"What to talk about in therapy?" is a common question I've heard from clients, friends, and family. Knowing what to talk about in therapy or where to begin can be difficult, and you are not alone. As a therapist, having worked with clients in sessions for many years now, gone through personal therapy, and still learning about myself and others on a daily basis, I’ve put together this article. I will give you some tips and ideas about what to discuss in therapy, so you can feel at ease before your next session. I will also briefly talk about setting goals for therapy, and about how long the process of therapy takes.
What is therapy?
Therapy is a general term that describes various treatment approaches, such as talk therapy/psychotherapy, cognitive behavioural therapy, family/couples therapy, art/music therapy, and more. The right therapy type depends on your needs, whether you need help coping with challenges, facilitating personal growth, or anything else. In therapy, the client and the therapist work together as a team to help address:
Emotional and psychological challenges;
behavioural challenges;
improve mental well-being;
and enhance overall quality of life.
In this article, I will discuss talk therapy, specifically, what to talk about in therapy.
Arula Counselling integrates creative, psychodynamic, mindfulness and ACT (Acceptance and Commitment Therapy) approaches with a focus on neurodiversity-affirming and trauma-informed care.
How to start therapy?
I get it; being in a room with a stranger probably feels weird and uncomfortable. You may have high hopes that everything will flow flawlessly, but it may turn out to be different when actually sitting in the session. Trust me, I have been there. It is common to feel nervous before your first session. After all, you've never even met the person, and your therapist is probably a little nervous, too!
There are a few approaches your therapist might take. Some may be more direct, guiding you and asking specific questions to gather more information about you and your situation. Others leave more room for you to open up and discuss your experiences, exploring what led you to reach out for support now. Both approaches lead to discussions and topics and can be a good starting point for knowing what to talk about.
What to talk about in therapy: 9 Tips
Therapy doesn’t always have to involve something ‘urgent’ that you need to resolve now. It can also be a place of self-discovery, starting from where you are, perhaps reflecting on how you feel in the present moment. Some of the topics you could to talk about in therapy include:
Emotions, thoughts, and feelings;
what brought you to therapy;
your goals for therapy;
relationships;
your upbringing;
self-esteem and self-image;
life transitions;
coping strategies;
self-care and well-being.
Most importantly, therapy starts from building, and establishing a trusting relationship with your therapist with whom you feel comfortable with. Now that I’ve covered some overall ideas for what to talk about in therapy, let’s get into it and look into each in more detail.
1. Emotions, thoughts, and feelings
The process of therapy involves opening up about your emotions, thoughts and feelings. It is about building trust in a therapeutic relationship to allow space for vulnerability, growth and healing. We may start by exploring and being curious about where your emotions, thoughts and feelings might be coming from, and how they may have been impacting your life. Brené Brown has written extensively on vulnerability, "Vulnerability is about showing up and being seen. It's tough to do that when we're terrified about what people might see or think." But it is a start.
2. What brought you to therapy?
Starting therapy is not an easy decision to make. Knowing what to talk about and where to even start might be intimidating. To make you feel more at ease, I always start by asking you to explore a bit more about what led you to reach out for support and what you may be looking to achieve in therapy. This could be a great starting point for a conversation in therapy. You deserve to be heard.
3. Setting goals for therapy
In therapy, we may explore further about how you would like to feel, how you would like to behave with yourself, others and the world around you. This can be helpful in setting goals for therapy together, thinking about how to structure future sessions. It is a continuous journey of self-discovery and personal growth where no path can be compared to another’s. Goals for therapy can be a helpful place for an initial conversation.
4. Relationships
Throughout therapy, you may want to explore any relationship challenges, conflicts, or patterns you have noticed and would like to change or support with. Through reflecting on your relationships and opening up, you can strengthen your communication skills, and discuss how to build healthier connections with family, friends, co-workers, and romantic partners in ways that work for you. As Sue Johnson has said, “To be human is to need others, and this is no flaw or weakness.”
5. Your upbringing and family dynamics
Talking about your upbringing and childhood can be a challenging subject. It is important for your therapist to know a little bit about what brought you to therapy and how your upbringing and family relationships have affected you. However, make sure you give yourself enough time to build a relationship with your therapist first, to feel comfortable enough to talk about these difficult topics. It may take time to be comfortable enough to reflect on your past, so make sure you’re kind to yourself throughout the process.
6. Self-esteem and self-image
Therapy can be a place to explore your thoughts and beliefs about yourself, such as your strengths, but also areas that may be more difficult for you, such as noticing how you may talk to yourself. It is about developing a more compassionate way of being to help strengthen your relationships with yourself and with people around you. It is a crucial part of developing independence, strengthening your sense of self, and increasing your confidence.
