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What to talk about with a new therapist

If you don’t know what to talk about in therapy, some things to consider talking about include recent life events, relationships, traumas, and more.

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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.

What to expect

Whether you’re like me and had difficulty opening up at your first sessions, or you’ve been going for a while and feel like you’ve “run out” of things to say, know that you aren’t alone.

“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.

Opening up is tough, and it may not come easily, especially when just getting to know your therapist. In order to help assist you with opening up, some therapists may give you an assessment to take to better understand you and your needs as their patient and help create a plan for future sessions.

Other therapists might let you lead the conversation. If you’re unsure how to begin a conversation with your therapist or don’t know what to talk about, here are 12 things to consider.

1. “Small” issues

It’s easy to feel like you need to talk about “deep” or “serious” issues in therapy But remember, there’s no “correct” topic to discuss in therapy. You can talk about whatever you want.

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.

If you’re finding it tough to open up, Small advises remembering that nothing is off-limits.

“People talk about everything in therapy. They talk about their hopes, dreams, fears, disappointments, hurts, shame, conversations with their mom, interactions with their partner, perceived failures as a parent, sexuality, [or] their most recent date,” she says.

Not sure where to start the session? Begin by recapping what happened since you last saw your therapist — good and bad — and from there, see what you want to explore further together.

2. Patterns and behaviors

It may be a good idea to track your thoughts, patterns, and behaviors by keeping a journal between therapy sessions. This can be especially helpful if you’re shy or find it difficult to remember things on the spot.

Of course, you don’t have to bring your journal with you or read from it in session. But writing things down allows you to look for patterns in your feelings and behaviors that you might want to address with your therapist, Small says.

“For instance, a person may observe that they have been feeling inadequate or insecure and this would be a good thing to address with their therapist,” she says.

3. Present feelings

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.”

The truth is, what you need from therapy changes day to day. It’s OK if you went in thinking you’d talk about your relationship and instead spent the whole session venting 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.”

“And sometimes,” she continues,” what you need at the moment is someone to allow you the space to just vent.”

4. Rumination

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 one night this week because your mind wouldn’t stop thinking about something you wish you’d done or you worried about something coming up, that’s often a great place to start your session.

5. Relationships

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 like you have support at home? Do you feel like you have other people to share your feelings with, or do you have difficulty opening up with others too, not just your therapist?

Relationships are important to your mental health, and they play an important role in affecting your mood and feelings on a day-to-day basis.

So, if you’ve been avoiding your mom’s calls, even though you love her, let your therapist know, and maybe you two can explore why you’re avoiding her.

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.

6. Past traumas

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.

For example, maybe you’ve spent your last month telling your therapist about your current relationship troubles, but you’ve never discussed your past relationships or your parent’s marriage.

Taking a moment to step back from your present and choosing to talk about your past could help you address some feelings you’ve been bottling up or left unresolved.

7. New life challenges

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 untapped areas in their life that they need help understanding,” he continues. “While not always able to articulate what that feeling is, they are able to recognize that something is different.”

If something has changed in your life and it’s making you feel different in some way, bring it up. You don’t have to talk just about the “bad” stuff. Change can be good and yet still bring up new feelings you might want to explore in a safe, nonjudgmental space.

8. Avoided thoughts and conflicts

This could be something you’re ashamed of thinking, or something you think is “silly” to worry about. Maybe it’s something you think is “insignificant” or “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.

For example, lots of people think they’re not entitled to be upset about the pandemic because they haven’t experienced as many hardships, like job loss or the death of a loved one, and yet they’re still having a hard time coping with its impacts.

It’s OK to feel whatever you’re feeling, and it’s definitely OK to bring it up in therapy.

“Sometimes I ask clients to think about what they’d least like to talk about that day,” says Rapoport. “It’s usually a good sign of where the trouble is.”

That makes sense. We often avoid talking about things that are uncomfortable, painful, or difficult, and yet when we let them fester, they get worse. Consider therapy your safe place to talk through those things you’d otherwise avoid.

9. Trouble opening-up

If you’re having trouble opening up right now, and you’re not sure why, tell your therapist. There might be something to explore there.

“Even if a topic is not addressed immediately because of discomfort, it is valuable to understand what barriers are keeping [you] from opening up about a particular subject,” says Hardy.

For example, when you’re depressed, you often lose interest in things you once enjoyed and feel decreased energy levels. If coming to session today and last week felt exceptionally hard and you’re not sure why, your therapist might be able to help you unpack that and figure out if something else is going on.

10. Discomforts with therapy

Trust takes time to build, and sharing your thoughts and feelings with a stranger isn’t easy. If you’re having trouble trusting your therapist enough to open up, which is very normal, don’t be afraid to bring that up.

With that information, your therapist can work on building a foundation of trust that will allow you to open up more down the road.

“Therapy is about a relationship between the client and the therapist,” says Small. “If a client is having a hard time opening up, it may mean that there is still trust that needs to develop in the therapeutic relationship. I attempt to meet the client where they are at and build a rapport that will give them the safety and security they need to begin to be more vulnerable and open.”

11. If therapy is working for you

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.

“Think about how comfortable you feel asking for exactly what you need from them,” says Rapoport. “Some people prefer a more directive approach. Some people prefer concrete tools — for anxiety management, for instance. Others want to feel like they can talk about a specific subject with someone who is knowledgeable about that in particular.”

“Consider whether your needs are being met,” she continues,” and how open your therapist is to your specific requests and needs.”

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.

12. When to end therapy

Psychotherapy isn’t meant to last forever. So, if you used to find it easy to think of things to talk about, and now you’re not, it might be a sign you’ve reached an end point.

It’s perfectly normal to feel like you don’t need therapy after a while. “As a therapist, we want to work ourselves out of a job,” says Small.

But before you quit, make sure you’re ending therapy because you truly got what you needed out of your sessions, and not just because you’re dissatisfied with your therapist.

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.”

To tell the difference, Rapoport recommends thinking back to your first session. “Does it feel like you accomplished what you set out to accomplish? If so, have you identified new goals along the way that you could shift to instead?”

“If you’re continuing to feel like you’re learning more about yourself, or you’re gathering new information and resources, it’s usually a sign that you’re still getting something out of therapy,” she continues. “If it feels like you’ve stalled, or that you’re not getting anything from your sessions that you wouldn’t be able to get from a conversation with someone else, it might be time to take a break.”

Keep in mind that you don’t need to stop abruptly. You can always talk with your therapist about putting more time between sessions and seeing how you feel.

If you currently see them for weekly sessions, for example, you could try doing a monthly check-in. If something comes up and you want to resume weekly sessions, you already have a foundation with a therapist you know and trust.

The bottom line

“No one has therapy all figured out, even the therapist,” says Hardy. If you’re finding it difficult to open up at first, don’t worry. It might take some time for you to really get in the swing of it. But with time, you should start to feel yourself becoming more comfortable and opening up more. If not, consider whether you might want to work with another therapist.