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A Guide for What to Talk About in Therapy

Written by: Amanda Levison, M.S., LMHC, LPC, CCBT

Going to therapy can be a daunting experience, especially if you're unsure what to talk about. Whether it is your first therapy session, you’re returning after taking a long break, or you’ve been in therapy for years, you may often ask yourself, “What do I even talk about?”

Wondering where to start or what would be appropriate to bring up that may or may not seem like a “big issue” can be challenging. But the good news is that therapy is a safe space to discuss anything on your mind or your current struggles in your day-to-day life. Often, you may seek therapy for one main issue while other things resurface that you also need help processing.

Therapist and client engaged in a deep conversation during a therapy session

Here are some ideas to get the conversation started to help alleviate any uncertainty or anxiety.

Your Current Struggles

Whether it's a difficult work situation, a strained relationship, or a personal challenge, therapy is a great place to unpack the issue and explore solutions. People may bring many different struggles to therapy, as everyone's experiences and challenges are unique. Here are some common examples of struggles that people may discuss in therapy: 


Feeling worried or stressed about the future, experiencing panic attacks, or having obsessive thoughts can all be signs of anxiety. Talking about anxiety in therapy can be a helpful way to gain insight into the root causes of your worries and fears. Anxiety can manifest in different ways, such as feeling nervous or uneasy, having racing thoughts, or experiencing physical symptoms like sweating or trembling. Your therapist can help you identify triggers that may be causing your anxiety and work with you to develop coping strategies to manage it. Triggers for anxiety can vary from person to person, but here are some common examples:

Stressful life events

  • Health issues or chronic pain

  •  Relationship issues

  • Traumatic experiences

  • Overthinking or worrying about the future

  • Self-esteem issues

Additionally, therapy can help you learn ways to calm your mind and reduce stress, such as through mindfulness techniques or breathing exercises. Remember, it's important to seek professional help if you're experiencing severe or persistent anxiety symptoms, as this can impact your overall mental health and well-being.


Feeling sad or hopeless, losing interest in activities that were once enjoyable, or struggling with low energy levels are all symptoms of depression. If you notice the following changes or increase in symptoms, be sure to speak up about it to your therapist to explore ways of managing your symptoms:

  • Increase or decrease in appetite

  • Fatigue or low-energy

  • Sleeping in too much or insomnia

  • Feeling worthless or guilt

  • Loss of interest in enjoyable activities

  • Increased frustration or irritation

Relationship Issues

Struggling to communicate effectively with a partner or family member, feeling disconnected or unfulfilled in a relationship, or experiencing conflict or infidelity can all be reasons to seek therapy. You and your partner can also benefit from specialized couples counseling to learn about areas of difficulties within the relationship and work toward shared goals of improving the relationship long-term. Here are a few things to consider sharing in your sessions:

  • Be honest about your concerns within the relationship, including your thoughts, feelings, and emotions regarding behaviors contributing to your issues in the relationship.

  • Avoid blame: It's easy to fall into the trap of blaming your partner for the problems in your relationship. Instead, focus on how you feel and what you can do to improve the situation.

  • Listen attentively: This means understanding their origin and showing empathy and compassion.

  • Be open to change: Be open to changing your behavior and communication style to improve your relationship.

  • Practice communication skills: Your therapist can provide tools and techniques to improve communication with your partner. This may include practicing active listening, using "I" instead of "you" statements, and learning to express your needs and boundaries healthily.

Remember, therapy is a safe and confidential space to explore any struggles you may be experiencing. It's okay to seek help and support to work through difficult times and find a path towards a happier, healthier life.

Your Past Experiences

Sometimes, our struggles are rooted in past experiences. Talking about your childhood, past relationships, or traumatic events can help you understand how they impact your life today. Childhood experiences, past relationships, or traumatic events can all play a role in shaping who you are today. Sometimes, past experiences can lead to negative thought patterns, feelings of low self-esteem, or difficulties in relationships. You can explore these experiences in therapy with the help of a professional therapist and understand how they may impact your life. Here are some tips to help you navigate discussing past experiences in therapy:

  • Take your time: Feeling comfortable and safe before delving into past experiences is essential. Take your time to build trust with your therapist and establish a solid therapeutic relationship.

  • Be honest: Honesty is essential in therapy. Share your experiences, thoughts, and feelings as openly and honestly as possible. This can be not easy, but it's a necessary part of the therapeutic process.

  • Work through difficult emotions: Discussing past experiences can bring up difficult emotions. Working through these emotions with your therapist is essential rather than avoiding them. Your therapist can help you learn coping strategies and provide support.

  • Focus on the present: While discussing past experiences, it's essential to focus on the present. Your therapist can help you understand how past experiences may impact your current thoughts, behaviors, and emotions.

Remember, discussing past experiences in therapy can be challenging, but it can also be incredibly rewarding. With the help of a skilled therapist and a supportive therapeutic relationship, you can work through unresolved issues and gain greater self-awareness.

