Wondering what to talk about in therapy? Therapists share advice

Starting therapy can feel both exciting and intimidating, especially if it’s your first time connecting with a therapist or counselor. It may bring some peace of mind to know you’ll have an experienced guide ready to lead you through each session.

Still, you may be wondering: What should you talk about in therapy? Where should you start, and what will be considered important by your counselor?

Therapy is all about addressing your needs and concerns at your comfort level, which means it’s hard to go wrong when choosing what to discuss. Here’s what therapists recommend talking about in therapy, whether it’s your first session or your fiftieth.

Feeling Stuck at the Start? That’s Completely OK

Alex Cromer, a licensed professional counselor at Thriveworks, assures clients that feeling unsure of what to say is completely normal—and part of the therapeutic process itself.

“In the beginning, you may have a variety of topics you’d like to talk about, which can lead to easy conversation or make it difficult to single one out,” Cromer says. “If you ever struggle to land on a topic, your therapist will often go through their notes from past sessions or even your intake and list some options for you until you find one that feels right.”

What about those awkward silences?

They’re not awkward to us, says Kate Hanselman, a board-certified psychiatric nurse practitioner at Thriveworks. “If there is silence on the part of the client, that’s completely OK—we’ll address that as well,” she says. “Is the silence purely because we had a good week and there’s not much to talk about? Maybe we’ll move our weekly sessions to biweekly. On the other hand, is the silence a type of avoidance? Then we’re going to talk through that.”

Despite the importance of building a relationship with your therapist, you don’t need to open up more quickly than you’re comfortable with. There’s no need to disclose all of your vulnerabilities or tell your life story in one session. Rather, go with your gut and share once you feel like a trusted alliance has formed.

“Therapy is collaborative,” says Hallie Kritsas, a licensed mental health counselor at Thriveworks. “The clients guide me, but I also guide them. You are steering this ship, and your therapist is with you every step of the way to help you chart your course.”

What Therapists Recommend Talking About in Session

When it comes to what to talk about in therapy, anything and everything is fair game. That also means you can start slow, if you want.

The idea that you have to talk about your childhood or traumatic events, especially in the first session, is a common misconception “A therapist doesn’t necessarily have a ‘capital E’ expectation,” Hanselman says. “The only true criterion is that the topic matters to you.”

What’s Really on Your Mind Right Now

“Therapists typically are very flexible in what they expect you to talk about in therapy, and your comfort is the most important thing,” Cromer says. “Typically, therapists might expect the topic of conversation to be about why your day-to-day life is or isn’t functional, as well as certain roadblocks and areas in which you’re currently feeling distressed, but in the end, it’s entirely up to you.”

Most therapists will start with questions that meet you where you are:

• “What brought you here today?”
• “What goals do you have for our time together?”
• “Tell me about your week”
• “What issues are presenting challenges to you lately?”

When You Don’t Know Where to Begin

If you’re still struggling to figure out what to say, Hanselman suggests going back to basics: “Start with whatever made you think, ‘Maybe I should talk to someone.'”

Most of the time, there’s a specific stressor or presenting issue that made you seek therapy. Maybe it’s something that’s difficult to express. If you don’t know where to begin, just bringing up a general feeling can open things up:

• “I just feel really off lately, and I’m not sure why”
• “I think I may be depressed”
• “I am having trouble processing grief and would like help navigating my loss”
• “Why am I struggling to maintain meaningful relationships in my life?”

“You don’t have to start digging around in your own history by yourself—that’s what we’re here for,” Hanselman says. “Start where you are today, and then we can help you connect some of the dots if they go forward, backward, or sideways in your life.”

Reporting Back on What’s Working (and What Isn’t)

After a few sessions, you can also start bringing up experiences you’ve had with therapy skills outside of sessions. These real-world applications can include:

• Homework assignments: Did that boundary-setting exercise work with your coworker? Did the breathing technique help during your presentation?
• Unexpected situations: “I used that thought-stopping technique you taught me when I got triggered at dinner with my family, but I’m not sure I did it right.”
• What’s working and what isn’t: “That journaling exercise felt forced to me—can we try something different?”

