Whether you are having trouble opening up during your first few sessions, or you’ve been going to therapy for a while and feel like you’ve “run out” of things to say, know that you aren’t alone.  Clients tell me often that they aren’t sure what to talk about.  There’s really no right or wrong when it comes to what to focus on in therapy - often the feelings lead you to the work you need to do.  

But if you feel stuck, here are 6 ideas that you can refer to before a session as you consider what you need support around.

1. “Small” issues

It’s easy to feel like you need to talk about “deep” or “serious” issues in therapy But remember, there’s no “correct” topic to discuss in therapy. You can talk about whatever you want.

True, some people come to therapy to address something specific, like anxiety or depression. But sometimes, people are just going through a life transition and want someone to talk with and help them cope with the change.

People talk about everything in therapy. They talk about their hopes, dreams, fears, disappointments, hurts, shame, conversations with their mom, interactions with their partner, perceived failures as a parent, sexuality, [or] their most recent date.  I’ve also had clients talk about their gardens, hobbies, athletics, trips…nothing is off limits.

Not sure where to start the session? Begin by recapping what happened since you last saw your therapist — good and bad — and from there, see what you want to explore further together.

2. Patterns and behaviors

It may be a good idea to track your thoughts, patterns, and behaviors by keeping a journal between therapy sessions. This can be especially helpful if you find it difficult to remember things on the spot.

Of course, you don’t have to bring your journal with you or read from it in session. But writing things down allows you to look for patterns in your feelings and behaviors that you might want to address with your therapist.

For instance, a person may observe that they have been feeling inadequate or insecure and this would be a good thing to address with their therapist.

3. Present feelings

You might have felt sad, angry, or depressed during the week, but if you’re not feeling that way right now, you don’t have to start with that. Focus on how you’re feeling in the present, and just say how you feel — even if what you’re feeling is just, “I didn’t really want to take this hour for therapy today because I’m slammed at work.”

The truth is, what you need from therapy changes day to day. It’s OK if you went in thinking you’d talk about your relationship and instead spent the whole session venting about your boss.  You get out of therapy whatever you are most needing that day.  And sometimes, you just need the space to vent.

4. Rumination

Depression and anxiety can both involve rumination, or a tendency to go over the same thoughts repeatedly.

If you had a hard time falling asleep one night this week because your mind wouldn’t stop thinking about something you wish you’d done or you worried about something coming up, that’s often a great place to start your session.

5. Relationships

This doesn’t just mean your love life. Tell your therapist about all your relationships, whether that’s your partner, your family, or your friends.

Do you feel like you have support at home? Do you feel like you have other people to share your feelings with, or do you have difficulty opening up with others too, not just your therapist?

Relationships are important to your mental health, and they play an important role in affecting your mood and feelings on a day-to-day basis.

So, if you’ve been avoiding your mom’s calls, even though you love her, let your therapist know, and maybe you two can explore why you’re avoiding her.

Even if you feel like you have good relationships, talking about them might help you realize the things that are working in your life — and the resources you can lean on out of session.

6. Past traumas

This one might sound obvious, but the truth is, if you’ve been focusing on your present in your last sessions, you might not have gotten around to filling in your therapist on your past.

For example, maybe you’ve spent your last month telling your therapist about your current relationship troubles, but you’ve never discussed your past relationships or your parent’s marriage.

Taking a moment to step back from your present and choosing to talk about your past could help you address some feelings you’ve been bottling up or left unresolved.

The bottom line

There is no right or wrong way to show up to a therapy session.  With time, you should start to feel like you can be yourself and become more comfortable opening up if it’s a good fit between you and your therapist.  Surrender to the moment and enjoy the journey of growth wherever that leads you.