What 104 Therapists and Allied Practitioners Said About Between-Session Follow-Through

What 104 therapists and allied practitioners told us about the practices associated with visible follow-through, the reasons most clients skip them, and how certain types of activities help.

About this study

Therapists often provide their clients with between-session homework. When a counselor suggests a breathing exercise before bed, or a five-minute walk after a tense meeting, the suggestion is a real clinical judgment. When clients ignore most of the follow-up suggestions, the question worth asking is why.

This report addresses that single, specific problem. There is broad practitioner consensus on which between-session practices help. There is much thinner public data on why so few clients actually follow through, and what, if anything, closes the gap. To narrow the second question, Olander Earthworks ran a short, anonymous survey of 104 working practitioners in April 2026. The survey panel was collected through self-reported occupational roles using Prolific. This report is the result. 

This is a small, anonymous, self-reported practitioner survey, not a clinical trial, not nationally representative, and not evidence that Olander products produce therapeutic outcomes.

Executive summary

Five primary findings emerged. 

1. The practices that work involve the body.

A walk. A breath. A hand on a page. A voice on the phone. The four practices therapists most often rank as producing visible week-over-week progress are the four that put the body in motion or in contact. They are embodied recommendations. A second cluster, creative, artistic, tactile, sensory, extends the same principle: 26 percent of therapists rank one of these in their top three, and 64 percent rank one in their top five.

2. Most clients do not actually do them.

Of the 104 practitioners surveyed, 73 said fewer than half of their adult clients consistently follow through on between-session recommendations. That is 70 percent. The follow-through gap is the median experience, not an outlier.

3. The main reason clients do not follow through is forgetting.

Sixty-five percent of practitioners chose “client forgets” as one of the top two barriers to follow-through. Add “no physical cue or reminder,” and the number rises to 74 percent. Three in four practitioners point to a barrier with a behavioral fix versus a willpower fix.

4. Under two minutes is the ideal between-session practice length. 

Ninety-two percent of practitioners say it is at least somewhat important that a between-session practice fit in under two minutes. More than half call brevity essential or very important. Anything longer is, for most clients, an aspiration.

5. Most therapists recommend activities with physical, sensory or tactile elements.

Eighty-six percent of practitioners would recommend at least one kind of physical tactile object to a client. Combine the two categories most associated with sustained palm contact, textured objects (smooth stones, ridged grips) and sand trays, and 59 percent of practitioners recommend at least one of them. Tactile and sensory tools are recommended by the majority.

Finding 1. The practices that work involve the body.

Sit down with a hundred therapists. Ask each one to rank the kinds of between-session practices that produce the most visible progress. You will get a short list.

Movement comes first. Seventy percent of practitioners ranked physical movement or exercise in their top three. Twenty-nine put it at number one outright. Three categories cluster behind it: breathing exercises (56 percent top-three), journaling or writing (56 percent), and social connection (47 percent). Below those four, the per-category numbers thin: nature exposure (22 percent), app-based meditation (21 percent), creative or artistic activities (19 percent), and tactile or sensory practices (9 percent).

The creative-tactile cluster is more substantial than the per-category numbers suggest. Twenty-seven percent of therapists rank a creative, artistic, tactile, or sensory practice among the three most visibly effective. Two-thirds rank one in the top five. They are what therapists reach for when the question shifts from the single most powerful intervention to the working set a clinician keeps within arm’s reach.

The four practices at the top of the list are simple. None of them needs equipment. None needs a coach. None requires the client to learn anything new. A walk. A breath. A sentence. A phone call. These are the things working therapists watch for to produce visible week-over-week change.

The four at the top are also short, or can be made short. A walk can be five minutes. Breathing can be six exhales. A journal entry can be one line. The practices that produce visible progress are not the ones that take an hour. They are the ones that fit between things.

Finding 2. Where it breaks down

Picture 100 adults walking out of a therapy session with a clear assignment. The therapist explained it. They practiced it together. The client agreed it made sense.

