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

If you’ve never been to therapy before, you may be nervous that there won’t be anything to discuss. While it might feel uncomfortable at first, you can discuss almost any issue or challenge you are facing with a therapist.

“Therapy is a safe place to discuss whatever is on your mind,” says Jaclyn Ross, PhD, a clinical psychologist in private practice in Chicago.

When it comes to therapy, no topic is off-limits, but some people may draw a blank on what to say in their sessions or how to get started. If you need guidance, read on to find out what you can discuss, what you can expect in your first session, and how to get the most out of your time.

According to the American Psychological Association (APA), it’s normal to feel nervous about going to therapy. You can calm your nerves by learning more about what your first session may look like and what questions your therapist might ask you. Sessions can vary by therapy type and provider, but generally, first appointments are relatively similar.

Before Your Session

Going to therapy for the first time can be intimidating. If you want to prepare for your first session, do some research. You can often learn more about your specific therapist, their qualifications, and the types of therapy they offer online. You can also ask your friends and family about their experiences with therapy.

The APA recommends making a list of questions before your session. You may learn more about your therapist by asking about these areas:

• What problems or challenges can they help you with?
• What experiences and qualifications do they have?
• How will they measure your progress in therapy?
• Are there any resources or books that they recommend?

Ask as many questions as you need. Your therapist is there to help you.

During Your Session

In the first session, your therapist may provide information on their confidentiality policy, fees, and process for making or canceling an appointment. They may talk about their background and their approach to therapy.

They may also gather some of your background information. Your therapist could ask you questions about yourself, your family, other relationships, and your reason for seeking therapy. They’ll gather as much information as possible so they can better understand the challenges you’re facing and what you hope to get out of therapy.

There may be topics you aren’t ready to talk about — and that’s okay. Building trust with your therapist takes time, according to Mental Health America. You can always let your therapist know if you aren’t comfortable discussing certain topics.

You may not get to cover everything on your mind during the first session. There will be plenty of time to revisit these topics and go into more detail during your next session. If you want to remember to bring up something later, write it down so you can start with it next time.

Therapy is your time to use as you wish. No topic is off-limits.

You might worry that you will get to your first session and won't have anything to discuss. That’s where your therapist comes in. They can help guide the conversation if you don’t know where to start.

“As a cognitive behavioral therapist, I often set an agenda at the beginning of the therapy session when the client and I collaboratively decide what is most important for us to talk about today,” Dr. Ross says. “This makes the process very collaborative and takes some pressure off the client to come in with a specific topic each week.”

It’s okay to be honest with your therapist and tell them you aren’t sure what to talk about. “If the client is really struggling to come up with things to talk about, I may ask them how things are going in the different areas of their lives to prompt some ideas,” Ross says.

Here are some possible topics to talk about in your therapy session.

Recent Life Events

Big life events — positive or negative — come with changes that can impact your mental health. They may bring up emotions you don’t understand or know how to deal with. Talking about these events in therapy can help you process them.

Therapy can help you navigate a variety of life events:

• Moving to a new city
• Switching careers
• The birth, adoption, or fostering of a child
• The death of a loved one
• Marriage or divorce
• New health diagnosis or other health issues

Sharing recent life events with your therapist will allow them to provide relevant support.

Personal Challenges

Personal challenges or setbacks can be difficult to deal with, especially on your own. You may be experiencing low self-esteem or body image issues, feel burnt out from work or school, or have other stressors in your life.

You should always feel empowered to talk about personal challenges with your therapist. They can provide support and suggest coping strategies.

Relationships

Our relationships can provide many benefits, but they can also impact your mental health.

“Connection with others is deeply important for our emotional health and well-being,” Ross says, adding, “relationship conflict can take a significant toll on our mental health. And our mental health difficulties can, at times, be disruptive to our close relationships.”

That’s why, in therapy, it’s essential to talk about the people in your life, like family members, romantic relationships, friendships, coworkers, or even neighbors. Therapy is a safe space to explore any feelings or concerns about your relationships. You may feel you can’t openly discuss issues with the people in your life, which is why talking about them in therapy is beneficial.

Discussing your relationships not only helps you work toward being a better partner, friend, or family member, it also helps you work on your personal growth. Therapy may help you:

• Uncover relationship patterns
• Establish healthy boundaries
• Develop communication skills
• Manage and resolve conflict
• Heal from past experiences

Past relationship experiences can impact your current relationships. Discussing them in therapy can help you better understand your thoughts, feelings, and behaviors.

Negative Childhood Experiences

Childhood provides a foundation for adulthood, so it’s natural to still think about past events or traumas as an adult.

You may realize that some stressful events stuck with you over the years. These potentially traumatic events are called adverse childhood experiences — and they’re more common than you may think. According to the Centers for Disease Control and Prevention, about 64 percent of U.S. adults experienced at least one adverse childhood event.

