Questions About Therapy:
What to Talk About in Therapy
If you’re finding yourself uncertain about what to talk to your therapist about, you’re not alone. Many people aren’t sure how to talk to a therapist, whether they’re just starting and aren’t sure what to expect from the process or have been in therapy for a while and feel stuck. Since so much of therapy is talk-based, it’s easy to feel pressure to talk about the “right” things.
While there are no “right” or “wrong” things to talk about in therapy, some things are actually more productive to talk about than others. You started therapy with specific goals and priorities, and it’s essential to keep those goals front and center. That’s how therapy works.
Below are some tips on what to talk about in therapy to ensure you’re getting the best out of your sessions. I’ve included some general advice on things that are common to talk about in therapy (dreams, family of origin, etc.) as well as some “process” things that are incredibly essential to the success of therapy — but that many people don’t know about.
Read on, to get the inside scoop on the things you should absolutely be talking about in therapy — including some that may surprise you.
How to Talk to Your Therapist About… You!
You and your personal growth is the most obvious main topic of therapy, but that can actually also be why it’s the hardest at times. While some people find it effortless to talk about and analyze themselves, other people find it far more difficult and can shut down before progress is made.
Also, just FYI, if you feel like you don’t have space to talk about yourself… that is a major red flag. I had a conversation with a colleague the other week who had a new client who came to us after experimenting with one of those therapy-mill online therapy outfits (not naming names), and my colleague told me that the client said, “With the last therapy I tried, I wound up knowing way more about that therapist and her life than she knew about mine.” That is not okay!
The mental health field can attract people who have their own stuff to work through. If your therapist is sharing way TMI about their own life, or their opinions, that is not fair to you. Therapy is your place to talk about you, not smile and nod politely and try to get a word in edgewise. More on how to find a (good) therapist, and avoid a bad one if you’re interested.
So, assuming that there is space for you to talk about yourself in therapy, let’s turn our attention to some of the most helpful and productive things you can talk about with your therapist.
In this next section, I’ll provide some helpful tips with simple things you can begin talking about that will help your therapist (and you!) understand your inner life.
Talk about your feelings in therapy
There’s usually an emotional catalyst for starting therapy. This can be a specific trauma, like losing a loved one, or infidelity. It can also just be a vague feeling that something is “off” or that you’re stuck in life.
A good thing to discuss with your therapist every session: What are you feeling? What do you think has caused you to feel this way?
It’s quite likely that your feelings will change from session to session, and this can always serve as a good place to start the conversation. Trusting yourself to follow your feelings can lead you to your goals faster than just following the prescribed path. Your feelings can also help you realize if a certain therapy practice just isn’t working for you. If a certain practice has you feeling worse every session, let your therapist know!
The only caveat here is that it should feel productive. If you find yourself getting caught in an endless loop of talking about your feelings without any progress toward self-acceptance and a happier life, focus more on goal-oriented topics.
Talk about your family of origin and significant life experiences
This is one of the most classic topics of talk therapy – and for a good reason. Everything you’ve gone through in your life – the good, the bad, the challenging – has contributed to your personality and the way you handle things today.
Talking about your family of origin as well as some of the hardest things from your past can be profoundly illuminating in understanding more about yourself. As you go over events and memories that you may not regularly say aloud, you’ll start remembering more. And although talking is not curative by itself, the insight gained from diving deep into your past can help generate new insight and acceptance.
Sometimes people can feel weird or bad about doing this, like talking about difficult parents or loved ones is disloyal. But your therapist is here to help you understand how your life experiences shaped you, in order to help you understand yourself, and others, and grow as a person.
Being honest with yourself about your past and how it’s shaped you, for better or worse, helps your self development in positive ways, and often results in having more compassion, empathy and appreciation for the people in our lives — as well as stronger, healthier relationships.
