Estimated reading time: 30 minutes
Feeling uncertain about what to talk about in therapy? You’re not alone. Embrace the uncertainty and learn how to explore these feelings in a way that can lead to profound growth and self-discovery. In this blog, we’ll guide you through what to do when you feel stuck on what to talk about in therapy.
The good news is – there are no real rules or absolute right things you must talk about in therapy. The most important element is being ready and willing to explore your thoughts, feelings, and experiences honestly in order to achieve your goals, gain self-awareness, and heal.
First thing is first: understand the roots behind the feeling of "not knowing what to talk about"
Believe it or not, randomly choosing from a list of topic may not be the best approach to address this question.
It can feel frustrating to feel stuck in therapy sessions without knowing what to talk about. It’s crucial to take the time to fully understand the roots behind this feeling before moving ahead to solutions. Why?
Rushing into solutions without understanding the core issues can result in only superficial progress – you want to achieve deep and lasting change. For example, if I have a client who asks for help with opening up, and I mistakenly focus on giving tips before addressing that they actually feel judged by me, our work together will likely feel ineffective. Or if we just practice social skills when the problem is a mismatch between our therapeutic modalities, they may continue feeling stuck. Taking time for discovery prevents wasted energy on misguided solutions.
When you get stuck about what to talk about in therapy, there are often different underlying reasons or causes behind it. The reasons can be complex, stemming from your psychology, the therapeutic process, and the client-therapist relationship dynamics. Taking time to uncover and explore the actual barriers first will allow for a tailored solution to get the sessions on a productive track.
Here are some reasons you may not know what to talk about in therapy sessions -- Along Suggestions for Each Reason
1. You are new to therapy and it takes time to build comfort with your therapist.
It’s understandable to feel hesitant about opening up personal issues and emotions to a therapist, especially in initial sessions when the relationship is just forming. . It’s very common for clients to initially struggle opening up and sharing candidly. The therapeutic process involves making yourself vulnerable by sharing intimate struggles, fears, and experiences. In the beginning, before you have built trust and familiarity, it can feel daunting deciding what private concerns or thoughts are okay to reveal. You may grapple with how much you want to disclose right off the bat when the environment feels foreign.
Your therapist’s role is to offer a non-judgemental space to unpack thoughts freely. Keeping a journal between sessions to tune into your inner experience can be a helpful reflection tool to identify what feels relevant to discuss.
2. You're not sure what topics to think about (therapy topic ideas included)
Here are some therapy topic ideas to mull over as you start to self-reflect and identify things to talk about:
Current Stressors, Problems, or Symptoms
It can be helpful for clients to discuss any current issues or symptoms they want to improve through therapy, such as anxiety, depression, grief, anger problems, disordered eating, etc. Ongoing sources of stress in work, finances, health, family, or other parts of life are also beneficial to address in therapy. Therapists want clients to feel comfortable sharing what brings them into therapy currently so progress can be made.
Goals and Desired Changes
It can be very valuable for you to identify specific hopes and goals for your own personal growth, progress, and positive change through the therapy process. You should feel comfortable sharing any desired outcomes you have for improving your life and addressing struggles through the therapeutic work.
For example, you may have goals around developing practical skills to better manage emotions, anxieties, depressive thoughts, or harmful behaviors. Other goals may be focused more on gaining meaningful insights into your own patterns, relationships dynamics, triggers, and inner workings that drive your behaviors. Additional goals you may have could relate to improving specific mental health symptoms like reducing panic attacks, learning to handle anger more constructively, or boosting self-esteem. Or you may have more general goals around achieving life balance, proper self-care, fulfillment in relationships, or simply finding a sense of purpose.
Voicing these therapeutic goals and areas for self-improvement enables the therapist to tailor approaches to help you craft an effective path forward to achieve your desired changes.
Trigger Points
It can be constructive to explore any trigger points that stir up emotions like worry, anger, sadness, overwhelmed and so on. You may have some awareness of what triggers these reactions, or they may seem to come out of nowhere. Discussing possible triggers openly with your therapist allows you to identify patterns, understand where these reactions come from, and explore the underlying emotional roots. This process also enables you and your therapist to collaborate on healthy ways to manage your reactions when faced with triggering stimuli.
Here are some examples of different types of triggers that could be helpful to discuss in therapy:
- Sensory triggers – Certain sounds (yelling, sirens), smells (perfume, smoke), textures (wool, slimy foods), lights (strobe lights, darkness), or other sensory stimuli can instantly provoke anxiety, rage, or other emotional reactions.
