What do you talk about in therapy, who decides the agenda, and should you mention things that seem trivial? A clear guide to what really happens in sessions.
Before starting therapy, many people have the same question on their mind: "What am I going to say for fifty minutes?" Some assume that only "big" problems are worth raising in front of a psychologist; others feel the exact opposite, that they have so much to say they cannot work out where to begin. The short answer to what to talk about in therapy is this: anything that is troubling you, preoccupying you or making you curious today. But that answer on its own is not much of a guide. In this article I explain how the agenda of a session takes shape, what part the therapist and the client each play in it, which topics come up most often, and what you can bear in mind in those moments when you hesitate and wonder, "Is this even worth mentioning?"
What to Talk About in Therapy: A Brief Framework
Unlike an everyday chat, therapy is a conversation with a purpose. That purpose is agreed together in the first sessions: sleeping better, making arguments with your partner less draining, being able to study during exam season without panicking, finding your footing again after a loss. What is discussed in sessions revolves around these goals, but it is not limited to them.
In general, several layers interweave in sessions:
- What is happening now: an argument this week, a meeting at work, the thoughts that arrive at night.
- Recurring patterns: themes that repeat across different areas of life, such as "I always end up backing down" or "Whenever something goes well, I wait for it to fall apart."
- Traces of the past: childhood, roles within the family, school years, significant losses. These do not carry the same weight in every therapy; they are discussed to the extent that they help make sense of the present.
- The therapy relationship itself: how you feel in the session, whether something the therapist said hurt you, why you are finding it hard to raise a particular subject.
- Attempts at change: what happened when you tried a step discussed in the previous session, what worked and what did not.
So therapy is not simply a place to unload your troubles; it is a place where you try to see the pattern in which those troubles keep appearing, and to change that pattern, even a little.
Who Sets the Agenda in a Session?
Most people starting therapy wonder about this, but few ask it out loud. The answer varies with the approach being used, yet there is a shared principle: the agenda is built collaboratively by two people.
The client's part
For the most part, you decide what you bring to a session. Whatever has occupied your mind most during the week is usually what needs to be talked about that day. The therapist will not impose on you by announcing, "Today we are going to discuss your relationship with your mother." Saying that you are not ready to talk about something is also your right.
The therapist's part
The therapist, meanwhile, keeps the agenda in mind like a map. They track the goals you have agreed, the topics left unfinished in earlier sessions, and the repetitions you may not have noticed. Sometimes they will suggest, "Last week your voice changed when you mentioned your brother; would you like to go back to that?" This is a gentle steer, not an obligation.
Differences between approaches
In structured approaches such as cognitive behavioural therapy, it is common to set a short agenda at the start of the session: How was the week, how did the homework go, what shall we focus on today? In more exploratory approaches, the agenda emerges naturally as the session unfolds. Either way, the aim is for those fifty minutes to be spent somewhere meaningful for you.
The agenda of a session is not written in advance like the minutes of a meeting; it emerges when what you bring meets what the therapist sees.
Which Topics Come Up Most Often?
Whatever brings someone to therapy, certain subjects surface at some point in almost every process. Knowing about them can ease the feeling of "Why on earth are they asking me that?"
Day-to-day functioning
Sleep, appetite, energy, being able to get to work or school, keeping up with housework. These questions may seem ordinary, but they are the most concrete indicators of your mood. For example, dishes piling up during a depressive period is not something to be ashamed of; it is important information.
Relationships
Partner, children, parents, siblings, colleagues, neighbours. In Turkey, relationships rarely stop at the nuclear family: whether your mother-in-law will come to Sunday breakfast, whose house you visit first during the bayram (religious holiday) visits, the silence between siblings over an inheritance — topics like these come up in sessions very often. They are not "petty family matters"; they shape how free or how trapped a person feels.
Body and health
Palpitations, heartburn, headaches, tension. What happens in the mind often speaks through the body as well. If a medical assessment is needed, the therapist will recommend it separately.
Past and family history
The kind of home you grew up in, how emotions were received, how criticism and praise were handed out. The aim here is not to blame anyone but to understand where your present-day reactions were learned.
Values and the future
What you live for, what matters to you, what wears you down. Big decisions such as changing jobs, moving cities, getting married or separating are discussed under this heading. The therapist does not make these decisions for you; they create space so you can see the decision more clearly.
What to Talk About in Therapy as the Process Moves On
The content of sessions changes noticeably depending on which stage of therapy you are in. Knowing this can reduce the puzzlement of "Why is she still asking about my past?" or "Why is she asking so few questions now?"
Early sessions: getting acquainted and drawing the map
The first few sessions are largely devoted to gathering information. The therapist asks about why you came, how long the difficulties have lasted, your family structure, your work or school life, and whether you have had support before. During this period the therapist is mostly the one asking and you are mostly the one answering. This barrage of questions can feel tiring at times, but its purpose is not to squeeze you into a category; it is to understand your story in its own context.
The middle phase: patterns and experiments
Once goals are clear, sessions become more focused. You no longer need to explain everything from scratch; the therapist knows what matters and makes connections from week to week. In this phase, questions like "What did you think, feel and do in that situation?", plans for trying out new behaviours and the results of those experiments come up frequently. The therapist may ask fewer questions and leave more room for your own thinking.
The final phase: consolidation and preparation
As therapy draws to a close, the agenda shifts again. What has changed, which skills have become lasting, what you could do if a difficult period returns, and the farewell itself are all discussed. At this stage sessions may become less frequent, and your share in setting the agenda grows considerably.
In short, the answer to what to talk about in therapy is not fixed; as the relationship deepens and goals change, the conversation itself changes too.
