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What to Talk About in Therapy

Counseling can be intimidating when you’re starting out. It’s hard to know what to talk about, which therapist to choose, and what to expect from your sessions. There’s also the internal war we wage with ourselves over whether we really need therapy. We debate with ourselves about the efficacy of therapy. Can we afford it? What if we don’t connect with our therapist? How will we find time for our sessions? And then there’s the obvious awkwardness that comes with divulging intimate details about our life to a complete stranger.

It’s a lot.

So I want to demystify the process for you a bit and help you navigate those early sessions and help you get started. I say this as a therapy dropout who had all but given up on it. If that’s been your experience as well, don’t write off therapy just yet.

Make sure you have the right therapist.

Before you start talking in therapy, it’s good to know you’re talking the right person – someone with a background suited for your particular therapy needs. This is not always easy. If you’re looking for in-person options, it is often the case that you’re given a list of providers covered by your insurance (if you have that) and little else.

Do your homework. Google any therapist you’re considering working with to see if you can find the following:

  • Reviews from current or past clients
  • Their specialities
  • Demographics they typically work with (some therapists work more with children, or couples, or other group)
  • Educational background
  • Years of experience
  • Gender (some people are more comfortable with women or men)
  • Languages spoken (especially if English is not your mother tongue)
  • Availability – What are their office hours and are they currently accepting new patients?
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What to talk about in therapy

Try to get a referral or recommendation.

If you have a primary care physician you like and trust, ask them for a referral. Who do they refer patients to? If you’re comfortable, you can reach out to friends and ask if they’ve worked with anyone good. You can even check local groups or forums online that have recommendations for who to see (or stay away from).

As a note, take recommendations (or warnings) from people you don’t know with a grain of salt. Therapy is complicated as are people’s needs and working style. What works for one might be completely wrong for another.

Telehealth Matching

One advantage to using a telehealth therapy service, like BetterHelp (an amazing sponsor of Soberish) is that these companies do the work of finding the right therapist for you. Before you start counseling, you take a quiz that helps them identify your therapy needs and counselor preferences. Then, they match you with someone who is a good fit.

If it doesn’t work out, you can easily switch to someone else.

I’ll be honest with you. Finding the right therapist was a nightmare for me. (Some very weird and wrong situations.) I had all but given up on therapy but decided to try BetterHelp to see if I could get better results.

When I signed up, I was paired with someone who was not only a good fit but the first therapist I’d ever worked with who helped me make progress. Honestly, it was the best counseling experience I’ve ever had, and you can read more about why –>> HERE.

Telehealth counseling tends to eliminate the crapshoot of finding the right in-person therapist. At least, that has been my (and thousands of others’) experience.

If you decide to try BetterHelp, you can receive 10% off your first month with the code “soberish.”

woman talking to her therapist from her phone
Finding a good therapist

Preparing for Your First Session

When I’m nervous or unsure of myself, I get very verbose. I talk in circles and take way too long to get the point (if I get there at all). This is not a great quality for therapy.

Whether you’re wordy, nervous, closed off, or some combination of these, preparing ahead of time can help you know what to talk about in therapy without all unnecessary details and “ums” and uhhhs.”

Get clear about why you’re there.

You are starting therapy for a reason. What is it? What are your primary concerns? Do you struggle with depression or anxiety? Do you have a history of abusing alcohol or drugs? Maybe you’re carrying baggage and don’t know how to forgive yourself and move forward with your life.

Is it a combination of several things?

Understanding why you are seeking counseling will help you get the most from your sessions. It is especially important to go into your first session with the ability to articulate why you’re there. For a lot of people, that requires writing it out ahead of time.

Your therapist is likely going to start the session introducing themselves and going over their background and working style. Then it will be your turn. What do you want this person to help you with?

If you don’t exactly know, say that. Not knowing why you’re feeling off is valuable information. They can help you explore what’s wrong.

Go into that first session with a spirit of transparency and honesty.

7 Things to Talk About in Therapy

It is often the case that our histories, feelings, and problems are multi-layered. Your therapist can help you pick those layers apart, but you still need to provide a roadmap. But how? There have been many times in my life when I knew I needed help and was depressed, but was unable to say why. I would speak in generalities. Sometimes I would be overwhelmed with emotion and shut down. If that sounds familiar, you may find it useful to have conversation topics ready ahead of time.

Here are seven ideas of things to talk about in therapy that can help get the ball rolling.

1. Discuss your relationships.

Our relationships with others, both current and past, can provide our therapists with valuable insight into our inner worlds. Your therapist is likely going to ask about your family, what it was like for you growing up, relationships with parents, siblings, caregivers, etc.

You can also talk about your relationships with friends, spouses, exes, or your dating life. Working relationships with colleagues and bosses are also important. If there are tensions or complications in any of these relationships, that is a great thing to bring up with your therapist.

They can offer an objective, third-party perspective in ways your friends and family members cannot.

Related Post: How Alcoholism and Sobriety Impacted my Marriage

2. Talk about your feelings from the week.

Another great topic to talk about in therapy is how you felt this past week. Your therapist might even start off a session with, “Is there anything from your week you’d like to talk about today?”

It’s a good exercise to write down any significant feelings or interactions you want to work through with your therapist in between sessions. If you journal, you’re one step ahead of the game.

