Why Flexible Therapy Appointments Can Be More Client-Centred
Flexible Appointments
Over the last couple of months some of my (neurodivergent) clients provided the feedback that weekly appointments can create a pressure of attending for them. Other people told me that they would like to have fortnightly sessions as weekly sessions were not financially viable. Yet other clients told me that sometimes they felt like skipping a session because they hadn’t had enough time to process what was discussed in the previous session or they hadn’t had enough time to try different behaviours or thought patterns.
I now offer both regular protected appointments and flexible appointments that can be booked as and when needed.
At first a seemingly controversial concept, as for many people therapy works best when it offers structure, consistency, and a protected space to reflect and grow. Weekly appointments can be incredibly valuable, particularly during times of distress or when working through deeper emotional stuff. This is how therapy has always been!
At the same time, therapy is not one-size-fits-all and today’s lives are very different to when therapy first emerged and later was empirically investigated regarding its effectiveness. Also, who considered neurodivergence in their RCT(randomised control trial) of CBT?
By offering flexible appointments to clients, I want to make therapy as accessible and as sustainable for as many people as possible. And maybe because I work in this client-centred way it also means letting go of traditional ways of workingthat requires rigid weekly attendance?
Therapy Should Fit Around Human Lives
Energy levels fluctuate. School or work becomes demanding. Executive functioning varies. Finances shift. Some weeks bring emotional overwhelm, while others feel relatively stable.
For some neurodivergent clients and families, committing to a rigid weekly schedule can feel difficult or even stressful. A child, teenager, or adult with ADHD may genuinely value therapy but struggle with consistency due to fluctuating motivation, changing demands, executive functioning difficulties, emotional intensity, burnout, forgetfulness, or periods where things feel relatively manageable followed by sudden overwhelm. Similarly, an autistic young person or adult may find transitions difficult, struggle with sensory or energy demands, or experience fixed expectations as stressful. For some autistic individuals, particularly those with a PDA (Pathological Demand Avoidance) profile, even well-intentioned obligations can unintentionally create anxiety, internal resistance, or a sense of pressure. In these situations, a more flexible therapeutic approach can sometimes reduce stress and help therapy to be supportive, collaborative, and accessible.
What Flexible Appointments Do (and Don’t) Mean
Flexible appointments are booked on an as-needed basis. Because of this, appointment slots are not protected or reserved in advance. Availability may vary from week to week, and there can occasionally be longer waits during busy periods. However, if a client later decides they would benefit from more consistency, they are always welcome to discuss moving into a protected recurring slot where availability allows. The goal is to offer different pathways into care that recognise people have different needs, capacities, and circumstances.
The Rising Cost of Living
Mental health is important but affording support comes alongside phone bills, rent, groceries, childcare, and many other costs of daily life. Alongside all these, being able to afford private high-quality weekly therapy is not easy! Impossible for some. I am hoping that flexible appointments make psychological support more accessible and sustainable. Clients are able to book sessions when they have the time, space, energy and finances available to make the sessions count, rather than not accessing support at all. I think this can actually help maintain continuity of care and it also considers individual circumstances.
Autonomy Matters for Motivation
At the core of person-centred therapy is the belief that clients are experts in their own lives. Offering flexible appointments reflects this value because it allows them to have a say in when and how they engage with therapy. Rather than assuming or even dictating what somebody needs, flexibility invites collaborative decision-making. In CBT we aim to support our clients to be self-sufficient. Why not start right in the beginning by giving them a choice regarding frequency of sessions? (Cooper & McLeod, 2011)
Some people may not require weekly appointments to benefit from therapy. Instead, they can use sessions intentionally during transitions, burnout, relationship difficulties, identity exploration, workplace challenges, or moments where they feel stuck.
This can be particularly empowering for neurodivergent adults who may have had experiences of systems feeling rigid, inflexible, or not designed with their needs in mind.
And when the client then comes into session they are much more motivated and able to do deep and meaningful work that may be more in line with manualised therapies like CBT.
Therapy Works Best When the Relationship Works
For most (neurodivergent) young people, therapy is most effective when it feels collaborative rather than imposed.Research suggests that clinicians are more likely to build strong therapeutic alliances with young people when they collaborate with them, explore their subjective experiences, find common ground, and avoid overly directive approaches or pushing them to talk before they are ready (Orlowski, Bender, Karver; 2023). Protecting engagement matters more than protecting a manualised schedule. Helping a young person remain connected to support in a way that feels manageable and sustainable is what matters.
Research shows that the therapeutic alliance, including the sense of trust, collaboration, agreement on therapeutic goals and tasks, and feeling understood, is associated with better outcomes in child and adolescent therapy (McLeod, 2011; Roest et al., 2023). CBT, DBT, ACT, and other evidence-based approaches only work when a young person feels engaged enough to participate.
Skills are important. Strategies are important. But without trust, collaboration, and emotional safety, even the besttherapeutic techniques can struggle to land. I know this both from research and experience.
Neurodivergent Young People Often Benefit from Flexibility
Lastly, clinical guidance increasingly recognises that neurodivergent young people may benefit from adapted approaches to therapy.
For example, NICE guidance (CG142 & CG 170) recommends adapting CBT for autistic children and young people through adjustments to pacing, communication style, structure, visual supports, and parent involvement where appropriate. Rather than expecting the young person to adapt to therapy, therapy should adapt to the young person.
In practice, this means being flexible about how and when support happens. Sometimes, flexible support can increase engagement, reduce avoidance, and help therapy feel safer and more accessible.
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I look forward to hearing from you!
