“If you don’t know what to talk about in therapy, you should consider talking about recent life events, relationships, traumas, and more.”

therapist sitting on couch talking to client
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When I decided to go to therapy for the first time, I spent the whole car ride thinking about how ready I was to work on myself. But when I got there and actually sat down on my therapist’s couch, I clammed up. Suddenly, while sitting face-to-face with this stranger that I knew was there to help me, I had no idea what I actually wanted to say. My mind had simply gone blank.

Admittedly, I’ve always been shy, and talking to new people has always been a little overwhelming to me. But I thought it would be easy to open up to a therapist since it had been my choice to come there. It wasn’t easy. Instead, I felt so much pressure to make the most out of my session that I couldn’t think of a single thing to actually say.

You are not alone if you have been going for a while and feel like you have run out of things to say, or if you have had difficulty opening up at your first sessions.

“It is not uncommon for people to come to session and be unsure about what they want to discuss,” says Jessica Small, licensed marriage and family therapist.

It is difficult to open up when you are just getting to know your therapist. If you want to help open up, some therapists will give you an assessment to better understand you and your needs as their patient, and help create a plan for future sessions.

“You might be allowed to lead the conversation. If you don’t know what to say to your therapist or you’re unsure how to start, here are 12 things to consider.”

It is easy to feel like you need to discuss serious issues in therapy, but remember there is no correct topic to discuss. You can talk about anything.

True, some people come to therapy to address something specific, like anxiety or depression. But sometimes, people are just going through a life transition and want someone to talk with and help them cope with the change.

Small says to remember that nothing is off-limits if you are having difficulty opening up.

People talk about everything in therapy. She says they talk about their hopes, dreams, fears, disappointments, hurts, shame, conversations with their mom, interactions with their partner, perceived failures as a parent, sexuality, and their most recent date.

Not sure where to start? You should begin by summing up what happened since you last saw your therapist.

It is possible to keep a journal between therapy sessions to keep track of your thoughts, patterns, and behaviors. If you are shy or have trouble remembering things on the spot, this can be helpful.

“You don’t have to bring your journal with you to read it in session. Writing things down allows you to look for patterns in your behavior that you might want to address with your therapist.”

She says that it would be a good thing to address the issue of being inadequate or being confident with their therapist.

You might have felt sad, angry, or depressed during the week, but if you’re not feeling that way right now, you don’t have to start with that. Focus on how you’re feeling in the present, and just say how you feel — even if what you’re feeling is just, “I didn’t really want to take this hour for therapy today because I’m slammed at work.”

What you need from therapy can change daily. If you went in thinking you would talk about your relationship, you should have spent the whole session vent about your boss.

“Therapy sessions really are meant to be as tailored as possible to what you’re needing at any given moment,” says Sol Rapoport, a marriage and family therapist working with UCLA’s Behavioral Wellness Center. “I actually tell my clients to think of their therapy time as the ‘Room of Requirement’ from Harry Potter — you get to get out of it whatever you are most needing that day.”

She says that you need someone to allow you the space to just vent.

Depression and anxiety can both involve rumination, or a tendency to go over the same thoughts repeatedly.

If you had a hard time falling asleep because your mind kept thinking about something you wish you had done or you were worried about something coming up, that is a great place to start your session.

This doesn’t just mean your love life. Tell your therapist about all your relationships, whether that’s your partner, your family, or your friends.

Do you feel supported at home? Do you feel like you have to share your feelings with others, or do you have a hard time opening up to others?

Relationships are important to your mental health and they can affect your mood and feelings on a day-to-day basis.

“If you have been avoiding your mom’s calls even though you love her, you should tell your therapist and they can explore why.”

Even if you feel like you have good relationships, talking about them might help you realize the things that are working in your life — and the resources you can lean on out of session.

This one might sound obvious — or conjure up stereotypical images of lying back on a chaise lounge a la Freud — but the truth is, if you’ve been focusing on your present in your last sessions, you might not have gotten around to filling in your therapist on your past.

“You have told your therapist about your current relationship troubles, but you have never talked about your past relationships or your parent’s marriage.”

Taking a moment to talk about your past could help you address some feelings you have been avoiding.

