Unsure What to Talk About in Therapy? Here Are 10 Ideas That Might Help
Key takeaways:
When you’re starting or continuing therapy, think about your goals and what you want to get out of your sessions.
Therapists have different approaches. Some may ask you to guide the conversation, while others may suggest areas to focus on.
Topics for therapy can vary from everyday problems to deeper issues. You may stay on one topic for several sessions or change topics week to week.
Meeting with a therapist can be a bit scary. After all, the focus will be all on you. This can be a strange experience, especially at first. You may feel like you’ll be put on the spot or that your therapist will be grading you.
Many people have these concerns. But keep in mind that your therapist works for (and with) you. It’s not their job to judge or compare you to others. Instead, they are there to accept you, support you, and help you with your goals.
The therapeutic relationship
How you and your therapist get along is an important part of therapy. This connection is called the therapeutic relationship. When you form a strong and trusting relationship, you and your counselor can work as a powerful team.
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This isn’t the same as having a friend because your therapist is in a different role. They won’t share many details about themselves, for example. They also have years of training and experience to help guide your treatment.
But having a good connection can make you more comfortable during this process. Research also shows that a strong relationship with your therapist helps you get the most out of therapy. Like with other relationships, this will grow with time as you get to know each other.
What to expect in therapy
So what exactly is supposed to happen in therapy? What will the first session be like? This can vary quite a bit, and it will depend on you and your counselor.
Many therapists start with an interview or assessment within the first few sessions. They may ask you questions about yourself and your background. This will help them direct the process going forward. After the first few sessions, you’ll likely get into a natural routine during your appointments.
Sometimes, counselors will guide your sessions toward symptoms or conditions you’ve shared with them — such as anxiety, trauma, and depression. In that case, they may offer structured sessions that focus on these challenges. Depending on the type of treatment, your therapy may continue for several weeks or months.
Other therapists take a different approach. They may prefer that their clients bring up topics for each session. In this case, your therapist may let you start the discussion because they want you to be in the driver’s seat.
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10 ideas to consider when at a loss for words in therapy
Regardless of how you work with your therapist, it’s not always easy to know what to say. Sometimes, people get to their therapy session and have no idea what to talk about. Even when you look forward to seeing your therapist, you may feel pressured or put on the spot.
What’s most important in any therapy session is you. Ask yourself, “What am I here to get, and how do I want to feel?” For example, you may be looking for a neutral person to help you talk through a recent problem. Or you may be hoping to feel more confident or less anxious over time.
With that in mind, see if any of these topics would be helpful to discuss.
1) Recent events
Many people find it helpful to talk about daily problems with a therapist. For example, if you’re struggling with a big career decision, it might help to talk it out.
Other everyday issues might include:
Relationship problems
Parenting stress
Work pressures
If you just had a fight with a friend, for example, that would be appropriate to bring up. Discussing it may help you deal with it better next time.
2) Coping skills
People typically experience a mix of good and bad in life. During tougher times, the right skills can help you cope.
Ask your therapist for strategies to use during difficult situations. They may make suggestions, such as how to get through an anxiety spell. They might also help you find strategies to manage work deadlines or family stress.
3) Relationship issues
We all have problems with relationships once in a while. You may be struggling with dating or your relationship with a long-term partner.
Often, couples continue to have the same conflicts over and over. Your therapist can help you understand recurring conflicts in relationships. They can also support you while you work through it and make helpful changes.
Or you may simply want to communicate better in general. Your therapist can help you with this too. You can bring up examples from past or current relationships.
4) Things that cause you anxiety
Do you have more anxiety than you would like? While it’s normal to get nervous once in a while, some people are often anxious. Whether you have an anxiety disorder or not, your therapist can help you cope.
If fear and anxiety interferes with your daily life, it may be helpful to talk it out. Sometimes, just discussing your fears can make you feel better. Plus, your therapist may be able to help you get to the root of the anxiety.
5) Mood changes
Do you feel down much of the time? Do you have trouble getting out of bed most days? Maybe you have noticed that you suddenly have lots of energy and motivation. Or perhaps you notice that your mood shifts quickly from low to high.