- Phrase triggers – Hearing or reading certain words, statements, or phrases can immediately evoke difficult feelings or memories. For example, a seemingly harmless phrase might subconsciously remind someone of emotional abuse.
- Situation triggers – Being in certain environments or situations such as parties, classrooms, family events, or places associated with a past trauma can automatically elicit overwhelming emotions.
- Activity triggers – Engaging in tasks that represent or remind someone of traumatic or painful experiences can instantly trigger emotional distress. For example, driving for someone who has been in a car accident.
- Interpersonal triggers – Dynamics like confrontation, criticism, rejection, yelling, or signs of disapproval from someone in a position of authority could trigger panicked reactions.
- Anniversary triggers – Important dates like the anniversary of a loss, accident, or abuse event can serve as painful emotional triggers each year.
- Internal bodily triggers – Hunger, fatigue, illness, and hormonal changes can lower thresholds for getting triggered emotionally.
Identifying Patterns and Behaviors
Engage in self-reflection and observation of your thoughts, feelings, and behaviors outside of sessions. Tracking patterns and themes that arise in your daily life or relationships provides extremely valuable insights to explore together in therapy.
Keeping a journal of your emotional responses, recurring reactions, inner critic voices, or other behaviors you notice can illuminate important themes for discussion. For example, you may observe critical self-talk arising in certain situations. Gaining awareness of these habitual thought cycles allows us to understand what purpose they serve and how to manage them.
Putting effort into identifying your own patterns – whether beneficial or problematic – leads to increased self-knowledge and opportunities for growth. Your time in therapy becomes most productive when you come prepared to explore your deepest patterns revealed through regular introspection and journaling between sessions.
Your Sociocultural Identities
Exploring your sociocultural identities, including race, ethnicity, gender, sexuality, class, religion, and other aspects, with your therapist can lead to profound healing and self-insight. Your lived experiences as part of diverse cultural groups provide an invaluable context for understanding your development, worldview, values, and unique struggles. Discussing how your identities have shaped you, any related discriminatory experiences, and how they connect to your mental health gives your therapist essential information to provide tailored support.
Here are some ways to explore the multilayered impact of your sociocultural locations, identities, experiences, and socialization in the therapeutic space:
- Share any experiences where you felt judged, excluded, discriminated against, or privileged based on aspects of your identity. Explore the emotional impact.
- Discuss how gender/sexual socialization and norms may have influenced your self-image, relationships, or opportunities.
- Sociocultural identities often play a role in family and community dynamics. Discussing how your identities interact with your family’s beliefs, cultural expectations, and traditions can provide insights into relationship dynamics, conflicts, or challenges you may be facing.
- Share any struggles, discrimination, or injustices faced by your broader cultural communities that feel personally meaningful.
- Explain how elements of your identity shape your worldview, life philosophy, morals, and goals.
- Discuss any identity-related pressures or expectations from your family or cultural community.
- Explore your evolving feelings about reclaiming identity labels that had stigma versus those that are still painful.
- Many individuals navigate multiple sociocultural identities, such as race, ethnicity, gender, sexual orientation, religion, or ability. Exploring how these intersect and impact your experiences can help you understand the unique challenges and strengths that come with navigating multiple identities.
- Share creative works, rituals, or activism empowering your cultural identities.
Our rich sociocultural identities are integral to our mental health and lives. Therapy should feel like a space to bring your whole self, including your sociocultural identities. Your therapist should provide a supportive and inclusive environment where you can openly discuss these aspects of your identity and work together to address the challenges and celebrate the strengths that come with them.
Your Childhood Experiences
Discussing your childhood and upbringing with a therapist provides crucial developmental context. It allows you to process buried emotions from your past with support. By exploring family dynamics, attachment patterns, adverse experiences like trauma or neglect, and your innate temperament as a child, greater self-awareness can emerge. This enables you to understand the origins of current issues, build self-compassion, and break negative cycles that may unconsciously still affect you today. With an empathetic therapist bearing witness to your childhood story, you have a unique opportunity to heal old emotional wounds, gain maturity and perspective, and interrupt dysfunctional patterns in your life. Our early years shape who we become in profound ways!
Past Traumas
When trauma impacts your mental health and functioning, exploring it with a trusted therapist can help you make sense of your experiences, process difficult emotions, and find closure. Your therapist’s role is to provide a judgment-free space to compassionately bear witness as you share memories and emotions.
