How to Talk to a Therapist  

What Can Therapy Help With? 

Therapy is widely used to treat a wide range of mental health disorders, eating disorders and addictions including: 

Depressive and mood disorders 

Conditions like depression or bipolar disorder (of which depression is one part) are typified by low mood, feelings of overwhelming sadness and despondency, shifts in energy levels and even a marked loss of interest in people or activities that once brought joy. Therapy helps you to confront, challenge and change the negative thought patterns that often fuel and exacerbate depression. 

Anxiety disorders 

Affecting 40 million adults each year, anxiety disorders are one of the most prevalent and common conditions that can include generalized anxiety, panic and social anxiety disorders. Therapy teaches how to adopt ways of thinking, coping or relating to one’s anxiety and the world around you. 

Trauma disorders 

Witnessing or living through even a single traumatic moment can raise one’s risk of developing a trauma disorder (70% of people will experience a traumatic event sometime in their lives), with symptoms ranging from intrusive memories to hypervigilance to feelings of constant fear or dread. Therapies like Eye Movement Desensitization and Reprocessing (EMDR), trauma-focused CBT and prolonged exposure therapy help safely process traumatic memories to reduce their emotional charge. 

Personality disorders 

Conditions like borderline personality disorder (BPD) are marked by an inability to manage or regulate intense emotions, often resulting in wild mood swings, impulsive behaviors and difficulty maintaining stable relationships. The APA endorses cognitive therapy, especially Dialectical Behavior Therapy (DBT) as a mainline treatment for its ability to teach four core DBT principles — mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness — to help stay present, focused, emotionally aware and balanced. 

Substance use disorder (SUD) 

Mental health and addiction share a strong link. According to a recent National Survey on Drug Use and Health, nearly 21.5 million Americans endure a co-occurring disorder — the co-existence of both a mental illness and SUD. Many people turn to substances as a way to self-medicate symptoms of an underlying condition like anxiety or depression; likewise, their mental health may exacerbate their substance abuse. Under a dual diagnosis (where both conditions are treated in the same plan), therapy becomes an indispensable resource for you to uncover those root causes of substance abuse and develop better coping mechanisms — not only to quit substances for good, but to prevent relapsing. 

How to Talk to a Therapist 

There are no rules for how to talk in therapy. Your therapist is not there to judge you, but to help, and their role is only to create a safe, confidential space, guide the conversation and allow you to express yourself freely. There are zero expectations on what you should say or how to say it. The most important thing to remember is to show up as who you are right now.  

Here are a few ways to get the most out of your first few therapy sessions:  

Be open and honest 

Feeling nervous or uncomfortable knowing what to talk about in therapy for the first time is common, and it’s perfectly acceptable (and expected) to start by saying, “I’m not sure where to begin” or “I’m really anxious about coming here today.” Therapy is the place to share what’s on your mind, even if it’s simply about feeling apprehensive or nervous. There’s value in transparency and honesty, even if it’s about discomfort, since it helps build a genuine connection that helps bolster the work you and your therapist do. Trust is built over time, so remain patient. 

Share what’s on your mind 

You don’t need to have a perfectly crafted, scripted and rehearsed dialogue ready to go when sitting down for a session. The openness of therapy means you can talk about anything, even if it’s simply observations of your day or week, like how you’re feeling today, a conflict with a loved one, a problem at work or a persistent concern or worry. Don’t be afraid to share something that seems too embarrassing or deep. Your therapist is trained to handle sensitive topics with empathy and understanding — and that’s oftentimes where the most healing moments begin. 

It’s OK to say “I don’t know” 

You’re not expected to have all the answers in therapy. Sometimes things begin to fall in place gradually. Other times might lead to a breakthrough where things start to make sense. And it’s OK to admit you don’t have those answers. In fact, the more questions that arise about yourself, the more gratifying therapy can be because it illustrates what a fluid process of self-discovery it can be. This is where your therapist can help you to explore questions you haven’t been able to ask or answer on your own, no matter how difficult or personal they are.  

 Ask questions and set goals 

Remember that therapy is a two-way street. It’s a conversation between you and your therapist — a place to learn more about yourself, but also to ask questions of them. If you’re unsure why your therapist is asking something, or if you’re unclear about homework exercises or your treatment plan, don’t be afraid to ask them about it. Therapy works best when you have clear-cut goals in mind, like lifting yourself from depression, working through trauma, improving relationships or managing your social anxiety. Asking for clarification (when needed) and goal setting give your sessions a tangible sense of focus.  

Reflect between sessions 

Although you might meet with your therapist only once or twice a week, your inner work is never complete. Some of the most important self-exploratory work happens outside the therapy room. Keeping a journal of your thoughts, reflections and ruminations, practicing mindfulness or putting coping exercises to the test in your day-to-day life are all examples of extending what you’ve learned in therapy in the real world in between sessions. As therapy progresses, you’ll be eager and anxious to share with your therapist the insights, reflections and realizations you may obtain from week to week — a clear sign that you’ve begun to evolve and grow past any initial trepidations you may have had about therapy. 

What types of things should you talk about in therapy, especially if you’re feeling stuck or at a loss for words? 

• Your current feelings: How do you feel today, in this moment? Are you sad, anxious, angry, numb or trying to cope with being overwhelmed? Are there bright spots when you feel happy despite depression or calm despite anxiety? Bring them into the dialogue. 

• Your relationships: The connections you share with family, partners, friends, loved ones and colleagues play a significant role in your mental health and well-being. Therapy is a place to discuss the dynamics of these relationships during times of good and bad. 

• Your past and present: Letting your story unfold over sessions — major life events, your childhood, past traumas and other experiences, positive and negative — lends important context to therapy, a way of piecing together who you are and letting your therapist get to know you better. 

• Your thought/emotional/behavioral patterns: What’s been on your mind as of late? Are there persistent negative thoughts you can’t shed? How have you been feeling? How do they reflect in your behavior? Talking about these consistent patterns you’d like to change are important matters to bring to therapy. 

• Your goals: What do you hope to achieve through therapy? It could be anything from better relationships to less anxiety to overcoming alcohol use disorder. Your goals should always be top of mind in therapy, since they can change — and new values and goals can emerge — as you go. 

You may find yourself immersed in multiple formats of therapy, too, that may call for different approaches: 

During individual therapy, where you sit one-to-one with your therapist, the focus is on you. Concentrate on your inner thoughts and feelings and remember to bring your journal with you to recount examples from your week. Use this allotted time to discuss, without self-censoring or filtering. The information you omit could be the key to reaching new levels of insight. 

In group therapy, you’ll be seated with other people like you in recovery grappling with similar issues — but more importantly, with similar goals. While it can be intimidating and scary to share personal details in front of others, remember that your peers are there to show support and learn new perspectives from you just as you can obtain insights from them. And it’s OK to merely listen until you’re ready to share. 

For couples and family therapy, avoid casting blame or aspersions on your partner. Remember that the goal of therapy with loved ones is to work together to strengthen your relationship. Take accountability for yourself by using “I” language (e.g., “I feel hurt when”) instead of “you” statements (“You always tend to …”). Like group therapy, pay attention more to listening completely and fully before responding.