Patient Instructions (CBT Homework Plan/Review)

Visit Info

Date: [session date]

Clinician: [name, credentials, and clinic contact]

Next Appointment: [date/time if scheduled]

(If next appointment is not yet scheduled, omit the line above or note the plan to schedule.)

Today's Focus

[1–3 sentence summary of what was worked on and why the homework connects to it]

(Use "you" language. Name the target mechanism in patient-friendly terms, e.g., "reducing avoidance," "breaking the rumination cycle." Include a brief goal if one was discussed.)

Homework Review

(Include this section only if prior homework was assigned. Omit entirely for intake sessions or when no prior homework existed.)

[Prior assignment name]

• What you tried: [brief recap of what was attempted]
• What you noticed or learned: [key observations or takeaways]
• Barriers: [obstacles that got in the way]
• Adjustments we made: [changes agreed upon for next time]

(Repeat assignment block as needed. If patient cannot recall specifics, document this neutrally and note the plan to simplify tracking.)

Your Practice Plan

(Include 1–3 assignments. If no homework is assigned this week, state this explicitly with a brief rationale and note what will happen next session.)

[Assignment name]

Why this helps: [1–2 sentences linking the practice to today's focus]

What to do:

• [specific action or steps]
• [when: days/times or routine slot]
• [where: location or context]
• [how long: duration or target number]

Minimum version: [smallest useful dose that still counts]

How to track: [what to record and where]

Safety note: [clear limits and stop rules]

(Include Safety note only for exposure work, activity changes, or emotionally activating tasks. Repeat assignment block for each additional assignment. Emphasize that partial completion is useful information, not failure.)

If Things Get in the Way

• If [anticipated barrier], then [specific action or fallback].
• If [anticipated barrier], then [specific action or fallback].
• If [anticipated barrier], then [specific action or fallback].

(Include 2–4 realistic barriers with concrete, specific workarounds.)

What to Bring Next Time

• [artifacts to bring: logs, worksheets, app screenshots]
• [what will be reviewed together]
• [likely focus for next session, if helpful for continuity]

If You Need Support Before Next Session

(Include only when clinically indicated—elevated risk, emotionally activating homework, or per local policy. Omit otherwise.)

• Coping steps to try: [2–3 brief strategies]
• Clinic contact: [phone/email and business hours]
• After-hours or crisis support: [crisis line and emergency instructions per local policy]