Do I have to go to therapy every week?

I had a consultation recently where someone said that every therapist they had spoken to only offered weekly sessions in the same fixed slot. I understood why that felt difficult not because weekly therapy is wrong or that fixed slots are bad; there are really good reasons why many therapists work that way. However, I also heard something underneath it... A sense of, “Is therapy something I’m allowed to fit into my actual life, or do I have to rearrange myself around it?”... that feels important to talk about.

Why do so many therapists offer weekly sessions?

Weekly therapy is very common, and it’s not just therapists being awkward for fun. Although, as a profession, we do enjoy a boundary.

A regular weekly session can create rhythm... It gives the work a sense of continuity. You don’t have to spend half the session trying to remember where you left off, the relationship has time to build and things that come up during the week can be brought into the room while they still feel alive and emotionally connected.

For some people, especially at the beginning of therapy, that consistency can feel containing. There is something powerful about knowing: “I have this space every week. I don’t have to hold everything alone until I’m desperate.”

Research does support the idea that session frequency can matter. A study by Tiemens et al. (2019) found that lower frequency in the early stages of therapy may be linked with less favourable outcomes and a more chronic course of difficulties. Robinson et al. (2020), also highlighted that therapy “dose” - including things like frequency and number of sessions - is an important part of understanding how people improve in therapy.

So when therapists suggest weekly sessions, it often comes from a thoughtful place. It can support momentum, safety, and the development of the therapeutic relationship.

And you've heard me say this many many times - the therapeutic relationship matters. Flückiger et al. (2018) found that the therapeutic alliance (the quality of the working relationship between therapist and client ) is a consistent predictor of therapy outcomes across different therapeutic approaches.

So no, weekly therapy isn’t some random therapy rule invented in a room full of clipboards.

There is a reason for it.

But... therapy every week is not the only meaningful way to do therapy

Here’s where I think the conversation needs more nuance because “weekly therapy can be helpful” is not the same as “weekly therapy is the only valid option.”

Research also points towards individual differences. Lin et al. (2024), looking at weekly and fortnightly therapy, found that weekly therapy was associated with a higher chance of early improvement for some clients but the study also highlighted that people do not all follow the same pattern of change, and that session frequency may need to be adjusted depending on the person.

Which makes sense, doesn’t it?

Some people come to therapy wanting weekly support because life feels very intense and they need regular contact. Some people need space between sessions to process, reflect, and notice what comes up. Some people want therapy, but weekly sessions are financially difficult. Some people work shifts. Some have childcare responsibilities. Some have caring roles. Some have health conditions. Some are just living very full, slightly chaotic, very human lives.

I don’t think therapy should become another place where people feel like they have failed before they’ve even begun.

Why flexibility matters in my work

One of the things I value deeply in therapy is autonomy. That means I don’t want therapy to feel like something being done to you. I don’t want you to feel managed, pushed, or quietly told off for not fitting neatly into a structure.

Therapy, for me, is collaborative. It’s something we work out together and that includes what we talk about, the pace we go at, what feels useful, what doesn’t.....And yes, how often we meet.

For some people, weekly sessions are absolutely the right fit. They can help build trust, create a steady rhythm, and keep the work moving. For others, fortnightly sessions feel more sustainable. They offer enough consistency without therapy becoming financially or emotionally overwhelming. For some returning clients, or people doing longer-term reflective work, a more flexible rhythm might make sense at different points.

And sometimes the answer changes.

You might start with therapy every week and later move to fortnightly. You might come fortnightly and realise you need a bit more support for a while.You might pause and return. You might not know what rhythm suits you until we’ve had a few sessions and can talk honestly about how it feels.

That is allowed.

Flexibility in couples therapy

This comes up in couples and relationship therapy too. When there are three people involved — two clients and me — finding a regular time that works for everyone can be a little bit like trying to organise a group holiday where nobody wants to be the difficult one....

Work schedules, childcare, energy levels, travel, finances, and general life admin all have to be considered. In couples therapy, the practical barriers can be bigger because it is not just one person finding space in their week. It is two people trying to find the same space, at the same time, with enough emotional capacity to actually be present...and presence matters.

Couples therapy asks a lot of people. It can involve honesty, vulnerability, listening when you feel defensive, and trying to stay open when things feel tender or stuck. So I would rather we find a rhythm that makes it possible for both people to show up properly, instead of squeezing therapy into a slot that leaves everyone rushed, resentful, or half on the school run mentally.

That might still mean weekly sessions for some couples, especially if things feel very difficult or you want more momentum. For others, fortnightly sessions may be more realistic and sustainable.

Again, it is something we can talk about together.

Flexibility does not mean therapy is casual

I think this bit matters....When I say I offer flexibility, I don’t mean therapy becomes vague, random, or something we only think about when everything has gone a bit sideways. Therapy still needs some kind of frame. It still needs care, thought and commitment. It still helps to have a rhythm, even if that rhythm isn’t weekly. There is a difference between flexibility and drifting.

Flexibility means we make space for your real life while still taking the work seriously.

It means we can ask:

“What feels supportive right now?”

“What feels realistic?”

“Are we meeting often enough for this to feel useful?”

“Do you need more space between sessions, or more steadiness?”

“Is this rhythm helping, or has it become another pressure?”

Those conversations are part of the work too because how you relate to therapy can sometimes mirror how you relate to other things. Do you feel you have to get it “right”? Do you worry about disappointing someone? Do you say yes to something before checking whether it actually works for you? Do you feel guilty asking for something different?

Even the conversation about session frequency can tell us something useful.

So, do you have to come every week?

Nope.

Weekly therapy can be incredibly helpful. It can offer consistency, depth and momentum. But I don’t believe weekly therapy should be treated as the only serious option.

For me, the question is less: “How do we make you fit therapy?” And more: “How do we create a rhythm that supports the work, respects your life, and still feels meaningful?”

That might be weekly. It might be fortnightly. It might change over time.

Whether you are looking for individual therapy or couples and relationship therapy, part of the conversation can be about what kind of rhythm feels supportive, realistic and sustainable for you.

You do not need to know exactly what you need before reaching out. Sometimes that is part of what we figure out together.

References (for all the serious intelligent stuff)

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340.

Lin, T., Heckman, B. D., & Anderson, T. (2024). Trajectories of change in weekly and biweekly therapy. Psychotherapy Research.

Robinson, L., Delgadillo, J., & Kellett, S. (2020). The dose-response effect in routinely delivered psychological therapies: A systematic review. Psychotherapy Research, 30(1), 79–96.

Tiemens, B., Kloos, M., Spijker, J., Ingenhoven, T., Kampman, M., & Hendriks, G. J. (2019). Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course: A naturalistic cohort study. BMC Psychiatry, 19, 228.