What to Talk About in Therapy: 10 Ideas to Help You Get Started

Getting started with a new therapist, especially if it is your first time in therapy, can be a bit scary. When I see people new to therapy, they sometimes struggle with what exactly to talk about. First, know that is completely normal! A therapeutic relationship is a new dynamic to many people, and it’s natural to wonder what is “right” to discuss in a therapy session.

If you come to therapy with a specific issue you’d like to address or a specific difficulty you’re experiencing, it’s often easy to decide what you wish to talk about. However, many people come to therapy without one big difficulty and are unsure what they should be sharing. This post aims to help you feel like you have an understanding of what to expect and give some ideas of things you can talk about in therapy.

What to Expect in Therapy

What is the first therapy session like? What exactly happens in therapy? Well, most therapists, myself included, will begin with an interview or asessment. This may include background questions regarding your life, experience with therapy, relationships, work, and more. The idea here is to get a foundational understanding of your needs.

After the assessment, therapists will work in different ways. Depending on the therapist and client, a therapist may jump right in to working with a specific symptom or disorder such as anxiety, depression, or trauma. Or, a therapist may allow you space to bring up topics or discuss what is going on with you.

A therapy session is really dependent upon what is present for the client in their life, what they are willing to talk about, and what the therapist sees as important to discuss. Although you may be able to be in the driver’s seat, the therapist will help direct the conversation in a way that is useful and practical for you.

Topics and Ideas for Therapy

So, when you do have time or space in therapy to bring up topics, what do you talk about? You may even be asked by a therapist what you want to talk about, or about what brings you to therapy. Here are a few things you can talk about with your therapist.

1. Your Present Feelings and Experience

This one is pretty simple and straightforward. Whatever is going on with you currently is a great place to start. You may not have any strong feelings or feel like you have something “big” to talk about, but sharing about your life with your therapist may help them understand your experience a bit more.

Really, anything goes. You might discuss that you don’t feel like being in therapy today, work has been tough, or you’ve just been feeling good and energetic over the last few days. There’s no wrong answer here. Whatever is present for you is the right answer!

2. Any Small Issues You Have

I notice a lot of clients tend to shy away from the small issues or move right into the serious or deep issues in therapy. Although those may be useful things to address with a counselor, the “small” things are equally as important.

Maybe your “small” issue is a frustration with someone over something you feel is rather petty, or perhaps you have been feeling relatively happy over the last week and content with your life. Many people simply struggle to show up for themselves. Whatever it is, it’s never too small to share with your therapist.

Sharing small things is also a great way to begin the process of opening up. With a new therapist, it is often difficult to jump into the most vulnerable and deep topics. Start with some of the smaller issues to ease your way in to the new therapeutic relationship. This way, you can get to know each other and build trust with your therapist.

3. Patterns of Thoughts or Emotions

This is something that is perhaps useful for anyone to begin noticing in their lives, in our out of therapy. Are there patterns of thoughts, feelings, or behaviors that you notice in your life? For example, do you find yourself feeling insecure in the workplace? Or perhaps you have trouble sleeping due to anxiety at night?

If you aren’t sure of any patterns like this, you might consider keeping a journal or inventory during the week between therapy sessions. This often helps people see patterns more clearly. As you begin to recognize the patterns in your life, you can bring these up in therapy and a therapist will help you unravel them.

4. Rumination or Repeated Thoughts

This one is pretty straightforward. Do you have a tendency toward certain topics when it comes to rumination? If you aren’t familiar, rumination is the act of going over the same thoughts repeatedly. It’s a common symptom of both depression and anxiety, and many others struggle with some form of ruminating.

Every individual is different. You may explore with your therapist the repeated thoughts about a relationship, ruminating about a past difficulty, or whatever it is that your mind seems to get stuck on. This is similar to the previous therapy topic of recognizing patterns, but in this case you can focus specifically on where you find yourself ruminating.

5. Personal Relationships

Personal relationships (or lack of) are an important part of all of our lives as social creatures. If you have an intimate relationship or relationships, that’s definitely a great place to start. But if you don’t, you can start by talking about friendships, workplace relationships, family members or whatever other relationships you have in your life.

As relationships impact our lives in many ways, talking about these relationships is a great place to begin with a new therapist. You don’t have to start somewhere really deep with the conversation. Sometimes just getting going with the talking is what is needed.

6. Past Difficulties or Traumas

This can be a bit of a deeper topic to bring up during a therapy session. You might start with general difficulties you’ve had in your life. Don’t worry if you think they’re too small or insignificant. Talk about the things you’ve struggled with, or even minor adversities you’ve faced. For example, you may share that you struggled last year with a situation with your roommate. Nothing is too small.

If you do have some bigger things, those are always great to talk about in therapy. Unraveling and investigating past traumas or major difficulties is part of what therapy is for. However, if it takes you a few sessions or longer to really open up about these things, that’s okay. Ease into the relationship by sharing what you’re comfortable sharing.

7. Any Changes or New Challenges

It is the nature of life and experience to be constantly changing. We are always facing new challenges in our lives or small changes. Try to reflect on any changes in your life recently, or perhaps some that are upcoming. This is a great topic for you and your therapist.

Adaptability is a great skill we can learn in therapy. Recognizing how we deal with change in general or specific types of change can lead to great insight. A lot of our suffering and pain surrounds changes or new challenges, and by talking about it with a therapist, you begin to get to know it a little better.

8. Discomfort with Vulnerability or Therapy

If you’re uncomfortable in your therapy session, afraid to be vulnerable, or just struggling to open up, you might literally talk about that exact experience! Many people have those feelings in therapy, and it’s completely normal. Use it as a jumping off point to talk about your emotions.

When you and a therapist begin working together, any hesitation to be vulnerable or discomfort with the dynamic is worth discussing. A therapist may be able to help you feel more comfortable, or just uncover the emotions to see them with more clarity. Either way, it is something to talk about in therapy when you’re out of ideas!

9. Personal Hobbies or Projects

One thing a therapist benefits from is getting to know their clients. If you have any personal projects, hobbies, or passions, talk about them. Whether it’s a sport, craft, a political position, or some type of art, go ahead and share it with your therapist.

Our personal hobbies tell a lot about us. As you share about what you enjoy doing in your free time, your therapist will understand you a bit better. You also may begin to explore why you love that activity and what that says about you.

10. Any Current or Past Self-Care Work

And finally, talk about therapy! Not just therapy, but any dedicated work you’ve done on yourself or for yourself. It may be something like therapy, church, reading, listening to podcasts, meditation, workshops, twelve-step, or anything else you’ve engaged in with the intention of growing. Again, there’s no wrong answer here.

Maybe you haven’t done any self-help work. That’s okay too! Whatever your experience is, share it honestly. I love when clients let me know what worked or didn’t work for them with past experiences working on themselves, as it helps me offer better care.

Remember to be patient with therapy. You may not walk out of the first (or second, or third, etc.) session feeling “healed” or “fixed.” It may be uncomfortable at first as you get to know each other. Give therapy a shot, and try to show up as honestly and presently as you are able.