Are you curious about what you can talk about in therapy? Are you wondering what might be helpful to share with your therapist?
It can be tricky to know what topics to disclose, especially if it’s your first time. But don’t worry—we’re here to help!
If you’re looking to make the most out of your therapy sessions, here are commonly discussed topics that therapists say you should talk about:
Christine Olsen, MSW RSW
Registered Social Worker and Psychotherapist, Olsen Psychotherapy
Talk about what made you seek help now
Commonly, people have something going on in their life that prompts them to seek a therapist.
What made you seek help now? You can even explain why you sought help now rather than last week or last year. This gives your therapist important information that can open other doors for conversation.
Also, you can go down the road of exploring how this current issue is affecting all areas of your life because it’s never isolated. Look at how this issue shows up in your relationships, work or school, emotional health, etc.
Talk about your past
If there are experiences from your past that you keep thinking about and you are wondering if it’s still relevant, it is. I would argue if it’s still coming up in your mind, then it’s a present issue too.
Many therapies explore your childhood, for instance, because those early experiences are critical to how you see and interact with the world, yourself, and relationships.
Some therapies even go back and connect the challenges of the generations before you. So go as far back as you like. If you are curious about it, then it’s a good topic for therapy.
Your important relationships
Whether you have lots or many, relationships are key to how we experience our lives. Talk about your mom, dad, siblings, an important friend, co-worker, or dog.
Whoever is important to you in good or bad ways is going to have an impact on your current issue. It will give critical information about how you deal with conflict or closeness and what positive support you have to lean on.
Your negative thoughts
Our inner world tells us so much. Talk about the thoughts that keep you up at night.
What’s the thing that’s on repeat, and you keep going over in your head? Are there thoughts you know aren’t true, but for some reason, they pop up at certain times?
This is connected to your feelings, behavior, relationships, and past experiences.
Related: How to Control Your Thoughts
Talk about your therapy and your therapist
Therapy is relational. Your therapist helps you with your issues, and there is a relationship between you that is supposed to be therapeutic.
This means if you aren’t getting along as well as you hoped, you feel like the type of therapy they do isn’t working for you, or that what they said hurt your feelings, then talk about it.
Hopefully, this is something your therapist brings up regardless, but certainly, do it yourself to get it off your chest sooner.
Kierstyn Franklin, CMP and Tiffany Denny
Certified Life + Health Coach, The Relationship Recovery
Therapy can be a safe place to talk about anything, really, whether it feels small or a major life decision. All are welcome in therapy. However, it’s easy to be shy about what to talk about when you are just starting therapy or starting with a new therapist or coach.
Here are some good talking points to consider:
Why you started therapy
This can typically be something that happens in our lives that drives us to therapy.
Be sure to identify what that was and bring it to therapy to be discussed. This will give the therapist insight into what drove you to therapy and a place to look for patterns.
Your day-to-day life
Allowing your therapist to get insight into day-to-day life will help them better understand how you respond to daily occurrences. They may help you establish better coping skills or reframe an event for the better.
Your internal dialogue
It can feel very vulnerable to share what we say about ourselves inside our heads, but it can be quite empowering once we do. Your therapist can help you identify where it’s rooted and how to reframe negative thoughts into positive ones.
Related: How to Get Rid of Negative Thoughts?
Anything you contemplate or look back on may be attached to an internal trauma. By allowing yourself to share, the therapist may be able to help you process whatever your mind is holding onto.
Sharing interpersonal interactions with your therapist can help you improve communication skills, seek validation in your relationship choices, and even help identify relationship patterns.
Being intentional with your therapy and what you talk about will provide more opportunities for personal growth.
John Cottone, PhD
Licensed Psychologist, Choosing Therapy
People come to psychotherapy for different reasons. Most often, people pursue therapy because they have psychological symptoms that are preventing them from their usual levels of functioning and well-being.
Your interest in self-actualization
However, sometimes people seek treatment because they’ve plateaued at a level of functioning that is below their estimate of their peak potential, and they’re interested in self-actualization.
Any medical or psychological conditions you may want to manage
On the flip side, other people pursue therapy because they have a medical or psychological condition that may never improve (like diabetes), and they may want to manage their symptoms with as little loss of functioning and well-being as possible.
Knowing where to begin or what to talk about in therapy can be anxiety-provoking and in-and-of-itself, especially for first-timers.
Recent incidents which provoked strong emotions
Many of my patients come to sessions saying, “I was anxious in the car on my way over here because I didn’t know what to talk about.” But once we break the ice, they can get in touch with deeper feelings hiding just below the surface, or recent incidents that they forgot, which provoked strong emotions during the week.
When in doubt, psychotherapy patients would be well-served by considering the following five topics in any given therapy session:
- Am I experiencing symptoms that are holding me back from my usual level of functioning or well-being? If so, what symptoms?
- Are there things in my life that are currently holding me back from my peak human potential?
- Do I know what I want my future to look like?
- Are the most important relationships in my life where I want them to be?
- Am I progressing toward the practical and spiritual goals I’ve set for myself?
