What to talk about in therapy: Establishing a trusting client-counselor relationship

Starting therapy can be both exciting and a little frightening, especially if it’s your first time ever connecting with a therapist or counselor. The good news is that the process is very straightforward, focused on addressing your needs and concerns from the very first session.

But still: You may be wondering what to talk about in therapy. After all, where should you start? And what will (and won’t) be considered important by your counselor? 

So to help you get started, we’ve outlined some of the most essential bits of information new clients often want to know when it comes to what to talk about in therapy. 

What Are Good Things to Talk About in Therapy?

When it comes to what to talk about in therapy, basically, anything and everything is fair game. It’s an old misconception that you have to talk about your childhood or traumatic events as is often depicted in TV shows and films—but if you want to, or need to, then you should discuss these subjects with your therapist. 

Most of the time, there may be a stressor or presenting issue that brought you to seek therapy, and that specific situation or “thing” might be something you would like to sort out. Many people attend counseling sessions because they want to work on a specific issue such as anxiety, depression, or a compulsive behavioral pattern they wish they were able to let go of. 

A therapist will help you to implement more healthy coping skills or behaviors, or they may offer much-needed support while you’re navigating a difficult life transition.

What Should You Not Talk About in Therapy?

Truly, nothing is off-limits when it comes to what to talk about in counseling. A big portion of therapy is developing a trusted, therapeutic alliance with your therapist. But this does not mean you need to disclose all of your vulnerabilities and tell your life story all in one session with your therapist. 

Rather, go with your gut and share once you feel like a trusted alliance has been formed with your therapist. You may choose to disclose however little or much you would like at any time. 

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What Can You Say and Not Say in Therapy?

As mentioned before, when it comes down to what to talk about in therapy, anything goes. But with certain subjects, therapists have to take precautions to ensure you and others are safe. Therapists abide by an oath to maintain confidentiality at all times and may only breach confidentiality when: 

• You are at risk of harm or danger 
• There is knowledge of physical, sexual abuse, or threat or imminent danger to a minor, disabled, or elderly person
• You are expressing suicidal ideation with the expressed intent or plan to end your life
• They are subpoenaed and required to submit counseling notes and diagnoses to law enforcement 

Therapists are subject to reporting the above concerns to authorities when your health and safety are in immediate danger, threat, or harm. But your therapist will let you know when and if they have to make a hard call for your safety and if any of the above issues are a concern prior to your therapy journey.

Additionally, a safety plan can be created with your help to ensure your safety before having to call outside support, as your privacy is of the utmost importance during the therapeutic process. So if you’re wondering what to talk about in therapy, remember that a counselor or therapist values your privacy and safety above all else—they’ll only share what you’ve mentioned if there’s a threat of immediate danger to yourself or others.

What Is the Best Way to Talk to a Therapist?

The best way to speak to a therapist is to simply be your most authentic self. If you find it difficult to be yourself or feel you are in any way being talked down to, belittled, or your therapist just doesn’t get you, it may be time to find a new therapist.

Honesty is always the best policy when it comes to what to talk about in therapy. It may be helpful to share with your therapist what qualities you are seeking in a therapist and choose your therapist based on some of the qualities you would wish to see in your therapeutic relationship.

What Are Leading Questions in Therapy?

Leading questions open the door for larger discussions about ongoing issues in a client’s life. Leading questions may include some of the following:

• “What brought you here today?”
• “What goals do you have for our time together in therapy?”
• “Tell me about your week.”
• “What issues are presenting challenges to you lately?”

Therapists often hone in on a “presenting problem or issue” that brings someone to therapy. Maybe it is something that is difficult to express, but a presenting problem may sound like:

• “I just feel really down lately and not sure why.” 
• I think I may be depressed.” 
• “I am having trouble processing grief after my grandmother passed away and would like help navigating this loss.” 

Therapists like to measure your progress toward reaching your goals by using something called a treatment plan. Your treatment plan identifies short-term and long-term goals you would like to achieve while in therapy. Objectives in your treatment plan make up interventions and strategies used by both the therapist and you together to work towards reaching your individualized goals.