Some people start therapy to address specific issues like anxiety, depression, relationship problems, or work stress. Others want therapy to become more self-aware, learn new coping skills, or even develop a more positive outlook on life. Others aren’t sure what topics to discuss in therapy and want to know how to get the most out of their therapy sessions.
This article will outline what things to talk about in therapy and which topics to avoid. It will also help you understand what to expect in therapy and where to begin your search for a therapist.
- What to expect
- Common topics
- Topics to avoid
- Is therapy working?
- How to find and choose a therapist
- Common questions
What to expect in therapy
It’s normal to feel a little anxious when starting therapy, but having a general idea of what to expect can help you feel more prepared. While every therapist has a unique approach to therapy, most initial therapy sessions have a similar structure.
Before the appointment (usually 50-60 minutes long), you will probably be asked to fill out some intake forms. These may include demographic information, questions about insurance, and possibly questions about your physical and mental health.
If you have chosen to get online therapy (aka telehealth), you can expect to get an email with instructions or a link to connect at the time of your appointment. It’s a good idea to test your internet speed ahead of time, install any needed plug-ins, and ensure you have a private space for the session.
We recommend BetterHelp for online therapy, since they offer unlimited messaging and a weekly session, and are cheaper than going to a therapist's office.
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If you’re planning on meeting in person, try to arrive at the office at least 10 minutes before the appointment, and bring a copy of your ID, insurance, and any intake forms with you.
In the first appointment, most therapists will use the session to: 
- Ask you questions about the issues bringing you into counseling and the goals you want to accomplish in sessions.
- Get information about your mental health, any current or prior treatment and medications, and current symptoms you’re having.
- Assess your current symptoms and determine your diagnosis (if any) and explain this diagnosis to you.
- Review your options for treatment (e.g., specific types of therapy, therapy + medication, etc.), make recommendations, and help you make an informed choice.
- Answer any questions you have about the therapist, the approach and methods used by the therapist, and how they may benefit you.
- Set preliminary goals for treatment and come up with a treatment plan outlining how you and the therapist can work together towards those goals (if time allows).
Since there’s so much to cover in the first appointment, it’s normal to leave your first session feeling like there wasn’t enough time to explore all of the things you wanted to talk about. Future sessions usually have a more relaxed pace that allows more time to dive into the issues you want to discuss.
Common topics to talk about in therapy
There isn’t an official list of therapy topics that you’re allowed to discuss with your therapist, but there are some that tend to come up more often. Certain topics are more likely to lead to sessions that feel productive in resolving core issues or working towards specific goals in therapy.
Below are 10 common things to consider talking about in therapy sessions:
1. Unresolved issues from the past
Things that happened in the past don’t always stay in the past. Instead, many continue to have an impact on your present thoughts, feelings, and choices. Therapy is the perfect place to revisit earlier experiences, interactions, and issues that feel unresolved. These topics could include:
- Early childhood memories or traumas
- Family conflicts or problems that affected your childhood
- Roles or expectations you assumed early in life
- Feelings of resentment, anger, or sadness towards someone/something in the past
- Inner conflicts that arose in you as a result of certain life experiences
With the help of a trained therapist, it’s often possible to gain new insight and perspectives that help you feel more at peace with these parts of your story. When there are difficult or painful emotions attached to these memories, a therapist can devote time to teaching new, healthier ways to cope.
2. Current stuck points in life
Stuck points are challenges, situations, or problems that leave you feeling stuck, unsatisfied, or unable to grow. They may be a primary source of stress, frustration, or anxiety. Someone might seek help from a counselor partly because they’re facing a stuck point.
Stuck points are different for each person, but may include any of the following:
- A relationship that’s become strained or isn’t meeting your needs
- A job you don’t want, like, or one that makes you feel incapable or unappreciated
- A stressful situation that can’t be easily changed or improved
- A negative cycle or pattern that keeps repeating in work, relationships, or another area of your life
- An inner conflict, insecurity, or issue holding you back from relationships, jobs, or anything else you want
3. Bad habits or patterns of behavior
Change isn’t easy because it almost always means leaving your comfort zone. Talking to a therapist can provide some quick relief but making changes outside of sessions is the key to lasting improvements.
The changes that need to be made can include bad habits, unhealthy coping skills, or patterns of behavior that are making the problem worse, including:
- Avoidance of difficult, stressful, or scary situations
- Excessive screen time or device use to ‘check out’ or distract
- Being either too needy or too distant from loved ones
- Excessive drinking, substance use, or other vices
- Neglecting self-care, health, or basic needs
While it might seem pointless to use therapy to talk about things you need to do differently, it actually does have an impact. Studies show that change talk (talking about making a change) boosts motivation and makes you more likely to follow through. For example, studies found that change talk in early sessions improved treatment outcomes for patients with alcohol use disorders.
