when done consistently.

Tips:

• Start with 2 minutes; build up slowly
• Expect your mind to wander—that's not failure; noticing and returning is the practice
• Apps (Insight Timer, Headspace) offer guided practices

6. Behavioural Experiments (Testing Beliefs)

Best for: Challenging avoidance, testing anxious predictions, building confidence

Sometimes you need to do something differently to learn that your fear isn't accurate.

How to do it:

1. Identify the belief: "If I say no, people will reject me."
2. Design the experiment: "I'll decline one social invitation this week and observe what happens."
3. Predict the outcome: "They'll be angry and exclude me."
4. Run the experiment: Actually say no.
5. Record what happened: "They said 'No worries, maybe next time!' and we chatted normally the next day."
6. Update belief: "Maybe saying no doesn't lead to rejection as often as I fear."

Examples:

• Social anxiety: Speak up in a meeting and see if anyone actually judges you
• Perfectionism: Submit work that's "good enough" (not perfect) and see if catastrophe follows
• Health anxiety: Go 24 hours without checking symptoms and observe what happens

Research support: Behavioural experiments are core to CBT and exposure therapy. They directly challenge avoidance and build evidence against catastrophic beliefs.

Tips:

• Start small—don't pick the scariest experiment first
• Write down predictions and outcomes; your anxious brain will distort memories
• Celebrate small wins; they're evidence of courage

7. Emotion Regulation Skills (Managing Intensity)

Best for: Overwhelming emotions, impulsive reactions, emotional volatility

Therapy helps you understand emotions. But you also need tools to manage them when they spike.

STOP Skill (DBT): When overwhelmed:

• S: Stop. Physically freeze. Don't react immediately.
• T: Take a step back. Mentally and physically create space.
• O: Observe. What am I feeling? What's happening around me?
• P: Proceed mindfully. Choose how to respond, rather than reacting automatically.

Opposite Action (DBT): When your emotion doesn't match the situation, act opposite to the emotional urge:

• Fear urges avoidance → Approach (when fear is disproportionate)
• Anger urges attack → Be gentle
• Shame urges hiding → Engage socially

Ride the Wave: Emotions are like waves—they rise, peak, and fall. You don't have to do anything. Notice the sensation building, stay with it (breathe, ground yourself), and wait for it to crest and recede.

Most intense emotions peak within 90 seconds if you don't fuel them with rumination.

Research support: DBT skills (developed by Marsha Linehan) are evidence-based for emotional regulation, particularly in borderline personality disorder, but effective for anyone struggling with intense emotions.

Tips:

• Print out skills summaries and keep them accessible (phone, wallet, fridge)
• Practice when emotions are mild, so skills are available when emotions are intense

8. Relationship Skills Practice (Interpersonal Work)

Best for: Communication, boundaries, conflict resolution, assertiveness

If therapy explores relationship patterns, between-session practice means doing relationships differently.

DEAR MAN (DBT Assertiveness): To ask for what you need or set a boundary:

• D: Describe the situation (facts, no judgment)
• E: Express how you feel
• A: Assert what you need/want
• R: Reinforce (explain positive outcome)
• M: Mindful (stay focused, don't get derailed)
• A: Appear confident (body language, tone)
• N: Negotiate (be willing to compromise)

Example: "When you cancel plans last-minute (Describe), I feel disappointed and unimportant (Express). I need more notice if plans change (Assert). That way I can manage my time and feel respected (Reinforce)."

Boundaries Practice: Identify one boundary you struggle to maintain. Practice saying no:

• "I can't take that on right now."
• "That doesn't work for me."
• "I need to think about it."

You don't need elaborate justifications. "No" is a complete sentence.

Research support: Assertiveness training and interpersonal effectiveness skills improve relationship satisfaction, reduce conflict, and increase self-esteem.

Tips:

• Rehearse scripts before difficult conversations
• Start with low-stakes situations (saying no to a telemarketer before saying no to your mum)
• Notice that the world doesn't end when you assert your needs

Building a Between-Session Practice

Start Small: Don't try all eight practices at once. Choose one that addresses your current biggest challenge. Do that for two weeks. Then add another.

Consistency Over Intensity: Ten minutes daily beats one hour weekly. Your brain learns through repetition, not marathon sessions.

Pair with Existing Habits:

• Journal after morning coffee
• Grounding practice after brushing teeth
• Thought record before bed

Habit stacking makes new practices stick.

Track (Gently): Notice: "Did this help? Did I feel different afterwards?" You're not aiming for perfection—you're gathering data.

Be Compassionate When You Forget: Life happens. You'll skip practices. That's normal. The question isn't "Did I do it perfectly?" It's "Can I start again today?"

When Between-Session Work Feels Impossible

If you struggle with homework:

• Depression: Energy is scarce. Do the absolute minimum. One sentence of journaling. One grounding breath.
• ADHD: Executive function is hard. Set alarms. Use apps. Do practices with someone (body-doubling).
• Trauma: Some practices may feel activating. Go slower. Work with your therapist to adjust.
• Perfectionism: You're waiting for the "right" way to do it. There isn't one. Messy practice beats perfect non-practice.

Discuss struggles with your therapist. They can adapt approaches to fit your brain and life.

Final Thoughts

Therapy gives you the map. Between-session work is how you walk the territory.

Your therapist can't do the changing for you. They can witness, guide, challenge, and support—but ultimately, you're the one living your life. You're the one who has to practice new ways of thinking, feeling, and behaving until they become second nature.

That's not a burden. That's empowerment. You're not a passive recipient of therapy. You're an active participant in your own transformation.

And every small practice—every thought record, every moment of self-compassion, every boundary you set—is a vote for the person you're becoming.

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Want support building a therapeutic practice between sessions? I'm Annabel Kicks, a BACP-registered therapist in Fulham, London, offering in-person and online therapy. I help clients develop practical between-session skills tailored to their unique challenges and lifestyles. Book a free 15-minute consultation to discuss how we might work together.