Ask your therapist to help you identify your blind spots
Have you ever felt like you’re better at giving advice to others than you are at helping yourself? If so, you’re far from alone. The reason for this nearly universally shared experience is that we all have “blind spots.”
When you’re learning to drive, you’re taught to always check your blind spots, where your mirrors can’t quite reach, so you can avoid collisions and danger. Psychologically speaking, blind spots are aspects of our personalities that other people can see but that we cannot, and are just as important to check with care.
We all have blind spots. We have patterns of thinking and acting that we’ve gotten used to and stopped examining. Almost inevitably, some of these thoughts and actions do not serve us as well as we’d like them to.
As you tell your therapist about events and relationships in your life and how you react to them, they may offer up information about your blind spots. If they don’t, or if you’d like more input, feel free to ask your therapist if they see any blind spots. You can’t work on what you can’t identify, and having someone point out a blind spot compassionately and constructively can go a long way, even if it can be quite painful to acknowledge.
While therapy should always be an emotionally safe space for you, your therapist is also there to promote your growth. Being lovingly challenged to recognize things that you may not have seen before is an important part of the development of self-awareness, which in turn, empowers you to actively make positive changes in your life and build self-love.
It is also absolutely okay to disagree with your therapist, as well! If they reflect something back to you that does not feel like “your truth,” let them know. Remember, you know you better than anyone else. Your therapist is there to help you grow as a person, not tell you who you’re supposed to be.
Talk to your therapist about your mental health symptoms
Many people seek therapy to help with mental health issues. They may be at the forefront of your conversations with your therapist already, but they might not. If mental health issues and symptoms of those issues are a primary concern for you, make sure they don’t get lost in the shuffle. It can be easy to talk to a therapist about the latest stressors or annoyances, but focusing on big-picture mental health will make everything feel better and easier, overall.
Think of it like the difference between weather and climate. The weather can change day to day, and week to week. This is like how you feel on any given day, depending on the circumstances of your life and what’s going on around you. But the climate refers to long term trends — this is like your overall mental health.
So, for example, if you’re dealing with a mental “climate” of anxiety or depression, you’re going to feel overwhelmed and stressed out week to week in general. It would be a mistake to get preoccupied with the details of the latest event in therapy, rather than have your therapist’s assistance with the big picture practices that can help you take good care of yourself and change your “emotional climate.” This is what will help you develop resilience and wellness, no matter what life throws at you.
Tell your therapist about any physical health issues or concerns
Let’s label this one as mandatory. People often make the mistake of separating their mental wellness from their physical wellness, but in many ways, mental health IS physical health. If you suffer from chronic pain, for instance, it can be easy to get into a funk or even slip into despair and depression.
It’s so, so common for people to seek therapy for things like depression and anxiety without having any awareness of the possibility that their physical health is directly causing their mental health symptoms. Talk about your lifestyle habits with your therapist; things like diet and sleep are profoundly linked not just to the way your body feels – but how your mind feels, as well.
The best therapist in the world won’t be able to help you feel better emotionally, if the underlying causes of your issues are stemming from your physical health rather than your mental health. Small examples: Did you know that common things like sleep apnea, or using asthma inhalers regularly can essentially mimic the symptoms of ADHD? Or low iron levels can make people feel (and behave) like they have major depressive disorder?
If you have any ongoing physical health issues and concerns, tell your therapist. They might be contributing to how you think and feel but they might also impact the way your therapist helps you. Don’t keep these things to yourself.
Talk about your dreams!
One of the best things to talk to your therapist about is that hidden subconscious life that you inhabit when you go to sleep every night: your dream life.
Even today, dreams are largely mysterious to us. Sometimes, the contents of our dreams can seem totally random, but many times, it’s our subconscious’ way of working through issues we may be having that we don’t even know about. That’s why bringing up your dreams and discussing them with your therapist might be a good use of your time.
