Between-Session Support Tools: What Therapists Need

Between-session support tools are resources a client uses outside appointments to carry the work of therapy into daily life. The most useful ones meet the client in the moment an urge, spiral, or compulsive check is happening, not only afterward. That timing is what matters. Most digital tools extend the session into reflection and homework. A between-session tool built for the moment itself reaches the client when insight alone has not been enough.

Paused is a real-time emotional urge awareness tool built for the seconds between a client’s urge and their action, the moment a therapist cannot see and homework does not reach. This guide covers what tools therapists can use between sessions, which frameworks those tools should support, how to evaluate one, and how to introduce it to a client.

Between-session support tool, defined: A between-session support tool is a resource a client uses outside scheduled sessions to practice skills or manage a pattern. The most clinically useful type meets the client inside a real-time emotional urge and offers a brief pause before they act, distinct from journaling apps, which are retrospective, and meditation apps, which are too slow for an acute moment.

What Happens Between Sessions that you Can’t See?

A weekly session covers 50 minutes. The urge to check, reach out, or spiral does not wait for an appointment. For clients with anxious attachment or limerence, the highest-risk moments rarely happen in the room. They happen at 11pm, after a text goes unanswered, after a name appears in a notification. You hear about these moments days later, filtered through memory and whatever meaning the client has already assigned to them.

This is a structural limit of session-based care, not a failure of the therapy. 

The client has the insight. They do not have it at the moment they need it.

Why Does Timing Matter More Than Insight?

Clinicians have long known that skills learned in a calm room do not automatically transfer to a distressed moment at home. DBT addressed this directly. Marsha Linehan built in-the-moment skills coaching into standard DBT as its own treatment mode, because clients needed help applying skills when urges were strongest, not a week later.

Digital health research has since formalized the same idea. Inbal Nahum-Shani and colleagues describe the just-in-time adaptive intervention (JITAI) as an approach designed to provide the right type and amount of support at the right time, adapting to a person’s changing internal state and context. Their 2018 framework, published in Annals of Behavioral Medicine, identifies vulnerable moments as the points where support matters most. It also names a gap the field still faces: the technology to deliver support at the right time has outpaced evidence on how to design it well.

For the client who keeps checking an ex’s profile, the vulnerable moment is easy to define. It is the ten seconds after the urge arrives. That is the window a between-session tool has to reach.

What Tools Can Therapists Use Between Sessions?

Therapists use five main kinds of tools between sessions: mood and journaling trackers, meditation and mindfulness apps, skills apps and digital workbooks, coaching or messaging access, and real-time pause tools. Each fits a different need. Trackers and workbooks support reflection and practice; real-time pause tools reach the client in the moment an urge happens.

Paused sits in the last category. None of these replace what happens in your office. What they can do is extend a piece of the work into the hours you do not see.

Which Clinical Frameworks Should a Between-Session Tool Support?

The strongest tools are built around frameworks you already use, not around a separate philosophy competing with yours.

Urge surfing

Developed by psychologist G. Alan Marlatt at the University of Washington as part of his relapse-prevention model, urge surfing asks a person to observe an urge rising and falling like a wave, instead of acting on it or trying to suppress it. Sarah Bowen and Marlatt tested a brief urge-surfing instruction in a 2009 study and found it reduced how many cigarettes participants smoked in the following week, even though it did not immediately change how strong the urges felt. That distinction matters clinically: the goal is not a weaker urge in the moment, it is a different response to it. The technique is now part of mindfulness-based relapse prevention and fits with DBT distress tolerance and ACT willingness work, which is why it transfers well to checking and reaching-out urges. More on the client-side experience in urge surfing for relationship anxiety.

Pattern interruption and DBT distress tolerance

The logic behind DBT’s STOP skill is simple: insert a step between impulse and action. Each step lengthens the gap, even by a few seconds, which is often enough for the client’s own coping skills to catch up.

ACT defusion

ACT frames intrusive thoughts as mental events, not commands. A tool that prompts a client to notice “I’m having the thought that I need to check” supports defusion without asking them to argue with the thought.

ERP, with one caution

For clients whose checking has an obsessive-compulsive quality, including relationship-focused checking and limerence, exposure and response prevention is often part of treatment. Brandy Wyant’s 2021 case study on treating limerence with CBT relied heavily on Exposure and Response Prevention (ERP). Here a between-session tool needs care. Any tool that offers reassurance, answers the “did they mean it?” question, or becomes something the client must check can turn into a new compulsion. A tool that supports ERP holds space for the uncomfortable feeling without resolving it.

How is this Different From Assigning Homework?

Homework matters. Kazantzis, Whittington, and Dattilio’s 2010 meta-analysis found that homework in cognitive and behavioral therapy is associated with better outcomes, and that clients who engage more with between-session assignments tend to do better. The problem the field has never fully solved is adherence. Clients forget, avoid, or never open the workbook, and the moments when they most need a skill are the moments they are least able to go find it.

