What to Talk About in Therapy: A Complete Guide for New and Returning Clients

Are you preparing for your first therapy session and wondering what to talk about in therapy? Or perhaps you’ve been in therapy for a while but feel stuck on which topics to explore next? Many people experience uncertainty about what’s appropriate or beneficial to discuss in therapy sessions. This uncertainty is normal, but having a clear understanding of productive therapy topics can help you make the most of your mental health care.

At Revive Counseling in Spokane, we believe that effective therapy starts with open communication. This guide will help you navigate therapy conversations, whether you’re just beginning your therapeutic journey or looking to deepen your existing work.

TLDR: Key Points About What to Talk About in Therapy

• Nothing is truly “off limits” in therapy—the safe space allows for discussing any topic causing distress
• First sessions typically focus on history, goals, and establishing a treatment plan
• Common therapy topics include emotions, relationships, mental health symptoms, and life transitions
• Different therapy approaches (CBT, DBT, EMDR) focus on different types of discussions
• Preparing between sessions with journaling and reflection enhances therapy effectiveness

 

Ready to Start Your Therapy Journey?

If you’re considering therapy and looking for professional therapy services in Spokane, Revive Counseling offers evidence-based treatments delivered by compassionate, skilled therapists. We provide a range of services including individual therapy, family therapy, and specialized approaches for trauma, depression, anxiety, and more.

Don’t wait to get the support you deserve. Taking the first step is often the hardest part, but our team is ready to help you navigate whatever challenges you’re facing. Schedule your first appointment today by calling 509-413-2950 or contacting us online.

URL Slug: what-to-talk-about-in-therapy
Meta Title: What to Talk About in Therapy: Guide for Productive Sessions
Meta Description: Wondering what to talk about in therapy? Learn about common therapy topics, how to prepare for sessions, and what to expect in different therapy approaches.

Understanding the Purpose of Talk Therapy

Talk therapy (also called psychotherapy) provides a structured opportunity to discuss your thoughts, feelings, and experiences with a trained professional. Unlike conversations with friends or family members, therapy sessions are specifically designed to help you explore difficult emotions, identify patterns, and develop problem-solving strategies that improve your overall well-being.

How Therapy Sessions Create a Safe Space

Effective therapy creates an environment where you can be the real you without fear of judgment. Your therapist works to establish this safe space through confidentiality, consistent boundaries, and a non-judgmental approach to whatever topics you bring to the session.

“Creating a safe therapeutic environment is fundamental to effective treatment,” explains Dr. Lynn Bufka in an article for the American Psychological Association. “When clients feel secure enough to be vulnerable, that’s when the most meaningful work happens.”

In this safe environment, nothing is off limits—you can discuss topics that might feel too sensitive, embarrassing, or complex to talk about elsewhere.

The Therapeutic Relationship: Building Trust with Your Therapist

The relationship between you and your therapist forms the foundation of successful therapy. This therapeutic relationship develops over time as you work together consistently, often in weekly sessions. Research shows that the quality of this relationship is one of the strongest predictors of positive therapy outcomes.

Building this relationship requires:

• Honesty about your experiences and feelings
• Willingness to provide feedback about the therapy process
• Openness to exploring uncomfortable topics
• Regular attendance and engagement

Even if your first therapist isn’t the right fit, don’t give up on therapy altogether. Finding a suitable therapist sometimes takes time, but the effort is worthwhile for your mental health journey.

Common Topics to Discuss in Your First Therapy Session

The first session typically serves as an introduction between you and your therapist. This initial meeting helps establish the framework for future sessions.

Setting Expectations and Treatment Plans

Your first therapy session often includes discussion about:

• The frequency and duration of sessions (typically weekly sessions to start)
• Confidentiality policies and limitations
• The therapist’s approach and treatment methods
• Insurance coverage and payment arrangements
• Your expectations for therapy

This is also when your therapist will begin developing a treatment plan based on your specific needs. This plan serves as a roadmap for therapy, though it remains flexible as your needs evolve.

Discussing Your Mental Health History

During early sessions, your therapist will likely ask about:

• Previous experiences with therapy or mental health treatment
• Family history of mental health conditions
• Current medications and medical conditions
• Major life events that have shaped your experiences

This information helps your therapist understand the context of your current challenges and informs their comprehensive mental health care approach.

