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What to talk about in therapy?

August 6, 2012

Some clients come in confused about what to talk about in therapy. They want to be helped, but genuinely don’t know what they should be bringing to their session. Some people come with the idea that the therapist will ask the questions that will stir the material. That is sometimes the case, especially in the initial sessions- the therapist will try to gather information, and so she will ask the questions that will help her understand you and the issues you present. For instance, she will ask about the specific problem that has led you to seek therapy. She will ask about the history of that issue, any other related issues that you’ve struggled with (past and present), family history, experience in past therapies, and more. Sometimes it’s the case that clients do a great job in the initial sessions, only to find themselves at a loss for what to talk about after that.

Well, here is what I would suggest:
Talk about what moves you, or stirs you, or pains you, or elates you.

Talk about what goes on for you, on the inside and the outside. Paint me the picture of your life, and your mind and your heart. Bring pictures, or a video clip if you have to, or graphs and charts, if you feel compelled….if you feel that will really help me understand, because I want to.

When you feel more comfortable with me, dare to tell me what’s in the very recesses of your mind….share the thoughts you’ve always found the ugliest, the most unloveable, the hardest for you or others to swallow. The fantasies or dreams that are the scariest or most disturbing. We’ll have to get there eventually if you want to get better, so try to be courageous and go there earlier rather than a few years down the line.

Tell me sweet nothings that occurred to you between sessions. Did you realize something new? Did you think back to a topic we had discussed a week or a month earlier? Was there something new that dawned on you that you thought was imperative to share?

Did you have a dream that confused you but left an impression? Talk to me about your day dreams, and night dreams, and nightmares. Nothing is too shocking or bizarre.

Talk to me about any aspect of the therapy. Nothing is too big or too small. Tell me how you think we’re doing. Is the treatment going well, what’s helpful and what isn’t? We are supposed to collaborate here, so if I’m going in a direction that you don’t like, tell me, don’t tell your best friend that you don’t like the direction your therapy is taking. Or maybe, something more specific happened? Did you have a bad reaction to something I said, or to my facial expression, or mood that particular day? Maybe you don’t like how I dress or my thighs bother you (all real life examples, by the way)? Tell me! Among therapists, this is often considered the most rich material. All of these can lead us in fruitful directions, helping us understand your reaction to people, the things that often bother you and nag at you, that in most social settings you would find inappropriate to bring up. Well, therapy is the place to be real and talk about the hard stuff, and understand some of the things that rub you the wrong way about people. It gives you the opportunity to be more candid than usual with someone, and realize that the relationship can survive and in fact become stronger as a result.

Finally, if there is a pause in our conversation, or a lull, don’t feel like you just have to rush in with something to say. This is not a regular conversation. You’re supposed to be going deep inside and that can take some mindful breathing, and quiet musing. Similarly, if you say something and I don’t respond immediately, bear with me. I am thinking all the time, and have plenty to say. I don’t want to say it too fast. I don’t want to reach conclusions too quickly and close the discussion. I don’t want to engage in day to day chit chat with you. I am deliberately setting a different kind of pace and tone to our conversation, one that is different from conversations that you have with friends outside the therapy room. Why? Because something deeper has to transpire here. You need to have enough space to feel things thoroughly, not just avoid them, the way you usually do out there (because believe me I know, they’re usually too painful to look at). I’m trying to give you room to flesh things out, and I am timing my interventions. And more than anything, I am trying to listen to you with my entire being, and not just offer up the first thing that comes to mind.

Also, to read more tips to clients from another psychologist, refer to this page written by Ryan Howes, Ph.D. He writes a blog for Psychology Today and I found these 21 tips on his website- I think this is an excellent summary of tips clients should know as they begin therapy in order to get the most out of the experience. http://www.ryanhowes.net/id42.html

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4 Comments leave one →
  1. Lily permalink
    July 30, 2013 12:59 am

    Extremely amazing article, thank you for such practical tips on what to talk about in therapy. I feel much better after reading this! I was so scared and nervous searching for appropriate topics, but now I feel confident that I can find something to talk about. Thank you so much for writing this! YOu are awesome

    • July 30, 2013 1:09 am

      I’m glad to hear it was helpful. Good luck with the process!
      Best wishes, Dr. Anat

  2. ashleigh permalink
    November 6, 2013 8:22 am

    Hi, Im 19, have an eating disorder or so im told, but I also have BPD and Depression, im a self harmer to. I did go and see a phycologist but I didnt stick to it. Simply because I show no emotion, at first he thought my problems were from my dad dying two years ago, but it wasnt I was fine about that in ways of emotion, I know I have left something important out but I cant put it here.. so what do you do if you or the person trying to help really doesnt knw, he said to me one session that he hadn’t any idea of where to start, please could you help somehow, my email is ashleigh.wigham@rocketmail.com. ..

    ashleigh.

    • November 8, 2013 1:48 am

      Dear Ashleigh,

      Thanks so much for your question. I can imagine that if your therapist told you he he had no idea where to start in the therapy, that probably didn’t make you feel too confident about getting better. I’m glad you’re reaching out again here in order to figure out how to have a good therapy experience.

      First, it’s important to spend some time looking for a therapist. When looking for one, it’s okay to interview several therapists and to find one that has some expertise treating your specific symptoms. Also, in the first session take the opportunity to see how it feels to sit with that person in the room, talking about your life issues, and choose someone you feel comfortable with. Then, it’s also beneficial to choose a kind of therapy that is proven to help your condition. Dialectical Behavioral Therapy (DBT) is a powerful treatment, that is corroborated by research to help when self harm is involved. In DBT, in addition to individual therapy, you are also required to attend a group that teaches certain life skills like managing emotions and interpersonal relationships.

      Once you find a therapist, you should begin to talk about the things that feel relevant to you. Talk about things that occupy your mind (if not you’re heart), and hope that your therapist will join you there, trying to understand how things are experienced from your perspective. In time, you will feel more comfortable and some emotions will begin to surface. A full therapy experience definitely involves experiencing difficult feelings, which is why therapy doesn’t always feel so good as it’s happening. If you get off to a good start in the therapy treatment, it will be easier to stick with it once things get more intense and difficult.

      Let me know if you have any other questions.

      Good luck to you.
      Dr. Anat

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