Talk to your therapist about your goals for therapy
“How can I get the most out of therapy?” is one one of the most common therapy questions, and the answer is to have clear goals before you even get a therapist. However, that doesn’t mean you’re doomed to fail if you don’t have a detailed strategy; Most people struggle with goal-setting, and a therapist can actually help you create and cement your goals! Use your first therapy appointments to clarify your more nebulous goals and set plans to achieve your more concrete goals.
If you’re totally stumped about your goals for therapy, you’re not alone. Here are some helpful jumping-off points to help you think about what your goals might be:
- Why did you decide to get therapy?
- When your sessions are done, what will have changed for you?
- What are the specific issues you want to get help resolving?
Is there something specific that’s been nagging at you all week? Lead with that in your next session! Even if it has nothing to do with your overall goals for therapy, working through specific issues you’ve had throughout the week can teach you the problem-solving tools you’ll need to tackle your more concrete goals.
Whenever I start a therapy or coaching session, my first question for my client is, “What would be most helpful for us to discuss today?” You’ll get the most out of therapy if you give that question some thought before you meet with your therapist so that you can make sure your priorities are being addressed.
Talk to your therapist about their conceptualization
After you and your therapist have gotten to know each other a bit and spent some time discussing your situation and your goals, it’s time to start talking about what progress looks like.
Competent and effective therapists will work quickly to build a case conceptualization for you. “Case conceptualization” is just a fancy term to describe your therapist’s understanding of your own personal obstacles, how to help you with them, and what success will look like. Ask your therapist to share this with you to be sure that your idea of progress aligns with theirs.
You’ll also want to ask your therapist about their thoughts of where you are in the change process and where this is headed. Getting into alignment with your therapist about what “the problem” is and what needs to happen for you to make progress is one of the most important factors in your personal growth journey.
What to Talk About in Therapy: Your Progress
One of the biggest myths about therapy is that just talking about how you feel helps you heal and grow. While that is certainly part of the process, it’s not as simple as that. In fact, one of the main criticisms of talk therapy is that just venting to your therapist week to week about random things can actually be counterproductive.
While therapy does certainly need to be a safe container for you to explore your thoughts and feelings, there should also be at least some direction or purpose to the work. Just answering the question, “How does that make you feel?” over and over again, starts to get old after a while — especially if it doesn’t lead to forward movement. Introspective, non-directive and insight oriented talk therapy can be incredibly valuable in some situations, but not all. There are many types of therapy and types of therapists, and if you need a more active, goal focused approach (which is often easier to find in coaching versus counseling), simply talking about how you feel from week to week can lead you (understandably) to assume you have a bad therapist, or that therapy is a waste of time.
It isn’t! But, in order for it to be genuinely meaningful and helpful to you, it’s essential that you are an active part of the process, and empowered to direct the work towards where you need it to go.
While insight and self-awareness are helpful, you should be working towards something in therapy. If you feel like you’re not progressing, no matter how often you talk to your therapist, trust your gut and advocate for your growth. If you’re feeling like therapy isn’t moving forward, it’s really important that you tell your therapist so that they know, and can shape the experience of therapy for you.
I am a therapist and I absolutely adore my clients. I genuinely care about them and want to help them. And, I’m also very aware of my role in their lives. Though many of my clients are people I would be friends with under different circumstances, and as much as I enjoy talking to them, I am not their friend. Your therapist isn’t your friend.
We are here for a purpose and that purpose is to help you grow. Here’s what your therapist wishes you knew: We love it when clients give feedback that helps us help them.
I encourage you to regularly analyze goals and discuss your progress towards them with your therapist, especially if you feel that your work in therapy may have veered off course, or is starting to feel unfocused.
Talk to your therapist about their approach
Far too many people continue attending therapy feeling that they’ve hit a standstill, but being afraid to speak up about it. Again, this is understandable. After all, the therapist is the one with all the education, training, and experience; they must know what they’re doing. Right?
Along with finding the right therapist and ensuring that they use evidence-based approaches, being an active participant in your own growth is the best way to help yourself achieve your goals for therapy.