A 2025 co-design study of ACTaide, a therapy companion app built with both therapists and clients, found the two groups wanted different things from the same tool. Therapists prioritized clinical appropriateness and accessibility. Clients wanted more interactivity and less friction at the moment they needed it.

That gap, between what is clinically sound and what a client will reach for at 11pm, is the central design problem for any between-session tool.

A tool built specifically for the urge moment avoids part of the adherence problem. There is no workbook to remember. The trigger is the reason the tool exists.

What Should you Look for Before Recommending an App to a Client?

You are vouching for anything you recommend. These eight questions cover the areas clinicians most often raise, and they align with broader app evaluation approaches such as the American Psychiatric Association’s App Evaluation Model.

1. Does it name its scope accurately? An awareness or skills tool should say so. Be cautious of anything that implies diagnosis or treatment. That is a scope problem, not a features problem.
2. Does it support your framework or compete with it? Tools built on urge surfing, DBT, ACT, or ERP principles extend your work. Tools with their own competing philosophy can create friction in session.
3. Is it built for the moment or for reflection afterward? Both have value. Know which problem your client has.
4. How many steps does it take to reach help mid-urge? Test it yourself. If it takes more than a few taps when you are calm, it will take longer under distress.
5. Could it become a new checking behavior? For clients with obsessive or reassurance-seeking patterns, ask whether the tool resolves uncertainty for them. If it does, it may reinforce the loop you are working on.
6. Does it give you visibility, and only with consent? Pattern data such as frequency, time of day, and what preceded an urge can sharpen sessions. The client should control whether it is shared.
7. Can you explain the privacy model in plain terms? Read the privacy policy. Know what is stored, where, and who can see it.
8. Is there a clear crisis pathway? A real-time tool is not a crisis service. It should say so and direct users to appropriate help.

Which Clients Benefit Most From a Between-Session Tool?

The clearest fit is the client who describes knowing better in the moment and acting anyway. They can name the pattern in session. They can explain why they check an ex’s profile, re-read a thread, or send the text. And they still do it. For these clients the gap is timing, not insight, and that is the gap a real-time tool addresses.

This commonly includes clients working on anxious attachment, limerence, breakup-related checking, reassurance-seeking in relationships, and impulsive messaging. Recent research supports attention here: Evans and colleagues’ 2026 study of 1,647 people found limerence associated with insecure attachment and obsessive-compulsive thinking traits, and called for evaluation of psychotherapy approaches targeting it.

When a real-time tool is not the right fit

• Clients at acute risk, where a safety plan and crisis resources come first.
• Clients for whom logging or tracking has itself become compulsive.
• Clients who would experience any pattern visibility as being monitored, where the tool could strain the alliance.
• Situations where the urge involves safety concerns for others, which call for clinical assessment, not self-directed tools.

How Do you Introduce a Between-Session Tool to a Client?

How a tool is introduced shapes whether it gets used. A short, collaborative introduction tends to work better than a recommendation at the end of a session.

1. Name the pattern together. Use the client’s own language: “the checking,” “the 11pm thing,” “when I end up in his profile.”
2. Locate the moment. Ask when it usually happens, what comes right before it, and what the first sign is. This defines the moment the tool is for.
3. Frame it as an experiment. “Let’s see what happens if there’s something between the urge and the check this week.” This lowers pressure and makes a missed moment information, not failure.
4. Agree on what is shared. Decide together whether any pattern data comes into session, and make clear the client can change that at any time.
5. Walk through it once in session. A brief practice run in the room makes it easier to reach for later.
6. Review at the next session. Start with curiosity: when did the urge come, what happened, what was different.

How Can you Use Between-Session Pattern Data in Session?

When a client chooses to share it, pattern data turns “I had a hard week” into something specific. Questions that tend to open useful conversations:

• What time of day do the urges cluster? What is usually happening then?
• Which triggers show up most: a notification, a memory, a quiet evening, alcohol, a specific person’s activity?
• Were there moments the pause held and moments it did not? What was different?
• Is the frequency changing over weeks, even if single urges still feel strong?

The data informs your clinical judgment. It does not replace it.

Where Paused Fits Between Sessions

Paused is a real-time emotional urge awareness tool, not a mental health application and not a substitute for therapy. It is built for the moment a client is about to check, re-read, or reach out, the moment that is hardest to bring into session because it is already over by the time you are talking about it. It is grounded in urge surfing and pattern interruption, so it supports DBT, ACT, and CBT approaches instead of competing with them.

For practitioners, that means clients have something concrete to reach for between appointments, and, with their consent, pattern visibility that makes the next session more specific. You can read how Paused works for therapists and apply to the Paused practitioner beta. To see the client-facing experience first, the individuals page covers early access for the version your clients would use.