What to Talk About in Therapy | Ideas, Tips & First Session Guide
If you’ve ever wondered what to talk about in therapy, you’re not alone. Many people feel nervous, unsure, or even overwhelmed when deciding how to start a therapy conversation. Knowing the kinds of topics you can bring to therapy—and understanding that there’s no “wrong” thing to say—can help you feel more confident and get the most out of your sessions.
Have you ever found yourself sitting in a therapist's office, unsure of what to say next? You're not alone. Some people feel anxiety about “where to start” or knowing “what’s important.”
The relationship with a therapist or psychoanalyst is unlike any other relationship you will have. It’s an intimate relationship in which you talk about things you probably haven't told another soul. You might share deeply personal things from the first session, or you might need to build trust over several months, even years, before feeling comfortable saying what’s on your mind. This is unlike most relationships because you don’t ordinarily lead with very personal information in the first meeting.
When starting therapy for the first time, you have no basis for comparing the relationship to anything you know. It can take time to discover, co-create, and negotiate the therapeutic relationship.
The relationship also has a very specific goal: improving mental health. Some patients feel responsible for knowing how to achieve that goal by bringing the “right” things to say.
In this guide, you'll discover practical ideas for what to talk about in therapy, strategies for opening up in your sessions, and ways to get the best results from your work with a therapist.
Why It’s Hard to Know What to Talk About in Therapy
Therapy is a safe space where you can openly discuss your thoughts, feelings, and experiences. It's a journey toward self-understanding and healing. A skilled therapist can help you explore your emotions, identify patterns, and develop coping strategies.
While therapy is a safe space, it might not initially feel like one. That’s because you are both starting a new relationship with a new person. Beginnings raise anxiety. You are also connecting to vulnerable parts of yourself and sharing them, which can feel very threatening.
The Benefits of Talking in Therapy
Emotional Release: Letting out your feelings can be cathartic.
Gaining Perspective: Talking things through can help you see them more clearly.
Problem-Solving: Discussing issues with a therapist can lead to finding solutions.
These benefits often come from speaking freely, not from perfectly planning your words.
Don’t Know What to Talk About in Therapy? Here’s Where to Start
Every therapist works differently. The suggestions below are based on my own clinical approach and what I believe can help patients get the most out of their sessions.
1. Your First Therapy Session
Share why you’re seeking therapy, what challenges you face, your goals, and how you generally see yourself. Be ready to explain some examples of these challenges and the surrounding context. This helps your therapist understand your background and priorities.
2. Say What Comes to Mind
Once you have a treatment plan, try to say whatever is on your mind in the moment. Many people over-prepare or filter their thoughts, hoping to say something “useful.” While it’s natural to bring in topics from the week, giving yourself the freedom to share spontaneous thoughts can reveal important emotional material. It’s not your job to organize or interpret your thoughts—that’s your therapist’s role.
3. Reflect on the Present Moment
Notice your current feelings in the session. Are you nervous? Excited? Unsure? Share your emotional experience of being with your therapist. Maybe a memory surfaces, or you recall an interaction from the week. All thoughts are welcome in therapy.
How to Get the Most Out of Therapy Sessions
Be Honest – Your therapist can only help you with the truth you share.
Be Patient – Change takes time, and progress may feel slow before it feels meaningful.
Be Open – Therapy is about exploration, not about having the “right” answers.
Final Thoughts: There’s No Wrong Thing to Talk About in Therapy
Therapy is a valuable tool for anyone seeking to improve mental health—whether you’re dealing with anxiety, depression, relationship struggles, or major life changes. The key is to show up with openness and curiosity.
When you explore your thoughts and feelings honestly, you take a powerful step toward emotional growth and self-understanding. Remember: there’s no “right” or “wrong” thing to bring up. The most important thing is that you keep thinking.