By the next session, most of them have not done it.

That is the headline number from this survey. Of the 104 practitioners who answered, 73 said fewer than half of their adult clients consistently follow through. Nineteen of those said fewer than a quarter do. Only three out of 104 said more than three-quarters of their clients follow through.

This is the typical case.

The follow-through gap is what the rest of this report explains. The practitioner believes the recommendation can help, the client agrees it is worth trying, and still it often does not happen. 

The next two findings explain why.

Finding 3. The primary reason for lack of follow-through is forgetting.

We asked practitioners to choose up to two barriers from a list of seven. Two answers came up most often. Sixty-five percent picked “client forgets.” Sixty-two percent picked “lacks motivation between sessions.” A second tier followed: “doesn’t believe it will help” (31 percent), “no physical cue or reminder” (27 percent), “feels awkward or self-conscious” (22 percent), and “not enough time” (20 percent).

Three out of four therapists are pointing at the same problem. The problem shows up at the moment the breathing exercise would help, in the kitchen at seven, in the car after a hard call: the recommendation is gone from their mind. 

This is a behavior-design problem. The fix is to make the practice present at the moment the client needs it.

Finding 4. Under two minutes is the ideal between-session practice length. 

Most adults have one window in their day when a between-session practice is realistic. The window is short. Usually under two minutes.

We asked practitioners how important it is that a between-session practice fit in under two minutes for clients to actually do it. The answers, in descending order: somewhat important (41 percent), very important (34 percent), essential (17 percent), not very important (7 percent), and not important at all (1 percent).

Ninety-two percent of practitioners say brevity is at least somewhat important. A majority, 51 percent, treat it as very important or essential.

A practice that takes ten minutes of uninterrupted attention is something most clients will mean to do. A practice that takes fifteen seconds is something they actually do.

Finding 5. Most therapists recommend activities with physical, sensory, or tactile elements.

When a therapist hands a client an object, a stress ball, a fidget cube, a smooth stone, they are doing something specific. They are giving the practice a body.

Most therapists in this survey have done that.

We asked which kinds of physical tools or objects practitioners are likely to recommend. They could pick more than one. The results, in descending order: fidget objects like spinners and cubes (64 percent), stress balls (61 percent), textured objects like smooth stones or ridged grips (54 percent), and sand trays (21 percent). Thirteen percent said they would not recommend any physical tool.

Recommending a physical tool is the norm for practitioners. Eighty-six percent of the sample would recommend at least one category. 

The tactile-and-sensory category is broad. Fidgets and stress balls answer one kind of need: a quick release of motor tension. Tactile and sensory tools answer another: an object to hold while doing something else, an anchor for attention rather than an outlet for it.

Method, sample, and limitations

One hundred and four practitioners completed the survey. The single largest group was allied wellness practitioners, occupational therapists, somatic practitioners, and the like, with 28 respondents. Licensed Professional Counselors and Licensed Clinical Social Workers tied at 17 each. Pre-licensed clinicians and licensed clinical psychologists round out the licensed-therapist subgroup. The full breakdown is below.

Practioner Roles

 

Practitioner experience

Forty-eight percent of respondents have five or more years of experience in their current role. The sample leans toward early- and mid-career practitioners, which is consistent with the national age distribution of the licensed mental-health workforce.

How to cite this report

Olander Earthworks. (2026). What 104 Therapists and Allied Practitioners Said About Between-Session Follow-Through. Field period April 26–28, 2026; n = 104.

Sponsorship and access

Olander Earthworks commissioned and funded this study. The questionnaire, anonymized response data, and full open-response excerpts are available on request for editorial verification.

About Olander Earthworks

Olander Earthworks is the original creator of the Wonderscape: a round Baltic birch tray of shallow sand with hand-carved designs reproduced as durable concrete objects you roll across the surface to create beautiful, impermanent textures. Patterns follow your path around the tray. No claims of clinical efficacy are made or implied. Olander Earthworks does not provide medical or mental-health advice and is not a substitute for licensed care.