Should Trivial-Seeming Things Be Discussed in Therapy?
"Talking about this would be a waste of time" is one of the most common inner voices in therapy. Yet seemingly trivial details are sometimes the most productive doorways.
Let's say someone in their thirties who came to therapy because of work stress mentions, almost apologetically, a small incident in a car park: another driver took their space, they could not say a word, and then they sat shaking in the car for twenty minutes. As it is explored, this "unimportant" event links to their manager at work, and from there to a father who used to raise his voice during their childhood. Had the car park never come up, seeing the same pattern might have taken weeks.
So the following rules of thumb may help:
- If an event keeps coming back to you throughout the week, it is worth talking about.
- If you feel embarrassed or bored while telling it, that feeling itself is worth talking about.
- Sentences that begin "This probably doesn't mean anything, but..." often do mean something.
Your therapist will help you explore together how a subject relates to your goals; you do not need to know that in advance. A scene in a TV series that made you cry, an old teacher who appeared in your dream, a moment of tension with a cashier at the supermarket, or the bad feeling that followed a post you saw on social media can all be brought into the session. Each carries small clues about what is sensitive in your inner world. You are not expected to interpret them "correctly", only to notice them and bring them along.
Topics That Are Hard to Raise in Therapy
Some subjects resist coming to the surface more than others. Habits that feel shameful, matters kept hidden within the family, money, anger, jealousy, thoughts of self-harm and feelings about the therapist are chief among them.
In our culture there is an added difficulty: the belief that "what happens at home stays at home". Someone describing what their mother says about their father, their partner's debts or a sibling's years-long estrangement may feel at the same time as though they are betraying their family. This sense of loyalty is understandable, and it is treated with respect in therapy. The therapist listens not to judge your family but to understand the place you have come to occupy within it. Talking about someone close to you does not mean condemning them; often, realising that love and hurt can exist side by side is one of the most relieving moments in therapy.
Here is what you should know about these topics:
- You can open up gradually. You do not have to say everything in the first session. Even saying, "There is something, but I am not ready to talk about it yet," is an important step.
- The therapist will not be shocked or judge you. Clinical psychologists work with a very wide range of human experience. What seems unspeakable to you is, for the therapist, an experience to be understood.
- Confidentiality is a framework. What is said in sessions is kept confidential, except within legal limits and situations involving risk to life. You can read about these limits in detail in our article on confidentiality in therapy.
If you are having thoughts of harming yourself or someone else, it is very important to share them with your therapist. In moments when you sense immediate danger, call 112 (emergency services) without waiting for your session.
Tips for Getting More Out of Your Sessions
Just as important as what to talk about in therapy is how the conversation becomes useful. The following small habits can make your sessions more productive:
- Take notes during the week. Jotting down a sentence that occurs to you on the bus or during your lunch break in your phone's notes app is enough. When you arrive at the session, you won't fall into the "What was I going to say?" gap.
- Write down the feeling too. Rather than just "Argued with Mum", noting "Argued with Mum, then felt guilty and angry" gives a much richer starting point.
- Ask for a brief summary at the end of the session. The question "What did we talk about today, and what should I hold on to?" helps what was discussed stay with you through the week.
- Reflect between sessions, but don't force it. If a topic keeps turning over in your mind of its own accord, note it down; you don't have to solve it.
- Bring your feelings about therapy as well. Saying "What we discussed last session didn't sit well with me" is valuable information for adjusting the direction of therapy.
Some weeks you may arrive having prepared nothing at all. That is normal too; I have covered what can be done in that situation separately in the article I don't know what to talk about in therapy.
When Should You Talk to Your Therapist About the Agenda?
How the agenda takes shape is itself something that can be discussed in therapy. It is helpful to raise it openly in the following situations:
- If you feel you keep circling the same topic in sessions without making progress.
- If you feel the direction your therapist suggests does not suit you.
- If the subject you really want to bring never seems to get its turn.
- If you often leave sessions with a feeling of "Why was I even here today?"
Saying these things is not the same as criticising your therapist; it is a natural part of fine-tuning the therapy relationship together. Many therapists carry out periodic reviews, asking, "How is the process going, and what should we change?" If no such review is taking place, you are free to suggest one.
An easy way to say it is to build the sentence from your own experience: "For the last few sessions we've been talking about problems at work, but what really wears me out is the situation at home. How can we move on to that?" Therapists usually welcome this kind of feedback, because nobody knows what you need better than you do, and with that sentence you have helped steer the process. Sometimes this conversation even becomes the starting point for understanding why you find it hard to voice your wishes in other relationships, too.
If you have not started therapy yet and are wondering what happens in the first meeting, the article on the first therapy session may give you an idea. In individual therapy with adults, the agenda takes on a clearer shape as your goals become more defined.
Frequently Asked Questions
Is therapy only about problems?
No. Things that are going well, achievements and moments that make you feel strong are also discussed. They matter for seeing which resources you can lean on in difficult times. If a week has genuinely gone well, understanding what went well is also part of the work of therapy.
Can the therapist change the subject?
Yes, they may sometimes suggest returning to a topic or looking in a different direction. But they usually do this by explaining their reasoning and checking that you agree. If the suggestion does not suit you, simply say so.
Does the therapist tell anyone else what is said in therapy?
No, what is said in sessions is confidential. The exceptions are situations required by law and situations in which your life or someone else's is in serious danger. Therapists may sometimes discuss their cases in supervision; this, too, is done with your identity concealed.
Do we need to discuss a different topic in every session?
No. Some topics are explored over weeks from different angles. Returning to the same theme often shows how central it is for you; within that repetition, the therapist also tracks with you what is changing.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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