What To Do In Therapy: A Beginner's Guide To Talk Therapy

When beginning therapy, it’s common to wonder what types of conversations you might have with your therapist. Pop culture depictions of therapy often involve images of a client lying on a sofa discussing their childhood or answering a string of questions about their past. However, therapy is a highly collaborative process with many different approaches, and it may look quite different from what you imagine. 

Even when going into therapy with specific goals in mind, it can be difficult to predict which topics may come up. While the exact topics can vary from one person to the next, there are some broad themes that are often covered. If you are new to talk therapy, this article may help you understand what you can expect in therapy, including common themes that often arise and ideas for what to do in therapy if you’re feeling stuck.

Understanding talk therapy and how it improves mental health

Talk therapy, also known as psychotherapy, is a collaborative process between a therapist and a client that aims to support a person’s mental health and well-being. It typically involves discussing and exploring thoughts, emotions, and behaviors with a licensed mental health professional, such as a licensed professional counselor (LPC) or licensed marriage and family therapist (LMFT). Therapy can be done as an individual, couple, family, or group. 

Talk therapy encompasses various approaches, such as cognitive behavioral therapy, psychodynamic therapy, and eye-movement desensitization and reprocessing (EMDR). When looking for a therapist, it may be helpful to learn more about different types of therapy to consider what approaches you feel may work best for you. 

Defining your goals for therapy

Setting clear goals can help you get more out of your time in therapy, and doing so may also be helpful when trying to choose a type of therapy that would work for you. Before starting therapy, it may be useful to reflect on what you hope to achieve. 

What to do in therapy: Questions to ask to define your therapy goals

• What specific symptoms or challenges do you want to address in therapy? 
• Are there specific areas of your life or relationships that you want to improve?
• Have you experienced trauma or significant life events that you want to work through in therapy? 
• Are you seeking support for substance use or addiction? 
• Do you have goals related to your personal or professional growth? 

Defining your goals can help both you and your therapist to focus and work towards tangible outcomes. Your goals may evolve and change throughout your time in therapy, and your therapist can work with you to establish realistic and achievable objectives as you make progress.

What to expect in your first session

The first therapy session is an opportunity to begin establishing a connection with your therapist and to tell important information about yourself and what you are hoping to get out of therapy. It's common to feel nervous or unsure during this session, but remember that your therapist is there to support you. 

Building rapport and trust is a crucial foundation for the therapeutic relationship. Your therapist may ask questions to get to know you better, understand your concerns, and gather relevant background information. This session is also a chance for you to ask questions, discuss your goals, and voice any concerns or expectations you have about therapy. 

What to talk about in therapy

Here are several possible areas you may explore with your therapist: 

Current challenges or stressors

If you are currently experiencing any difficulties or stressors in your life, such as work-related stress, relationship conflicts, or major life transitions, these concerns can be a natural place to begin. Your therapist can help you process and cope with these current challenges, and discussing these can also be a good place to begin exploring your mental health concerns more deeply. 

Emotional experiences

Therapy provides a supportive space to explore and process difficult emotions such as sadness, anger, disappointment, fear, or frustration. Your therapist can help you identify the underlying causes of these emotions and offer practical advice for processing them and developing healthy coping mechanisms.

Relationships

Therapists often help clients explore and improve patterns and dynamics in familial, romantic, platonic, or professional relationships. They may be able to help you strengthen your communication skills, set boundaries, or work through conflict more effectively. Depending on the types of relationships you would like to improve, you may consider trying family therapy or couples counseling.

Past experiences

Therapy can also be a place to discuss significant life events, traumas, or childhood experiences. Your therapist can help you understand how your past may be influencing your thoughts and behaviors, and they can offer useful strategies for moving forward and healing from these experiences. Some types of therapy, such as EMDR, are specifically designed for trauma recovery.

Self-esteem and self worth

Cultivating healthy self-esteem and self-worth are also common goals in therapy. Your therapist can work with you to explore your sense of self and help you build self-confidence, challenge self-critical thoughts, and develop a more positive self-image. They may use therapeutic techniques such as cognitive restructuring or positive affirmations to help you cultivate a healthier self-image.

Coping strategies for mental health concerns

Therapy can be helpful for learning new ways to effectively manage depression, anxiety, and other mental health conditions. Depending on your specific concerns, your therapist may draw on a range of therapeutic approaches, and they may help you improve your self-care habits and teach you new strategies for managing difficult emotions. 

Thought patterns and beliefs

Your therapist can help you examine negative or self-defeating thoughts and beliefs that may be contributing to emotional distress or holding you back. They can help you become aware of unhelpful thought patterns that contribute to negative emotions or self-sabotage, and offer skills and activities aimed at challenging those beliefs.

Behavioral patterns

Self-destructive or harmful behaviors are a common focus of therapy. A therapist can help you gain insight into unhealthy patterns and work with you to change them. Cognitive behavioral therapy and dialectical behavioral therapy are two types of therapy that are commonly used for these concerns. 

Personal growth and self-development

If you are experiencing uncertainty about the future or are unhappy with your current situation, therapy can be a supportive place to explore opportunities for personal growth. Your therapist can help you explore your values, strengths, and interests and offer guidance on living a more fulfilling and purposeful life.

Identity and self-exploration

Therapy can offer a safe space to explore issues related to your identity. This may involve your cultural or religious background, your sexual orientation or gender identity, or other aspects of your identity that shape your sense of self. Therapy may be helpful for exploring your identity, addressing any internal conflicts, and embracing your authentic self.

What if I have nothing to talk about in therapy?

At times, you may feel unsure about what to discuss in therapy, or you may feel that you have nothing to talk about. If this is something you’re feeling, consider some of the following suggestions: 

Reflect on your recent experiences

Take some time to reflect on any recent events, emotions, life transitions, or challenges that have arisen. Consider discussing with your therapist any patterns or recurring themes that you may have noticed.

Explore your emotions—it’s something you should talk about in therapy

Even if you don't have a specific topic in mind, it can be helpful to begin by telling your current emotional state with your therapist. Discussing how you're feeling, even if you're not sure why, can lead to valuable insights and discussions.

Discuss therapy itself—clear things with your therapist

If you’re having thoughts, concerns, or questions about the therapeutic process, it may be worth discussing them with your therapist.

Discuss any changes or progress

If you've noticed any changes or progress since starting therapy, consider telling those with your therapist. You may discuss how these changes have come about and explore strategies for building upon that progress.

What to do in therapy if you struggle to make progress

If you find yourself struggling to make meaningful progress in therapy, it can be helpful to reflect on the reasons behind it. If you have tried different approaches, communicated your concerns, and still feel stuck, it may be worth considering switching therapists. Each therapist has their own style, approach, and areas of expertise. Finding a therapist who is a better fit for your needs and goals can make a significant difference in your therapeutic experience.

Getting started: Finding a therapist

Finding the right therapist can be crucial for a successful therapy experience, but doing so can sometimes feel confusing and intimidating, especially for those who are new to therapy. 

If you are feeling intimidated by the process of finding a therapist, you may find that online therapy feels a bit easier. With a platform like BetterHelp, you can get matched with a licensed therapist online by filling out a short questionnaire; plus, if a therapist doesn’t seem like a good fit, it is simple to switch to a new one. 

Whether you choose to attend in person or online, therapy can be beneficial for a range of concerns, and research suggests that online therapy can be just as effective as face-to-face sessions.