How you want to fix a problem that’s holding you back
Each session, with every one of my patients, our discussion touches on at least one of these topics, and sometimes more. Many people start therapy because they want to fix some problem that’s holding them back from their usual level of functioning.
However, after getting back to baseline, they realize that they can still progress closer toward their ultimate human potential, and they continue in therapy longer.
In this way, psychotherapy can be a lifelong endeavor, like exercise or meditation. However, if a person seeks only to use therapy as a means to an end—the relief of a specific symptom or problem—that’s fine too.
Lydia Angelica Antonatos, LMHC
Licensed Mental Health Counselor, Choosing Therapy
The reason why you are there
A good start is addressing what prompted you to seek therapy now.
Describe the struggles you are facing and how these are impacting your life—personally, your relationships, work, and other important areas.
Provide as many details as you feel comfortable sharing, like:
- Recent events
- Losses or anything else causing you distress
- Symptoms you have been experiencing
- How long you have been struggling
This is also an excellent time to discuss your strengths, resources, and supports and how these can have helped you overcome obstacles.
Discussing background history can give your counselor some context and a better idea about contributing factors that may relate to your current struggles.
Talk about your mental health history, if you have been in therapy before—what was helpful and what wasn’t, and any psych medications you are on or have been on in the past.
This is also a good time to let your therapist know about any past trauma (you don’t need to go into detail if you don’t feel comfortable), any history of suicide or self-harming behaviors, and if you have received a mental health diagnosis.
Share any other information you feel is important for your therapist to know, like health conditions and history (if any) of substance use.
Things you hope to get out of therapy
Another important area to talk about is what are your expectations for therapy.
Discuss the problems you want to resolve, how resolving these problems would enhance your life, and what specific changes you would notice.
Also, describe how you think your counselor and therapy itself can help you while sharing if you have any concerns about therapy. Addressing these areas can help you, and your counselor set your goals for therapy.
Therapy goals: What you’d like to accomplish and work on
Although during your first session, you probably will not go into a detailed treatment plan. It is still essential to have some idea of what you’d like to accomplish and work on throughout the course of treatment.
These goals can give you and your counselor direction regarding the areas you want to focus on. You can begin by identifying three broad goals you would like to work on during therapy sessions.
Ensure that these are realistic and doable for you. Consider what is important for you.
For example, is it personal growth? Developing better coping strategies? Managing stress more effectively? Etc.
Ask questions about your therapist
During your first meeting, you have every right to know information pertaining counselor’s professional background and policies and what to expect throughout the process.
Consider asking questions important to you.
- Have you helped people with similar issues as me?
- What methods do you use in therapy?
- How long have you been in the field?
- How long are the sessions, and how long will I be in therapy?
- Policies for contacting them in-between sessions or during emergencies, what is expected of me during therapy?
Ashley Levin, LMFT
Clinical Director, Pacific Sands Recovery Center
Overwhelming emotions from a precipitating event
One of the most important things to talk to your therapist about when you first start therapy is the precipitating event that prompted you to seek help.
What recent events happened that led you to the point of reaching out for help?
Usually, people find themselves looking for help due to overwhelming emotions, an inability to cope with certain circumstances, trauma, relationship issues, or other stressful events.
What you’re struggling with currently
It is pivotal that you let your therapist know what you are currently struggling with. Open communication during your initial appointment allows you and your therapist to collaborate on a treatment plan that will correctly and quickly address your most pressing needs.
Your beliefs and feelings regarding therapy
Another great thing to talk to your therapist about is your beliefs and feelings regarding therapy. Therapy can be a scary experience for some, and being transparent with these emotions can help the therapeutic relationship.
Some people may also have preconceived notions about therapy. Maybe their family is not supportive of it, or they may think that therapy won’t work for them.
A conversation about these beliefs may feel uncomfortable, but it will allow your therapist to understand where you are coming from and educate you on how the therapeutic process works.
It will also be beneficial to talk about past experiences with therapy, what has helped you, and what hasn’t.
Your coping skills and the barriers to utilizing them
It’s important to discuss what coping skills you may already have and the barriers to utilizing those coping skills. Maybe some coping skills work well for you, or there could be ones you have not tried.
Reviewing the therapeutic tools that you currently have in your toolbox is essential. It allows both you and your therapist to build upon your existing foundation of coping skills.
Your relationships and support systems
Another topic to bring up in therapy is relationships. Having a support system benefits anyone, so exploring current relationships with others helps identify who you can talk to outside of the therapeutic setting.
Discussing childhood experiences and relationships with your primary caregiver would also be beneficial in assessing any attachment issues that may be prevalent.
Although scary, it is also important to talk about any history of trauma, whether it happened in childhood or adulthood.
The effects of trauma can permeate through your entire life and change how you process emotions and thoughts. Working through trauma with a licensed therapist is the pathway to your healing.
Lastly, your clinician may choose a specific therapeutic modality to help you process your trauma, such as EMDR.
There is a multitude of topics to discuss with your therapist.
The most important thing to remember is that your therapy is a judgment-free environment. No topic is off-limits. Being vulnerable with another person can seem intimidating, but the benefits of therapy are certainly worth the initial uncomfortably.