If you feel unsure where to start, you may choose first to discuss how the trauma generally affects your life today – the emotions, behaviors or thought patterns you struggle with. You do not need to reveal any details you aren’t prepared for. As trust deepens, you may naturally open up more about the events themselves. The key is remembering you are in control. Share vulnerably at the speed that feels right.
If you ultimately want to process and heal from past traumas but don’t feel fully comfortable or ready yet, it is perfectly acceptable to explain these mixed feelings openly to your therapist. A compassionate therapist will meet you where you’re at rather than rushing sensitive topics before you have built skills and trust. Be honest about what makes you hesitant or uncomfortable so your therapist understands how to support you sensitively.
Together, you can take gradual steps such as describing basic facts first and building up to accessing emotions slowly over multiple sessions. Recognize progress may be gradual and involve both forward movement and setbacks. Know that you are in control of the pace. With patience and a caring therapist helping you address any emotional blocks first, you can work through mixed feelings to face past traumas in your own time and experience healing.
If you’re unsure whether or not something is considered “trauma”
It’s common to grapple with whether or not difficult past experiences can be classified as traumatic. Try not to get caught up in labels. What matters most is being honest with your therapist about what happened and how it impacted you emotionally. Explain the details matter-of-factly so your therapist can help assess the level of impact and appropriate treatment approaches. Pay attention to any ongoing trauma symptoms like nightmares or avoidance tendencies, as these can validate an experience as traumatic regardless of severity. Also, notice any minimization or denial about the seriousness of what you went through, as this is common with burying trauma. The healing comes through processing these challenging experiences compassionately, not from making definitive trauma determinations. With patience and support, relief and understanding can unfold even if trauma recognition takes time.
Relationships and Interactions
Relationship dynamics and social interactions reveal a great deal about our inner selves. You can share any relationship conflicts, communication issues, family challenges, isolation tendencies, or other interpersonal experiences that feel significant. Many insights can be gained by discussing relationships.
Here are some things you can talk about:
Communication:
How you communicate with others can play a big role in your relationships. Discussing any challenges, conflicts, or difficulties you face when expressing yourself or understanding others can lead to better connections with those around you
Conflict resolution:
We all have disagreements from time to time. Talking about how you handle conflicts and finding healthier ways to resolve them can make a big difference in your relationships. Learning effective communication skills and strategies for managing conflicts can help you build stronger connections.
Boundaries:
Setting and maintaining boundaries is important in any relationship. Exploring your personal limits, needs, and values, and discussing any difficulties you face in asserting them can contribute to healthier and more fulfilling relationships.
Trust and intimacy:
Trust and intimacy are key ingredients in any meaningful connection. Exploring any challenges or fears you have around trust, vulnerability, and emotional closeness can help you build stronger and more authentic relationships.
Family dynamics:
Your family history can have a big impact on your current relationships. Talking about the dynamics within your family, including roles, communication patterns, and unresolved conflicts, can help you understand how they influence your current interactions and enable you to make positive changes.
Support networks:
Your support system plays an important role in your overall well-being. Discussing the presence or absence of social support, feelings of loneliness or isolation, or challenges in building and maintaining meaningful connections can help you identify strategies for cultivating a supportive network.
Intimate partnerships:
If you’re in a romantic relationship, it’s important to talk about various aspects of it. This can include exploring relationship satisfaction, emotional needs, intimacy, trust, commitment, and shared goals. Addressing any concerns or conflicts within the partnership can contribute to its growth and overall happiness.
These are just some examples, and therapy is a personal journey tailored to your needs. Your therapist is there to help you navigate these discussions and support you as you improve your relationships and overall well-being.
Your sexuality
Talking about sexuality in therapy can be incredibly helpful and empowering. It’s a space to openly discuss your feelings, experiences, and concerns without judgment. Whether you’re exploring your sexual identity, facing challenges in your relationships, or dealing with sexual trauma, therapy can provide the support and guidance you need. Here are some examples of when it can be helpful to talk about sexuality in therapy:
Discovering your sexual identity:
If you’re questioning your sexual orientation or gender identity, therapy can be an excellent resource. It’s a safe space to explore your feelings, gain clarity, and embrace who you are. Your therapist can help you navigate this journey of self-discovery and provide support throughout the process.
