What Should I Talk About in Therapy?

Going to therapy when you’re not going through a major personal crisis can seem like a psychiatric version of the vulture scene in The Jungle Book — you and your therapist just staring at each other saying, “I don’t know, what do you want to talk about?” 

And yet, a growing number of mental-health professionals believe that therapy shouldn’t be something you only resort to when you hit rock bottom. Instead, they see it as a preventative measure you should have some access to regardless of what’s going on in your life. But when you see a therapist without a specific issue, what exactly are you supposed to discuss?

First, rest assured that not knowing where to start is entirely normal. “This can happen in the beginning of treatment,” says psychiatrist Priscilla Hidalgo, who practices talk therapy along with prescribing medication. “I always tell patients that the best way to start is to share with the therapist that you don’t know what to talk about.”

But beyond admitting to your therapist that you’re stumped, Hidalgo and other experts say there are a few other key categories to cover, too.

Your Family History

Our family histories, particularly our childhood experiences and relationships with our primary caretakers (whether or not they’re biologically related), can set the foundation for our future mental health — though not necessarily in a Freudian desire-to-date-our-moms kind of way. Rather, we learn a range of ways to cope with psychological distress from how these people model behaviors, and for better or worse, it can take a lot of work to reverse those patterns. 

A lot of this is usually covered in your first appointment, explains marriage and family therapist Jessica McCall. But you can only cover so much ground in one intake session, and it’s always a topic worth diving back into. It will help you and your therapist identify goals you can work toward, like “understanding and repairing toxic relationships patterns, working through anger at your mother from childhood or developing skills for effective communication and boundary-setting,” McCall explains.

Your Romantic and Platonic Relationships

Our relationships with friends and significant others can be similarly good ground to cover because our behavior patterns with these people can tell our therapist about how much our childhood experiences and familial relationships have potentially messed us up. Even if a breakup isn’t what brought you into therapy, examining how your needs have been met (or not) in past or current relationships is a crucial part of the process.

“We have expectations within our romantic relationships that we wouldn’t expect from our family,” says psychotherapist Kate Ecke. For instance, someone who had a smothering caretaker growing up may demand more mothering from their romantic partners than is healthy. On the other end of the spectrum, someone with a particularly withholding or neglectful parent might bail anytime a friend or significant other needs them.

Both extremes can cause a lot of problems, and “a therapist can offer an unbiased view into our relationships and give feedback that we may not otherwise see,” Ecke continues. 

Your Job and Career Path 

A big part of a therapist’s job is teaching people how to be nice to themselves, which sounds simple and cheesy. But it’s something a lot of people struggle with, and a clear indicator if someone is practicing self-compassion is the balance between their work, personal lives and self-care. 

Putting too much time and energy into work can lead to burnout, which is often an overlooked warning sign that something is going wrong mentally, per psychotherapist John Carnesecchi. When we burnout, it’s easier to lose track of our daily routine, become less organized and mix up our priorities and boundaries. All of which results in more stress, anxiety and self-neglect — and is why Carnesecchi makes sure to check in on self-care practices when talking with clients about their jobs. 

“There are many common ways to care for yourself, like taking a walk to clear your mind, exercising, reading a book in a quiet space or taking a long bath,” Carnesecchi says. Therapy — and the lessons therein — count, too. “Taking a deeper look into your emotional wellness, asserting boundaries and saying no are beautiful examples of caring for yourself,” he notes. 

Self-Destructive Behaviors 

Addiction, unsafe sex, eating disorders, aggression, depression and bullying are all ways we may be self-punishing without realizing it, Carnesecchi explains. (If anything, we may think we’re fixing ourselves through these forms of self-harm.)

Such behaviors can come with a lot of shame, so therapists won’t always push it. But if you’re concerned about any of the above habits, it’s worth checking in about it during your time, even if some of that time is spent hesitating and avoiding eye-contact. Therapists are trained to respond to these disclosures in empathetic, non-judgmental ways, and they can model self-compassion, as well as help you develop methods for how to be nicer to yourself on your own.

Something You Lost

Grief can be obvious when the death of a loved one is what lands you in therapy, but when you’re going for mental maintenance, grief can show up in more subtle ways. “Loss doesn’t always have to be death,” Ecke explains, noting how loss can occur when you’ve been laid off, moved across the country or have a falling out with a friend. Not to mention, “the pandemic brought an onslaught of loss and grief,” Ecke adds. “Aside from losing loved ones, we lost a sense of safety.”

The problem is, when you don’t talk about grief and loss — whatever the source — it can manifest in many of the aforementioned self-harming behaviors. 

Anything You’ve Written Down 

Even if it’s not a conventional diary, Hidalgo recommends her clients journal “to reflect on how the week has been and what’s been challenging.” Besides, something as simple as keeping a list of all the times you were pissed off between sessions will give you something to talk about. 

“Journaling is a great way to gain insight,” Ecke agrees. If you don’t know where to start, Ecke suggests tracking your mood by writing down the day, how you felt and anything significant that occurred. There are also a number of mood-tracking apps like Youper and Moodfit if journals aren’t your thing.

How You’re Feeling, Not How You’re Doing

As much as a therapist turning their head and asking, “How do you feel about that?” can feel like a cliché, therapists frame questions that way to get you to talk about how you’re feeling instead of how you’re doing — mostly because they get better answers. When you’re typically asked how you’re doing, “the expected answer is ‘good,’ regardless of how you may be,” Carnesecchi points out. “But good isn’t even a feeling.” 

Whatever You Do, Don’t Vent

It’s a common misconception that therapy is a dumping ground for all the complaints your friends are sick of hearing about. But using session after session to vent only wastes your time and money because by complaining about other people, you end up working out their shit instead of your own, which is a largely pointless pursuit given how little control we have over others. 

Paying attention to this is crucial if you want to have a productive experience with therapy, because not every counselor is going to call it out. “If you notice yourself venting week after week and your therapist doesn’t shift the focus back to you and what’s within your control, it’s time to find another therapist.”

But hey, at least you’ll have something to talk about with your next one.