Family Systems Psychotherapist
What clients talk about in therapy depends on the therapist’s theoretical orientation. Despite superficial differences between therapeutic models, most talk therapists use techniques descended from Freudian theory.
These techniques emphasize the therapeutic relationship and the open expression of feelings, particularly around traumatic events in the past that are thought to contribute to symptoms in the present.
The therapist asks questions that elicit feelings, with the idea that the expression of these feelings within the safe space provided by a caring and supportive therapist will lead to the resolution of the trauma and symptom reduction.
Incidents of child abuse, abandonment, and other negative experiences
Therefore, clients are encouraged to search their history for incidents of child abuse, abandonment, and other negative experiences and to relate those to the challenges they are having in the present.
There is a branch of therapy called Bowen Family Systems theory that views the therapeutic process through a different lens.
This natural systems theory considers the human in the context of evolution and biology and sees the individual’s experience as embedded in the larger family system and history.
Symptoms are viewed as expressions of anxiety as families strive to adapt to circumstances over time. Symptom modification is thought to come from the ability to behave more deliberately and thoughtfully when relating to important relationships.
This is challenging because the intense emotional bonds between family members lead to people reacting automatically to one another in patterns that serve some members better than others.
However, changes in any one person will lead to changes in the entire system so that any motivated individual can work on the family “problem.”
Accordingly, the therapist will ask questions that stimulate thinking rather than feelings. These questions will involve learning about facts of a family’s history with many questions that focus on the who, what, where, when, and how of the problem.
Certified Grief Counseling Specialist
Generally, people seek therapy for any of three primary reasons:
- To vent
- To heal
- To improve
Sometimes all of the above. To best utilize your therapy session, you want to clarify for yourself which is your priority at the moment.
If you want to vent
Let it all out. Anything goes, particularly recent stressors. But many people have endless therapy sessions of venting and eventually feel like it is no longer working, or they are not making progress on any of their “stuff.”
This is often when people quit therapy, saying, “I just felt like I was talking to a friend, and I have friends for that.”
If you want to heal
Share this goal with your therapist. You might talk about your formative years, your primary hurt, shame, addiction, or stuck point.
Start with whatever is most distressing to you at the moment or seems to be most impacting your present life. Your therapist may help you connect the dots, identify destructive patterns, or reframe some experiences.
If you’ve suffered trauma, EMDR might be helpful, as well as other healing modalities such as meditation or visualization techniques.
If you want to improve
You are looking for concrete tools to improve your relationship, your health habits, or communication skills, and you want practical guidance and not just a listening ear.
Identify the areas you need help with, and ask your therapist to help you experiment with and apply techniques or tools to improve. You can practice some, return to your therapist to share what worked and what didn’t, then adjust and move forward from there.
If you are looking for a therapist, you will find a better fit if you ask prospective therapists whether they can help you with that particular objective.
If they can, you start your therapeutic relationship with clear treatment goals, which leads to better outcomes.
Kali Wolken, LMHC, LPC, CCC
Licensed Counselor, The Lookout Point, LLC
Almost every therapist will ask you what your goals are in therapy. After all, the therapeutic process is a service to help you improve in some way. So before that first appointment, consider what you want to change through counseling.
A common question you’ll hear is, “If you wake up tomorrow and a miracle has occurred, what is different about your life as a result?”
This “miracle question” is designed to help you think about your ideal life and what you truly want to be different. So ask yourself this question now so you can walk in with a vision for what you hope life to be after counseling.
Your mental health
Yes, I realize this may be obvious, but counseling is the best place to share how you’re thinking and feeling. Sometimes, even though you’re in counseling because of depression, anxiety, or other mental health needs, it can be hard to be vulnerable.
Give yourself permission to share your struggles. You’d be surprised at how much this permission can help.
Talk about the people in your life
What you talk about in counseling stays in counseling.
So when you feel annoyed at partners, friends, or family members, share this. So much of therapy is about support and relying on someone else to carry the load for a while.
Sometimes, the people in (or not in) our life are the reason we are struggling, so it can be helpful to talk with someone else to get that outside perspective and support.
Sometimes, we need skills. We may need communication skills, coping skills, people skills, parenting skills, etc. If you want to gain support in building these skills, you can most definitely seek this out in counseling.
While most therapists have an arsenal of tools to help teach these if you know you want a specific set of skills, be sure to seek out therapists who specialize in the area where you need the most support (e.g., seek out a therapist who specializes in working with kids and families for parenting skills).
Anything you want
One of my favorite things about counseling is that as you share your story, themes will arise.
A good therapist can take these themes and help you identify the patterns for where you are getting stuck. So you could be discussing about a conflict with a coworker, and you might discover how this conversation reminded you of a fight with a close friend in your childhood.
You never know, but I believe that everything we share is interwoven into how we live our lives.
Fun fact: Even therapists use Dungeons & Dragons as a medium for therapy. So when I say you can talk about anything, I mean that even your level 14 Half-Orc Paladin is a part of your story.
Rachel Davidson, MA, LPC-A
Licensed Professional Counselor Associate, Malaty Therapy
Managing stress at work
Deciding what to talk about in therapy can be intimidating, especially for those who are new to the process.
