What can I talk about in therapy?

Perhaps you’re interested in starting therapy but just don’t know what you’re supposed to talk about… the short answer is there are no rules about what you should or shouldn’t say in a counselling session, however, that would make for a particularly short (and pretty unhelpful) blog, so here are some things to consider…

What is your Why?

Firstly, think about the reason(s) that prompted you to begin counselling in the first place. Often there is a trigger for making that initial contact to access therapy, sparking a recognition that ‘something needs to change’. You may not know what that change looks like yet, or how you might get there, but beginning with what’s happening in life now that is painful, problematic or distressing, is a good place to start.

Your Feelings, Thoughts, and Behaviour

How you talk about what’s led you to therapy is up to you, and it’s likely that your therapist will ask more questions to help them understand your difficulties more fully. You might want to express something about the feelings that you’ve been having, such as feeling low, anxious, sad or overwhelmed – or it might be that you’ve been experiencing an absence of emotion altogether, where you feel numb or ‘shut down’. You may not be able to label the feelings you’re having at all, which is totally ok, and is something you and your therapist can work on together throughout sessions. It might be that certain types of thinking have been affecting you, such as intrusive, critical or disturbing thoughts, all of which can have a real impact on the ability to function day to day, contributing to low self-esteem, low confidence and an inability to trust the self. You may want to talk about the desire to change certain aspects of your behaviour, for example, tackling addiction, moderating obsessive behaviour, recovering from an eating disorder, finding more helpful ways of relating to others, or taking action towards doing the things you’ve been avoiding. The therapy room is a space for you to discuss and make sense of your behaviours, understand what keeps them going, and move towards making changes.

Life Experiences, Trauma and Relationships

Whilst you don’t need to tell your therapist your entire life story, there may be specific relationships, significant life events and traumatic experiences that you feel have shaped you and contributed to how you experience life now. It will be important to talk about these, although of course, you will be in control of how much and when. You shouldn’t feel pressured to disclose specific details of events (you can obviously talk about these if you want to), often it’s the emotions, thoughts and beliefs that they leave you with that are helpful to process and explore during therapy. Although childhood experiences and early relationships may not seem relevant to your difficulties in the here and now, often your therapist will ask you about these, as this is a key time in life where we learn a lot of what and how to feel, including deep-seated beliefs about our self, others and the world. This will include the often neglected but arguably most important relationship we have: the one we have with our self. If you experience low confidence or self-worth, struggle to trust your self or have an overly critical way of being with your self, this will be a key relationship to talk about and explore.

You’re not Weird or Crazy! (well, no more than the rest of us)

You might be worried that what you want to say, or have been experiencing, sounds weird, ‘crazy’, silly, or not really worthy enough to take to therapy… all of these are very common concerns when embarking on therapy. It’s important to remember that whatever your experience and whatever you have to say, is valid and will be treated as such by your therapist. Make sure you’re honest during therapy sessions, even if it feels uncomfortable to talk about and doesn’t really make sense to you yet (and no, you’re not crazy, and your therapist won’t think so either!).

It’s ok to Not Know

You might know exactly what you want to say and how to say it, however, more often than not, this is not the case (hence the reason for this blog!). When starting therapy, it’s very common to not have the words for how you’re feeling, to have difficulty in describing your thoughts, or to know how you want things to be different… you might just have a sense that something needs to change in order to improve your experience of life, but don’t really know what that is. Part of the process of therapy is to help you navigate these questions, to be able to identify, acknowledge and label the feelings and thoughts you’re having, to consider what would need to change for things to be different, and to figure out what it is that’s stopping you getting there – and how to overcome this. You may also find that what you want out of therapy, changes over the course of sessions – this is completely normal and fits in with the idea that everything is in a state of flux (including us!).

Suicidal thoughts and ideation

Talking about suicidal feelings and ideation is an important subject to voice in therapy. Some people worry that this might sound like ‘too much’, however, your therapist will be used to talking about this and will not panic or become distressed at your response. Suicidal feelings are more common than you might think, and having the opportunity to talk about them is the first step to understanding and managing them. Whilst some people do have very strong suicidal thoughts and may already have a suicide plan, others may have feelings of hopelessness or a sense of overwhelm with thoughts of wanting to escape life or disappear. Whatever your own experience, talking about it can be therapeutic in itself, and it’s likely that your therapist will discuss coping strategies, or work with you to establish a safety plan.

More than just Words

Sometimes it’s difficult to find the words to express what you’re thinking and feeling in a way that feels accurate or meaningful. Your therapist may invite you to draw what you’re feeling, or you may feel more able to express your experience in metaphor, story-telling or images. Tuning into and noticing what happens in your own internal world can also be an incredibly useful and powerful resource to help you connect with your experience, for

instance, noticing the sensation of a ‘lump in the throat’, an ache in the chest, a sense of feeling ‘trapped’, a suppression of rage or tears, or an impulse to run away. Talking about and describing such ‘Autonomic Nervous System’ responses, can provide a real insight into our difficulties and what keeps them going.

Length of Therapy

More of a practical consideration of what to talk about, is how you can most effectively use the number of sessions available to you. If you’re accessing short-term therapy (for instance, between 4 and 8 sessions) you may decide with your therapist that focusing on one or two priority issues would be more effective than exploring many topics at a surface-only level. On the other hand, if your sessions are open-ended (where you decide how many sessions you want), you’ll have more time to explore a range of issues in depth.

Limits of Confidentiality

Although you’re free to talk about anything in therapy, before you start you should be aware of the limits of confidentiality that your therapist works to. These should be detailed in the Therapy Contract, or explained at an initial session. Limits of Confidentiality are circumstances within which your therapist may be required to seek help and share information outside of the therapeutic relationship, for instance, if you disclose information which suggests that your safety or that of others is a cause for concern, or if there are child protection issues, disclosures of fraud, crime or terrorism.

Say it how it is

Ultimately, there are no rules about what to talk about in therapy, and there will certainly be no expectations from your therapist (who, by the way, is also just human) for you to say the ‘right’ thing (whatever that is!). As sessions progress, you’ll likely feel more able to open up about the things that you want and need to, and don’t forget, your therapist will be there throughout, helping to guide you through the whole process. As with many things in life, therapy is one of those things where if you put the work in to it, you can expect to get the most out of it – this involves having the courage to be honest. Try not to edit or censor what you want to say (and yes, you can definitely swear!), plus you don’t need to use therapy jargon or say what you think your therapist wants to hear.


Don’t let the concern of not knowing what to talk about in therapy put you off, in fact, entering the process with a curious ‘not knowing’ may even be the best approach to have. You might just find that what you do have to say is the start of something life-changing.

Contributed by Louise Bellamy