What Should I Talk About in Therapy?

I was chatting to some of my therapist-friends and this was a topic that sparked some interesting debate: How much should clients prepare before their sessions?

Some therapists believe that the premise behind the question – that there's a right or wrong thing to bring to a therapy session – is exactly the kind of thinking that keeps people from getting the most out of it. Yet others, myself included, believe that there might be an important function to the factor of preparation – of thinking what you might want to talk about ahead of time.

Let's examine both sides.

There Should Be No Agenda

A typical counselling session

One of the biggest misconceptions about therapy is that you need to arrive with a topic prepared. Something meaningful, something serious, something worthy of the time. Well, yes and no!

According to a 2026 BACP Public Perceptions Survey, 37% of UK adults have now seen a therapist, and many of them will tell you the same thing: what they ended up talking about in sessions was rarely what they expected to talk about when they walked through the door.

That's usually how the process works.

Tip: Start With What's on Your Mind Right Now

The simplest and most honest answer to "what should I talk about?" is this: whatever is on your mind when you walk in.

It could be something that happened this week. An argument, a difficult conversation, a moment where you reacted in a way that surprised you. It could be something you're partner said that annoyed you. It could be something you've been carrying for years. It could be a feeling you can't quite name. As it could be just saying: "I don't know where to start." That helps us therapists, too.

All of these are fine starting points. In my experience, the sessions that begin with "I don't really know what to say" are often the ones that go deepest. Because that uncertainty itself is usually pointing at something worth exploring.

So, generally, you don't have to prepare much, if (and this is a big if!)... if you can sustain an emotional conversation.

Because if you can't, if you're someone who's always been used to digging their head in the sand, and avoid difficult conversations, then chances are you're gonna do the same in therapy. And yes!... eventually you'll get there, if you persevere, but it might be after a number of sessions that you will feel were not really going anywhere.

Reflection is an important part of therapy

So, as a rule of thumb, I would say that if you're one to speak their emotions out and can sustain an emotional conversation, then you don't really have to prepare much and can trust what comes out in the moment, but if you don't understand what I mean with "sustaining an emotional conversation," then maybe preparation wouldn't be such a bad thing after all.

Because, let's face it! Therapy is damn expensive. Tell me! I'm the one having to ask for payments of up to £85 per session on a regular basis. It's not easy. Why don't I lower my fees, you ask? I wish I could, trust me. Life is expensive these days.

So, considering the financial factor, you really want to make the most out of every session, trust me. And for that, preparation isn't a bad thing at all.

What People Typically Talk About In Therapy

While there's no prescribed list, there are themes that come up again and again in therapy sessions. If you're not sure where to begin, any of these might be a natural starting point:

How you've been feeling lately. Not the polished version you'd give a colleague or a friend, but the honest one. The one you haven't said out loud yet. How are you really doing?

Something that's been bothering you. A relationship that feels difficult. A situation at work that's draining you. A pattern you keep noticing in yourself but can't seem to change. Something in your life constantly being a source of problems.

Something from the past that still feels present. According to research published in Frontiers in Psychiatry, the therapeutic relationship is at its most effective when it creates the conditions for the "unresolved experiences" to be explored safely: often for the first time. Think of things that have been difficult in your life that have remained totally or partially undigested: a loss, a difficult period, an experience you've never quite made sense of. Think of the things you've never told anybody.

Similarly, be prepared to touch on the difficult things that happened to you that you have had the chance to process. Nothing's lost in revisiting something that you think is done and dusted. These things rarely are!

Relationships, relationships, relationships. They say we are relational beings. Although I don't generally love that saying (since we're so much more than that!) I think it's very relevant in this context. Dilemmas and frictions in relationships are all very valuable because they expose the areas that need your attention. So be prepared to talk about your relationships: parents, siblings, romance (or the lack of it!), friendships, and most importantly, your relationship with yourself. How do you feel about yourself, eh?

Anything you don't want to talk about. That's the best rule of thumb: is there anything you really don't want to talk about? Maybe because it makes you feel ashamed, or hurt, or it brings discomfort to the surface? Aha!... That's exactly what we want to talk about. The sooner we can get there the better.

The things that feel most uncomfortable to say are almost always the things most worth saying. The topics you've been avoiding in your head, the things you've never told anyone, the feelings you've been pushing down: these are exactly where therapy tends to be most useful.

As I explored in a previous article on whether you need therapy, many of the difficulties people carry are connected to things they haven't yet found the space to look at directly. Therapy is that space.

One Final Thought

Journaling is a great way to prepare.

If you’re spending a lot of energy worrying about what you should talk about in therapy, it’s worth remembering that there is no admissions exam.

You don’t need to arrive with a perfectly organised life story, a neatly packaged problem, or a list of talking points. Equally, if you’re someone who finds it difficult to access your emotions or tends to avoid difficult conversations, there is nothing wrong with giving some thought beforehand to what you might want to bring. Preparation is simply a way of helping yourself get started (and of making the most of it).

Ultimately, the most important thing is not whether you come prepared or unprepared. It’s whether you’re willing to be honest. Honest about how you’re feeling. Honest about what isn’t feeling well in your life. Honest about the topics you generally find hard to talk about.

As I wrote in my article on How Do I Know If I Need Therapy?, many people spend years convincing themselves that everything is fine when, deep down, they know something isn’t quite right. Therapy begins when we’re willing to stop arguing with that feeling and start listening to it instead.

And if you’re still feeling nervous about what a session might actually be like, you might find it helpful to read my article on What Happens in a First Counselling Session? One of the things people are often surprised to discover is how ordinary it feels. You’re not expected to perform. You’re not expected to have the right answers. You’re simply invited to talk, and together we see where the conversation leads.

That’s really all therapy is at the beginning: two people sitting down and being curious about your life. From there, sooner or later, the important things tend to find their way into the room.

--- About the author: Alex Jurgensen is a BACP Accredited psychotherapist with over 8 years of experience. He offers face-to-face counselling and psychotherapy in Hammersmith, Islington, Fulham and Reading, and online sessions across the UK. If something in this article resonated, feel free to get in touch. Learn more at truthfullytalking.com.

Published: June 18, 2026 12:00pm