What to tell a psychologist

What to Talk About in Therapy: 12 Ideas to Consider

If you don’t know what to talk about in therapy, some things to consider talking about include recent life events, relationships, traumas, and more.

When I decided to go to therapy for the first time, I spent the whole car ride thinking about how ready I was to work on myself. But when I got there and actually sat down on my therapist’s couch, I clammed up. Suddenly, while sitting face-to-face with this stranger that I knew was there to help me, I had no idea what I actually wanted to say. My mind had simply gone blank.

Admittedly, I’ve always been shy, and talking to new people has always been a little overwhelming to me. But I thought it would be easy to open up to a therapist since it had been my choice to come there. It wasn’t easy. Instead, I felt so much pressure to make the most out of my session that I couldn’t think of a single thing to actually say.

Whether you’re like me and had difficulty opening up at your first sessions, or you’ve been going for a while and feel like you’ve “run out” of things to say, know that you aren’t alone.

“It is not uncommon for people to come to session and be unsure about what they want to discuss,” says Jessica Small, licensed marriage and family therapist.

Opening up is tough, and it may not come easily, especially when just getting to know your therapist. In order to help assist you with opening up, some therapists may give you an assessment to take to better understand you and your needs as their patient and help create a plan for future sessions.

Other therapists might let you lead the conversation. If you’re unsure how to begin a conversation with your therapist or don’t know what to talk about, here are 12 things to consider.

It’s easy to feel like you need to talk about “deep” or “serious” issues in therapy But remember, there’s no “correct” topic to discuss in therapy. You can talk about whatever you want.

True, some people come to therapy to address something specific, like anxiety or depression. But sometimes, people are just going through a life transition and want someone to talk with and help them cope with the change.

If you’re finding it tough to open up, Small advises remembering that nothing is off-limits.

“People talk about everything in therapy. They talk about their hopes, dreams, fears, disappointments, hurts, shame, conversations with their mom, interactions with their partner, perceived failures as a parent, sexuality, [or] their most recent date,” she says.

Not sure where to start the session? Begin by recapping what happened since you last saw your therapist — good and bad — and from there, see what you want to explore further together.

It may be a good idea to track your thoughts, patterns, and behaviors by keeping a journal between therapy sessions. This can be especially helpful if you’re shy or find it difficult to remember things on the spot.

Of course, you don’t have to bring your journal with you or read from it in session. But writing things down allows you to look for patterns in your feelings and behaviors that you might want to address with your therapist, Small says.

“For instance, a person may observe that they have been feeling inadequate or insecure and this would be a good thing to address with their therapist,” she says.

You might have felt sad, angry, or depressed during the week, but if you’re not feeling that way right now, you don’t have to start with that. Focus on how you’re feeling in the present, and just say how you feel — even if what you’re feeling is just, “I didn’t really want to take this hour for therapy today because I’m slammed at work.”

The truth is, what you need from therapy changes day to day. It’s OK if you went in thinking you’d talk about your relationship and instead spent the whole session venting about your boss.

“Therapy sessions really are meant to be as tailored as possible to what you’re needing at any given moment,” says Sol Rapoport, a marriage and family therapist working with UCLA’s Behavioral Wellness Center. “I actually tell my clients to think of their therapy time as the ‘Room of Requirement’ from Harry Potter — you get to get out of it whatever you are most needing that day. ”

“And sometimes,” she continues,” what you need at the moment is someone to allow you the space to just vent.”

Depression and anxiety can both involve rumination, or a tendency to go over the same thoughts repeatedly.

If you had a hard time falling asleep one night this week because your mind wouldn’t stop thinking about something you wish you’d done or you worried about something coming up, that’s often a great place to start your session.

This doesn’t just mean your love life. Tell your therapist about all your relationships, whether that’s your partner, your family, or your friends.

Do you feel like you have support at home? Do you feel like you have other people to share your feelings with, or do you have difficulty opening up with others too, not just your therapist?

Relationships are important to your mental health, and they play an important role in affecting your mood and feelings on a day-to-day basis.

So, if you’ve been avoiding your mom’s calls, even though you love her, let your therapist know, and maybe you two can explore why you’re avoiding her.

Even if you feel like you have good relationships, talking about them might help you realize the things that are working in your life — and the resources you can lean on out of session.

This one might sound obvious — or conjure up stereotypical images of lying back on a chaise lounge a la Freud — but the truth is, if you’ve been focusing on your present in your last sessions, you might not have gotten around to filling in your therapist on your past.

