15 Things to Talk About in Therapy

Starting Therapy · What to Talk About

15 Things to Talk
About in Therapy

Including when you have no idea where to start, with specific things you can literally say out loud.

By Sagebrush Counseling 8 min read TX · NH · ME · MT

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If you are new to therapy and anxious about it, this page is for you. The most common worry people have before a first session is not about whatever brought them in. It is about the session itself: What if I say the wrong thing? What if my problem is not serious enough? What if I cannot explain it properly and the therapist thinks I am wasting their time?

Here is the short answer: there is no wrong thing to say. There is no correct format, no threshold of suffering required, no way to explain yourself that will make a good therapist think less of you. You do not need to arrive knowing what your problem is. You do not need to have done any preparation. You can literally say "I don't really know where to start" and that is a perfectly fine beginning.

You can also just talk about your week. That counts. A lot of meaningful therapy starts with someone describing an ordinary Tuesday, and somewhere in the middle of that description, the real thing surfaces. Your therapist is listening for it even when you are not.

I.

You do not need to arrive prepared

Therapy is not a test. You are not being graded on how clearly you can articulate your inner life, or whether you have done the introspective homework. A good therapist is not waiting for you to say the right thing. They are listening underneath whatever you say, and finding the thread. Your job is just to show up and speak as honestly as you can. The therapist's job is to figure out what that means.

If you are sitting in a session and nothing comes to mind, you can literally say that. "I don't really have anything to bring today." Or: "I've had a weird week and I'm not sure how to describe it." Or: "I just want to tell you about what happened this week." All of those are fine starting places. A good therapist can work with any of them.

And if you feel something without having words for it, like a low feeling, a tightness in your chest, a kind of heaviness when you wake up, that is worth saying too, exactly like that. You do not need to explain it or diagnose it before you bring it. "I've been feeling really anxious this week and I'm not sure about what" is a complete sentence in a therapy session. So is "I've felt kind of flat lately, like nothing is quite landing" or "There's a tightness here" with a hand on your chest. Your therapist will follow that.

You do not need to know what your problem is before you start therapy. That is part of what therapy is for.

This is especially worth saying for people who are neurodivergent. If you have ADHD or are autistic, you may have spent years being told that the way you explain things is too much, too long, off-topic, or hard to follow. You may arrive at therapy already pre-editing yourself, leaving out the parts that feel excessive, trying to get to the point faster than your processing allows. You do not have to do that here. Say the background. Say the tangent. Say it in the order it comes. Part of what a therapist does is find the thread in what feels like a mess, and that is their job, not yours.

II.

6 reasons people come to therapy: you might recognize yourself here

People rarely arrive at therapy with a clean, clearly defined problem. More often they arrive with a sense that something is off, a pattern they cannot break, a recent thing that made the longer thing impossible to ignore. Here are the most common reasons people seek therapy, not as a diagnostic checklist, but as a way of saying: whatever brought you here is real, and it belongs in a session.

1

Anxiety that will not quit

Not a specific fear so much as a background noise that never quite turns off. Difficulty sleeping. The mental loop that starts when things go quiet. The physical tightness that arrives before something difficult. You might open with something like: "I've just been really anxious lately and I can't point to one thing." Or: "I feel this sort of low-grade dread a lot and I've been living with it so long I don't know if it's normal." That is enough. Therapy is not about removing anxiety. It is about understanding it well enough that it stops running in the background without your permission.

2

A pattern that keeps repeating

The same kind of relationship conflict. The same self-sabotage at the same point in a project. The way you respond to stress that you recognize from your parents. You might say: "I keep doing this thing and I don't know why." Or: "Every time X happens, I react the same way and I hate it." You do not need to have figured out the cause. That is what the sessions are for. Naming the pattern is the whole starting point.

3

A recent diagnosis or a lifelong sense of being wired differently

Whether you were recently diagnosed with ADHD or autism, have suspected it for years, or just know that your nervous system works differently from what the world seems to expect, and therapy can be a place to finally stop interpreting your wiring as a character flaw. You might say something like: "I was just diagnosed with ADHD and I'm still figuring out what that means." Or: "I've always felt kind of different and I think it might be autism but I'm not sure." Or simply: "I feel like I work really hard just to do things other people find easy and I'm tired." All of that belongs in a session.