Establishing Goals for Therapy

Setting clear goals helps focus therapy and provides a way to measure progress. Your goals might include:

• Reducing symptoms of anxiety or depression
• Improving relationships with family members or partners
• Developing healthier coping strategies
• Processing trauma or difficult life experiences
• Making important life decisions
• Building self-confidence and self-acceptance

These goals may evolve throughout the therapy process, but having an initial direction helps you and your therapist establish a productive framework.

Key Topics to Explore in Ongoing Therapy

As therapy progresses beyond the first session, you’ll likely delve deeper into specific areas that affect your everyday life and mental well-being.

Processing Difficult Emotions and Intrusive Thoughts

Many people seek therapy when they’re having a hard time managing emotions like:

• Overwhelming anxiety or panic
• Persistent sadness or depression
• Unresolved grief or loss
• Anger management challenges
• Guilt or shame
• Emptiness or numbness

Discussing these difficult emotions in therapy provides relief and helps you develop emotional regulation skills. Similarly, intrusive thoughts—unwanted, distressing thoughts that seem to come out of nowhere—can be addressed through various therapeutic techniques, including cognitive behavioral therapy approaches.

“Learning to process emotions effectively rather than avoiding them is central to psychological health,” notes the National Institute of Mental Health in their guidelines for mental health treatment.

Navigating Relationships and Interpersonal Issues

Relationships significantly impact our mental health and are a common focus in therapy. You might discuss:

• Communication patterns in your relationships
• Setting healthy boundaries
• Conflict resolution strategies
• Romantic relationship concerns
• Family dynamics and challenges
• Workplace relationships
• Social anxiety and connection difficulties

Whether you’re struggling with a specific relationship or notice patterns across multiple relationships, therapy provides a place to explore these interpersonal issues and develop healthier ways of connecting.

Managing Anxiety, Depression, and Stress

Mental health conditions like anxiety and depression affect millions of Americans and are among the most common reasons people seek therapy. In sessions, you might discuss:

• Specific symptoms you’re experiencing
• Triggers that worsen your symptoms
• Coping strategies for managing difficult moments
• The impact of these conditions on your daily functioning
• Medication considerations (if applicable)

At Revive Counseling, we offer specialized effective depression treatment and evidence-based approaches for anxiety management that can help you find relief.

Life Transitions and Current Challenges

Significant life changes—whether positive or negative—often bring stress that benefits from therapeutic support. These life transitions might include:

• Career changes or job stress
• Moving to a new location
• Relationship beginnings or endings
• Becoming a parent
• Facing health challenges
• Aging-related concerns
• Educational transitions
• Loss and grief

Therapy helps you navigate these changes by providing support, perspective, and problem-solving strategies tailored to your specific situation.

Evidence-Based Therapy Approaches at Revive Counseling

Different therapy modalities focus on different types of topics and techniques. Understanding these approaches can help you know what to expect in sessions.

Cognitive Behavioral Therapy (CBT) and What to Discuss

CBT focuses on identifying and changing unhelpful thought patterns and behaviors. In CBT sessions, you might discuss:

• Automatic negative thoughts
• Cognitive distortions that contribute to emotional distress
• Behavioral patterns that maintain problems
• Practical experiments to test and change beliefs
• Skills for managing specific symptoms

This structured approach has strong research support for conditions like anxiety, depression, and many other mental health concerns. Our therapists are trained in delivering effective cognitive behavioral therapy approaches tailored to your unique needs.

Dialectical Behavior Therapy (DBT) Focus Areas

DBT combines cognitive-behavioral techniques with mindfulness practices. Originally developed for borderline personality disorder, it’s now used for many conditions involving emotion regulation difficulties. In DBT sessions, you might discuss:

• Mindfulness skills for staying present
• Distress tolerance strategies for crisis moments
• Emotion regulation techniques
• Interpersonal effectiveness skills
• Finding balance between acceptance and change

Our dialectical behavior therapy techniques can help you build a life worth living while developing concrete skills to manage emotional challenges.