Where do you start? Even if you know what you want to say, it can be scary to be entirely open with someone you have just met.
Giving yourself an outline can provide some structure for those of us who need it
Before the first session, it can be helpful to make a list of the topics you want to work on. You don’t necessarily have to go into detail right away but giving yourself an outline can provide some structure for those of us who need it.
The list might include general topics such as:
- Relationships with family members
- Managing stress at work
- Communicating with a loved one
These types of topics will give your therapist an idea of why you are seeking support but don’t require you to open up about personal details or past trauma right out the gate.
Some clients know exactly what they want to discuss with their therapist and wish to jump right into the deep stuff. That’s ok too.
It’s the therapist’s job to meet the client wherever they are in the process.
If possible, I recommend a consultation with a potential therapist before the first session. This will give you and the therapist an idea of whether you are a good fit for one another and may begin to ease your nerves about what to say.
You may find that the therapist is directive or that conversation comes naturally, hopefully alleviating some of that initial apprehension.
Building the relationship
A major component of successful therapy is the therapeutic relationship. The more you feel you can trust your therapist, the more likely you will make substantial progress toward your goals.
Developing a strong rapport with a therapist is no different than building trust with anyone else. It takes time, and you must learn that the therapist has your best interest at heart.
As your therapist shows you through their actions that they are in your corner and will support you through your therapeutic journey, you will likely begin to feel more comfortable opening up to them.
This feeling of safety and security in therapy is an invitation to go deeper and allow your therapist to help you explore some of your more personal issues.
Remember: You are in charge of your experience with therapy
Always remember that you are the expert on your own life and in charge of your experience with therapy. You get to be in the driver’s seat and make decisions about what you talk about and what issues are off-limits for the time being.
Your therapist may give you a push, but ultimately, it is up to you to determine what you want to talk about. Listen to yourself and talk about what feels right to you when you are ready.
Jordan Brown, MS, LPC, NCC
Licensed Professional Counselor, No Worries Wellness
Your goals (and what you want from therapy)
Therapy is a collaborative effort between you and your therapist, so it’s important that time is spent discussing your goals and what you want from therapy and your therapist.
This helps you feel empowered in your role in your treatment and allows your therapist to guide you in therapy with techniques and approaches that are better suited for what you are looking for/what concerns you want to address.
You may not know what you want or need right away, but this is a discussion that can happen throughout your therapy process as you learn what you want and as your goals evolve.
There is a wide range of possible therapy goals.
Some goals might include reducing the negative impacts of anxiety on your school or work attendance, stabilizing mood by increasing the use of healthy coping skills or improving assertive communication skills and boundary setting to build healthier relationships.
You and your therapist can work together to create short and long-term goals that feel meaningful and achievable for you.
What is and isn’t working for you in therapy
It’s also important to let your therapist know what is and isn’t working for you in therapy.
Do you need to meet with them more or less frequently? Did they say something that upset you? Do you want a more direct approach? These are all great topics to discuss with your therapist to help you get the best possible therapy experience.
Therapy can be a great place to improve skills like assertive communication and taking care of your needs, and this is one way to practice those skills.
Your past and present
Many therapy approaches include discussion about both your past and present. Depending on what concerns you want to address, the amount you discuss your past versus your present may vary.
For your present, it is helpful to discuss any symptoms you are experiencing, such as low mood episodes, difficulty with sleep or eating, anxiety in social situations, feelings of not being “good enough,” etc.
This can lead to discussions that help you gain awareness of the struggles you’re experiencing. It can also help guide your goals and helps your therapist have an idea of how to support you.
You can also talk about stressful situations in your life, and don’t forget to talk about the good things! It’s essential to also talk about your strengths and what is going well in and out of therapy.
Typically, it is crucial to address your past to help you process difficult, possibly traumatic, experiences and gain insight into how those experiences may be contributing to things you are struggling with in the present.
This insight can help you more clearly see a way through the challenges to make way for learning more effective and helpful ways of coping and interacting with the world around you.
Coping skills and techniques
In therapy, you will likely discuss coping skills and techniques (e.g., relaxation or distress tolerance techniques; mood, anxiety, or stress management techniques, etc.).
Related: 9 Ways to Relax and Calm Your Mind
You may discuss unhealthy coping skills you would like to unlearn, why you started using those unhealthy coping skills in the first place, and explore healthy coping skills to use instead. You might practice skills with your therapist in the session.
They may give you suggestions of skills to try at home between sessions or some combination of the two. Another topic to discuss is whether you prefer practicing these skills in sessions, at home, or both.
Whatever you want
Sometimes in therapy, you may not talk about things that seem “therapeutic.” However, if you had a really great weekend or saw something funny happen at the store earlier that day, feel free to share that with your therapist.
Feel free to share whatever you’d like. As therapists, we have a responsibility to make sure our clients are benefiting from treatment, working towards their goals, etc.
However, the most important part of the therapy process is the relationship between you and your therapist.
So it’s okay (more than okay —maybe necessary) to have discussions unrelated to your goals, coping skills, or other traditionally “therapy-related” topics to help build and strengthen a trusting therapeutic relationship.