For example, maybe you’ve spent your last month telling your therapist about your current relationship troubles, but you’ve never discussed your past relationships or your parent’s marriage.

Taking a moment to step back from your present and choosing to talk about your past could help you address some feelings you’ve been bottling up or left unresolved.

People in therapy tend to have something they want to address, says Nicholas Hardy, a psychotherapist in Houston, Texas. “However, it is not always a problem. Sometimes, it is a feeling or an emotion that is unfamiliar to them.”

“When clients experience new aspects of life, like childbirth, marriage, relocation, this can ignite untapped areas in their life that they need help understanding,” he continues. “While not always able to articulate what that feeling is, they are able to recognize that something is different.”

If something has changed in your life and it’s making you feel different in some way, bring it up. You don’t have to talk just about the “bad” stuff. Change can be good and yet still bring up new feelings you might want to explore in a safe, nonjudgmental space.

This could be something you’re ashamed of thinking, or something you think is “silly” to worry about. Maybe it’s something you think is “insignificant” or “stupid.”

We all censor ourselves and judge our feelings. But therapy is exactly the place to explore all our thoughts and feelings, even the ones we feel like we shouldn’t be having.

For example, lots of people think they’re not entitled to be upset about the pandemic because they haven’t experienced as many hardships, like job loss or the death of a loved one, and yet they’re still having a hard time coping with its impacts.

It’s OK to feel whatever you’re feeling, and it’s definitely OK to bring it up in therapy.

“Sometimes I ask clients to think about what they’d least like to talk about that day,” says Rapoport. “It’s usually a good sign of where the trouble is.”

That makes sense. We often avoid talking about things that are uncomfortable, painful, or difficult, and yet when we let them fester, they get worse. Consider therapy your safe place to talk through those things you’d otherwise avoid.

If you’re having trouble opening up right now, and you’re not sure why, tell your therapist. There might be something to explore there.

“Even if a topic is not addressed immediately because of discomfort, it is valuable to understand what barriers are keeping [you] from opening up about a particular subject,” says Hardy.

For example, when you’re depressed, you often lose interest in things you once enjoyed and feel decreased energy levels. If coming to session today and last week felt exceptionally hard and you’re not sure why, your therapist might be able to help you unpack that and figure out if something else is going on.

Trust takes time to build, and sharing your thoughts and feelings with a stranger isn’t easy. If you’re having trouble trusting your therapist enough to open up, which is very normal, don’t be afraid to bring that up.

With that information, your therapist can work on building a foundation of trust that will allow you to open up more down the road.

“Therapy is about a relationship between the client and the therapist,” says Small. “If a client is having a hard time opening up, it may mean that there is still trust that needs to develop in the therapeutic relationship. I attempt to meet the client where they are at and build a rapport that will give them the safety and security they need to begin to be more vulnerable and open. ”

If you truly don’t feel comfortable with your therapist, there’s a chance they aren’t the therapist for you — and that’s OK.

Therapists have different professional backgrounds and specialties, and there are different types of psychotherapy.

“Think about how comfortable you feel asking for exactly what you need from them,” says Rapoport. “Some people prefer a more directive approach. Some people prefer concrete tools — for anxiety management, for instance. Others want to feel like they can talk about a specific subject with someone who is knowledgeable about that in particular.”

“Consider whether your needs are being met,” she continues,” and how open your therapist is to your specific requests and needs.”

If you aren’t getting what you need, if you don’t feel challenged in a good way or like your therapy is progressing, or if you prefer a therapist who shares your gender or racial identity, it might be worth exploring other therapist options.

Psychotherapy isn’t meant to last forever. So, if you used to find it easy to think of things to talk about, and now you’re not, it might be a sign you’ve reached an end point.

It’s perfectly normal to feel like you don’t need therapy after a while. “As a therapist, we want to work ourselves out of a job,” says Small.

But before you quit, make sure you’re ending therapy because you truly got what you needed out of your sessions, and not just because you’re dissatisfied with your therapist.

A 2019 study of 99 adolescents ages 11 to 17, for example, found that people who ended therapy out of dissatisfaction had poorer outcomes than those who left because they felt they “got what they needed.”

To tell the difference, Rapoport recommends thinking back to your first session. “Does it feel like you accomplished what you set out to accomplish? If so, have you identified new goals along the way that you could shift to instead?”