Even effective, well-intentioned therapists can be unsure of how to help their clients, especially when communication is evaporating into avoidance. Many people report that they go through the same experience of continually discussing the events that transpired between sessions without making any progress. If you find this is your situation, tell your therapist that it’s time for them to help you steer the conversation back towards your goals and progress.
If you’re just showing up, going with your therapist’s flow, hoping that it works out, you won’t be able to make the progress you deserve. Speaking up, advocating for yourself, and providing your therapist with feedback and even criticism when appropriate is the best way to make sure that your needs are being met.
Good therapists utilize a number of different approaches depending on your unique needs and unique scenarios. Some people respond better to certain approaches than others. Part of moving your therapy in the right direction involves you and your therapist getting on the same page about what feels helpful and what doesn’t. For this to happen, you’ll need to speak up.
Feel free to go ahead and tell your therapist, “It doesn’t feel helpful when you simply ask me about how my week was,” for example.
At the same time, you can tell your therapist when you particularly like some approach they’re taking and encourage them to use that approach more.
It is your right to speak up if you feel that your sessions are unproductive. No therapeutic path is right for everyone, and you’re not doing something wrong if something isn’t working for you.
Tell your therapist how you feel about them
In addition to providing your therapist with feedback about what’s helpful and not helpful to you, it’s important to tell your therapist how you feel about them, especially if you’re having feelings of avoidance, irritation, or embarrassment. I know this sounds cringey, but trust me — this is where the action is, and can lead to hugely powerful growth moments for you.
If you’re worrying that your therapist will be annoyed with you, or dismissive of you if you ask for what you need, tell them! Your therapist is there to help you heal and to develop self-esteem, not to judge you, and if you’re holding things back from them out of feel, you won’t be able to make as much progress as you otherwise could.
Be fearless, and say how you feel. We need to know! But even more importantly, speaking up assertively and authentically with your therapist about how you’re feeling in your relationship with them IS THE WORK. It’s basically training wheels for being able to be assertive and have healthy boundaries with people in other parts of your life.
Also, if your therapist has said something that rubbed you the wrong way, or felt invalidating, or minimizing, or hurt your feelings, it’s vital to share that openly. We’re humans, and we say the wrong things sometimes! We’re also trying to have a real relationship with you that is devoted to your growth. Telling us how you feel about us can be not just good for your work in therapy, it can be a really powerful growth experience that leads to positive changes and greater security in your other relationships too.
Consider this: The way you unconsciously relate to your therapist can be the way you relate to people in general. Issues you have with us are going to feel familiar. But working through these feelings with us is how to change your patterns in all of your relationships.
If you need therapy, it’s likely that your therapist is one of the most non-judgmental and unconditionally accepting and supportive people in your life. Having emotionally safe relationships with people is what we do! So your therapist is a safe person for you to practice being authentic and assertive with, and it also gives you a chance to gain awareness about your patterns.
Furthermore, telling your therapist about how you feel about them allows you to understand how you habitually feel in many of your relationships. For example, if you worry that your therapist is going to judge you, or reject you, or become angry with you, or dislike you — say that to them. It can shed a lot of light on your attachment patterns and other ingrained styles of relating.
I have clients who have had huge breakthroughs in their personal growth work when they’ve had the courage to tell me that they were afraid of my reactions to them, and that it was keeping them from being fully honest with me. Once they did, and we could talk through it, it helped them understand that they were projecting (on to me) the fears that they have with many people in their lives — and how their assumptions are often untrue. It also allowed them to become more honest with me, and more vulnerable in our relationship. They could then open up about aspects of their experience that they’d formerly felt a lot of shame around, and this was really healing for them.
Your relationship with your therapist is a professional relationship with unique boundaries, but it’s still a real relationship. When you and your therapist can address the relationship you have together, openly and honestly, it can lead to incredibly powerful growth work.