Addressing sexual concerns:
If you’re struggling with sexual difficulties or concerns, therapy can help. Whether it’s low desire, performance anxiety, or other challenges affecting your sexual functioning, discussing them in therapy can lead to understanding and solutions. Your therapist can provide guidance, education, and strategies to improve your sexual well-being.
Relationship and intimacy issues:
Sexuality is often connected to our intimate relationships. If you’re facing communication problems, intimacy issues, or navigating non-traditional relationship dynamics, therapy is an ideal space to address these concerns. Your therapist can help you work through these challenges and develop healthier relationship patterns.
Healing from sexual trauma:
If you’ve experienced sexual trauma or abuse, therapy offers a supportive environment for healing. Your therapist can guide you through the recovery process, help manage trauma-related symptoms, and support you in reclaiming your sexuality and rebuilding trust.
Exploring sexual values and desires:
Therapy is an opportunity to explore your values, desires, and boundaries regarding sexuality. It allows you to develop a healthier relationship with your own sexuality, promote self-expression, and enhance your overall sexual well-being.
A knowledgeable and affirming therapist should provide a non-judgmental and supportive environment where you can openly discuss your sexual experiences, concerns, and aspirations. Together, you and your therapist can navigate the unique aspects of your sexuality.
Here’s an article with more tips on how to get comfortable talking about sex in therapy.
The Value of "Small" Issues in Therapy
In therapy, no issue or topic is ever too small or trivial to discuss. As a therapist, I encourage my clients to feel comfortable sharing anything on their minds – including hopes, dreams, fears, disappointments, and recaps of recent everyday experiences. While some clients feel they need to talk about only the “biggest” issues, highlighting so-called smaller topics leads to just as much productive exploration. Using recent events or moments as a jumping off point allows us to explore the deeper thoughts, feelings, and patterns that arise for you. And sharing more lighthearted aspirations opens doors to insightful discussions about your values, interests, and direction in life. Remember, therapy is an open space to unpack whatever is weighing on you, big or small. The more forthcoming you can be about your inner world, the more opportunities will arise for self-discovery and change.
3. You feel unsure of or disconnected from your own thoughts & feelings so you don't know what to talk about during therapy
Sometimes it can be tough to figure out what’s going on inside your own head. You might feel unsure or disconnected from your own thoughts and emotions, and that’s completely normal. The good news is, therapy is a great place to tackle this challenge head-on.
Don’t hesitate to tell your therapist about it when you’re not quite sure what’s going on, or you’re struggling to understand your feelings. They’re there to help you navigate through these uncertainties and reconnect with your inner world.
As a starting point, many clients have found it helpful to keep a journal to jot down things that have bothered them or preoccupied their mind throughout the week.
Take time at the end of each day to reflect on how your day went. What was your mood like? What were some parts of the day that nourished you? What were some parts of the day that were stressful or upsetting? If you’re in the mood for it, you can make art representing your emotional state. I dive deeper into how to be emotionally available to ourselves in this blog.
If you frequently struggle with feeling spaced out or blanking out, you may be dealing with dissociation, and this is something to explore with your therapist.
4. Your therapy goals are unclear so you don't have anything to ground what you talk about in therapy
You might be unsure what to talk about in therapy because you need more clarity about your therapy goals. Treatment can provide a space to clarify your objectives, identify focus areas, and establish meaningful therapy goals.
During your therapy sessions, take the opportunity to discuss your uncertainties and work together with your therapist to define your goals. They can guide you through a process of self-reflection, helping you gain clarity on what you want to achieve and what areas of your life you want to address. By discussing your needs and values, you can collaboratively establish therapy goals that resonate with you.
Therapy is a dynamic process, and your goals may evolve and change over time. It’s okay to start with some uncertainty and use the sessions to explore and refine your objectives. Your therapist is there to support you and help you navigate through these uncertainties, ultimately assisting you in establishing goals that are meaningful and aligned with your unique needs and values.
What it means when you usually have things to talk about in therapy, but you're suddenly hitting a wall
Experiencing a sudden block or hitting a wall in therapy, even when you usually have plenty to talk about, can happen in therapy. It often indicates that something specific is causing you to feel stuck or uncertain in the therapeutic process. When this happens, reflect on what happened right before hitting the wall with your therapist. The surface reason may be that you feel there’s nothing to discuss, but underlying factors could be at play unconsciously. For example, you may have brought up a sensitive topic last session that triggered resistance, you may be experiencing anxiety about the process, or you may have had a conflict with your therapist you’re avoiding.