“If you’re continuing to feel like you’re learning more about yourself, or you’re gathering new information and resources, it’s usually a sign that you’re still getting something out of therapy,” she continues. “If it feels like you’ve stalled, or that you’re not getting anything from your sessions that you wouldn’t be able to get from a conversation with someone else, it might be time to take a break.”

Keep in mind that you don’t need to stop abruptly. You can always talk with your therapist about putting more time between sessions and seeing how you feel.

If you currently see them for weekly sessions, for example, you could try doing a monthly check-in. If something comes up and you want to resume weekly sessions, you already have a foundation with a therapist you know and trust.

“No one has therapy all figured out, even the therapist,” says Hardy. If you’re finding it difficult to open up at first, don’t worry. It might take some time for you to really get in the swing of it. But with time, you should start to feel yourself becoming more comfortable and opening up more. If not, consider whether you might want to work with another therapist.

Simone M. Scully is a writer who loves writing about all things health and science. Find Simone on her website, Facebook, and Twitter.

6 Awkward Things You Should Always Tell Your Therapist

Source: Mego studio/Shutterstock

People have all different levels of comfort when it comes to talking about difficult things with their therapists, just as people can vary greatly within their real-world relationships. We all know those people who are all too willing to dive into a potentially difficult conversation with gusto—they'll send a soup back a second or third time if it's not exactly the right temperature. At the other end of the spectrum, others will eat a cold soup—even with a hair in it.

For those who have anxiety around potentially awkward situations, and are experiencing something difficult within their therapy, therapy itself is the very place to work through that. In fact, not only are certain difficult topics important to bring up in the therapy setting, but that setting can provide the ideal place to talk about why a topic is so difficult for you.

It's very important to remember that you can get the most out of therapy when you bring up what you are truly thinking and feeling—even when, or especially when—it involves the therapy itself. If you don't want to say it, you can bring in a piece of paper to have the therapist read, spelling out that you need to have a conversation that's difficult. Here are six common topics that can be tough to talk about, and why you're doing yourself a favor if you can put them on the table.

1. There is an issue or behavior you haven't revealed to them.

It's quite common not to tell your therapist your deepest, darkest issues right away. And it can be fine to begin therapy talking about one main issue and being slow to reveal something going on deeper under the surface until you feel more comfortable. Wait too long, though, and you're just wasting time and preventing yourself from working on it or understanding how significantly it may be connected to the issues you are talking about.

Maybe you're OK talking about your depression symptoms but have never told anyone about childhood sexual abuse, and can't seem to bring it up even with your therapist. Or maybe you've omitted just how much you drink, how often you take painkillers, your problems with binge-eating, or the fact that you have extreme road rage. Whether it's because it's embarrassing, scary, or shameful to talk about it, you eventually need to—so that the therapist can get a fuller picture and you can really start working on the root of the problems, rather than the more surface-level symptoms that you might be hiding behind.

It is worth noting, of course, that there are some times when your therapist might be put in a position of potentially having to report a situation to get further help. Almost always these involve imminent danger to the health or well-being of you or another specific person. Your therapist should have spelled all this out clearly for you during the informed consent process before you started therapy. If you are unsure or concerned, you can broach the topic generally to get further clarity about confidentiality limits before giving details.

2. They said something that has upset you.

Maybe it was an offhand remark that you felt minimized what you were working on or a way that they interpreted something you said that you found to be condescending or unhelpful. Ideally, you would bring up your reaction in the moment—such honest and open discussion of those interpersonal interactions and emotional responses can be the stuff that great therapy is made of.

But if you didn't say anything at the time and you find that it is sticking with you and continuing to annoy or upset you, it can still be extremely useful to bring it up, perhaps even more so. For one thing, your therapist can better understand how and why they erred, and get a fuller picture of your emotional make-up that they might not have realized before. For another, it can prevent similar situations from getting in the way of the therapeutic process and can help build an even more emotionally intimate relationship.

3. You are unsure if you are making progress.

For many people, especially if they are conflict-avoidant, one of the most difficult conversations of all is to express doubt or dissatisfaction about the therapeutic process or, even more specifically, the therapist themselves. A large percentage of people would rather just stop seeing the therapist than have this conversation and try to recalibrate whatever doesn't seem to be working.

Of course, this can be an understandable reaction. Some therapists are simply better than others, and even when competence is not an issue, the match can be—certain styles and theoretical orientations and personalities are more bound to click with your needs than others are.

