Starting therapy is one of the most courageous steps a person can take. Yet once you sit down—whether in person or online—you may suddenly wonder: “What should I talk about?”
This question is far more common than people think. Therapy offers a rare space where you can discuss anything, and with that freedom often comes uncertainty. My clients sometimes worry they’ll say the wrong thing, disappoint the therapist, or simply “not know where to begin.”

Let me reassure you: there is no wrong place to start. Therapy becomes powerful not because you arrive with perfect clarity, but because you are willing to explore, question, feel, and be honest—especially with yourself.

Common—and Powerful—Starting Points

You don’t need a polished narrative or a dramatic event to begin therapy. Some of the most meaningful sessions start with simple observations or subtle emotions. Here are common jumping-off points that often lead to deep, productive work:

• Tension or conflicts in relationships – Whether with a partner, family member, colleague, or friend
• Past trauma or unresolved emotional wounds
• Difficulties at work – stress, burnout, performance anxiety, or communication issues
• Recent mood changes – irritability, sadness, overwhelm, numbness
• Long-term goals and life transitions – starting a new job, getting married, parenting, aging
• Complex internal experiences – self-doubt, shame, guilt, grief, loneliness, confusion
• Patterns that keep repeating – procrastination, conflict cycles, anger outbursts

Therapy thrives on authenticity, not perfection. Even a single sentence like “I’m not sure why, but something feels off lately” can open the door to real transformation.

When Talking Feels Hard—Especially with Anxiety

For some clients, talking openly feels impossible. This is especially true for those struggling with severe anxiety. Anxiety’s nature is avoidance: don’t feel it, don’t say it, don’t go near it.
So when faced with the prospect of opening up to another person—someone who is truly listening—the internal alarm bells go off.

Clients often tell me:

“If I say it out loud, it’ll become too real.”
“I don’t even know how to start.”
“What if I fall apart in front of you?”

This fear is normal. And it’s important.

While I am committed to creating a deeply safe, compassionate space, therapy also requires courage from the client—the courage to express feelings, worries, and concerns they have avoided for years. Those first moments of honesty often become the turning point in their healing.

The Fear of Vulnerability—and Why It Matters

Opening up in therapy means confronting vulnerable parts of yourself. It’s natural to think:

• “I don’t want anyone to know this.”
• “I’ll feel too much shame if I say it.”
• “I’m afraid of being judged.”

These fears make sense. Vulnerability often feels like exposure. But in truth, vulnerability is the gateway to transformation.
Effective therapy often requires you to share something you’d instinctively rather hide. That discomfort is not a sign that something is wrong—it’s a sign that something is working.

As trust builds, clients begin to recognize the immense power in saying out loud what they’ve long held inside. Over time, they discover:

• relief where there was tension
• compassion where there was shame
• clarity where there was confusion
• confidence where there was fear

This shift doesn’t happen overnight, but it unfolds naturally when clients allow themselves to be fully human, fully honest, and fully seen.

What Matters Most in Therapy

If you remember one thing, let it be this:

The most productive therapy starts with whatever feels most alive in you today.
Even if it’s messy. Even if it’s small. Even if you think it isn’t important.

You don’t need the perfect words—you just need willingness.
You don’t need a grand insight—you just need curiosity.
You don’t need to feel comfortable—you just need to stay engaged.

Therapy is a collaboration between your courage and your therapist’s guidance. Together, we create a space where your stories, emotions, and patterns can be safely explored—and ultimately transformed.

A Final Thought

You come to therapy not because something is wrong with you, but because something inside you is calling for clarity, healing, or change. When you honor that call—by showing up honestly—you open the door to growth that can reshape your relationships, your emotional life, and your sense of self.

So when you ask, “What should I talk about in therapy?” the answer is simple:

Talk about what’s true.
Talk about what hurts.
Talk about what you want.
Talk about what you avoid.
Talk about what’s happening right now inside you.

That is where the real work begins. And that is where transformation becomes possible.