What to Talk About in Therapy When You Don't Even Know Where to Begin

Therapy is repeatedly cited as an important tool in building good mental health, and nearly 25% of Americans use it. Research has also found that the majority of people who do talk therapy for conditions like depression do so well, they no longer meet the criteria for the condition afterward. With that, you may have […]

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Therapy is repeatedly cited as an important tool in building good mental health, and nearly 25% of Americans use it. Research has also found that the majority of people who do talk therapy for conditions like depression do so well, they no longer meet the criteria for the condition afterward. With that, you may have decided to check therapy out for yourself. But if you’re new to the practice and don’t have a big issue to go over when your first appointment rolls around, it’s understandable to wonder what to talk about in therapy. 

Here’s the thing: There’s no pressure around what you talk about in therapy — it’s there to work for you, after all — but the process can feel a little overwhelming at first if you’re new to it. “Therapy is intimidating as a whole,” says Sreela Stovall, Ph.D., a mental health therapist with BetterHelp. “You are asking a perfect stranger for help and trusting that person to help you work through things. You are trusting them to stick by you when you are at your worst and you have no idea how that is going to go.”

But Stovall also says that there “isn’t a perfect script” that you need to follow for therapy. “Each therapist and their approach will be different,” she says. “The best thing to do is to be upfront about that. Letting your therapist know that this is your first experience is critical because then they will know where and how to begin.”

Whether you’re meeting in an office or doing a telehealth session with a company like BetterHelp, it’s understandable to prefer to have some idea of what you’ll discuss during your first session. Mental health experts recommend keeping these topics in mind. 

What brought you to therapy in the first place

Something drove you to make your first appointment, even if it was hearing a friend talk about how much they benefited from therapy. Experts say that’s a good place to start. “Begin with the truth of what is going on that brought you to therapy at this time in your life,” says BetterHelp therapist Kassi Diwa-Kite, M.S., L.M.F.T. “By speaking your truth and beginning the practice of telling your story, the journey towards your growth and healing begins.”

Talking about what prompted you to go to therapy can also open things up to discuss what you can expect on your therapy journey and what happens from here, Stovall says. “You don’t have to have a ‘big issue’ — sometimes it’s about general themes or stressors,” she says. 

Something that’s been disruptive to you

Things that may not overwhelm your thoughts but still crop up from time to time are worth addressing — even if they feel small on the larger scale of your life. Maybe you expect to become a caregiver for a parent in a year or so and aren’t sure what it will mean for your day-to-day, or you’re annoyed that your family is always late getting out the door in the morning. Those things are worth discussing.

“When small issues are left unaddressed, they tend to build up, gain momentum, and eventually have a much larger impact than if they were addressed as they came up,” Diwa-Kite says. “Talking about, being curious about, and strategizing around the small issues that come up in our daily life is a preventative strategy.” 

Flow Advisory Council member Minaa B., L.M.S.W., founder and CEO of Minaa B. Consulting, recommends thinking of it this way: “If it is something that is causing a disruption to the quality of your life, then it is worth addressing.”

How you’re feeling in the moment

If something bothered you in the immediate lead-up to therapy, it’s more than OK to discuss it. “How you are feeling in that moment may be fleeting but a significant cue as to how you are reacting to something,” Stovall says. “Our feelings are a compass — they help us to understand our thought process and our behaviors so paying attention to that in the moment can help to understand other experiences you are having. If your therapist asks you, ‘how do you feel right now?’ it’s to help you to go deeper and understand yourself better.”

Where you are in life

Maybe you’re in perimenopause and nervous for what’s ahead or you have a child heading off to college and you’re not sure how you feel about it. Going over what’s happening in your life can help you and your therapist explore how you feel about those milestones and events. Diwa-Kite says these are common topics for her patients. “Therapy can provide a safe and healing space to explore all of these concerns and how they are impacting your life,” she says. “It’s a place to free yourself from any held shame or guilt, feel validated, heard, understand these are normal struggles, and hopefully find some relief and healing.”

Your relationships

You have a lot of relationships in your life — with your partner, your kids, other family members, your friends. With that, there’s a lot to discuss. “The dynamics and experiences you are having with your relationships can give you and your therapist a lot of information about the interpersonal experiences and skills you have and what needs are being met — or not — in your life,”  Diwa-Kite says.

Stovall says it’s “critical” to go over these. “The relationships you have and the quality of the relationships you have can either help or hinder you,” she says. “Do you have support? Who is that [and] who are those supports? It’s important for your therapist to know this so that they know you have others to lean on and, if you don’t, how to maybe work on that.” 

Things you’re trying not to think about

Sure, talking about these things means you actually have to think about them — but that can help you work through them. “The question here is, ‘Why are you trying to avoid it?’” Stovall says. “Is it helping or hurting you to avoid it? Avoiding thoughts can make them more persistent and intense, so make sure to bring this up with your therapist if and when it is happening.” 

New emotions you’re experiencing

As you go on with therapy, new emotions may crop up for you — and experts say it’s important to discuss them. “The term ‘growing pains’ is the best analogy for this,” Stovall says. “Therapy has a way of bringing up feelings that you may have never dealt with or been aware of.” (She says this is “totally normal and expected.”) Stovall recommends letting your therapist know when this happens. “When this happens, it means you are growing,” she says. 

What to expect in therapy

Therapy has a certain look in pop culture, where the patient lies on a couch as the mental health practitioner watches over them and talks. But Stovall stresses that every therapist and therapy environment is different. “Some therapists are more traditional and have a couch space while others have several seating options,” she says. “If you are doing online therapy or telehealth, then you can expect that the space the therapist is using is private and that you can be in your own space.”

With a telehealth service like BetterHelp, you can sit, stand, walk, or lay down during therapy from pretty much anywhere. “That’s completely up to you and your comfort zone,” Stovall says. “Just make sure to discuss it with your therapist when you begin so that there are no surprises.” BetterHelp will match you with a therapist in as little as 48 hours (you can switch or cancel at any time) and your subscription includes one weekly live therapy session that can be conducted via video, phone, or live chat for ultimate flexibility. If you’re new to the platform, make sure to use code “flow” to get 25% off your first month.

Overall, experts say you can get a lot out of therapy, whatever you choose to discuss. “The value of therapy as a whole lies in its ability to provide individuals with a psychologically safe and supportive space to express and explore their thoughts, emotions, and experiences,” Minaa B. says. “Therapy is a resource that is designed to help individuals build emotional resilience to life’s hardships and gain tools on how to support their mental health and well-being better.”