Kristin Davin, Psy.D
Psychologist, Choosing Therapy
Previous experience in therapy
If you are just starting therapy, there are several things you can talk about to get you started.
- Reason for seeking therapy
This is an important first step that helps a person share with the therapist why—at this moment, as opposed to another—they are starting therapy.
It could be many things, from a specific situation, an unresolved problem in a relationship (family, friend, partner, work), or just now having the resources (money, time, insurance).
Being curious as to what brings the person to therapy now is key.
- Family of origin
The person’s first family. Often a person is still struggling with issues that stem from their upbringing (same relationship choices, communication style, attachment style, repetitive behaviors, estrangement from a family member), to name a few.
It’s important to get an excellent foundation to help the person ‘connect the dots and understand how their past may be affecting their present so they can change their future. This also provides context for the therapist.
It also provides much invaluable information about the person that helps a therapist probe deeper and asks thought-provoking questions.
- Have they had any previous experience in therapy, and what was that like?
Sometimes a person needs a change of therapist because it wasn’t a good fit, OR they did have a positive experience, but they are looking for a different type of therapist.
- What are their goals, and what do they hope to get from therapy?
Goals help dictate treatment and the direction of therapy. Providing goals allows them to see where they want to be and what they want to get out of therapy.
- If therapy were successful, what would that look like?
What are the steps you would have to take to get to that place? How would you know when you arrived? How can I help you get there?
- What are your expectations of therapy?
The last two questions take a more solution-oriented focus—so they can begin to visualize their ‘end game’ and where they want to end up, helping each person have a framework they are working from and not several sessions of just venting as this often creates more frustration for the person.
Amber Weiss, M.A., NCC, LMHC
Licensed Psychotherapist | Founder, Transformative Mindset
Go down the journey of self-exploration
There is no agenda on what you should or shouldn’t disclose in therapy. Therapy is a safe space to share your thoughts and go down the journey of self-exploration.
Here is a list of some possible topics to discuss during your therapy sessions:
- Talk about how it feels to be in a therapy session
- Ask about the process of therapy
- Discuss anything that seems to be bothering you or causing a conflict
- How to open up to others
- Past therapy experience
- Why you are in therapy
- Need for a referral
- Ask the therapist what you can talk about
There is no “correct” topic to talk about in therapy.
Noticeable patterns in your behaviors or thoughts
Read from your journal or notes.
How you are feeling in the present.
- Family, friends, partners, work, etc.
- Good and bad relationships
- Current or past relationships
Talk about your past.
- Life changes and transitions
What you have been avoiding
- Life conflicts
- “Stupid” thoughts
- Thoughts you pushed to the back burner
Things you care deeply for/about
- Your career
- How you do currently deal with your feelings and emotions outside of therapy
- Medical background/issues
- Goals for therapy
- Income and monetary situations
- Positive situations in your life
- Values, morals, things you care deeply for/about
Therapy can allow you to learn about your past, accept your present, and prepare for your future. Utilize the opportunity in front of you to talk about anything on your mind, and you may be surprised by how much you learn throughout the process.
John F. Tholen, PhD
Cognitive Psychologist | Author, “Focused Positivity: The Path to Success and Peace of Mind“
There are several aspects of psychotherapy that can be beneficial. We often feel better when someone we respect treats us kindly, listens to what we say, seems interested in us, wants to help us, and is encouraging.
For therapy to have a significant lasting benefit, however, it must teach us to challenge our dysfunctional automatic thoughts—the ideas that spontaneously “pop” into our self-talk and cause distress without inspiring constructive action.
At some point in therapy, therefore, the conversation should shift to the thoughts that underlie our emotional distress and inhibit our self-assertion—and, even more importantly, to balanced and reasonable (functional) alternatives that are reassuring, hope-inspiring, or motivating.
Although it seems that our feelings and motivations result directly from the events and circumstances we encounter in life, they are instead reactions to our self-talk—the internal monologue that streams endlessly through our waking consciousness, interpreting our every experience and creating our perspective.
This is also referred to as mindset.
Whenever we become aware of an external event or circumstance that may be of some consequence to us, an interpretive thought spontaneously pops into our mind.
The nature of these automatic thoughts is determined by our programming—a complex interaction between our inherited biology and the impact of our early life experience, neither of which is under our control.
When that interplay has left us cynical about life or excessively self-critical, our automatic thoughts tend to be dysfunctional—causing distress without inspiring constructive action.
When dysfunctional thoughts are allowed to occupy our attention, they infuse our self-talk, trigger a negative emotional reaction, inhibit our self-assertion, and disrupt our peace of mind.
To better manage our emotions and motivation, therefore, the best strategy is to learn to identify dysfunctional thoughts, collect balanced and reasonable (functional) alternatives, and—as much as possible—shift our attention to the latter.
Perspective is everything
Virtually everything in life is relative, and our perspective determines what we value and how we feel.
Whether we feel rich or poor depends on the following:
- Where we stand with respect to our peers
- How our financial status has changed recently
- Whether we are comparing ourselves to those, who are worse off or better off
Most of us say we would prefer to make $50,000 per year in a world where everyone else makes $25,000 than make $100,000 in a world where everyone else makes $200,000—even if all costs were the same.
