How do you choose what to talk about in therapy?
A few topics get covered often in therapy; what to work on is undoubtedly one of the more consistent topics. While the question is straightforward, the answer varies significantly. The cause for the variation is how each person views therapy itself. Below are three examples of how this unfolds (none of this content is from one particular client, patterns I’ve noticed). Most importantly, I do not want to paint a picture that any of these three types will do better or worse or are ranked in any particular order.
The Structured type:
Plenty of people view therapy in its former traditional clinical sense. You come to therapy after feeling this lingering sadness or chronic anxiety that seems not to go away. You know what feelings you want to change and understand how therapy can benefit you, provided you open up and work on implementing the skills and insights gained from therapy. Choosing what to share for the structured type will vary slightly depending on your stage of change.
Let’s stick with anxiety, for example. In early sessions, what to bring up would consist of any insights you gained about yourself, times that anxiety is more pronounced than others or patterns you can detect on what helps regulate your anxiety. You may share that you had a moment in the week where you felt anxious, and you want to talk about possible reasons why your anxiety popped up and then create a plan on how to work through that experience for a new outcome.
Later on in therapy, you may reflect on how much of your conversations in therapy lead back to a few concepts driving your anxiety rather than the feeling itself being the focus of attention. So, you decide to start therapy by mentioning that you noticed frequently in and out of sessions that your anxiety comes back to a fear of judgment. You then share that you want to talk about how that insight has shifted how you see yourself experiencing anxiety and want to either change that further or continue to process it because you’re seeing things more clearly. Your session then sets a new focus moving forward to talk about the new relationship with anxiety and creating new habits in response.
Towards the end of your time in therapy, it may seem like there’s not much to talk about, and you’re seeing yourself operate in new paths and routines. You begin to share that you want to space out each session to have more content to look at between appointments. Wonderful work!
The Catharsis type:
There’s also a growing trend of seeing the value of therapy in managing symptoms. From this perspective, there may be a sense of dissatisfaction with much of life, and it may be hard to focus on one particular area. You view things holistically and systemically rather than establish one part of your life.
In this type, you may check in with yourself sporadically throughout the time between sessions, evaluating where the dissatisfaction has shifted during the week. There may also be a sense that there are a few people in your life that you feel safe enough to open up to. Therapy becomes a space to vent and release your emotions (catharsis) without fear of judgment.
Perhaps your life has complexity and nuance, where you see discomfort in one area yet realize that’s probably the case in others. For example, maybe you struggle with a coworker and begin your therapy session revisiting the moments that grind your gears throughout the week.
Therapy is both a space for release and a place to have accountability for changing when you are ready to change. As you continue therapy, the focus may shift from coworkers to friends, to career changes, and everywhere in between those two. How you determine what to focus on can be addressed with one question: “What squeaky wheel can we get some grease on today?”
The Cautious type:
The cautious type is someone hesitant to be themselves in therapy, which is also a natural experience. Opening ourselves to ourselves even seems intimidating, let alone letting someone else in on our inner workings. While there’s nothing wrong with being cautious, try sticking to topics just outside your comfort zone. There’s no chaos right outside your comfort zone; there’s a growth zone where things may be challenging and lead to new insights or habits to be created.
In the early phases of therapy, what you may talk about can be related to building a relationship and a space in which you feel safe. Sometimes, we come from a background filled with criticism and judgments, and we have to break that pattern in therapy to work on the core issue of constant fear of judgment. Something to consider at this phase is the next step of trust you can offer to see how they respond.
During the middle phases of therapy, as you begin to feel safer sharing and not being judged, you may consider talking more about working within yourself. How are you helping yourself or hurting yourself? Bringing up broad concepts in society can help talk about a tricky subject. For example, maybe a topic during the middle phases is asking how people operate in life without comparing themselves to others.
As therapy progresses, you may find yourself in a similar pattern to the other two types, unsure of what to discuss. The patterns you’ve learned about, why you naturally resist trust, how you can work with yourself, and how you build a life you want to live are outlined. You may also start those sessions with that observation; I’ve noticed I frequently bring up the same topics and start to space things out a bit.
Whether depression, anxiety, social anxiety, or substance use brought you to my page. Welcome, and I hope these three types help you figure out a little which mold you fit into and guide you to making the most of your next therapeutic hour. Whether that’s with me or someone else, I hope you are getting the help you deserve. Begin today with your strategy session to keep learning more!