Here are a few possible reasons for this shift:
Conscious or unconscious avoidance of certain topics
Sometimes, in therapy, it’s natural to steer away from discussing difficult or uncomfortable subjects. You might find yourself consciously or unconsciously avoiding these topics because they evoke strong emotions or trigger more sensitive issues that you’re not ready to address. Your therapist’s role is to create a safe and supportive space where you can gently explore any resistance or avoidance.
They’ll work with you to understand the underlying reasons behind this avoidance and help you navigate through these sensitive areas at a pace that feels comfortable for you.
Remember that therapy is a process that proceeds at a speed that respects your boundaries and emotional readiness. It’s completely okay to discuss your emotional hesitance or resistance about a topic in therapy, even if you’re not ready to dive into the topic itself just yet. By acknowledging and exploring your emotional barriers, we can gain valuable insights into what might be holding you back from addressing certain topics. It provides an opportunity to understand the underlying fears or concerns contributing to your hesitancy.
You have thoughts or feelings about the therapeutic process itself or your relationship with your therapist but you don't yet know how to voice it.
It’s possible that you aren’t sure how to do this because you haven’t had the experience of having meta-discussions in other relationships. Meta discussions usually involve stepping back from the usual interactions and openly discussing the dynamics and patterns within the relationship itself. It’s like having a conversation about the relationship rather than just engaging in the relationship itself.
In therapy, meta discussions about the therapeutic relationship involve talking about the process itself and the dynamics between the client and the therapist. It’s a reflective conversation about how the therapy is progressing, how both parties are experiencing the therapeutic relationship. It involves talking openly about how therapy is unfolding, exploring the dynamics at play, and addressing any thoughts or feelings that arise about the therapeutic process.
If you think you have some thoughts and feelings about your experience but aren’t sure how to voice it, I recommend saying that to your therapist. An experienced therapist should be able to ask questions that guide you in articulating your thoughts and better understanding what’s happening in your internal world. A therapist may want to know when you started feeling this way, what was happening in the relationship before, and so on with the aim of pinpointing what’s at the root of your experience.
Meta-discussions allow you to reflect on your progress, voice any doubts or uncertainties you may have, and gain a better understanding of how therapy is helping you. It can involve discussing your goals and expectations, exploring the strategies and approaches being used, and expressing any concerns or doubts you may have.
In addition, these types of discussions can also involve exploring the dynamics between you and your therapist, such as the feelings or reactions you have towards them or the ways in which the therapeutic relationship may mirror other relationships in your life. This can touch upon the concept of transference (the unconscious redirection of feelings from past relationships onto the therapist) and countertransference (the therapist’s emotional response to the client).
Engaging in conversations about the process itself can lead to meaningful insights, increased self-awareness, and improved communication between you and your therapist. It fosters a collaborative and transparent therapeutic relationship, where you actively participate in shaping the therapy process and working towards your goals. The key is to remember that whatever you’re experiencing in the moment with your therapist is usually relevant and worth discussing transparently.
You feel therapy is not effective so you don't see the value in sharing.
Feeling like therapy isn’t effective can be a significant concern, and it’s important to address this directly. Openly discussing your feelings of dissatisfaction or doubt about the progress can be an essential step in getting the sessions back on track.
In fact, like any other relationship, the therapy relationship is an ongoing process of communication and collaboration. Your therapist should be receptive to your feedback and willing to work with it. Expressing your concerns and having them acknowledged and respected is a healing experience, especially for those who have felt unheard or invalidated in the past.
An effective therapist understands that your needs and wants are crucial in shaping the therapeutic journey. They will listen attentively and tailor the sessions to address your specific concerns and goals. By actively engaging in this process of negotiation and expressing your needs, you are actively participating in your healing and growth.
However, if you have expressed your needs multiple times and your feedback is consistently ignored, minimized, or invalidated, it may be time to reconsider your fit with this therapist.
Here’s a helpful blog on red flags to look out for in a therapist.
The bottom line
Whether you’re new to therapy or you’ve encountered a stuck point, don’t worry, you’re not alone – it’s a common experience. The key is how you approach it. Take a moment to understand why you’re feeling this way before diving into solutions. By exploring the roots of your uncertainty or blockage, you can find a tailored approach to get your therapy sessions back on track. Once you’ve identified the reasons, feel free to try out the tips I’ve shared in this blog that align with your specific situation. Therapy is a journey, and these moments of uncertainty can lead to meaningful growth and progress. Embrace the process, and you’ll find your way forward.
