What to Talk About in Therapy

Many people consider starting therapy but feel unsure about what to say once they’re in the room. It’s a common concern: “What if I don’t know what to talk about?” or “What if I just sit in silence?” Therapy doesn’t come with a script, and there are countless meaningful paths of conversation. The most important part is showing up with openness and honesty.

This article will guide you through topics that are helpful to bring up in therapy, why they matter, and how they can help you move toward your goals. Whether you’re starting therapy for the first time or returning after a break, understanding what you can talk about may ease the anxiety of beginning the process.

Why It’s Normal to Feel Unsure About What to Say
When meeting a therapist, you might worry about being judged, saying the “wrong” thing, or not having anything “serious enough” to discuss. These thoughts are normal. Therapy is different from most conversations. It is private, non-judgmental, and focused entirely on you.

Your therapist isn’t expecting perfection. They do expect honesty, curiosity, and sometimes even confusion. Not knowing where to start is part of the process, and talking about not knowing what to talk about can actually be a powerful entry point.

Topics That Often Come Up in Therapy

1. Your Current Symptoms or Stressors
Many people begin therapy because of symptoms like anxiety, sadness, irritability, or sleep difficulties. Bringing these up directly helps your therapist understand your situation.

• How long have you felt this way?
• When are the symptoms better or worse?
• What impact are they having on your daily life?

Even if you feel vague discomfort like being “stuck” or “not yourself, that’s worth mentioning.

2. Life Events and Transitions
Major changes often lead people to therapy. Examples include:

• Moving, starting a new job, or changing schools
• Ending or beginning a relationship
• Becoming a parent
• Retirement or loss of a loved one

Transitions can stir up emotions, even when they are positive. Therapy offers a space to reflect, adapt, and grow through change.

3. Past Experiences
Sometimes our past shapes the way we think and act today. If certain memories, family dynamics, or earlier experiences come to mind, bringing them up can be important.

• Childhood events
• Past traumas
• Early relationships or losses

Your therapist won’t push you to share more than you’re ready for, but when you choose to explore the past, it often sheds light on current patterns.

4. Relationships
Romantic, family, friendships, or work-related relationships are central to emotional health. In therapy, you can discuss:

• Conflicts and communication struggles
• Feelings of loneliness or disconnection
• Patterns you notice repeating in different relationships

Talking about how you relate to others can help you better understand yourself and improve those connections.

5. Thoughts and Beliefs
Therapy is a place to explore how your thoughts influence your emotions and actions. You might notice:

• Self-critical or perfectionistic thoughts
• Worry or rumination
• Beliefs about yourself, others, or the world that hold you back

Your therapist can help you reframe unhelpful thinking patterns and build a healthier mindset.

6. Coping Skills
Some patients come to therapy because their current coping strategies aren’t working, or they feel unhealthy (such as overeating, drinking, or avoiding responsibilities). Therapy helps you explore new strategies to manage stress more effectively.

7. Goals and Aspirations
Therapy isn’t only about problems. It’s also about growth. You might want to discuss:

• Personal or career goals
• Improving self-confidence
• Strengthening relationships
• Building healthier habits

Setting and tracking goals in therapy can provide structure and a sense of progress.

8. Self-Understanding
Many people use therapy as a tool for self-discovery. Questions like “Who am I?” or “What do I really want?” are valuable to explore. Your therapist can guide you in understanding your identity, values, and priorities.

9. Emotions You Don’t Understand
Sometimes feelings surface without clear reasons. You may notice sudden sadness, anger, or anxiety. Bringing these to therapy, even if they seem “irrational,” can uncover deeper insights about yourself.

10. Patterns of Behavior
Do you notice yourself repeating certain cycles? Maybe you push people away when they get close, procrastinate until the last minute, or sabotage your own success. Therapy can help identify patterns and change them.

How to Decide What to Bring Up
Here are some strategies to prepare for sessions:

• Keep a journal: Write down thoughts, moods, or events between sessions.
• Notice triggers: Pay attention to moments when emotions spike.
• Bring questions: Even asking, “Why do I feel this way?” is valuable.
• Trust the process: Sometimes the most important discussions emerge naturally in the moment.

What If You Don’t Know What to Say?
This is a common situation, especially at the beginning. Some options include:

• Talk about your day or week.
• Share a recent dream.
• Reflect on what it’s like to be in therapy.
• Explore silence—sometimes not talking reveals just as much.

Remember: you don’t need to prepare a script. Therapy is about showing up as you are.

Sensitive Topics You Can Bring Up
You may hesitate to discuss certain issues, but therapy is designed for openness. Topics often include:

• Sexual concerns
• Addictions or compulsive behaviors
• Feelings of shame or guilt
• Thoughts of self-harm (which should always be shared for your safety)

Your therapist’s role is to support, not judge.

The Role of Trust in Choosing What to Talk About
At first, you might not feel comfortable sharing everything. That’s normal. As trust builds, you’ll likely find it easier to bring up sensitive or vulnerable topics. Therapy is a journey, and what you share may evolve over time.

Examples of First-Session Topics
If you’re starting therapy and wondering what to say in the very first session, here are useful entry points:

• Why you decided to seek therapy now
• What you hope to gain from therapy
• Any symptoms or struggles you’ve noticed recently
• Your background including family, relationships, work, health

The first session is about laying the groundwork. You don’t need to tell your entire life story right away.

Why Talking Matters
Therapy works because it provides a structured, safe space to explore thoughts and emotions. Research consistently shows that talking about difficulties like naming them out loud reduces distress and improves clarity.

By verbalizing your experience, you can:

• Gain perspective on challenges
• Feel less isolated
• Identify choices and solutions you hadn’t considered
• Strengthen resilience

When Therapy Feels Stuck
Sometimes you may feel therapy isn’t moving forward. If that happens:

• Talk directly about feeling stuck.
• Share if you feel misunderstood.
• Revisit your goals with your therapist.

Open communication keeps therapy effective.

Therapy as a Collaborative Process
What you talk about is your choice, but therapy is most powerful when it’s collaborative. Your therapist will listen, ask questions, and sometimes challenge you. The combination of your openness and your therapist’s guidance creates change.

The question “What should I talk about in therapy?” doesn’t have one single answer. You can talk about your feelings, relationships, past experiences, future goals, or even your uncertainty about what to say. The important part is showing up honestly and being willing to explore.

Therapy is not about being “interesting” or “perfect”. It’s about being real. Over time, you’ll find that the process naturally guides you toward the conversations you need most.
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