A Simple Guide to What You Can Talk About in Therapy

What Do You Talk About in Therapy? A Guide for When You Don’t Know What to Say 

Starting therapy can bring up anxiety about what to say, where to begin, and how much to share. The good news is that you don’t have to have it all figured out before you walk through the door.

By Aviva Boxer, Registered Psychotherapist

Starting therapy with a new therapist can feel stressful and create anxiety, even when you know why you are coming to therapy and what you hope to get out of it.

You may be walking into a therapist’s office or clicking on a video call and seeing this person for the first time. Suddenly, you may feel pressure to explain yourself. You may wonder whether you should share everything that feels meaningful or important. You may worry that you will leave something out or that you won’t know how to explain what is happening.

You may even find yourself worrying about your therapist’s opinion of you.

What if you talk too much? What if you are too loud, too emotional or too much? What if you are too quiet and your therapist thinks you don’t have anything important to say? What if you say something your therapist doesn’t like?

And then there are the things you may know you eventually want to talk about, but feel nowhere near ready to discuss in your first few sessions. You may have experienced trauma or have deeply personal things you want to work through, but wonder how you are supposed to go from introducing yourself to talking about some of the most difficult experiences of your life.

Starting therapy can feel incredibly relieving, but it can also be confronting. You have finally found a space to work on something that has been difficult, and then you realize that doing the work may sometimes mean going to uncomfortable places.

If you are just starting therapy, or if you sometimes find yourself sitting across from your therapist and thinking, I have no idea what to talk about today, there are a few things I want you to know.

You don’t have to know what to say

One of the things I often tell clients who arrive for a session worried because they don’t know what to talk about is that, in all my years as a therapist, I have never had a completely silent session.

But if a client did want some time to think or simply wanted to sit quietly for a few moments, that would be completely okay, too.

There is no requirement that you arrive at therapy with a perfectly organized list of everything you want to discuss. You don’t have to prepare a presentation about yourself. You don’t have to make sure that every minute of your session is productive.

In fact, sometimes the most important thing you can say is, “I don’t know what to talk about today.”

That is something you and your therapist can work with.

You don’t have to perform for your therapist

I also like to remind clients that therapy is their time.

You have carved this time out of your life for yourself, and part of the beauty of therapy is that you don’t have to worry about taking care of your therapist’s feelings. Your therapist is there to support you, to listen, to help you understand yourself and, when appropriate, to gently challenge you.

You don’t have to make sure your therapist is having a good time.

You don’t have to make yourself interesting.

You don’t have to make your story sound coherent.

And you don’t have to worry about whether you are talking too much or too little.

For many people, having a space that is truly for them is a new experience. We spend so much of our lives thinking about other people’s needs, reactions, and expectations. Therapy can be a place where you can begin to notice what happens when you don’t have to do that.

So what do you talk about when you don’t know what to say?

When a client doesn’t know where to start, I might ask whether they have had any memories coming up recently. I might ask them to tune into their body and notice whether they are experiencing any physical sensations.

Sometimes I’ll ask about their day or what stood out to them during the week. If we have worked together before, I might ask how they have been feeling since our last session.

And sometimes a question that seems completely unrelated to what brought someone to therapy can open up an important conversation. I might ask about what school was like when they were a child, for example, or about a relationship, a memory or an experience that has been on their mind.

There isn't one correct place to begin.

You can start with something that happened yesterday. You can start with something that happened 20 years ago. You can start with a feeling you can’t quite name or a sensation in your body that you don’t understand.

You can even start with, “Something has been bothering me, but I don’t know why.”

That is enough.

You don’t have to tell your whole story at once

Sometimes people come to therapy knowing exactly what they want to talk about but feeling anxious about how quickly they are supposed to get there.

If you have experienced something traumatic, deeply personal or painful, you may wonder how you are ever going to tell a stranger about it. You may think that because this is the reason you came to therapy, you should be talking about it immediately.

You don't have to.

Trust takes time. So does feeling comfortable enough to talk about difficult experiences.

Sometimes you may talk around something before you are ready to talk directly about it. Sometimes you may share one small piece of a story and realize later that there is much more underneath it.

Therapy isn't a race to get to the hardest thing.

Your therapist can help you find a pace that feels manageable, while still allowing you to move toward the things you want to understand and change.

There are no tangents

One of the things I hear frequently from clients is an apology for going off on a tangent.

They might tell me a story about something that happened during the week and then suddenly say, “Sorry, I’m completely going off topic.”

I usually tell them that there are no tangents.

Everything we talk about can lead to something else.

A story about an argument with your partner might lead to a memory from childhood. A frustrating interaction at work might connect to a familiar feeling of not being good enough. Something that happened on your commute might bring up a thought you hadn't realized you'd been carrying around for weeks.

We don't always know where a conversation is going to lead when we begin it.

That is part of the work.

Over time, the things you talk about begin to connect. Themes emerge. You may start to recognize patterns in your relationships, your thoughts, your emotions or the way you respond when you feel overwhelmed.

Sometimes the thing you thought was a tangent turns out to be exactly where you needed to go.

What if I freeze in therapy?

If you find yourself sitting in therapy and suddenly feeling as though your mind has gone completely blank, you can tell your therapist that, too.

You can say, “I don't know what to say.”

You can say, “I had so much to talk about before I got here, and now I can't remember any of it.”

You can say, “I'm nervous about talking about this.”

You can even say, “I'm worried you're going to think I'm wasting this session.”

Those aren't failures to participate in therapy. They are experiences that can be explored together.

Sometimes what happens between you and your therapist in the moment can tell you something important about what happens in other relationships or situations in your life.

You don't have to hide the uncertainty. You can bring it into the room.

You don't have to do therapy perfectly

Perhaps the biggest thing I want people to know is that there is no perfect way to do therapy.

You don't have to arrive with the right words, the right insight, or a neatly organized version of your life.

You can be quiet.

You can talk too much.

You can cry.

You can laugh at something that feels unexpected.

You can change your mind about what you want to talk about.

You can tell a story and then realize it wasn't actually the story you meant to tell.

You can say, “I don't know.”

And you can begin there.

Therapy is not a test you have to prepare for. It is a space where you and your therapist can become curious about what is happening in your life, what you are feeling, and what you may want to understand differently.

Sometimes you know exactly where you want to begin.

And sometimes you just need to start talking and see where the conversation takes you.

There are no tangents. Everything connects. And you don't have to figure it all out before you walk through the door.

Interested in starting therapy?

If you have been thinking about starting therapy but feel unsure about what you would say or where you would even begin, you are not alone. You don't need to have everything figured out before reaching out.

At everwell, our therapists can help you create a supportive space to explore what is happening in your life, at a pace that feels manageable for you.

If you’re ready to explore whether therapy could be helpful, reach out to our team to learn more or book a consultation.