People in therapy tend to have something they want to address, says Nicholas Hardy, a psychotherapist in Houston, Texas. “However, it is not always a problem. Sometimes, it is a feeling or an emotion that is unfamiliar to them.”

“When clients experience new aspects of life, like childbirth, marriage, relocation, this can ignite areas in their life that they need help understanding. They are able to recognize that something is different even though they can’t articulate it.”

“Bring it up if you feel different because of something that has changed in your life. You don’t have to talk about the bad stuff. Change can be good, but it can also bring up new feelings that you might want to explore in a safe space.”

This could be something you think is silly, or something you think is something you should be ashamed of. Maybe it is something you think is stupid.

We all censor ourselves and judge our feelings. But therapy is exactly the place to explore all our thoughts and feelings, even the ones we feel like we shouldn’t be having.

“Many people think they are not entitled to be upset about the Pandemic because they haven’t experienced as many hardship as others, but they are still having a hard time dealing with the effects.”

It is ok to feel whatever you are feeling, and it is also ok to bring it up in therapy.

Rapoport asks clients to think about what they would least like to discuss that day. It is a good sign of where the trouble is.

“That makes sense. When we let things get worse, we are avoiding talking about things that are uncomfortable, painful, or difficult. Therapy is a good place to talk about things you wouldn’t normally do.”

If you are having trouble opening up, you should tell your therapist. There might be something to do there.

It is important to understand what barriers are keeping you from opening up about a particular topic, even if it is not immediately addressed.

When you are depressed, you lose interest in things you used to enjoy and feel less energetic. If you came to session last week and felt very hard, your therapist could help you figure out if something else is going on.

“Sharing your thoughts and feelings with a stranger is hard to build trust in. If you are having trouble trusting your therapist enough to open up, don’t be afraid to bring that up.”

Your therapist can use that information to build a foundation of trust that will allow you to open up more down the road.

Small says that therapy is about a relationship between the client and the therapist. It may be that there is still trust that needs to be developed in the therapeutic relationship if a client is having a hard time opening up. I try to meet the client where they are at and build a relationship that will give them the safety and security they need to be more open and vulnerable.

If you truly don’t feel comfortable with your therapist, there’s a chance they aren’t the therapist for you — and that’s OK.

Therapists have different professional backgrounds and specialties, and there are different types of psychotherapy.

Rapoport says to think about how comfortable you feel asking for what you need. Some people prefer a more direct approach. Some people prefer concrete tools for anxiety management. Others want to feel like they can talk about a topic with someone who is knowledgeable about it.

She asks if your needs are being met and how open your therapist is to your specific requests.

If you aren’t getting what you need, if you don’t feel challenged in a good way or like your therapy is progressing, or if you prefer a therapist who shares your gender or racial identity, it might be worth exploring other therapist options.

“It isn’t meant to last forever. If you used to think of things in a way that was easy to talk about, now you are not, it could be a sign that you have reached an end point.”

It is normal to not need therapy after a while. Small says that as a therapist, they want to work themselves out of a job.

If you want to end therapy, make sure you do so because you really got what you needed out of it.

A 2019 study of 99 adolescents ages 11 to 17, for example, found that people who ended therapy out of dissatisfaction had poorer outcomes than those who left because they felt they “got what they needed.”

Rapoport suggests you think back to your first session. Do you feel like you accomplished what you set out to do? Have you identified new goals that you could shift to instead?

“She says that if you are learning more about yourself or gathering new information, it is a sign that you are still getting therapy. It might be time to take a break if you feel like you aren’t getting anything from your sessions and you can’t get a conversation with someone else.”

“You don’t need to stop suddenly. You can always talk to your therapist about how to spend more time together.”

If you see them weekly, you could try to do a monthly check-in. If you want to resume weekly sessions, you already have a foundation with a therapist you trust.

“The therapist is the only one who has figured out therapy. Don’t worry if you’re having trouble opening up. It might take some time to get used to it. You should start to feel more comfortable with time. If you don’t want to work with another therapist, consider another.”

Simone M. Scully is a writer who loves writing about all things health and science. Find Simone on her website, Facebook, and Twitter.