EMDR Therapy and Trauma Processing

Eye Movement Desensitization and Reprocessing (EMDR) therapy is specifically designed for processing traumatic memories. In EMDR sessions, you might discuss:

• Traumatic experiences and their impact
• Current triggers related to past trauma
• Resources for managing distress
• Negative beliefs about yourself connected to trauma
• Desired positive beliefs to develop

EMDR therapy for trauma processing helps the brain reprocess traumatic memories so they become less distressing over time.

Somatic Experiencing and Body-Focused Discussion

Somatic approaches focus on how emotions and trauma are stored in the body. In these sessions, you might discuss:

• Physical sensations related to emotional states
• Body awareness exercises
• Tension patterns in your body
• Grounding techniques
• The connection between physical and emotional experiences

Our trauma-informed therapeutic approaches include somatic techniques that acknowledge the mind-body connection in healing.

Preparing for Your Next Session: A Few Tips

Getting the most out of therapy often involves some preparation between sessions.

Keeping a Therapy Journal Between Sessions

Many therapists recommend keeping a journal between appointments to:

• Track patterns in your moods, behaviors, or thoughts
• Note questions or topics to bring to your next session
• Record insights or realizations
• Practice skills learned in therapy
• Document your progress over time

This journal becomes a valuable tool for therapy, helping ensure important topics aren’t forgotten.

Tracking Your Progress in Weekly Sessions

Progress in therapy isn’t always linear, and sometimes it can be hard to recognize your own growth. Regularly assessing your progress helps you:

• Celebrate improvements, even small ones
• Identify areas that need more focus
• Determine if your treatment plan needs adjustment
• Stay motivated through challenging periods

Your therapist can help you establish appropriate methods for tracking progress toward your specific goals.

When to Consider a Different Therapist

While the therapeutic relationship sometimes takes time to develop, there are situations when finding a new therapist might be necessary:

• You don’t feel comfortable or safe with your therapist
• Your therapist doesn’t respect your boundaries
• You don’t feel heard or understood after several sessions
• The therapist’s expertise doesn’t match your needs
• You’re not making progress despite consistent effort

Remember that finding the right therapist is similar to any relationship—compatibility matters. The Substance Abuse and Mental Health Services Administration (SAMHSA) emphasizes that the fit between client and therapist significantly impacts treatment outcomes.

FAQs About What to Talk About in Therapy

Is there anything that’s considered off limits in therapy?

Generally, nothing is off limits in therapy—you can talk about anything causing distress or interest. However, there are certain limitations therapists must follow regarding confidentiality, particularly if you discuss plans to harm yourself or others. Your therapist should explain these boundaries in your first session.

How do I know what to focus on in a given session?

Sometimes you’ll come to therapy with a specific issue that arose since your last session. Other times, you might feel stuck or unsure what to discuss. Your therapist can help you identify meaningful topics through thoughtful questions. It’s equally important to discuss both current challenges and positive changes you’re experiencing.

What if I feel uncomfortable talking about certain topics?

Feeling uncomfortable discussing sensitive topics is completely normal. You might talk about this discomfort itself with your therapist—they can help you explore why certain subjects feel difficult and work at a pace that feels manageable. Building trust takes time, and a good therapist won’t push you to discuss things before you’re ready.

How can I tell if therapy is working?

Signs that therapy is working include improved ability to manage emotions, better relationships, decreased symptom intensity, and progress toward your personal goals. Some people prefer face-to-face check-ins about progress, while others might use formal assessments. Discuss your expectations with your therapist if you worry about your advancement.

Should I talk about my therapist in therapy?

Yes! Discussing your experience of therapy and your relationship with your therapist is not only acceptable but often valuable. If something in therapy isn’t working for you or if you particularly appreciate something your therapist does, sharing this feedback can help optimize your experience. This meta-conversation about therapy itself can strengthen the therapeutic relationship.

What if I feel stuck and don’t know what to talk about?

Feeling stuck is a common experience in therapy and can actually represent an important moment in your therapeutic journey. If you feel this way, consider:

• Discussing the feeling of being stuck with your therapist
• Reviewing your initial goals to refocus
• Asking your therapist for structured exercises or topics
• Exploring whether there’s something you’re avoiding

Sometimes feeling stuck occurs just before an important breakthrough in self-discovery.