If you experienced an adverse childhood event that still affects you or feel the need to discuss any type of experience from your childhood, your therapist can help you unpack the incident and develop coping strategies.

Identity

Exploring experiences related to your identity — like gender, sexuality, ethnicity, culture, and religion — is also common in therapy.

According to the National Alliance on Mental Illness (NAMI), your identity and culture should be a source of strength and support during your time in therapy. Your therapist should understand your cultural differences and be able to incorporate them into your therapy sessions.

If you’ve faced discrimination or challenges related to your identity, therapy is a safe space to talk about it. You may also want to discuss how your cultural differences or identity have impacted you.

Different types of therapy will suit different people’s preferences and needs. Here are some of the most common types:

• Cognitive behavioral therapy (CBT) is one of the most common types of psychotherapy, or talk therapy. This approach focuses on behavior and thought patterns. CBT allows you to learn skills that can help you understand, identify, and change these patterns.
• Eye movement desensitization and reprocessing (EMDR) aims to reduce the distress linked to past events. According to the APA, EMDR is an effective treatment for those with trauma and PTSD.
• Interpersonal therapy is a short-term therapy that focuses on the relationships in your life.
• Dialectical behavioral therapy is a type of talk therapy that focuses on practicing mindfulness and developing skills for regulating your emotions, tolerating times of stress, and interacting with others.
• Exposure therapy aims to reduce anxiety by exposing people to their fears so they become less fearful over time. This type of therapy is most effective for people with obsessive-compulsive disorder and phobias.

Your personal goals should determine the type of therapy you choose.

You can also decide between in-person or online therapy. Online therapy can make sessions more accessible and affordable, depending on your insurance and treatment provider or platform.

While therapy is an excellent tool for managing your mental health, it also requires a commitment of time, energy, and money. Here are some suggestions for getting the most out of your sessions.

Be Open and Honest

It can be difficult to be vulnerable with a stranger. “Opening up to a new person can be intimidating, so it does take some bravery to share vulnerable information in therapy sessions,” Ross says. Opening up may be a gradual process. Don’t force yourself to overshare, but go at your own pace. Let your therapist know if anything is getting in the way of your progress.

Honesty is key when it comes to your mental health, according to the National Institute of Mental Health. Communicating openly with your therapist will build trust and help your therapist provide you with the best possible support and guidance.

“The important thing to remember is that you will get out of therapy what you put into it,” Ross says. “If you are open, from the start, about things that are distressing to you — even if you feel they are embarrassing — you and your therapist can develop a shared understanding of the issues that are most important to you. Then you can work collaboratively to create meaningful change in your life.”

Remember that therapy is a safe space. “Your therapist is not there to judge you,” Ross says. “They are there to help you move closer to the life you want.”

Find the Right Therapist for You

When you’re looking for a licensed therapist or mental health professional, you should keep an eye out for specific qualities. According to NAMI, your therapist should be someone who:

• Accepts you
• Challenges you and pushes you out of your comfort zone
• Treats you with kindness and compassion
• Understands various cultural barriers
• Helps guide you to reaching your goals

You may want to look for additional qualities depending on your personal goals and what type of therapy you are looking for. Overall, your therapist should be a kind, trustworthy person who provides support and guidance.

Set Therapy Goals

Whatever your reason for starting therapy, it’s essential to figure out exactly what you want from the experience. Having specific goals can guide your experience and help you track your progress.

Here are some potential goals for therapy:

• Develop healthy coping skills.
• Learn how to communicate your feelings to others.
• Understand your emotions and learn how to accept them.
• Develop and maintain your relationships with others.

You can develop your therapy goals before you start or you can work with your therapist if you’re unsure. Your goals may change over time as you make progress.

Take Notes Throughout the Week

For some people, writing about your emotions may be easier than talking about them. Taking weekly notes can help guide your therapy sessions by reminding you of topics or events you want to discuss.

“I often encourage people to take advantage of note-taking apps on their phones,” Ross says. “Throughout the week, whenever you notice a strong emotion, jot down what the emotion is, what situation prompted it, what thoughts went through your mind, and how your behavior changed as a result.”

If you feel like you have nothing to talk about or you draw a blank during your session, it can be helpful to have a written record to refer to. “Having these notes from the week can help you and your therapist work collaboratively to better understand your patterns and to gain tools for managing distressing thoughts and emotions,” Ross says.

You can talk about anything in therapy. The conversations with your therapist will likely cover a range of topics, like recent life events, personal challenges, relationships, negative childhood experiences, or aspects of your identity.

If you are worried there won’t be anything to talk about, or if you draw a blank during your session, your therapist will ask you questions and help guide the conversation.

The best type of therapy for you will depend on your preferences and personal goals. To get the most out of therapy, focus on being open and honest, finding the right therapist, setting goals, and taking notes between sessions.