What do I talk about in therapy? Reflections on where to go when you’re not sure where to go.
What do I talk about in therapy? Where to start when you don’t know where to start.
Being in therapy can feel like standing at the edge of a diving board; hopeful, but also a little terrifying. Often, we arrive at counselling or therapy during a difficult time. Many of my clients are grieving, navigating a health crisis, exploring aspects of identity, navigating Autism or ADHD, managing anxiety or depression or just feeling completely overwhelmed. I’ve been to therapy for many of those things myself and I know that however transformative therapy can be, it can also be really hard work.
Some clients come to therapy with a good understanding of why they feel the way they do. For others they might have no idea what’s contributed to them finding themselves where they are. Either way many clients who come to counselling or psychotherapy have reflected about the why. Even with that reflection it can be hard to know where to start.
The first thing to know is that you don’t need to have everything figured out to begin. A good place to start is simply by naming that uncertainty. Therapy isn’t about having everything figured out, it’s about showing up as you are. Whether you’re feeling stuck, overwhelmed, numb, or just curious about your inner world, a good therapist can help you gently explore what’s beneath the surface. Sometimes the first step is giving yourself permission to begin, even if you feel like you’re beginning in the dark.
Sometimes the first step is just giving yourself permission to begin, even if you feel like you’re beginning in the dark.
That might still feel a little unstructured. As an Autistic and ADHD therapist who works with a lot of Autistic and ADHD clients I really get this and I’ve shared some practical suggestions below about how to approach therapy when the path feels uncertain, along with some other things that might be going on if you’re feeling uncertain about what to talk about.
One question I often ask new clients is: “Why now?” Often the issue you’re bringing to therapy has been present for a while but something has shifted that means you’re ready to reach out for support. This can be a really useful place to begin. What was it that made you decide to begin therapy now not six months ago? What do you hope will change as you explore your circumstances in therapy?
For ongoing clients, if you find yourself sitting in therapy feeling blank it might help to pause and ask: is there really nothing to talk about today? Or is there something I’m avoiding talking about?
When simply talking about your struggles feels like it won’t change anything
This is something I hear often. The benefits of the talking part of talk therapy can feel unclear but there are so many benefits. Talking through your experiences can help you to process them, understand your emotions, identify and change unhealthy patterns and develop coping mechanisms for various challenges.
Doing this with the support of a therapist you have built a relationship with can change and challenge patterns that are rooted in past experiences. When we know why something has impacted us and we can indentify the thoughts and emotions that show up as a result we can change the narrative and come to a place of acceptance. This can really be supported by the reparative experience we might find with a counsellor or therapist who sees us, holds a compassionate and non-judgemental space for what we’re sharing and gently challenges us to see where we might be contributing to our stuckness.
There is a lot of evidence that shows that the therapist relationship is one of the biggest factors that contributes to successful outcomes in therapy but there is also a place for clear, practical action that creates space for change and supports momentum. This can include:
• Setting goals
• Skill building such as learning tools like mindfulness, emotional regulation, or communication strategies
• Psychoeducation that helps you to understand what’s going on for you and why
• Looking at behaviours, identifying patterns that aren’t serving you and gently challenging them.
• Homework such as trying new approaches between sessions to reinforce what you’ve worked on and identified in your therapy sessions
Facing the fear beneath the surface
Fear can play a huge role in us not knowing where to start. Not just fear of judgment or saying the “wrong” thing but fear of the pain that might rise up if we really look at what we have been avoiding. Maybe it’s a memory you’ve buried deep, a truth you’ve been avoiding or grief you haven’t allowed yourself to feel. This fear is deeply human and a good therapist will support you to move through it at your own pace.
Here are some ways that therapy can be adapted to support you to go at your own pace:
• Emotional regulation tools that can support you to find the breaks before you hit the accelerator. Exploring nervous system states and identifying tools to respond to the different states when they show up is a piece of work I do with almost all of my clients. This, combined with monitoring levels of nervous system and emotional arousal, means we can make sure we work at your pace and don’t overload your system.
• Trusting the process and taking your time. You don’t have to tackle everything at once. Therapy is about building safety first then going deeper when you’re ready. When I’m working with new clients I always share that I totally understand if it takes time for them to trust me. This is true of any new relationship. Therapy is a vulnerable space so it makes sense that people might need a bit of time to feel comfortable enough to connect with the really hard things.