Olympians who win the bronze medal (3rd place) are usually more pleased than those who win the silver (2nd place) because they tend to compare themselves to a great many competitors who won no medal.
In contrast, second-place finishers tend to compare themselves to the gold medal winner. Our reference point often plays a greater role than reality in determining how we feel.
All therapies are cognitive-behavioral
Although many forms of psychotherapy can benefit a troubled person, the changes that occur result from a change in the thoughts to which attention is being paid.
Except for alterations in our neurophysiology (i.e., via surgery, radiation, medication, or brain damage), enhancements of our mental state depend on an “upgrade” in the language of our self-talk that improves our perspective on either ourselves or our prospects:
In Rogerian Therapy, the basic system first taught aspiring therapists that “unconditional positive regard” leads to improvement when it challenges and alters negative self-perception.
When the patient perceives the therapist to be both relatively important and approving, they are forced to consider the possibility that they may be more acceptable—or less unacceptable—than they had previously imagined.
Insight-oriented treatments such as psychoanalysis produce benefit by replacing one or more dysfunctional thoughts (e.g., “It was my fault that my parents divorced,” “Having been abused makes mean unacceptable relationship partner,” etc.) with insights more likely to reassure or inspire hope.
- “No child is responsible for the actions of their parents.”
- “It’s a parent’s responsibility to protect their child, both physically and emotionally.”
- “Having been abused was not my fault and doesn’t define my value as a person.“
- “I’m better off apart from anyone who would be so unreasonable as to think less of me because of a misfortune over which I had no control,” etc.
Desensitization and relaxation therapies work because they force us to re-evaluate what we can tolerate or how well we can control ourselves to entertain thoughts such as, “If I can remain calm in this situation that used to terrify me, maybe I’m not so fearful after all.”
Behavioral treatments succeed because they change our belief about our own capacities (e.g., “I guess I can do that after all,” “I must be tougher/stronger/ smarter than I thought,” etc.).
Even self-help programs (e.g., Alcoholics Anonymous) work because they lead us to focus attention on functional thoughts such as, “The wisdom of 12-step philosophy—combined with the support of others who have attained sobriety—will make it possible for me to stay sober one day at a time.”
Cognitive behavioral therapy (CBT) is one of the “evidence-based” methods for altering our mood and actions.
A review of 325 different research studies involving more than 9000 subjects found CBT to be effective in treating depression, anxiety, and related conditions (Frontiers | Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy | Psychiatry (frontiersin.org)).
CBT works because it is one of the most efficient methods of challenging our dysfunctional thoughts, and the most efficient form of CBT is focused positivity strategy:
- Becoming mindful of our thoughts by recording and examining the ideas that occupy our minds when we become distressed or inhibited
- Identifying the dysfunctional thoughts that have become the focus of our attention and are causing our distress or inhibition
- Collecting more reasonable, balanced, and functional alternatives
- Refocusing our attention away from dysfunctional thoughts and toward functional alternatives
Siera Phillips, M.S.Ed., LCPC
Licensed Clinical Professional Counselor, Reflection Is Healing Counseling
Explore your past
A big misconception about counseling is that you only benefit from it in a moment of crisis. And once that crisis is resolved, then there’s nothing else to talk about. However, this way of thinking is far from true.
Once the problem has been resolved, it’s the perfect opportunity to take a deeper look and explore other areas of your life.
Remember, your mental health encompasses all parts of your wellness, which includes emotional, psychological, and social well-being. Taking this approach requires that you become comfortable with awkward moments.
Here are three topics to discuss in therapy. Start with what brought you to therapy, relationships, and explore your past:
- Start with what brought you to therapy
If you’re not sure where to begin, start with what made you schedule the appointment. Was there a specific incident, conversation, or overwhelming feeling that made you call? Start with your most recent stressors, and the conversation will naturally progress as time goes on.
Many of the struggles we face always have something to do with people. Either how we think people perceive us or direct relationships with friends, family, colleagues, or romantic partners.
Relationships are an integral part of your mental health, so tell your counselor or therapist about all of your relationships and how they impact you.
- Explore your past
Now this one may be more challenging to talk about, especially in the first couple of sessions. However, taking a step back in your past could help you resolve unresolved feelings that are impacting your future.
Licensed Clinical Psychologist
Dangerous, frightening, or “taboo” thoughts
Sometimes, the scariest things to bring up in therapy can be the things you need the most help with.
For example, many people are afraid to admit that they are having suicidal thoughts or engaging in self-harm behavior because they are worried they will be immediately hospitalized against their will.
In reality, most therapists will ask you detailed questions, create a plan with you to keep you safe, and only consider hospitalization if it is the only option that will keep you from harming yourself.
Additionally, many people experiencing Obsessive-Compulsive Disorder (OCD) experience “taboo” thoughts, such as worries about harming others, sexual themes, and sacrilegious ideas. These thoughts are very normal within the context of OCD and are so helpful to share.
At the end of the day, while therapists will always be respectful of you and give you space to share or not share, the more you tell us, the more we can help.
There is nothing too scary or strange, and you don’t have to worry about emotionally damaging us because we’re trained to engage in our own self-care.