4. Relationship conflicts
Relationships with friends, family, and romantic partners are an important part of your life, which is why relationship conflicts can have such a dramatic effect on you. This is also why therapy sessions are often used to explore interpersonal problems and conflicts. Some of the relationship issues you may want to discuss in therapy include:
- Conflict at work or in personal relationships
- Friendships that have become toxic or one-sided
- Lack of intimacy in a romantic relationship
- The betrayal of a loved one or problems with infidelity
- Breakdowns in communication with a boss, coworker, or colleague
Some relationship issues are best addressed in couple or family counseling sessions where a counselor can help facilitate more productive conversations. Other times, relationship issues need to be explored in individual therapy because there are personal issues, thoughts, and feelings that need to be resolved first. Therapists can also help teach healthier communication, assertiveness, and social skills that can help improve strained relationships.
5. Personal fears and insecurities
Fears and insecurities are something that everyone struggles with, but few are willing to talk openly about. Because of this, a lot of people don’t feel like they can open up about their fears and insecurities, even with those closest to them. Luckily, counseling offices are safe spaces, and personal fears and insecurities are welcome topics.
Here are some examples of common fears and insecurities counselors can help people work through:
- Feelings of inadequacy or not being good enough in some way
- Fears of rejection, failure, or letting other people down
- Body image issues or insecurities around physical appearance
- Specific fears (aka phobias) of flying, public speaking, needles, etc.
- Abandonment fears or fears of being alone
6. Goals for the future
Setting goals is one of the best ways to help establish a sense of direction and purpose in your life, making it an important topic to explore in therapy. Talking to a counselor about things you want and envision for yourself in the future is a wise way to use your time in therapy. These conversations can help you clarify your goals, make a plan, and keep you focused and motivated to achieve them.
An added benefit of talking to a psychologist about your personal and professional goals is that they can also help you work through any roadblocks that you may encounter. Many of these are psychological in nature, including:
- Loss of motivation or willpower
- Lack of confidence in yourself or your abilities
- Trouble resisting impulses and urges
- Negative self-talk or a harsh inner critic
- Prioritization and time management skill
7. Unhelpful thought patterns
It’s normal to have an inner monologue or conversation inside of your head. These inner thoughts influence your feelings and mood, your actions and choices, and your interactions with others. Most of the time, people have certain thought patterns that are contributing to their stress, anxiety, or other problems that bring them into therapy.
Some examples of unhelpful thinking patterns include:
- Black-and-white thinking, that divides experiences into two opposite categories (e.g., bad or good with nothing in between)
- Negative self-talk or harsh self-criticism that lowers self-confidence
- “What if…” thoughts and worries that people ruminate on too often
- Excessive self-doubt, that causes a person to question each word or choice
- Negative expectations or ‘worst-case scenario’ thinking patterns that increase anxiety
The benefit of sharing your inner thoughts in therapy isn’t just the relief of saying them aloud; you can also learn healthier responses that can help to change them over time. Therapists use a variety of different approaches to help people struggling with these kinds of unhelpful thinking patterns. For example, CBT therapists might help their patients challenge irrational worries, while other therapists might encourage the use of mindfulness to detach from them.
8. Personal grievances
It probably doesn’t come as a surprise that most therapy sessions focus more on a person’s problems than on the things going well for them. Therapy is a protected space where it’s perfectly OK for you to air your grievances and vent about your issues without feeling guilty.
In therapy, there’s no need to worry about oversharing or burdening someone else with your problems. Opening up to someone who isn’t personally involved in your life also can make it easier to speak freely. You don’t have to worry that the things you say will negatively affect you or the relationship.
Here are some examples of things you may want to talk to a therapist about instead of venting to a loved one:
- Stressful aspects of your job or a difficult colleague
- Frustrations you have with a romantic or sexual partner
- Chronic health problems or medical issues affecting your quality of life
- Regrets or resentments you have about something in the past
- Issues with a friend that feel too petty to mention
9. Meaning and life purpose
Questions about the meaning of life may feel a bit heavy for casual conversations with a friend, but they make perfect therapy topics. Most therapists are very comfortable engaging in deep conversations about meaning and purpose and may even initiate them with you. Some examples of deep questions to ask your therapist or explore in sessions include:
- What are the 5 ingredients for a meaningful life?
- What have my experiences (good and bad) taught me about life?
- If I only had a short time left to live, what would I prioritize?
These existential conversations can help you become more self-aware and develop more insight into your current problems. They can also help you connect more to your core values.
10. How therapy is going
If you want to get the most out of your therapy sessions, it’s a good idea to get comfortable talking openly about how therapy is going. Giving your counselor feedback can help ensure that you’re focusing on the right things in session and getting your needs met.