4

Something happened that changed things

A loss. A relationship that ended. A job change or a diagnosis. Something that was supposed to be good but did not feel the way you expected. You might say: "Something happened a few months ago and I haven't really been the same since." Or: "Things are fine on paper but I've felt off since X happened." You do not have to have processed it already. You do not have to be in crisis. The fact that it changed something is enough of a reason to bring it.

5

Chronic self-criticism and the feeling of falling short

A pervasive sense of not quite measuring up, of working hard and still feeling behind, of succeeding at things that should feel good and mostly feeling like you got away with it. You might say: "I'm really hard on myself and I can't seem to stop." Or: "I achieve things and then immediately feel like I don't deserve them." This one is particularly common in neurodivergent people who have spent years overcompensating, and it tends to shift once someone starts examining it rather than just running from it.

6

Relationship difficulty, with a partner, a family member, or yourself

Communication that keeps breaking down. Distance that was not there before. The feeling of being in a relationship you value and not knowing how to reach the other person. You might say: "My partner and I keep having the same fight." Or: "I feel lonely even when I'm with people." Or: "I'm really mean to myself and I want to work on that." The relationship with yourself counts just as much as any other relationship. Your inner voice is worth bringing to therapy too.

You do not need a clinical vocabulary for any of this. "Something feels off and I do not know what to do with it" is a complete reason to be in therapy.

What Feels Hard

What is making it difficult to say what you want to say?

Four questions to help you name what is getting in the way

Question 1 of 4

Which feels most true about why you have not said the thing?

I am afraid of what the therapist will think of me if I say it. I am not sure it is serious enough to bring up. It might not be a real problem. I cannot figure out how to explain it. Every time I try to put it into words, it sounds wrong. Saying it out loud would make it feel more real than I am ready for.

1 of 4

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Question 2 of 4

When you imagine saying the thing, what do you feel?

Shame, or the anticipation of being seen as someone I do not want to be. A kind of preemptive embarrassment, like I am being dramatic about something that other people handle fine. Frustration, because I already know that what comes out will not match what I mean. A tightening, like something closing. The idea of saying it feels like it would set something in motion I cannot take back.

2 of 4

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Question 3 of 4

What have you done with the thing until now?

Told a partial version to a few people and never the whole thing. Or told it in a way that left out the worst part. Mostly kept it quiet and hoped it would resolve on its own, or told myself I should be able to handle it. Tried to explain it to people and felt worse afterward, like the explanation made it sound different than it is. Avoided thinking about it. I keep myself busy enough that it does not come up unless I let it.

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Question 4 of 4

What would it mean to finally say it?

Either relief, or the end of being able to pretend it is not who I am. I am not sure which. Having to take the problem seriously when I have been telling myself it is not really a problem. Maybe it would help. I just need someone who understands before I try to explain it. Something changing. And I am not sure yet whether I want things to change or whether I am afraid of what change would cost.

4 of 4

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III.

9 things to talk about when you are not sure where to start

Some sessions arrive with nothing obvious in them. The week was fine, or the week was hard but you cannot locate why, or you have been in therapy for a while and hit a quiet stretch. This is completely normal and it happens to everyone. It happens more often for people with ADHD or autism, where the connection between an experience and the words for it can take longer, where some weeks you just feel a vague something that does not have a name yet.

You do not have to arrive at a session knowing what you want to talk about. You can just start talking and trust that something will surface. Or you can use one of these as a starting point. You can even read one of these lines to your therapist directly to open the conversation.

1

Just tell them about your week

This is more valid than it sounds. "I don't really have a specific thing, can I just tell you about my week?" is a perfectly reasonable thing to say. A lot of meaningful therapy starts there. Something in the telling of an ordinary week will catch, and the therapist will follow it. You might be surprised what surfaces when you stop trying to identify the Important Thing and just describe what happened.

2

Name a feeling or sensation even if you cannot explain it

You do not need to have a fully formed explanation to bring something to therapy. Try any of these: "I've been feeling really anxious this week and I'm not sure what about." Or: "There's this kind of heaviness I wake up with." Or: "I don't feel depressed exactly but I feel flat, like things aren't quite landing." Or: "I have this tightness in my chest a lot." Describing the physical sensation of a feeling is completely valid. Your therapist can work from any of those.

3

If you are neurodivergent: talk about your nervous system this week

If you have ADHD or are autistic, some weeks the most honest thing you can bring is not an event but a state. Try: "My executive function has been really bad this week." Or: "I've been overwhelmed by a lot of small things and I can't explain why." Or: "I've been masking a lot this week and I'm exhausted." Or: "I had a sensory day on Tuesday and it kind of derailed everything." These are not small talk. They are the substrate of your whole week, and they are worth talking about in detail.

