What Do I Talk About In Therapy? Finding Your Conversation Flow
Written by Miranda Keene, LMHCA
Reviewed by Lauren Crockett, LMHC
It can be overwhelming, to say the least, sharing personal details of what feels like every corner of your life to a complete stranger. Maybe you were feeling confident and ready to start therapy only to find that you clam up in the first session. Or maybe you’ve been to therapy many times already but find you’ve run out of things to bring in that you feel like haven’t already been talked about over and over.
Whether you’re new to therapy or you’ve been going for years, it’s normal and incredibly common to not know what to talk about. Those new to therapy might find themselves unsure about where to start or what’s even appropriate to bring up.
Someone that’s been in therapy for a while might feel a lot of pressure to continually supply problems to work out, or there may be discomfort with the feeling of needing to steer a ship they have no idea how to operate.
On an actual ship, the navigator and the steerer (helmsman) are two important but very different positions. The navigator determines the ship’s course using navigational tools while the helmsman manages the ship’s direction by controlling the rudder at the helm. The two work together to get the vessel where it needs to go.
Similarly, therapy is a collaborative process on which you and your therapist will be working together towards a shared destination (i.e., your treatment goals). As the client, you are like the helmsman, providing the direction and steering us there. But you don’t need to do all of the work; your therapist is there as your navigator, helping to provide tools for how to get there.
This does mean that you will need to bring in your thoughts, feelings, goals, ideas, etc., but it also means that your therapist is there to provide the structure and support you might need if you’re feeling unsure about the process itself.
All that said, really just about anything is on the table to discuss in therapy, and it doesn’t have to all be problems and concerns. It can be just as important to understand your strengths, values, and the things that light you up inside.
But because we also understand that “anything goes” can potentially be more daunting than helpful, we’ve provided some topics below to help generate some ideas and alleviate some of that uncertainty or anxiety.
Before we jump in, a note to hold lightly when choosing what to talk about:
Yes, anything is fair game in this space, but also keep in mind that we are ultimately working towards the goals that brought you in. It’s always ok to bring in one-off situations (they might even be connected to your goals), but if therapy starts to feel like whack-a-mole, it may be time to do a check-in on your goals and modify them if need be.
Thoughts or feelings around being in therapy
Not all of us feel comfortable being direct with healthcare practitioners about our thoughts and feelings around their process. For example, imagine telling your doctor that you’re not sure you’re becoming more healthy under their care.
You might find yourself in a similar situation in the therapy room but remember that therapy is a space designed for openness and transparency. Consider the following as potential avenues down this route:
Being confused about how the process works
Your hesitation or skepticism about being in therapy
Your previous therapy experiences
Not knowing what to say in a first session or follow-up sessions
Feeling unsure about what’s bringing you to therapy
Wondering how long therapy takes to work
Feeling unsure if you’re making progress
The present moment
A good place to start is where you are right now, in this moment. How are you feeling today? What's been happening in your life recently? Maybe you're struggling with stress at work, a conflict with a friend, or just a general sense of unease. Perhaps you're experiencing a surge of joy or excitement and want to share that. Don't feel pressured to delve into deep-seated trauma right away. Sometimes, simply acknowledging and processing your current emotional state is the perfect starting point. Consider the following:
Things that are adding unease to your life
Things that are adding joy to your life
Changes in your eating or sleeping patterns
Realizations or insights you’ve had connected to your work in therapy
Things that are making you feel stuck
Things that you want to change
Things you want to stay the same
Things that bother you
Things that you enjoy
The things that are helping you get through hard times
The goals you want to set
Your identity
Therapy isn't just about addressing problems; it's also about personal growth and self-discovery. It's a space to explore your values, identify your goals, and develop a plan to achieve them. What do you want to achieve in your life? What kind of person do you want to be? Consider the following:
Your personality style or temperament
Your values across different life domains (e.g., family, relationships, work, etc.)
The type of qualities that you want to cultivate as a person
Your strengths and limitations
Concerns about identity transitions
Confusion about your identity
Your thoughts and feelings around your various social identities
Feelings of disconnect from your sense of self or who you felt you used to be
What brings you purpose and meaning, or provides a sense of awe and wonder
Relationships
Relationships are a common focus in therapy. Whether you're navigating conflict, seeking deeper connection, or simply wanting to understand your interpersonal dynamics better, discussing your relationships with your therapist can be incredibly insightful. The following are potential areas to explore with your therapist:
Important people in your life
Frustrating people in your life
People you miss
Patterns you find yourself repeating
What you wish people would do more of
What you wish people would do less of
How to set boundaries
Your family and friends
Your attachment style
Your emotions
Emotions are the language of our inner world and they hold valuable clues about our needs, desires, and wounds. In therapy, exploring your emotions is essential for self-discovery and healing. By understanding your emotional landscape, you gain insights into your mental health and overall well-being. Here are some emotion-focused conversation starters for your next session:
What makes you laugh
What makes you angry
What makes you cry
What scares you
How your mood has changed
Emotional patterns you’re aware of
How your emotions feel in your body
Your thoughts
Your inner world isn’t all about emotion, exploring your thoughts is also important. Identifying and addressing irrational or intrusive thoughts can be a significant step towards healing and self-awareness. Consider discussing these thought-focused topics with your therapist:
Thought patterns you find yourself repeating
Memories you think about a lot
What worries you
Irrational thoughts
Intrusive thoughts
Your thoughts about yourself
Life transitions
Life is full of transitions – from starting a new job to ending a relationship, moving to a new city, or experiencing a significant loss. These transitions can be challenging, and therapy can provide support and guidance as you navigate these changes. Consider the below:
Starting or ending a new relationship
Marriage or divorce
Becoming a new parent
Identity transitions (e.g., emerging adulthood, gender identity, sexual orientation, empty nest, retirement, etc.)
Starting, changing, or ending a career
Losing a loved one
Graduating college
Ultimately, therapy is about exploring your inner world and finding pathways to healing and growth. Don't be afraid to delve into any topic that feels relevant to your journey. The above is just a small glimpse into the vast landscape of topics you can explore with your therapist.
Remember, your therapeutic journey is unique, and the conversations you have will evolve over time. Trust your instincts, communicate openly with your therapist, and allow the process to unfold organically. Finding a therapist who creates an open and comfortable space for you is essential in this journey of self-discovery. Here at Alignwell Modern Therapy, we are here to do exactly that. If you are ready to schedule a free consultation or first appointment with one of our relatable counselors, click here.