What do I Talk About in Therapy?

It’s a big deal setting up your first appointment, and an even bigger deal to actually show up and be honest. So many new clients express anxiety to me about worrying about what to say or what to expect when finally coming to therapy. I’ve had clients clam up entirely, answering my questions with grunts or single syllables. I’ve had clients speak rapidly on tangents, barely pausing to take a breath. The anxiety of sitting in front of a stranger asking invasive personal questions is valid and however, you respond to that anxiety is ok. Here’s what I want you to know – I know what I’m doing. I went to school for several years, was supervised for a couple more, wrote extensive papers, took exams, practiced sessions, read, studied, accepted feedback and criticism, and generally submitted myself to all kinds of academic stress to be sitting in front of you. Even if you don’t know what to say, I do. It is never your job to know what to talk about or lead a session if you’re feeling lost – it’s mine.

I love it when clients come to session with an agenda or challenge they want to tackle, but rest assured if you don’t we will still have plenty to work on. After your initial intake session, your therapist will generally develop a treatment plan. This treatment plan will include objectives and goals discussed in the first session, as well as interventions and approaches to work on progress areas. This treatment plan, though certainly changeable and not cast in stone, will inform the direction of your sessions and serve as a roadmap toward your stated desired outcome. And, once again, it’s not your job to follow that treatment plan, it's your therapist’s.

Those who know me know that I rarely pull punches. In a hopefully loving and compassionate way, I tell people the truth as I see it. As such, I encourage my clients to be direct with me. If you’re not sure where a question came from, or if you’re having difficulty identifying your progress, just ask. Not every therapeutic approach will be right for you, there may even be things you’re not ready to look at and address, it’s ok to identify that and share it with your clinician. I will always do what I can to meet my client where they’re at and support their journey.

So the next time you’re feeling nervous before a session and asking yourself, “what are we even going to talk about”, remember, you don’t have to know. Be kind to yourself and know, I’m here to help if you need it.