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Free Clinician Tool · 5 min

The Between-Session Engagement Self-Audit

Ten questions to tell you whether your between-session work is actually reaching clients in the 167 hours — or just generating activity that looks like engagement. Run it on your own caseload. It's diagnostic, not a grade.

Matthew Sexton, LCSW, NATC Read the full guide →

How to use it Answer each question honestly about your typical caseload — not your best client, not your hardest. There's no score to hit. The pattern of your answers is the signal: if most of them point to "scheduled, in my language, only works when they're calm, and I'm not really in the loop," your between-session work is meeting the calm of the office, not the 167 hours where the pattern actually lives. — Matthew Sexton, LCSW, NATC
  1. Can your client name the pattern in their own words — without your handout in front of them?
  2. Does what you've given them work in an activated state, or only a calm one?
  3. When the pattern fires midweek, is there anything reachable in the moment — or only the memory of last session?
  4. Is the between-session practice in the client's language, or in your clinical vocabulary?
  5. Does the work carry material back to you, or send the client somewhere else with it?
  6. Have you ever actually asked what they did — or didn't do — and why, without it landing as a test?
  7. Are you assigning tasks, or building something the client co-owns?
  8. Does your between-session approach assume a regulated nervous system that may not be available?
  9. If a client is blended or shut down at 11pm, is there a path back to one degree of choice?
  10. Is whatever you use HIPAA-compliant, and does it keep you — the clinician — in the loop?

Reading your answers

Mostly "yes, in their words, reachable in the moment, routed back to me": your between-session work is meeting the 167 hours. Keep going — and notice what makes it portable, because that's the thing to replicate across the caseload.

Mostly "scheduled, in my vocabulary, only works when they're calm, and I'm not in the loop": that's not a client-motivation problem. It's a design problem the whole field is sitting in — and it's fixable. The fix is to co-build something small, in the client's own words, reachable while activated, that carries back into the room.

The questions map onto the deeper write-up: why insight doesn't survive the week, why generic homework fails, and the line between a clinical mirror and an AI chatbot. If a question stung, the section that explains it is in the full guide.

Where each question comes from

This audit is the condensed, runnable version of a longer clinician-to-clinician piece. If you want the reasoning under each question — the state-dependent learning behind Q2–Q3, the adherence design behind Q4–Q7, the nervous-system read behind Q8–Q9, and the HIPAA/clinician-in-the-loop line behind Q10 — those live across the between-session field notes:

Free to use, print, or share with colleagues. If you reference it, a link back to this page is appreciated.

About the author

Matthew Sexton, LCSW, NATC, is a practicing psychotherapist in private practice working with adults across attachment, Internal Family Systems (IFS), and nervous-system regulation frames. He built VibeCheck, a HIPAA-compliant between-session mirror, for his own caseload: a clinical tool for the 167 hours between sessions. It is not an AI therapist, not a chatbot, and not a replacement for the clinician — it's a way to extend the holding of the therapeutic relationship into the hours you're not in the room together.

Built by a clinician, for the 167 hours you're not in the room.

See the founding cohort →