Jayne Green, LPC
Licensed Professional Counselor, Choosing Therapy
Work-related issues contributing to dissatisfied feelings with the workplace
Taking the initiative to begin mental health therapy takes courage. Therapy requires being vulnerable and transparent about oneself with an unfamiliar person, which of course, can be nerve-wracking.
It can sometimes feel overwhelming when wondering what to share in therapy because maybe:
- You do not want to overshare with this new person.
- You are uncertain about how the therapy process works.
- You possibly have so much to release that it is difficult to know where to start!
No worries, starting your therapeutic journey does not have to be scary or intimidating.
In fact, it is one of the most acceptable times to be completely selfish in talking about yourself and dumping your struggles on a trained professional whose total purpose is to ensure you accomplish what you set out to accomplish by considering therapy in the first place.
To get you started with what to talk about in therapy, here are five things to consider:
- The reason you built up the courage to initiate therapy.
- Any relationship issues (i.e., familial, romantic, friendship, coworker, etc.). We need healthy engagements with others because we are social beings. When our social life is not as we would like, it can impact many other areas of our lives.
- Work-related issues or anything that may be contributing to feeling dissatisfaction with the workplace. Most of the average person’s time is spent at work; therefore, you want to have a sense of solace in your work environment, coworkers, and manager.
- Past issues that seem to be resurfacing. Sometimes we face emotionally burdensome challenges, yet we do not want to actually manage the emotions, so we suppress the situation instead. We can be easily triggered to suppress past situations and may not realize what is actually triggering us until we further explore our emotions and experiences. This is an important area of exploration that can create major changes in many areas of life (i.e., physically, emotionally, relationally, and with work).
- You can also talk about any major decision you need to make at the present moment. Having a fresh, unbiased person to explore making a wise decision for yourself can bring a great deal of relief without judgment from those closest to you.
Mental Health Counselor Intern | Founder, Holistic-Momma
Whatever is in your heart
There is no right or wrong answer to what you should talk about in therapy. Although it can be scary, sharing what you are struggling with and what is in your heart is beneficial.
If you sit there silently and don’t share, we can’t help you problem-solve.
You can share about your:
- Struggles with your job
- Excessive use of your cell phone
- Lack of desire to go out
Whatever is on your mind and affects you—at work, home, or school—and it messes with your ability to enjoy life, share it.
It is normal to cry about it
Crying is okay, and it is normal, just like smiling or being angry can be. Having different emotions and expressing them is beneficial. If you cry in session, you are working through something deeper, allowing us to see how deeply something impacts you.
Many clients cry for different reasons, and it doesn’t make you weak or just emotional and other beliefs that society may convince you of.
Crying in session is good because it helps you get over it and deal with those feelings; they can decrease in intensity if you get them out.
Do the homework that you agree to do with your therapist
If you want to get the best results out of your therapy session, working on that agreed-upon homework for the next week or two weeks until your next session can be more impactful than what you share in the session.
This way, when you have your next session, you can be making progress and not have to rehash the same thing every session.
It’s okay if you are unclear on the homework, need extra sessions, or aren’t ready to deal with some things.
Showing up and agreeing to talk about it or even some of it is a great start, and you must give yourself credit for that!
Myisha Jackson, LPC
Licensed Professional Counselor | Owner, Healing Journey Counseling Center
Therapy is a good space for the client to vent to a mental health professional. Clients should not feel limited on what they should and should not discuss in therapy.
Share what you’re comfortable with
I encourage the client, in the beginning, to share what they are comfortable with during the beginning of their treatment; it will help them build comfort and rapport with their therapist.
Therapy is not a scripted show, nor does it have any structure or limitation on what you can and cannot share. It is more of a reality. It is important to keep in mind that sharing about harming yourself and harming others could result in your therapist seeking help to protect you and others.
Remember that you can talk about anything you would like in therapy. It can be any:
- Behaviors you are experiencing
- Significant changes in your life
It can also be because you notice that you struggle to make decisions or have been arguing with your partner more often.
There is not anything too small to share in therapy. It is important to build a rapport with your therapist in the beginning—sharing things about yourself is okay to help you get comfortable.
I have been going to therapy on and off for almost two decades. Therapy saved my life and gave me the opportunity to thrive. I am a ride-or-die for therapy so let me tell you what to talk about to make sure you ride or die, too.
Everything and anything
Talk about it all. Tell the truth. Bare your soul. Be honest and real, and vulnerable. Leave it all on the court. Don’t worry about making sense of it all. Liberate yourself from the prison that is your mind.
I know it is difficult. I know these sentences make it seem like it is easy and breezy to just show up to therapy and say it all. I know it isn’t. I have been through fear, shame, guilt, and sadness time and time again.
I am telling you to push through those emotions. Share your truth and your story no matter how much your voice shakes. Say it even though your body is tensing up as you struggle to get the words out. Say it and watch how your mental health professional validates you and helps you navigate it.
Take it in as your therapist helps you see that there is nothing wrong with you — there is something different about you, and that brings you some of your lows, sure. That difference will also help you evolve into the best version of yourself. The evolution is remarkable.