7. Life transitions
Have you recently been through major life changes such as moving to a new country, starting or ending relationships, a career change, or health difficulties? We may begin by exploring any challenges, fears, or uncertainties accompanying these changes, staying curious about any feelings that are coming up for you, and processing these in a safe space. Changes usually bring up grief, it takes time, and that’s okay. During this time, it’s especially important to create a self-care routine that works for you.
8. Coping strategies
You may want to explore ways of dealing with stress, anxiety, or other challenges, finding out what works and what doesn’t work for you—creating awareness around healthier coping strategies, learning new ways of managing your emotions more effectively. It may be about taking up activities that you used to enjoy doing. Through therapy, you may notice your habits changing, finding new ways of being.
9. Self-care-practices
Exploring your current self-care routine can be a great start. Discussing ways you are already prioritising your mental well-being, or about how to make room for it. The more you are able to be honest with yourself about where you are, the more you can create space for yourself towards the life that you want to live. Your therapist can also support you in developing more self-compassion and kindness towards yourself. You can also read more on self-care for ADHD here.
Additional questions you may have
What should I talk about in therapy?
When you don’t know what to talk about in therapy, there are some specific topics you may begin with:
Are there any challenges you’re facing at the moment?
Are there any medications you are taking (if any)?
What kind of difficulties have you faced before, even if they happened a long time ago?
What is your current life situation? For example, have you recently been through a life transition that you feel is affecting you?
You can tell your therapist about anything, but it doesn't mean you have to. Therapy is a process about showing up and doing the difficult work, feeling your feelings, being curious about them, even though it might be a LOT easier to run away from them and avoid them completely. Remember, therapy is much more of a marathon than a sprint.
What shouldn't I talk about in therapy?
There are no topics that you ‘shouldn’t’ tell your therapist. However, sometimes, it may take a little longer to feel comfortable discussing complex matters, or perhaps you never get to them. This is YOUR therapy process, and there is no pressure to talk about anything you’re not ready for. Be kind to yourself - everyone’s journey is different.
Be mindful of the discomfort that may notice:
You may never feel 100% ready to talk about the most difficult topics;
It is important to build and establish trust first.
What to talk about in therapy when things are going well?
It is a privilege to be witnessing the growth that you have been working really hard on. You may want to discuss these thoughts with your therapist, perhaps reflecting on the progress you have made throughout your sessions. Therapy is not meant to be ‘forever’ and as much as it might be difficult to do, perhaps it is time to start working towards an ending together.
Although, when things are going well, it doesn’t have to mean that you need to end therapy straight away. Many people still carry on with therapy, even if the initial goals seem to have been met.
What to talk about in therapy when you have nothing to talk about?
When you notice that you have nothing to talk about in therapy, it may be worth sharing these thoughts with your therapist to reflect on where you are at. Ask yourself questions like:
Is it difficult to trust and to open up to your therapist?
Am I feeling stuck after working with my therapist for some time now?
Have I simply run out of things to say?
As therapists, we want you to be able to talk these thoughts and feelings through with us so we can be curious about what might be going on for you and support you in your process.
How long does therapy take to work?
There is no set timeline about how long it takes for therapy to work. Therapy is about challenging yourself and taking small risks. The progress in therapy depends on how willing you are to do the work, to be vulnerable, open and committed to making a change in your life. If you’re finding it difficult to do that, this is a part of the process, and it doesn’t mean that therapy ‘doesn’t work’ and the changes that may seem to other people, are not so small to you. It is important to celebrate all the small wins, and pay attention to your own progress.
How long therapy takes to work depends on things like:
Your current life circumstances
Your goals for therapy
Your commitment to the process
You may not want to do it and face challenges or make a change at first, but therapy will open up space for topics you haven't been able to share with anyone else. Through being vulnerable, open, and transparent, you will inevitably deepen the therapeutic relationship and your process and progress in therapy.
Conclusion
In this guide, I've given some tips and examples about what to talk about in therapy. These insights will help you feel more at ease before your next therapy session. Knowing what to talk about can be difficult, but being open and transparent with your therapist helps. You can discuss your history, where you currently are in life, and what you're looking to achieve or change will support your therapeutic process. You don't have to move through life alone. It can be a difficult start, but talking to a trustworthy friend or professional counsellor to offer you support is already a step forward.
If you’d like further support or have any questions, you can reach me on the link below.