The Wait

Is twice-a-week therapy better than once a week?

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Short answer

For the acute phase, twice a week may help you turn the corner faster. In a 2020 randomized trial of 200 depressed adults, twice-weekly therapy cut symptoms more at six months than once-weekly, with fewer people dropping out. It measured speed and staying power, not a long-term promise.

The research
Bruijniks, S. J. E., Lemmens, L. H. J. M., Hollon, S. D., Peeters, F. P. M. L., Cuijpers, P., Arntz, A., and colleagues (2020). The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients. The British Journal of Psychiatry, volume 216, issue 4, pages 222 to 230.
Sample 200 adults with depression across nine specialist mental health centres in the Netherlands
Published 2020
Journal The British Journal of Psychiatry
Sanne Bruijniks and colleagues ran a multicentre randomized trial in the Netherlands to test a plain question: does seeing people twice a week instead of once help? From 2014 to 2017 they enrolled 200 adults with depression at nine specialist mental health centres and randomly assigned them to once-weekly or twice-weekly sessions of either cognitive behavioural therapy or interpersonal psychotherapy, with a cap of 20 sessions over 16 to 24 weeks. Everyone was measured with the Beck Depression Inventory, and the team analysed all the people they randomized. The twice-weekly group improved more. At six months their depression scores had fallen further than the once-weekly group, a moderate difference of about d = 0.55. Fewer of them dropped out, 16 against 32, and they were more likely to respond to treatment, with a hazard ratio of 1.48. The kind of therapy did not matter once the frequency was matched; what moved the needle was how often people came, not whether it was cognitive behavioural therapy or interpersonal psychotherapy. Because this was a controlled trial with random assignment, it can speak to cause in a way that everyday clinic records cannot. The honest limit is that it tracked the acute phase of treatment, so it shows a faster, steadier start, not whether that early edge still holds a year or two later.
Read the paper

What does this mean for you?

Here is the plain version. How often you sit down for therapy seems to matter, at least for how quickly depression lifts. In this trial, the people seen twice a week improved more by six months than the people seen once a week. They were also less likely to quit partway through. If your clinician offers twice-weekly sessions and your life can hold them, this is a real reason to consider it.

What makes this study stronger than most on the subject is the random assignment. People did not pick their own schedule, so the twice-weekly and once-weekly groups started out alike. That lets the researchers say the frequency itself, and not some hidden difference between the groups, is what drove the gap. A large earlier study of ordinary care pointed the same way, that shorter gaps track with faster recovery, but it could not rule out that people who came more often simply differed to begin with. This trial can.

Now the honest limits, and they matter. The clear advantage was in the acute phase, the first stretch of treatment up to about six months. This study followed the faster start, not the finish line a year or two out, so it does not promise that twice-weekly care ends up further ahead in the long run. Twice weekly also was not more therapy overall. Both groups were capped at the same 20 sessions; the twice-weekly group simply packed them into a shorter calendar. And twice a week asks more of your time, your travel, and sometimes your budget, which is a real constraint, not a failing. If once a week is what fits, both groups in this trial got better.

The takeaway

Terms in this page
Between-session support Mental readiness

This is the work Asendar™ was built for: keeping the thread from one session to the next from going slack, especially when a longer gap is what your schedule allows. If you want a simple read on where your head is today, take your Mental Readiness Score.

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People also ask

Does it matter whether the therapy is CBT or IPT?

In this trial, no. Once the frequency was matched, cognitive behavioural therapy and interpersonal psychotherapy produced similar results. The difference in outcomes came from how often people were seen, not from which of the two treatments they got.

Does twice a week just mean more therapy overall?

No. Sessions were capped at 20 either way, so twice-weekly patients were not getting more therapy in total. They were getting the same number of sessions in a shorter stretch of calendar. The gain tracked with the tighter spacing, not with a larger amount of treatment.

Is this the same as the research on weekly versus every-two-weeks therapy?

It is related but stronger. A large naturalistic study found weekly clients recovered faster than every-two-weeks clients, but people there chose their own schedules. This trial randomly assigned people to once or twice weekly, so it can speak to cause, and it points the same way: shorter gaps, quicker progress.

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