Working out what to talk about in therapy is a more common problem than people admit. When a few weeks pass between sessions it gets hard to remember where you left off, and things that felt urgent at the time quietly drop away.
Sometimes the opposite happens. Nothing much occurred since the last session, you arrive with nothing prepared, and the first ten minutes go on deciding what to do with the hour.
Why It Is Hard to Know What to Talk About in Therapy
It is rarely because nothing is going on. More often the week’s material has simply not been written down anywhere, and the pressure of the moment makes it hard to retrieve. Occasionally it is avoidance — the real subject is present and the mind is politely steering around it. Both are worth noticing, and neither means therapy is not working.
A Checklist for What to Talk About in Therapy
Keep a note on your phone between sessions and add to it as things come up. When you sit down, you will have somewhere to start.
- What stayed with you. A conversation you replayed, a comment that landed harder than it should have.
- Where your mood shifted. Any noticeable turn, up or down, and what surrounded it.
- What you avoided. A call you did not make, a plan you cancelled, a message left unread.
- What you tried. If you took something from the last session into the week, how did it actually go?
- Patterns you noticed. The third time this month the same thing happened.
- Anything about therapy itself. Including if something your therapist said did not sit right.
- What you have been dreading. Usually the most useful item on the list.
If you arrive with nothing
Say so. “I don’t know what to talk about in therapy today” is a legitimate opening and a good therapist will work with it rather than wait you out. Some of the most productive sessions start exactly there, because the unstructured space is where the thing you were not planning to mention tends to surface.
You can also use a quiet week deliberately: revisit something from months ago that never got finished, look at what has actually changed since you started, or talk about what you want the next stretch of work to be for.
On bringing up the hard thing
Many people circle a subject for weeks before naming it. If that is happening, it is worth saying at the start rather than at minute fifty — “there is something I keep not bringing up” is often enough to get it into the room.
A note on preparation
The checklist is a prompt, not a script. Therapy is not a status report, and a session that goes somewhere unexpected is usually a session doing its job. The point of writing things down is only to make sure the week’s material is available to you, not to control where the hour goes.
Bring the checklist, not a script
One caution about deciding what to talk about in therapy in advance: a list is a prompt, not an agenda. Sessions that go somewhere unplanned are usually the ones doing the most work, and holding too tightly to what you meant to cover can quietly keep the hour safe.
If you notice you are managing the session — steering away from a subject, filling silences, checking your list to avoid a pause — that is worth saying out loud. It is often more useful than anything you had written down.
If you are new to therapy
Early on, working out what to talk about in therapy is genuinely harder, because you do not yet know what is relevant. The short answer is that almost everything is. What you assume is too small, too old, or too unrelated is frequently where the useful material turns out to be.
You are also not responsible for running the session. A good therapist will ask questions that open things up. Your job is to answer honestly, including when the honest answer is “I don’t know.”
Getting started
If you are thinking about beginning therapy, you can read about what to expect or request a free 15-minute consultation.
Submitted by: Lindsey Lane, Graduate Student, Wake Forest University