But other times, feeling stalled can be part of the therapy process itself, as there's a certain truth to the fact that sometimes you must feel worse before you can get better. This is virtually a guarantee if you are reopening old wounds or spending a lot of time talking about things that sadden or anger or frighten you. And to flee the therapy at that crucial point can be shooting yourself in the foot—doing the work without sticking around to get the reward. So bring it up instead, and see where it goes.

4. You are having difficulty with payments.

Money and financial arrangements can often feel like an annoying pest intruding upon the therapy at best or a serious stressor that threatens your ability to be in therapy in the first place at worst. Many therapists dislike dealing with the financial arrangements as much as you do—that's why we became therapists and bypassed majoring in accounting.

But all too often, a client may be having trouble coming up with payments, and by not being direct about it, the therapist has no idea. The client then digs themselves into a deeper and deeper hole, where they might be prone to break off the relationship without warning or default on payments—neither of which is going to help them feel better.

5. You feel they're not getting something.

Maybe you've tried explaining a relationship or a feeling or a habit of yours, and instead of feeling understood and validated, you've felt like your therapist is misconstruing what you're saying. Or maybe they're unfamiliar with a certain aspect of what you're going through at work because they have no clue about your industry, or you feel like they're minimizing something that really bothers you. Give them a chance to get a clearer picture by talking to them about how you're feeling unheard about it. The more the therapist realizes that they're missing the mark, the harder they can try to really understand and do the work with you that you deserve.

6. They're doing something that you find disconcerting.

No therapist I know will ever admit to being the one who takes phone calls during sessions, is routinely late, nods off, glances at the clock obsessively, or reveals too much about themselves. And yet I've heard clients say that they've actually experienced plenty of this in past therapeutic relationships!

Of course, it is reasonable if you experience one of these transgressions that you might want to end the therapy without having a discussion about it. But if you're otherwise doing good work together, don't let it be tainted by not bringing the issue to the therapist's attention. That will give you the opportunity to see if it is just a singular oversight that can be corrected, or if it's part of a more problematic pattern that means they're not the therapist for you. If you never bring it up, you'll never know—and you risk losing the investment you've already put in.

To find a therapist near you, visit the Psychology Today Therapy Directory.

LinkedIn/Facebook image: Mego studio/Shutterstock

I can't describe my problem: how to prepare for a visit to a psychologist

The presence of a problem is already a request

Psychotherapy is not a business negotiation that needs to be “entered” with goals formulated in advance according to the SMART system. This is the place where you can finally relax and delegate goal setting to the therapist. The task of a psychologist is to help the client formulate a request, overcome internal resistance and prohibitions in order to bring him closer to a solution.

Every therapy must follow the principles of the three Ps: permission (decision), protection (security) & power (strength), which were formulated back in 1966 by transactional analyst Pat Krosmann. This means finding the problem with the client, providing security to solve it, and finding resources for change. None of the foregoing implies that the problem must be formulated into a clear request, without which therapy is impossible. It is normal for a dialogue with a therapist to begin with the request "I don't know what I really want."

In addition, psychotherapy is not always linear. It is more like a path, in the process of moving along which the initial request of the client will be supplemented and corrected. It may even change completely or turn into several new tasks. The only thing that is truly important is the desire and internal resources of the client to solve a specific problem. The task of the therapist is to support him on this path.

Stop factors

According to client-centered psychotherapy, a person is the main expert in his life. Therefore, many psychologists will not give you ready-made recipes and recommendations, but rather help you explore the reasons that prevent you from solving the problem.

If you have a desire to work with a psychologist, but for some reason you can't start therapy, focus on why this is happening. Ask yourself: Why do I think about therapy but don't go for it? What fears are limiting me?

It may turn out that there is a lack of information behind the fear. Then it is worth moving on to the next question: “What kind of information do I lack in order to decide on psychotherapy, and how can I get it?”:

– I do not have enough positive experience of therapy with my friends and should I ask for it?

– Do I need information about the method in which the psychologist works?

- Do I want to try several specialists and choose for myself the one who will inspire more confidence and most accurately hear my request?

Sometimes deeper reasons may be hidden behind the lack of a request. Clinical psychologist and psychotherapist Robert Ciampi identifies the following stop factors:

- stigmatization of the topic of mental health and psychotherapy

- the need to look weak or vulnerable to another person;

- fear of upcoming changes, which increases with age;

- do not want to work on yourself

- fear that the family and close circle will not be happy with the changes, which will cause a conflict;

- high cost and long-term psychotherapy

All these reasons are understandable and valid. Moreover, most of them in themselves can be a topic for working with a psychologist. Therefore, one way to start a dialogue with a specialist is to discuss with him what exactly stopped you on the way to therapy. It may turn out that the same limitations appear in other areas of life, then working on them will be the first request.