“I really enjoy when clients discuss or bring questions about what’s happening outside of therapy—techniques they’ve used, situations they encountered—and let me know when things are working or not working,” Kritsas says. “If a certain strategy doesn’t work for them and they need something different, I want to know—we’ll adjust and move on to the next.”

Tips If You Still Feel Unsure About What to Say

Unanimously, our therapists encourage clients to voice how they’re feeling, especially if it’s to say they don’t know. “Name it! Say that out loud,” Hanselman advises. Your therapist is trained to guide you through that.

“We don’t always have the language to describe really hard things, and saying that out loud can also help—’I don’t know how to say this. I don’t know what to say. I don’t know how to describe it,'” Hanselman continues.

Here are three ways your therapist might help you identify, name, and work through challenges:

1. Try the “body scan” approach.

If emotions are hard to identify, therapists might ask about physical sensations occurring alongside the feeling. “We’ll ask you to notice where it is in your body, as well as what the specific sensation feels like—tightness, fluttering, shakiness, burning,” Hanselman says. This can help your therapist get a better idea of what you’re feeling and work with you to name it.

Sometimes saying “I feel this knot in my chest” is easier than saying “I feel anxious about my relationship.”

2. Use your phone’s notes app between sessions.

It’s often hard to describe intense emotions in an unrelated moment, but it can be easier to break it down when you’re actively feeling it. Try jotting down what feelings and sensations come up when facing a challenge, as well as what situations seem to bring them on. This can help you trace a pattern of possible causes you can bring to your therapist to look at and process together.

3. Start with the “weather report” of your week.

When all else fails, treat your emotional state like you’re giving a weather forecast. “This week felt stormy with some scattered anxiety showers on Tuesday” or “It’s been pretty cloudy lately, but there was some sunshine when I talked to my sister.” This gives your therapist a framework to dig deeper.

“It is a learned skill to figure out how to talk about tough stuff, and we’re here to help,” Hanselman says. “Talking about emotions can feel so intimidating or scary to people, but that’s exactly what we’re here to do—put words to things that you don’t necessarily have words for. You don’t have to try to figure that out alone.”

Therapy Is a Safe Space for Any Topic

If there’s any space where it’s safe to bring up the hard stuff, it’s in therapy. In fact, Thriveworks’ 2025 Pulse on Mental Health Report found that two-thirds of Americans feel more comfortable sharing sensitive information with their therapist than with their partner, friends, or family.

“I don’t want someone to be nervous about coming to therapy. We talk about anxiety and other hard topics, but I don’t want the session itself to be anxiety-provoking,” Kritsas says. “I know that can happen, especially if you haven’t been in therapy before. It’s not always fun to talk about the scary, the big, or the bad things, but when you come, say whatever’s on your mind—we’ll figure out what things to talk about.”

Remember: There’s no grade for therapy, Kritsas adds. “There’s not a ‘good session’ or a ‘bad session’. Sessions are sessions, and as long as we’re talking, I feel like there’s progress being made.”

Understanding Privacy vs Personal Safety

As mentioned before, when it comes to what to talk about in therapy, anything goes. But with certain subjects, therapists have to take precautions to ensure you and others are safe. Therapists abide by an oath to maintain confidentiality at all times and may only breach confidentiality when:

• You are at risk of harm or danger
• There is knowledge of physical, sexual abuse, or threat or imminent danger to a minor
• You are expressing suicidal ideation with intent or plan to end your life
• There is knowledge of danger to a minor, disabled, or elderly person
• They are subpoenaed and required to submit counseling notes and diagnoses to law enforcement

Therapists are subject to reporting the above concerns to authorities, but that doesn’t mean therapy is any less of a safe space—these protocols are designed with your safety in mind and will only be used if your safety is in immediate danger. They will also let you know when and if they have to make a hard call for your safety. Your privacy is of the utmost importance during the therapeutic process.

What’s most important to remember: Your therapist wants you to succeed, feel heard, and find the support you’re looking for. Every question you bring, every concern you voice, and every moment of uncertainty you share is valuable material for your healing journey. Trust the process, trust your therapist’s guidance, and most importantly, trust yourself to know what feels right to discuss and when.

For more ways to make the most of your sessions, explore our guide on getting the most out of therapy.