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What to Talk About in Therapy

... and what topics, if any, should stay off-limits?

Key points

  • Deciding what to talk about during a therapy session can be daunting, especially for first-time clients.
  • Some may struggle to share what is bothering them or articulate why they're seeking therapy to begin with.
  • Asking themselves exploratory questions before a session can help clients uncover potential topics.
  • Clients should feel empowered to set boundaries around subjects they don't wish to discuss.
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After completing the often-arduous tasks of researching nearby therapists, setting up consults, and choosing a clinician who seems like a good fit, first-time therapy clients may suddenly find themselves grappling with an unexpected question: Wait—what am I supposed to talk about? Having a 50-minute session to fill, and no set agenda with which to fill it, can feel overwhelming, especially for those who have never done therapy before and aren’t sure what to expect.

Luckily, deciding what to talk about in therapy is often less fraught than people might imagine—and they can expect some help from their therapist along the way. Here’s what to know.

What Should I Talk About in Therapy?

The simplest and perhaps most obvious answer is that clients should talk about whatever they want, or whatever the issue is that’s bringing them to therapy in the first place. Common jumping-off points include tension or conflicts in relationships, past trauma, difficulties at work, or recent mood changes. Clients may also come to therapy to discuss long-term goals, upcoming life changes, or complex feelings like poor self-esteem, shame, guilt, or grief.

But while the freedom to talk about anything may feel liberating for some clients, others can find it intimidating or confusing. Someone struggling with serious anxiety, for example, may believe that voicing their worries aloud would be impossible, says Stephanie Cox, a mental health counselor in Jacksonville Beach, Florida. Because a hallmark of anxiety is avoidance, when faced with the prospect of opening up to another person, “someone who’s already anxious may start to think actually, I don’t want to talk about any of this.

Other clients may desperately want to talk about what’s bothering them but find that they’re just not sure where to start. Someone who is feeling depressed without any discernible cause, for example, may feel at a loss when a therapist asks, “So what brings you to therapy?” This is perhaps especially true for clients who present as successful and well-functioning; without an obvious culprit to point to, like career challenges or a difficult relationship, identifying a specific topic that warrants exploration can feel daunting.

Questions to Contemplate

What can clients do to overcome this obstacle and start talking? As a first step, Cox says, it can help to take some time before a session to make a game plan and ideally identify one or even two concrete areas to address. Asking a few general questions like “Why did I decide to seek therapy now?” or “Where in my life do I feel like I’m getting stuck?” can aid in this process.

Answers can focus on outcomes—like, “I’m struggling to meet deadlines at work”—or on internal processes, like “I feel empty and sad a lot.” Some clients may find metaphors helpful, says Nicholas Balaisis, a psychotherapist in Ontario, Canada. “I had a client recently who said he didn’t feel depressed or anxious, but just that something was off—like there was no salt in his food. We just kind of explored that feeling.”

If self-exploration isn’t particularly fruitful, coming up with a list of questions to ask the therapist can also help clients—especially first-time ones—feel like they have something to talk about. “Viewing the first therapy session as an interview of the therapist can help quell some fears,” explains Cox, and can shift some of the focus from the client to the process itself. Useful questions include what modalities the therapist utilizes, what their process is typically like, and what they expect from the client, both in and out of the therapy room (some therapists, for example, will ask clients to complete “homework” between sessions).

Why Is My Therapist Silent?

It's almost never necessary for a client to come in with enough pre-planned material to fill the entire session. That’s because in most cases, the therapist will ask questions, point out patterns in the client’s thinking or behavior, or otherwise guide the conversation. This is especially true of therapists who employ more contemporary and evidence-based methods, says Balaisis, including those based on cognitive behavioral techniques.

On the other hand, there are still some therapists who employ a more traditional, psychoanalytic approach, which encourages the client to free associate and typically involves less input from the therapist. While some clients find immense value in this less structured approach—perhaps finding that their free association leads them to explore unexpected topics or stumble upon surprising insights—others may find their therapist’s relative lack of input to be confusing or distressing, especially if they feel unsure of what to talk about.

For these clients, it may be that this therapist simply isn’t a good fit, says Cox. “Therapy is not just one thing; it’s a million different things,” not all of which will be the right fit for a particular client. Clients who prefer a more interactive approach should feel empowered to ask their therapist for a referral to another clinician who may be a better match.

What, If Anything, Should You Avoid Discussing?

It’s normal, too, for clients to wonder if they should withhold certain things—either because they’re worried that the therapist will tell someone else or because they fear being judged.

In the vast majority of cases, the former worry will never come to pass. Therapists are ethically and legally bound to protect their clients’ confidentiality, except in very rare cases: when the client poses an imminent danger to themselves or others; when the therapist believes that a child, elderly person, or dependent adult is being abused; or when they are legally forced to by court order. Otherwise, the vast majority of therapeutic interactions will never leave the privacy of the therapist’s office. Concerned clients are welcome to ask their clinician about the ins and outs of confidentiality to give themselves peace of mind.

The latter fear—worrying that the therapist will judge them if they share something sensitive or unsavory—is common and completely normal, Cox says. “It’s very natural to be hesitant to talk about vulnerable things period, let alone with someone you just met.” Clients should feel empowered to draw boundaries if they don’t want to talk about certain subjects. “An ethical therapist will recognize a boundary that a client puts forth and know that it’s not going to be beneficial to push them there.”

But effective therapy demands a bit of discomfort, she adds, meaning that almost every client will be called upon to share something that they’d instinctively rather not share. Clients will ideally never feel judged by their therapist in these moments; if they do, it may simply mean that it’s not a good match.

Yet therapists are human, Balaisis notes, and it’s not always possible for them to stay totally neutral if a client tells them something upsetting. But reacting is not the same as judging. In fact, some therapists may even choose to discuss their reaction with the client, or the client may choose to ask the clinician about it. “That kind of conversation can be productive for the therapeutic process when it’s well-handled,” Balaisis explains, helping ease the client’s fears about judgment and strengthening the therapeutic alliance.

Even if a particular topic feels unmentionable at the beginning of therapy, it might not stay that way forever, Cox emphasizes. “Clients often think, I don’t want anyone to know this because I’m going to feel a lot of shame.” But over time, with the therapist’s guidance, they’re likely to come to recognize the immense power of vulnerability, she explains. “That’s where the magic of therapy can happen—in the sharing of things that we once felt were unshareable.

To find a therapist near you, visit the Psychology Today Directory.

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