Your Emotions 

Therapy is a place to be honest about your feelings, even if they're challenging to express. Sharing your emotions with a therapist can help you better understand them and learn how to manage them healthily. It can be challenging to express our feelings, especially if they are intense or conflicting. It's important to remember that there is no right or wrong way to feel. Discussing how we feel with a therapist can help us gain insight into our emotional experiences and develop healthy ways to manage them. Emotions can vary, ranging from joy and happiness to sadness and anger. In therapy, you can explore your emotional landscape and learn how to identify and express your feelings healthily. Your therapist can help you develop coping strategies, such as relaxation or mindfulness exercises, to manage difficult emotions. Some tips for discussing emotions in therapy include the following:

  • Be honest: Honesty is essential when discussing emotions in therapy. Be open and truthful about your feelings, even if it's complicated.

  • Be specific: Be as straightforward as possible when discussing your emotions. This can help your therapist understand your experiences and provide more targeted support.

  • Don't judge yourself: It's important to remember that your emotions are valid, even if they don't always make sense to you. Try not to judge yourself for how you feel.

  • Practice mindfulness: Mindfulness can be helpful when discussing emotions in therapy. Focus on your breath and body sensations to help ground yourself in the present moment.

Therapy is a safe space to share your emotions without judgment or criticism. Your therapist is there to support you and help you work through any emotional challenges you may be facing. With time and practice, you can learn to express your emotions more effectively and gain insight into your experiences.

Your Goals

Whether personal growth, career aspirations, or improving relationships, therapy can help you clarify your goals and develop a plan to achieve them. Talking about your goals in therapy can be a helpful way to stay focused and motivated throughout the therapeutic process. Setting goals can give you a sense of direction and purpose and help you work towards achieving positive changes in your life. You can work with your therapist to identify your goals and create a therapy plan. Your goals may be related to:

  • A specific issue you are struggling with, such as anxiety or depression

  • Improving your overall well-being or relationships

  • Understanding your emotions and thoughts and where they come from

  • Changing behaviors and building positive habits

  • Learning and enhancing coping skills

Whatever your goals may be, discussing them with your therapist can help you clarify what you want to achieve and how to get there. Your therapist can provide guidance and support and help you develop strategies for overcoming any obstacles you may encounter. Remember, therapy is a collaborative process; your therapist is there to help you achieve your goals and improve your quality of life.

Your Feelings Around Being in Therapy

Talking about your feelings about therapy can be a valuable part of the therapeutic process. It is expected to have mixed emotions about seeking therapy, especially if it is your first time. You may feel anxious, unsure, or even ashamed about seeking help. However, discussing these feelings with your therapist can help you work through any reservations and create a more favorable therapeutic experience. In therapy, you can explore any negative beliefs or stigmas about therapy and address any barriers preventing you from fully engaging in the therapeutic process. Some of the common ones include:

  • “People who go to therapy are weak.” This is a common misconception that people who go to therapy are weak or can't handle their problems on their own. However, seeking help is a sign of strength, not weakness.

  • “Therapy is only for people with mental illness.” Another common belief is that therapy is only for people with mental illness. However, therapy can be helpful for anyone who wants to improve their mental health and well-being.

  • “Therapy is expensive.” While therapy can be expensive, many options are available for people with different budgets, including sliding scale fees, insurance coverage, and online therapy. Your investment in better mental health care is up to you, depending on what you deem worth your time and money.

  • “Therapy is a waste of time.” Some people believe that therapy is a waste of time and that talking to a therapist won't help them. However, therapy is an effective treatment for a wide range of mental health issues, with many techniques used alongside talk therapy.

You can also discuss previous therapy experiences and any fears or anxieties about being open to a therapist and explore ways to build trust and rapport with your therapist. Remember, therapy is a collaborative process. Working with your therapist and following these tips can create a strong foundation for a successful therapy experience. Seeking help and going to therapy is a brave and positive step towards improving your mental health. Don’t let stigmas or negative beliefs stop you from getting the support and help you need when building your therapeutic relationship.

Silence Isn’t Always A Bad Thing

Silence can be a powerful tool in therapy. Yes, awkward pauses can be uncomfortable when waiting for the therapist to start a new topic or you do not know what to say next. Silence can provide a space for reflection, introspection, and processing of emotions and solutions. Sometimes, silence is necessary to allow more profound insights and connections to emerge. You don’t always need to fill in every empty pocket of silence when in therapy, so don’t fear silence for a few moments and see what comes up for you. However, it's important to note that silence should only be used intentionally and with the guidance of a trained therapist. It's not always appropriate or helpful to remain silent, and a therapist can help navigate when silence may be beneficial or hinder the therapeutic process.

So, when you are returning to therapy after a long time or starting your very first session, always remember that therapy is a safe and confidential space to explore any feelings or concerns you may have about being in therapy, your past experiences, your current struggles, emotions, and overall goals. Your therapist is there to support you and help you feel more comfortable with the therapeutic process.

Therapy is a collaborative process between you and your therapist. Embrace the silence as a part of the journey, and feel encouraged to express what you aim to work on. Trust that your therapist will steer you in the right direction. To explore more about this supportive partnership and begin your path to healing, visit Neurofeedback & Counseling Center of PA.

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