When dissociation shows up in therapy
Sometimes when we get close to something painful or overwhelming, our brain and our nervous system protects us by dissociating or zoning out, going numb, or feeling disconnected from our thoughts, emotions or even our body. This nervous system state is known as dorsal vagus shut down and it’s a survival response, especially for those who’ve experienced trauma or anyone who has a sensitive nervous system due to neurodivergence. If this happens in therapy it’s not a setback; it’s valuable information. Your system is telling us something feels too much or that we’re moving too fast.
If you find yourself dissociating in session, or in general, there are suggestions in this post about how you can work with your system to respond to it. As I mention above, learning to apply the breaks before you hit the gas is important and this baseline level of resourcing is something I explore with most of my clients. Managing dissociation is part of the process, not a detour from it.
When avoiding a topic becomes a pattern
If you’re someone who came to therapy knowing that you had to address some specific things but you find you never quite get around to going there, that might be something to reflect on or to raise with your therapist. It’s totally okay to not want to talk about something in a particular session or even for several sessions but there’s a difference between timing and avoidance. If “I’m not ready” becomes “I never want to go there,” it might be getting in the way of you meeting your goals.
Avoidance often comes from fear of pain, of being overwhelmed, or of what we might discover. We often learn avoidance in our early relationship as a way of staying safe where are needs are not met or where there is inconsistency. If this sounds familiar, you’re not doing therapy wrong. Even knowing this brings you closer to something important. A good therapist will help you move toward that edge safely and slowly.
Sometimes, we can explore these edges without words at all. The body and nervous system has its own wisdom and we can explore body sensations and emotional cues simply by being with what ever’s present and using our tools to support ourselves through it. This can be a powerful way to connect with something difficult, without having to put it into language.
Still not sure what to talk about? Here are some suggestions to get things flowing
If you’re heading into your next session feeling stuck, here are some things you might talk about in therapy when you’re not sure what to talk about:
Explore something that happened recently that impacted you, even if it seems small. The way we experience events in the present is often impacted by things that have happened in the past.
Explore current concerns and challenges: discuss any current problems or difficulties you're facing, whether they are related to work, relationships, or personal issues. Therapy is a place to process and connect with our emotions and experiences. Doing this in real time can prevent the unprocessed aspects of our experience causing problems down the line.
Review your goals for therapy or set some. This can help you to focus the work and stay on track. It can also give you something focussed to reflect on between sessions.
Ask yourself what are some things that happened in my past that I know impacted me, but that I haven’t talked about yet.
Talk about your current relationships with family, friends, romantic partners or colleagues. Reflect on what patterns might be present and how they show up in your relationships.
Discuss how you currently cope with stress, anxiety or other difficult emotions. Explore the effectiveness of these strategies and identify possible alternatives if your current strategies aren’t working for you.
Explore what you would like to be different in your life and what might be getting in the way of change. It can be helpful to reflect on what’s working for you and what’s not.
If you’ve been coming to therapy for a while you might want to revisit something you’ve explored before to see where you are now and what might have changed.
Explore your wins. These are important too! Really connecting with our positive experiences and the things that bring us joy can be an important part of resourcing ourselves. It can also re-wire your brain and create new neural pathways.
Consider journaling or recording voice notes between sessions to record your your day to day experience. This can help you to notice patterns, emotions, or themes you may want to explore later.
Final thoughts about where to start when you don’t know what to talk about in counselling or psychotherapy
Not knowing what to talk about in therapy is a common experience. I’m a therapist who has had a lot of therapy over the years and I still find myself sitting in some sessions with my therapist and feeling like I don’t know where to go. It’s almost always because of one of the reasons above. When I find myself in a space of not knowing where to go or not wanting to go somewhere in particular, simply being honest about this with my therapist creates an opportunity to really look at what might be getting in the way. Remember, therapy is a collaborative process, and your therapist is there to guide and support you every step of the way.
Whether you're setting goals, building new skills, or gradually facing your fears, the path to healing and growth is a journey worth embarking on. Don’t be afraid to take that first step and trust in the process. Your future self will thank you.
If you’d like to explore your experience with the support of me, Laura, a counsellor, therapist and somatic practitioner, you might want to check out my counselling page and my nature therapy page.