4

A moment that felt bigger than it should have

A conversation that left you unsettled for no obvious reason. A reaction to something small that surprised you. "Something happened this week that I keep thinking about and I don't know why." The things that stick, even when they seem small, are usually touching something bigger. You do not need to know what. Bringing the stickiness is enough.

5

The thing you have been not quite saying

If there is something you keep meaning to bring up and then do not, you can say that directly: "There's something I keep almost bringing up and I don't know why I keep avoiding it." That is one of the most useful things you can say in a session. You do not have to know what the thing is or why you are avoiding it. Naming the avoidance is already the first step.

6

How therapy is going for you

If a session did not land well, if something your therapist said has been sitting wrong, if you are not sure it is helping, say so. "I left last week feeling kind of worse and I wanted to tell you." Or: "I'm not sure this approach is working for me." A good therapist will not be defensive. They will want to know. Being honest about how therapy is working is itself a skill, and it is a good one to practice here.

7

A recurring thought, image, or dream

If the same thought keeps coming back, or a specific image surfaces when you are anxious, or a dream has stayed with you, bring it. "I keep having this thought that I can't seem to shake." Or: "I had this dream and it stuck with me for days." You do not need to interpret it first. The therapist will be interested in the fact that it is recurring at all.

8

Something you want that you have not said out loud yet

Something you want from the relationship you are in. Something you want for your life that feels too uncertain or too big to name. Something you want from therapy itself. "I want to feel less anxious, but I'm not sure if that's realistic." Or: "I want to be closer to people but I don't know how." Naming wants in therapy, even vague ones, is often where the most useful work begins.

9

Something that went well, or something you are proud of

Therapy does not have to be about problems. "Something good happened this week and I want to tell you about it." Or: "I did something I've been avoiding and it went okay." Bringing the things that are working matters too, because understanding what helps is as useful as understanding what hurts. Neurodivergent clients especially often need space to notice and name their wins, not just their struggles.

You can also just say "I don't know what to say today." That is a starting place too. A good therapist will pick it up from there.

Ready to say something, to someone who gets it.

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How Online Therapy Works → Frequently Asked Questions → Do I Need Therapy, or Am I Overreacting? → Signs You Might Benefit from Therapy → About Sagebrush Counseling →

Frequently Asked Questions

What if I start crying and cannot stop? ▾

Let it happen. Crying in therapy is not a disruption or an embarrassment, it is often the point at which something real is being touched. A therapist is not going to rush you through it or feel uncomfortable with it. You do not need to apologize for it or explain it. If you want to understand what is coming up, you can say so afterward. If you just need to let it pass, that is fine too.

What if I do not know what I want to work on? ▾

Say exactly that. "I am not sure what I want from this" is useful information to start with. A therapist will use the first session to help you figure out what is most alive for you, what patterns are showing up, and where to direct the work. You do not need to arrive with a treatment goal. You just need to arrive and be honest about where you are.

Is it okay to tell my therapist when something is not working? ▾

Not only is it okay, it is one of the most important things you can do. Research consistently shows that the therapeutic relationship is one of the strongest predictors of therapy outcome, and the therapeutic relationship depends on honest communication in both directions. If a session went somewhere unhelpful, if a comment landed wrong, if you are not feeling progress, say so. A good therapist will not become defensive. They will want to understand and adjust.

Do I have to tell my therapist everything? ▾

No. Therapy is not a confessional, and you are not obligated to share anything before you are ready. What matters is honesty about where you are, not completeness of disclosure. If you are not ready to talk about something, you can say "I am not ready to talk about this yet", that itself is useful information. What tends to be less useful is mentioning something and then offering an incomplete version that avoids the essential part. Either go there or say you are not ready to yet.

I am in Texas, New Hampshire, Maine, or Montana. How do I get started? ▾

All Sagebrush Counseling sessions are via secure HIPAA-compliant video. You can access therapy from home in Texas, New Hampshire, Maine, or Montana without commuting to an office. A free 15-minute consultation is the starting point, and no intake forms are required before that call. See how online therapy works or read the FAQs if you want more detail before reaching out.

The thing you almost did not say is usually the thing the therapy needs.

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This content is for educational purposes only and does not constitute clinical advice. Sagebrush Counseling, PLLC is licensed in Texas, New Hampshire, Maine, and Montana. If you are in crisis, call or text 988. To get started, schedule a free consultation.