Collaboration

The main condition for the effectiveness of psychotherapy is not a clearly formulated request, and not even specific psychological techniques, but the established therapeutic relationship with a specialist.

Therefore, it is not so important to choose the exact words in advance to describe the problem and the goal of therapy, but to find a psychologist with whom you will feel comfortable and safe. You can trust and open up to him. And already he will help you find formulations and set tasks for your joint work.

What to say to the psychologist at the first consultation?

Miscellaneous

This article is for you if you have never turned to psychologists, but have already decided to get the help of a specialist. Usually at this stage a person is overwhelmed by a lot of doubts. One of the questions that arises is what to say to a psychologist? How to explain your situation, describe the problem in order to get effective help?

Today I will tell you how you can prepare for the first psychological consultation. I suggest before visiting a psychologist to answer a few questions. This will help you to more clearly articulate what you want to communicate to the specialist. I must say right away that it is far from always easy to answer the questions that I have given below. And if you can't do it, don't despair. However, I will talk about this in more detail at the end of the article. And now let's move on to questions.

01. What made you turn to a psychologist?

Think about when you got this idea. Maybe there was some situation that prompted the decision to visit a specialist. Maybe nothing much happened, but there is a vague feeling that something is not going right. Or maybe everything is going well, but you want internal development, and you feel that things can go even better?

02.

Specify the reason for contacting

Evaluate how specifically you described at the previous stage the reason for contacting a psychologist. It will be great if you can find some concrete examples illustrating the reason for the appeal.

For example, self-doubt may be the reason that prompts you to consult a psychologist. Self-doubt is a very vague concept. It can manifest itself in completely different ways, and, accordingly, psychological work can be built in different ways, depending on the specifics. For example, there may be insecurity at work, there may be insecurity in defending one's opinion in front of a loved one, in making decisions, or in being attractive to the opposite sex. These are all different types of uncertainty. Therefore, in order to determine as accurately as possible what exactly uncertainty is, it is best to start from specific life situations. Where, at what moments do you feel insecure? How does this affect the whole situation as a whole? Why is uncertainty a problem?

Another example. Behind the complaints of a woman about a tense relationship with her husband, completely different reasons can be hidden. In order to understand them, it is worth giving an example of a number of situations in which this tension manifests itself.
A clear understanding of how and under what circumstances manifests what you would like to change is necessary not only to quickly bring the psychologist up to date. Subsequently, you will be able to evaluate your changes that have occurred as a result of working with a psychologist, and the situations you have named will become an indicator of changes for you. After all, if you do not “ground” the existing problem on the specifics of life, then it will be difficult to understand what has changed.

03. Formulate what you want

If before you described what you weren't satisfied with, now it's time to think about where you want to go. It also needs to be as specific as possible. What will change in your life? What will those life situations look like that currently do not suit you? It is important to describe the desired results not through a denial of the existing state of affairs. For example, if a young man is nervous when communicating with girls, then he should not describe the desired situation as follows: "When communicating with girls, I do not have nervousness." He should focus on what should appear when the nervousness goes away. Perhaps there will be ease in communication, confidence, the ability to joke, etc.

04. In your opinion, what do you need to change in yourself in order to change the existing state of things?

Working with a psychologist always results in internal transformations. By changing himself, a person changes his life situation. Do you have any suggestions what internal changes will help you change the situation? Maybe you need to learn how to manage your emotions, or increase self-esteem, or develop the ability to negotiate with other people, or learn to understand yourself better.

05. Do you connect problem situations now with past experiences?

Often problematic situations now have their roots in the past. For example, self-doubt can accompany a person all his life and be associated with a lack of support from parents. Fear and distrust in a relationship with a loved one can be associated with painful experiences in previous relationships.

By answering questions, you prepare for the work ahead: you look inside yourself, listen to yourself, learn to understand yourself better. This ultimately saves consultation time and speeds up your work with the psychologist.

It is worth saying that it can be very difficult for an unprepared person to answer all five questions. Even the very first question about what prompted you to turn to a psychologist can be difficult: a person can only vaguely feel that something needs to be changed, and the help of a psychologist will be useful, but cannot say anything more specific.

If you have a desire to see a psychologist, and at the same time you could not answer the questions in the article, this may be the first goal of working with a psychologist.

Learn more