If you were in a funk this past week, talk about it. It’s okay if you don’t know why. On the flip side, maybe you had an exceptionally positive week. That’s important to note as well. Or maybe you’d been feeling great, and something happened this week that you’re struggling to bounce back from.

Sometimes talking about your week out loud helps you interpret things differently. The story we tell ourselves in our heads can sound different when spoken out loud to another person. You may think nothing of import happened during the week, but as you start talking about it, you realize, “Well actually, there was this one thing…”

woman talking in a therapy session
Ideas for what to talk about in therapy

3. Discuss changes in thoughts or feelings.

This is related to #2. If you’ve noticed that your feelings have taken a turn or your thoughts are becoming more distorted, it’s important to let your therapist know.

Were you feeling good about someone you’ve been dating, but this past week you’re doubting the viability of the relationship? Or maybe you were getting along well with your mom, but now you’re ignoring her and aren’t sure why.

Maybe you’ve been working on building your confidence at work and it’s not going as well. Any changes in thoughts or feelings is an important topic for discussion in therapy. Don’t hesitate to bring it up.

Related Post: How to Stop Struggling with Black and White Thinking

4. Talk about your past.

We all have skeletons in our closets – things from the past that have shaped our present situation. Talk to your therapist about them. If you had a rough childhood, talk about it why. What happened?

Sometimes our past is littered with mistakes or regrets that has us bogged down in shame. Let your therapist in on that part of your life so they can help you move on from it. Often there are experiences in our past that have shaped us in ways we never realized before. Talking about your past allows a good therapist to tease out some root causes we hadn’t considered.

5. Talk about things you’re struggling to process or get over.

We’ve all had something we can’t seem to move past in our lives. Sometimes these are things like ex relationships or missed opportunities that haunt us. You have no idea why you can’t move on. Other times, we might struggle with trauma like the death of a loved one or an act of violence against us.

Be open with your therapist about things you have not been able to process in a healthy or meaningful way. Your therapist is here to help you with the stuff you cannot manage on your own. Let them know what’s going on with you.

6. Discuss anything that is bothering you.

This one seems obvious, but sometimes we withhold things that are bothering us when we don’t fully understand them. You don’t have to do that with your therapist.

If you’re feeling lost for words, talk about what’s bothering you. And if you don’t know what’s bothering you, talk about that. Both are significant. It is 100% fine to say, “I feel off and I don’t know why.”

7. Talk about any challenges you’re having with therapy.

If you’re new to therapy and struggling to open up or be forthcoming, talk about that. Therapy is a type of relationship that is open to the same kinds of conflicts and misunderstandings as any other. Maybe you’ve had bad experiences with therapists in the past. Let your therapist know that upfront.

Similarly, if the vibe is off with your therapist, you need to bring it up. If you feel misunderstood or like your therapist isn’t listening to you, say so. It serves no one to go through these sessions with that kind of tension.

If your therapist isn’t receptive to having this conversation with you, that is a sign you need to switch therapists.

Access should not be a barrier to help.

Soberish is proudly sponsored by BetterHelp. If you have tried (and failed) to find a therapist who has the knowledge and background to help you navigate your specific issues, try BetterHelp. Learn more about my counseling journey with BetterHelp or visit their website below.

Tips for Having a Good Session With Your Therapist

Once you know what to talk about in therapy, there are some expectations you need to have for yourself before your sessions.

Here are 3 suggestions that will help you get the most our of your time together.

1. Be completely honest.

We all want to put our best face forward, but if you’re not completely honest with your therapist, there is no point in going to therapy. It’s tough! Who wants to admit to doing or thinking terrible things? None of us. But lying to your therapist, either outright or by omission, is not going to help you.

It also erodes trust, which is the cornerstone of any good therapist/client relationship. If you’re struggling to be honest, talk about that. But come to your sessions in good faith.

2. Focus on the important stuff.

You’re in therapy to work through your stuff, not to gossip about the colleague you hate at work (for example). It’s important to maintain perspective in therapy. You aren’t shooting the breeze with your bestie. You’re working with a medical professional who wants to help you navigate the tricky parts of your inner and outer world.

Sometimes we slip into friendly shit talk as a way to avoid having more difficult conversations. A good therapist will recognize when you’re doing this and try to steer the conversation back to core problem. If you get off track, let them guide you back.

3. Communicate your feelings.

Can I be honest for a second? I was terrible at this. If someone was pushing too hard or making me confront something I wasn’t ready for, I would shut down. Other times, I became overwhelmed by emotion and instead of letting the tears come, I just went silent.

These are not helpful behaviors in therapy. It is okay to cry. It is okay to say, “This topic is hard for me and I’m not ready to go there yet.”

For your relationship to be effective and rooted in trust, you have to be open with them about your experience. Remember, this is not a friend. You’re not going to hurt their feelings. Letting your therapist know what you’re feeling during a session is important. They can adjust or modify accordingly. Unfortunately, they can’t read minds. So if you don’t talk about what’s making you shut down, you can’t move past it effectively.

Bottom Line on What to Talk About in Therapy

There’s no right or wrong thing to talk about. We all come to the table with specific needs and problems we’re working through. The most important thing is that we are honest and forthright about why we’re there.

As long as you’re committed to doing the work and you’ve got a good therapist on your team, you’ll be able to make progress.

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