You may want to talk to your therapist about these experiences. They could be a sign of a mood disorder, such as depression or bipolar disorder. If this is the case, your therapist will likely ask you more questions about it. Then, you can make a plan together to help you feel better.
6) Traumatic or stressful events
If you’re facing a lot of stress or coping with the effects of a traumatic event, your therapist can help. A trauma can be any event that causes you to experience intense fear, feel helpless, or believe that your life is in danger. At least half of people will experience a trauma in their lifetimes.
In many cases, people work through the event in the first several weeks and start to feel better. But some people who experience trauma develop a mental health condition, such as post-traumatic stress disorder (PTSD).
In this case, symptoms related to the trauma may interfere with your life months or years later. Talking to your therapist about any traumas you still struggle with can be a great first step toward healing.
7) Childhood memories
Many of us have major events in our childhood that continue to impact us as adults. Some of these are obvious, such as physical or sexual abuse. However, other situations — like being bullied as a teenager or your parents’ divorce — can have an impact as well.
Understanding how these events affected you can make a difference as you get older. Your therapist can help you better understand your childhood and how you can heal from painful experiences.
8) Life patterns
If you find yourself repeating similar patterns in your life, there may be a reason for it. For example, many people are attracted to unreliable partners. If this is the case for you, it may connect back to your childhood or a past relationship.
This doesn’t mean that it’s your fault, but it is something you can work on changing. In therapy, you can get to the bottom of these patterns and learn how to combat them in future relationships.
9) Your strengths
You can also talk about positive things in therapy. It can be hard to see the good things about yourself, but your therapist can help you recognize them. Building on your strengths can help you feel more confident about your future.
For example, you may have certain hobbies that bring you joy. Spending more time on these can help you have a more meaningful life. You may also want to build on the talents or personality traits that can help you find more success in your career. Therapy is a great place to explore these.
10) Life goals and values
Whether things are going well or not, it’s helpful to remember what’s important to you. Talk to your therapist about where you want to be in a year or even 5 years.
Perhaps you would rather have a different career, or you’d like to start having children. Ask for help to identify your goals, and make a plan to meet them.
Ultimately, this is what’s most helpful about therapy: It can help you discover and create the life you want.
How to know if therapy is working
Is therapy helping you? The best way to know is to check in with yourself and your goals. Do you feel like you’re making progress?
Progress might mean a decrease in symptoms, such as feeling less depressed. It could mean building stronger relationships with others, having more meaningful experiences, or just seeing your future more clearly. Therapy is different for everyone, and you decide when it’s working.
At some point, you may feel like you’ve gotten everything you need. Or maybe it’s time to move on to a new therapist or a different type of therapy. You may worry about telling your therapist this. However, this is a sign that your treatment has been helpful. It’s OK to bring it up and think about what’s next.
The bottom line
If you’re looking for a non-judgmental ear, a therapist can provide it. Counseling can also help you focus on specific goals. For example, you may want to decrease your mental health symptoms, work through a particular problem, build healthy relationships, or work toward your life goals. What you talk about in therapy will depend on your needs and goals. Fortunately, you get to decide with support from your therapist. Bring up any concerns you have, and don’t be afraid to ask for what you want.
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References
American Psychological Association. (2020). Understanding psychotherapy and how it works.
American Psychological Association. (n.d.). Trauma. APA Dictionary of Psychology.
Ardito, R. B., et al. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in Psychology.
Cloninger, C. R., et al. (2011). Person-centered therapeutics. International Journal of Person Centered Medicine.
Flückiger, C., et al. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy.
Kaya Tezel, F., et al. (2015). Relationships between childhood traumatic experiences, early maladaptive schemas and interpersonal styles. Archives of Neuropsychiatry.
National Alliance on Mental Health. (n.d.). Psychotherapy.
National Center for PTSD. (2021). How common is PTSD in adults?
National Child Traumatic Stress Network. (n.d.). Trauma types.
National Institute of Mental Health. (2018). Anxiety disorders.
National Institute of Mental Health. (n.d.). Post-traumatic stress disorder.
Substance Abuse and Mental Health Services Administration. (2021). Understanding child trauma.
Yuen, E., et al. (2020). Accentuate the positive: strengths-based therapy for adolescents. Adolescent Psychiatry.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
