What to talk about in therapy sessions: 6 things to consider

It’s often difficult to know what to talk about in therapy. It’s not uncommon to have something really pressing that you plan to discuss but, when you sit down opposite your therapist, you go completely blank.

Sometimes, merely looking at your therapist can have this effect. Then, as soon as you leave the session, the pressing issue you planned on discussing pops back into your mind and you feel like you’ve wasted the session. This can be a deeply frustrating experience. So, how do you decide what to talk about? How do you determine what’s relevant? This article is here to help.

What to talk about in therapy: 6 things to consider

1. The type of therapy you are having can determine what to bring

There are many different types of therapy, all with their own theories and practices. This can dictate what may be best to talk about and how to approach your therapy sessions.

The three main types of therapy currently practised in the UK are cognitive behavioural therapy (CBT), psychoanalytic or psychodynamic therapy, and humanistic therapies such as gestalt therapy and person-centred therapy. Many practitioners are also integrative, which means they combine multiple approaches in their work.

It is useful to ask your therapist about the type of therapy they practice and what they feel would be helpful for you to bring to each session.

2. Think – what’s meaningful?

Clients often say they struggle to know what to say in therapy, or what is ‘useful’. Although, anything can be useful in therapy (for example, something you may think is insignificant may open the doors to an important event from your past or a buried emotion), consider what is meaningful to you, either recently or in relation to your life so far.

Meaningful means something that stands out in your mind: for example, something that you value, something that has contributed to your distress, and/or something that triggered an emotion in you.

Ask yourself:

• Did something recently trigger an emotion that disrupted your day?
• Does a thought frustratingly continue to swirl in your mind?
• Is there a feeling that you can’t describe, but won’t go away?
• Do you find yourself getting really angry at someone or something?
• Did you recently have a frustrating conversation with a friend, partner, or family member?

Ultimately, your therapist can only work with what you bring, so try to bring what matters to you. If nothing jumps out, say this to your therapist and start from there.

3. Let your body do the talking

Often, when we don’t know what to say, we spend a lot of time thinking about what we should say. However, most therapy is an attempt to connect to buried feelings in your body. The idea is not to think too much about what you want to say before saying it. This is particularly important for specific types of therapy, such as psychoanalytic therapy, and is based on the knowledge that much of what we experience manifests emotionally in our bodies. Therefore, it's useful to try to orientate from your body, not your mind, in your sessions.

Take a moment just before your session, perhaps in the waiting area or during your commute, to ground yourself in your body and your environment. You could even do this with your therapist at the start of your session. Below are three helpful ways to connect to your body: via your breath, sounds in your environment, and/or sensations (or rather, a body scan). You can also combine all three techniques in one meditation.

To connect via your breath, close or lower your eyes and breathe from the deepest part of your stomach, allow your chest to expand to its fullest capacity as you breathe in – this should last for about six to eight seconds. As you breathe out, take the same amount of time to release all the air in your body and allow your chest to sink fully. Repeat this until your muscles feel thoroughly relaxed and your mind feels clearer.

To connect via your environment, close or lower your eyes and allow your breath to grow deep, try and be conscious of any sounds in your environment (the birds chirping, the radiator, your own breathing), and focus your entire attention on these sounds. When a thought arises, revert your attention back to the sounds whilst maintaining your deep breathing. Try to do this for at least three minutes.

To connect via bodily sensations, again close or lower your eyes and allow your breath to grow deep. Feel the weight of gravity pulling your body into the chair or ground beneath you. Starting from your head, envisioning a light making its way down your body, imagine you are inside your body and connect to the sensations that arise in each body part the light passes: your eyes, your heart, your stomach, your legs. As you do this, try to relax the muscles in each body part. Stop once you’ve reached your toes.

From this embodied space, you will be more able to speak from your emotions. Things should flow more organically and your thinking mind shouldn’t get in the way as much. 

4. Get a journal

Studies show that journaling is beneficial for mental health. It is also an invaluable tool for getting the most out of your sessions, as it allows you to keep track of any feelings, thoughts, dreams, and experiences you have throughout the week. If you really struggle to know what to say, this can provide useful material for what to bring into a session. You can even read a journal entry to your therapist and go from there.

Journaling shortly after your sessions is also a great way to reflect on what you’ve explored and gain perspective on your process so far. It will help things stick, highlight topics that keep coming up for you, and show a picture of how far you’ve come.

5. Reflect on what you usually talk about

Make a note of what you decide to bring to therapy. Do you find yourself attempting to engage in small talk with your therapist? Does it feel more like a friendly chat? If so, that could indicate that you may be avoiding something.

When we experience trauma or something intensely emotional, we attempt to protect ourselves from re-experiencing it by not allowing ourselves to go there. Therefore, this may indicate that you are not ready to explore some things yet, and this is OK. You may need more time before you are ready. Nonetheless, it’s good to be aware of this avoidance and it provides great discussion material in therapy.

6. Voice your frustrations with your therapist

It's normal to get frustrated at your counsellor, psychotherapist, or psychologist. Therapy is an intimate experience. You are opening up about your deepest anxieties and traumas. Within this intimate space, past relationship dynamics - say with your mother or father, for example – get activated and replay in the relationship you have with your therapist. This can make it difficult to voice your grievances with your therapist, as you may fear their reaction. Likewise, if you find that you are a people pleaser in your relationships, the same thing can happen with your therapist. This can be incredibly stressful and often leads to people abruptly terminating therapy.

Sometimes therapists get it wrong and can say or do harmful things to clients, therefore causing frustration. However, it is your therapist’s duty to provide a safe space for you to voice any concerns you have, and to be able to receive this. In many ways, getting your frustrations out in the session is a vital part of the work. Your feelings and concerns are valid and therefore worth voicing. Try to connect with your inner courage and tell your therapist how you feel, particularly before making the decision to terminate sessions. How they respond can be hugely therapeutic and help you better manage conflict in the future. If they become defensive or hostile, this makes the decision to leave clearer.

It’s natural not to know what to say in therapy. Try not to judge yourself too harshly. I hope this article provides some tangible tips to ease some of your anxiety. If you are ready to make a change and start your therapy journey, I’d love to do this with you – email me today to learn more.