Open dialogues with your therapist can also help to build trust with them, clear up misunderstandings, and make the therapist’s office feel like a truly safe space. Consider talking with your therapist about any and all of the following topics related to your work together:
- How much progress you feel you’re making
- The things that have helped the most or the least
- Things they said or did that may have offended you
- Questions you have about their approach or methods
- What you would like to spend more time focusing on
- When you’re feeling ready to stop therapy or come less often
3 things to avoid talking about in therapy
There aren’t many topics that are strictly off-limits in therapy, but there are a couple that aren’t advised and a few more that aren’t productive. Depending on your circumstances, therapy can be a big commitment of time, money, or both, so it’s important to make the most of your sessions.
Below are 3 topics to avoid talking about (too much) in therapy:
Small talk and chit chat
There’s nothing wrong with spending a few minutes at the beginning of your session making small talk. But making too much casual conversation isn’t a good use of your therapy sessions. The weather, the latest gossip headlines, or TV shows you’re binging typically aren’t appropriate therapy topics.
Therapists are professionally trained to help their clients work through their struggles, which isn’t possible if clients aren’t willing to open up and go a little deeper. Sometimes, therapists believe their clients use small talk to avoid more difficult conversations that need to be addressed.
Personal questions about your therapist
In most of society, it’s normal and also polite to ask someone about themselves as a way to show interest, but this rule doesn’t apply in the therapist’s office. In fact, personal questions from patients can place therapists in an uncomfortable position because they aren’t allowed to disclose a lot about themselves.
These rules and codes are in place for your benefit. They help ensure that your time in therapy is all about you, not your therapist. For this reason, it’s not a good idea to ask your counselor personal questions about themselves or their life, family, etc.
Other people and their problems
It’s normal to bring other people into conversations with your therapist, but it’s also important to understand that your therapist is dedicated to helping you with your problems. Spending hours in therapy talking about other people and their problems is rarely productive. It can also distract from the real tasks at hand, limiting your own progress. For these reasons, it’s a good idea to limit the time you spend talking to a counselor about other people and their problems.
How to know if therapy is working
Because people come to therapy with a wide range of different issues to address and goals to achieve, progress in therapy doesn’t look the same for everyone. Studies suggest that most people benefit from therapy, with 75% of people seeing an improvement within 6 months.
It is important to periodically reflect on your goals and progress in therapy so that you can assess whether it’s helping you. This can be done in an open conversation with your therapist or just in private moments of self-reflection.
Some of the signs that can indicate the therapy is helping include:
- More insight and self-awareness
- Higher emotional intelligence
- Having more healthy coping skills
- Positive changes in your behavior or routine
- Better responses to difficult thoughts and feelings
- Improved communication or social skills
- Higher self-confidence or less self-doubt
- Boosts in your mood, energy, or motivation
- Achievement of personal goals
- Lowered levels stress
- Improvements in your relationships
How to find and choose a therapist
Choosing a therapist can feel like a daunting task, but the internet has made it easier than ever before. Online therapist directories are free, simple to use, and can help you find therapists with certain specialties who also accept your insurance (if this applies to you). Call the number on the back of your insurance card (or use the insurance company’s online portal) and ask for a list of in-network therapists.
After making a shortlist of therapists who meet your specifications (e.g., insurance coverage, specialty, location, gender, online vs. in-person, etc.), the next step is to narrow the list down by scheduling consultations with each candidate.
According to a number of studies, people are much more likely to benefit from therapy with someone they like, can relate to, and feel comfortable with. You may need to have consultations with a few therapists before you find someone who seems right for you.
Most counselors offer brief 15-20 minute consultations for free or at a very low cost. This time should be used to ask questions that help you decide whether the therapist:
- Is experienced and knowledgeable about the issue you want help with
- Has a style that you like and an approach you think will work for you
- Is a person you think you’d feel comfortable opening up to
- Is affordable and able to see you during the times you’re available
When you’ve chosen a therapist, the final step is to move forward and schedule the first appointment. Make sure to ask what you need to bring or provide prior to the appointment, and also to clarify whether you’ll be meeting in an office or online.
Therapy can be an excellent way to address relationship issues, mental health challenges, bad habits, and other issues interfering with your quality of life. There are no strict guidelines about what things are OK to talk about in therapy and which are not, but certain therapy topics are more productive than others. For example, unresolved issues from your past, inner thoughts and feelings, goals for the future, and sources of stress or dissatisfaction are often helpful to discuss with a therapist.
Common questions about therapy
How much is talk therapy?
The cost of therapy varies depending on your location, the kind of therapist you see (e.g., psychologist vs. counselor), and the type of therapy you’re looking for (e.g., couples vs. individual). If you have insurance that covers therapy, the cost will depend on the details of your plan.
What are the different types of therapy?
Therapists work with individuals, couples, groups, and families. Therapists use a wide variety of therapy approaches, including CBT, ACT, and trauma-informed therapy. Depending on the issue you need help with, some of these treatments may work better than others.
How can I get the most out of therapy sessions?
Before each session, it can also help to jot down some ideas about things you want to discuss in sessions. Between sessions, try your best to complete any tasks set or recommended by your therapist. For example, they may ask you to practice grounding techniques or keep a thought record.