You made it to therapy but now what do you talk about? Are there right things to talk about? Are there wrong things to talk about?

Topics to Consider for Discussion in Therapy

It is a big (and sometimes scary) decision to start therapy and I commend you on this choice to prioritize your mental well-being! Perhaps you are at a crossroads in your life; maybe a relationship is not as easy as you had hoped; perhaps you seek to gain some tips, tools and increased insight to better your life. Whatever brought you to treatment, congratulations, you are here, and that is half the battle.

But now that you are here, what should you discuss in your sessions? Are there right things to talk about? Are there wrong things to talk about? The answer is simple: talk about what matters to you because there are NO right or wrong topics to discuss. This is a nonjudgmental space that is meant to focus on you and your needs, so any topic is appropriate -nothing is off limits! Still feeling stuck? Don’t worry, I have ten suggestions for you.

  1. What brought you to therapy in the first place? What are your goals or hopes for treatment? It is difficult to be an open book at the start, and to bare your soul to a relative stranger. The good news is that you don’t have to all at once. Share as you feel comfortable, making sure your therapist knows what you are seeking so that they can gently guide and help you alter old habits that are holding you back from achieving your goals.

  2. As you find it easier to share, consider those thoughts that you keep buried in your journal or in the back of your mind. The things you hide away and don’t speak about and are hesitant to share with your friends and family? Let your therapist in. Allow them to see these vulnerable sides of you that will help you build your sense of self, self acceptance and self esteem. This will also help your therapist guide you toward adaptive coping strategies to mitigate life stressors.

  3. What is stressing you out today? Is it family? Work/school? Your children? Another relationship? Your health? All of the above? Some days we feel overtaxed, and some days, less so. Share what is occurring today so you can better identify how to adaptively cope with your own presenting stressors. Therapists have many tools in their tool box to help you view situations from different perspectives, and build your skill set to manage those stressors with greater ease.

  4. When you are ready, talk about your past - these experiences do impact how you feel and function today. We all behave from ingrained, albeit unconscious, patterns and learned experiences. Share these with your therapist so they can help you identify ways in which you may be able to alter your current interactions, subsequent reactions and overall behaviors to help you feel lighter and happier as you navigate the world.

  5. What thoughts keep you up at night? They may be negative, positive, or the thoughts that simply run on a hamster wheel of thought that disrupts your sleep. Restful and restorative sleep is a crucial component of mental health. Sometimes it is difficult to turn off your brain - allow your therapist to help you sort through these thoughts to hopefully develop a better nighttime routine and promote restful sleep.

  6. How do you understand your own identity? As humans we shoulder multiple identities. Your cultural identity, sexual identity, family identity, occupational identity, to name a few. Therapy is a nonjudgmental space available for you to explore any and all of these pieces of yourself to better understand your feelings and, most importantly, accept yourself more fully.

  7. Are you a people pleaser? Are you a perfectionist? Do you like to stay in? Do you like to go out? Do you see everything through a negative lens? Do you only see situations in a positive light? These, and more, are traits that can be helpful, or less so, in your daily grind. Understanding your personality traits is a great topic to explore in therapy, especially exploring those traits that may have a negative impact on your life. Your therapist can work with you to identify ways in which to alter some of the less helpful tendencies, and strengthen the more helpful ones.

  8. Setting Boundaries - Many people struggle with this topic. While difficult, setting boundaries with family, friends at school and work, neighbors, etc. are designed to protect you so you do not feel stretched too thin or quickly get worn out. Setting these limits are an integral part of healthy relationships in every facet of your life. Your therapist can guide you as you identify when, why, where and how to implement healthy boundaries in your life.

  9. I will let you in on a little secret - sometimes, silence is the best element of therapy. Maybe there is no pressing issue or topic on your mind. Sit in the silence and see what comes to you. Is it a memory? A dream? A past experience that floats to the surface? These can be topics that you don’t consciously realize are weighing on you and will guide your session for the day.

  10. Sometimes, the hardest topic to discuss is the one right in front of you (and your therapist) - the therapy relationship itself. Perhaps you don’t think therapy is working, or it is not progressing as well as you’d anticipated. Maybe you are thinking about stopping therapy, or changing providers. I strongly encourage you to acknowledge these thoughts as a signal to bring those thoughts forward for discussion and exploration, instead of avoiding this crucial topic. Remember when you learned to ride a bike? It was not easy at first - spills, and scrapes and bumps and bruises - but you kept practicing and trying. Therapy is no different - if it feels as if something is not going well, don’t get off the bike - say something instead! The most important element of successful therapy is the relationship between you and your therapist - give them some feedback just as you consider the feedback you receive. Broach a discussion about additional ways in which they may be able to help you, and see if that feedback loop allows for positive growth and change. If not, your therapist may be able to point you in the right direction for a better fit with a different clinician.

Remember, there is no prescribed formula or path for therapy. There are no gold stars, right answers nor wrong. You cannot fail therapy because you did not discuss a certain topic. Therapy is all about what you need it to be. Talk about what matters most to you because at its core, the time is yours to use in a way that feels most productive and helpful to you. Yes, it is hard to adjust to a space in which you are the sole focus, but if you lean into the discomfort you will find that therapy may be even more helpful than you had expected!

Dr. Joy Nadler Frankel is the Clinical Director for the Northeast Region of CHE Behavioral Health Services. She has been part of the CHE family for 12.5 years.