What to Talk About in Therapy

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After researching nearby therapists, setting up consults, and choosing a clinician who seems like a good fit, you may suddenly find yourself grappling with an unexpected question: What am I supposed to talk about in therapy? 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. Here’s what to know.

What should I talk about in therapy?

The simplest answer is that you should talk about whatever you want, or whatever the issue is that’s bringing you 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. You 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 people, others can find it intimidating or confusing. For example, someone with anxiety may feel overwhelmed by the idea of talking about their symptoms. Someone who is feeling depressed without any single concrete reason, for example, may feel at a loss when a therapist asks, “So what brings you to therapy?”

Questions to contemplate

If identifying topics to discuss in therapy feels difficult, taking a few minutes before the session to reflect can help. You may ask yourself a few general questions like:

• Why did I decide to seek therapy now?
• Where in my life do I feel like I’m getting stuck?
• What has changed recently in my emotions, relationships, or daily routines?

Answers to these questions can focus on observable outcomes (e.g., “I’m struggling to meet deadlines at work”) or on internal processes (e.g., “I feel empty and sad a lot”). If you still feel unclear after considering these questions, you may consider preparing a short list of questions for the therapist. This can help you feel like you have something to talk about and can help you focus on the process of therapy itself. Useful questions include:

• What approach or therapy modalities do you use?
• What does a typical session look like?
• Do you assign homework or skill-building exercises between sessions?

Why is my therapist silent?

It’s almost never necessary for you 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 your thinking or behavior, or otherwise guide the conversation. This is especially true of therapists who employ more contemporary and evidence-based methods, such as those based on cognitive behavioral techniques.

On the other hand, there are still some therapists who employ a more traditional, psychoanalytic approach, which encourages you to free associate and typically involves less input from the therapist. While some people find 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. If you prefer a more interactive approach, you should feel empowered to ask your therapist for a referral to another clinician who may be a better match.

What, if anything, should I avoid discussing?

It’s normal to wonder if you should withhold certain things, either because you’re worried that the therapist will tell someone else or because you fear being judged. In the vast majority of cases, the former worry will never come to pass because therapists are ethically and legally bound to protect their clients’ confidentiality, except in very rare cases, such as when the client poses an imminent danger to themselves or others. If you are concerned about disclosure or confidentiality, you are encouraged to ask your clinician about the ins and outs of confidentiality to give yourself peace of mind.

The latter fear, worrying that the therapist will judge you if you share something sensitive or unsavory, is common and completely normal. You should feel empowered to draw boundaries if you don’t want to talk about certain subjects, and ethical therapists will notice these boundaries. That said, effective therapy does require a bit of discomfort, meaning that almost every person will be called upon to share something that they’d instinctively rather not share. You will ideally never feel judged by your therapist in these moments; if you are, it may simply mean that it’s not a good match.

It’s also important to remember that therapists are human. It’s not always possible for them to stay totally neutral if you tell them something upsetting. But reacting is not the same as judging. In fact, some therapists may even choose to discuss their reaction with you, or you may choose to ask the clinician about it. This kind of conversation can be productive for the therapeutic process when it’s well-handled. It may actually help ease your fears about judgment and strengthen the therapeutic alliance.

Even if a particular topic feels unmentionable at the beginning of therapy, it might not stay that way forever. Over time, with a therapist’s guidance, you may come to recognize the immense power of vulnerability and may become comfortable sharing things that once felt unshareable.