Talk to your therapist about your boundaries
It may sound contradictory after emphasizing goals and progress, but there are some cases in which therapists may push their clients to move past feelings they’re not ready to move past yet. Especially when grief and loss are involved, the real value of a therapy setting might be its function as a “container” or “safe space.”
Many people who’ve lost loved ones, for example, find it difficult or frustrating to talk about their loss with close friends and family members. They may simply want someone to listen and be there, but often, other people don’t know how to help and try their best to give practical, productive advice. Then, if they go to therapy seeking a container space where they can sit and feel their loss and the therapist also starts trying to “fix” and “resolve their symptoms,” the frustration and helplessness are multiplied.
Just like it’s okay to ask your therapist to provide you with a more structured or active approach, it’s also okay to say, “What I need from you today is just to sit and listen while I talk through some things. Please help me process this.”
If you’re in any situation in therapy where your therapist is trying to push you to make progress but you’re simply not ready, tell them!
Tell Your Therapist About Things You Don’t Want to Talk About
While it’s common to have the belief that people in therapy divulge everything to their therapists, this is not often the case. Many people regularly attend sessions to discuss things they want to make progress about while dealing personally with issues that they’re either not ready to address or simply don’t want to address at all. This is totally OK. But it’s still important for your therapist to know about the fact that those issues exist — even if you don’t want to do anything about them right now.
Let’s talk about a hypothetical person named Steve. Steve is working through relationship and career issues but also smokes a lot of cannabis. Steve’s well aware of his substance problem, but does not want to talk about it in therapy. Rather than being forced to talk about it – or keeping the problem a secret entirely – Steve might find the best temporary solution to be saying to his therapist, “I need to tell you that I’m smoking a lot of pot lately, but that’s something I don’t want to talk about here.” With a statement like that out in the open, Steve’s therapist can be aware of this other issue while understanding and respecting Steve’s boundaries.
So if there’s something that you don’t want to talk about, bringing it up even without the intent to discuss it further can be very beneficial – for you, your therapist, and your progress.
Talk to your therapist about not having anything to talk about
If you don’t have a clear purpose for therapy anymore and don’t feel like you have specific things you’re working on or working towards, maybe it’s time to take a break from therapy.
If you enjoy talking to your therapist about what’s going on in your life week to week, and you have the resources to do that just because you like it, that’s great.
But if you’ve really run out of things to talk about, maybe that’s a sign that your work has been successfully accomplished! You don’t need to stay in therapy for years on end, and you can always come back if you need to. I have numerous clients who I have seen episodically over the years. They show up when they need my help with something, we get to the other side, and then eventually, when I ask them what we should focus on, I can tell that they’re digging around for ideas. They’ll say, “I don’t know? I felt kind of annoyed with my mom the other week?”
An ethical therapist will say, “Or maybe you’re in a really good place, and there’s not much else left to do in this chapter of our work? I’m happy to talk to you about your mom if you’d like. Still, maybe today’s session would be better spent talking about all the great work you did to get here and how to keep it going on your own once we stop seeing each other?”
In short, good, ethical therapists are here to help you not need them. Legitimately not having anything to talk about in therapy is a good sign that they’ve done their job well.
How to Get the Most Out of Therapy
The relationship you have with your therapist should be one of open, honest communication. If you’re finding it’s hard to talk to your therapist, or you’re running out of ideas to talk to your therapist about, it’s important to let them know. Not having anything to talk about in therapy isn’t a sign that you’re doing something wrong; in fact, it could be a sign that your therapy has taken effect!
I hope these tips about what to talk about in therapy help you progress in your personal growth journey!
Dr. Lisa Marie Bobby is the founder and clinical director of Growing Self. She is a licensed psychologist, a licensed marriage and family therapist, and a board-certified coach, as well as the author of “Exaholics: Breaking Your Addiction to Your Ex Love,” and the host of The Love, Happiness & Success Podcast.
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