All of this is to say, “Show up for yourself,” and when you show up, actually show up. You owe it to yourself and deserve to be happy and healthy. Go get it.
Carol Gee, MA
Author, “Telling Stories, Sharing Confidences“
Chronic health issues
Typically people go to a therapist when they have an issue to talk about what brought them to therapy in the first place.
For example, roughly 15 years ago, my husband and I saw a therapist, which was one of the employment benefits the university I worked for offered.
With a number of chronic health issues and his recently recuperating from one, I felt my husband was downplaying my fears. Married without children and having no family living in our area, I frequently waited alone in the family waiting room, feeling scared and alone.
A couple of times, friends or a colleague waited with me. When I tried to convey my feelings, he’d say, “I’m okay now. Nothing else is going to happen.”
Of course, another health crisis happened. So I made an appointment with the therapist, where I shared my fear of waiting for the next shoe to fall and possibly losing him and his not understanding how this affected me and our life together.
With the therapist’s help, one-on-one discussions, and as a couple, my husband began to understand my pain and fears and how dismissing my feelings made me feel.
Caroline Gebhardt, NCC, LPC, RYT
Psychotherapist, Body-Based Psychotherapy | Nationally Certified-Counselor | Registered Yoga Teacher
Let them know they have a choice of what to talk about
Sometimes therapy can initially be awkward—people might freeze or feel shy about sharing what’s on their minds.
In school, therapists are taught to stay silent to let the client speak first, but I find this sometimes induces more fear and overwhelm. So, I help ease clients into sessions by normalizing that there is no right or wrong thing for them to say or feel.
There is no rush; clients have a choice about what to talk about. Putting choices on the table can help empower someone, and the words can flow.
Explore an experiential approach instead of talking
However, sometimes there are no words—sometimes feelings, experiences, and what drives someone to seek support linger in how they experience the world, how their body feels, or how they cope.
Bringing more awareness to one’s experience, how connected or disconnected they feel from their body, or reducing shame around compulsive behaviors or coping mechanisms can also pave the way to a supportive and deeply nourishing therapeutic journey.
Diane Renz, MA, LPC
Licensed Psychotherapist | Neuroscience Practical Applications Facilitator, Center for Healthy Habits
Talk about who and how you want to be, and what gets in the way of that
What do you hope for?
“Your pain indicates what is already whole and well within you.”
Use therapy to identify what blocks or obscures this truth. What gets in the way of your well-being?
Do Your Pre-work:
Do your own reflection on your Intention for entering into ‘therapy’.
Intention is a direction you want to move toward — EnVision it. See it. Who do you want to be, and how do you want to be? What actions might support that? What gets in the way?
See what you want to ‘walk out the door’ with post-therapy. Keep the end in mind.
Keep the focus on the opposite of what you might complain about as the problem. This will orient your Mind to move in the direction of cultivating wellness.
Then, be very interested in ‘patterns‘ (problems or symptoms)—existing patterns of thinking, beliefs, emotions, moods, behaviors, interpersonal, and recreational habits.
See beyond ‘talk’ therapy and view it as Training. Insight is great but rarely creates long-lasting change in repeated Action.
Take it all “out of the room”
It’s not what happens in the session but everything you do between sessions that determines you as an expert and experimenter in your own life. Make sure the therapist aligns with action-oriented takeaways.
Dr. Ketan Parmar
Psychiatrist and Mental Health Expert, ClinicSpots
Any traumas or difficult experiences you’ve been through
If you’re feeling lost or stuck in therapy, it may be helpful to consider what you want to talk about. Here are some ideas to get you started.
Your therapist should be a blank slate—someone who doesn’t judge you and is there to help you explore whatever is on your mind. That said, it can still be helpful to have an idea of what topics you want to discuss in therapy.
Some things you may want to talk about include the following:
- Your childhood and upbringing
- Your current situation and how it’s impacting your mental health
- Any traumas or difficult experiences you’ve been through
- Your relationships with family and friends
- Your work life and career goals
- Any other areas of your life that are causing you stress or anxiety
Remember, there is no wrong way to approach therapy. The most important thing is that you feel comfortable talking about whatever is on your mind. If you’re not sure what to talk about, simply tell your therapist how you feel, and they can help guide the conversation.
Naheed Ali, MD, PhD
Physician | Contributor, USA Rx
Bring up your own perspectives
Many people find it challenging to talk about their feelings and problems. The good news is that you don’t have to be an expert at talking about emotions and feelings. This is one of the advantages of therapy—you can learn how to talk about things that are hard for you.
There are many different ways to talk about your emotions and feelings. You can use words and phrases such as “I’m feeling sad” or “I’m worried.”
You can also draw pictures or write in a journal. These can be helpful because they allow you to express your emotions and feelings without putting them into words.
You don’t have to talk about everything at once in therapy. There is no right way to do it. You can go at your own pace and choose the topics that feel comfortable for you.
If you are new to therapy, it might be helpful to start by talking about some of the big ideas from the therapist’s presentation.
You should feel free to bring up your own experiences and perspectives when you’re in therapy. They may be different from what the therapist had in mind, but that’s okay too.
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