What If I Don’t Know What to Talk About in Therapy?

Have you ever sat down for a therapy session...and quickly realized you have no idea what to talk about?

Maybe you had plenty on your mind earlier in the week, but now it’s all disappeared.

Or maybe you know something feels off, but you’re not sure how to put it into words.

(Image credit to kepdesigns)

You don’t need to show up to therapy with an agenda, a perfectly organized list of concerns, or even a clear understanding of how you’re feeling. Figuring out where to start can be part of the therapeutic process—and there are plenty of ways to communicate and explore what’s going on besides simply talking.

In this article, we’ll look at what happens when you don’t know what to talk about in therapy, ways you and your therapist can find a starting point together, and alternatives for when words just aren’t working.

Do I Need to Prepare for a Therapy Session?

Nope! It’s completely normal and okay to show up without an itinerary. One of the benefits of meeting with a licensed therapist is that they are trained in guiding sessions. They can ask questions, revisit things you’ve talked about before, or help you find a place to start.

That said, some people find a little preparation helpful. You might jot down something that happened during the week, a feeling you keep noticing, part of a conversation you want to process, or a question you want to explore. If you tend to forget what you wanted to discuss once the session starts, keeping a note on your phone or a running list between sessions can make it easier to remember.

There’s no “right” amount of preparation. You can arrive with a detailed list one week and absolutely no idea what to talk about the next. Both are perfectly workable starting points for therapy.

What Happens If I Have Nothing to Say in Therapy?

Sometimes your mind just goes blank.

A therapist can help take some of the pressure off by asking questions, checking in about your week, returning to something you discussed in a previous session, or offering a more structured activity.

You also don't have to fill every moment of silence. A pause can give you time to notice what you're thinking or feeling without immediately needing to turn it into a polished explanation. Therapy can be a place where it’s perfectly ok to be unpolished, unfiltered, and raw.

If you regularly find yourself unsure what to talk about, that's something you can tell your therapist, too. You might discover that you prefer more questions or structure during sessions. Or you may need more time to process a question before responding.

Therapy can be adjusted around how you communicate best rather than expecting you to become good at one particular style of conversation.

What If I Know Something Is Wrong, but I Can’t Explain How I Feel?

You don't have to know exactly what you're feeling before you can talk about it in therapy.

Sometimes the starting point really is, “I don't know. Something just feels wrong.”

Instead of immediately trying to find the right emotion word, you and your therapist might explore other pieces of the experience. What have you noticed in your body? Has your energy changed? Are you avoiding something you normally enjoy? Is there a thought you keep returning to? Did something happen recently that has stuck with you?

You can also use comparisons, metaphors, images, music, sounds, gestures, or art to communicate an experience that is difficult to explain directly.

For some people—especially those who process experiences visually, creatively, or more slowly than a back-and-forth conversation allows—having alternatives to verbal communication can make therapy more accessible.

The goal isn't to produce the “correct” description of what you're feeling. You and your therapist can be curious about it together.

Can I Bring Notes or a List to Therapy?

Absolutely. If writing things down helps you organize your thoughts or remember what you wanted to discuss, you can bring notes to therapy.

Your notes don't need to be formal. You might keep a running list on your phone, write in a journal, save a text you want to talk about, or jot down a few words when something happens during the week.

You also don't have to discuss everything on your list. Think of it as a collection of possible starting points rather than a checklist you have to finish before the session ends.

Writing can be especially helpful if you find it easier to organize your thoughts when you have time to process them on your own.

What If I Forget Everything I Wanted to Talk About Once Therapy Starts?

This happens more often than you might think.

You may spend the week thinking, “I definitely need to talk about this in therapy,” only to sit down for your appointment and suddenly remember none of it.

Keeping a note between sessions can help, but your therapist can also help you retrace your steps. You might think about what has taken up the most mental energy that week, whether anything felt particularly difficult or surprisingly good, or what you were thinking about immediately before your appointment.

And sometimes the thing you planned to discuss isn't what you end up needing that day. That's okay too. Therapy doesn't have to follow a predetermined plan.

Does Therapy Have to Be Mostly Talking?

Talking is one way to participate in therapy, but it doesn't have to be the only one.

As an art therapist, I sometimes use drawing, painting, collage, writing, digital art, or other forms of creative expression with clients. Art can give us something concrete to respond to when answering an open-ended question like “How are you feeling?” feels overwhelming or impossible.

You might choose colors that represent your week, draw what an emotion feels like, make a collage about something you're trying to understand, or simply experiment with materials and notice what comes up.

You don't need to be artistic, and you don't have to know what your artwork means before you make it. We can explore it together.

Art therapy is also optional. Some clients use art frequently, others use it occasionally, and some sessions may involve no art at all.

[Learn more about art therapy →]

What If I Need More Structure From My Therapist?

It's okay to want your therapist to provide more direction.

Some people enjoy beginning a session with an open-ended question and deciding where the conversation goes from there. Other people find that much freedom stressful and would rather have questions, prompts, activities, or a clearer structure.

You can tell your therapist what works better for you. You might ask them to offer a few topics to choose from, ask more specific questions, help you prioritize what's on your mind, or suggest an activity when you aren't sure where to begin.

Your preferences can change, too. You may want more guidance when you're overwhelmed and less when there's something specific you already know you want to explore.

This kind of flexibility can be particularly important in neurodivergent-affirming therapy. Rather than assuming there is one correct way to communicate or participate in therapy, you and your therapist can work together to find approaches that fit the way you process information and express yourself.

[Learn more about neurodivergent-affirming therapy →]

Is It Okay to Talk About “Small” Things in Therapy?

You don't have to save therapy for crises, major life events, or your deepest feelings.

You can talk about the awkward interaction you keep replaying in your head. You can talk about something your partner said, a frustrating day at work, a decision you've been putting off, or why you've been thinking so much about a character in a TV show.

Sometimes seemingly small things lead somewhere important. A minor conflict might bring up a familiar pattern around boundaries. Procrastinating on one task might open a conversation about perfectionism or overwhelm. Something you strongly relate to in a book, game, or TV show might give you language for an experience you've had trouble describing.

And sometimes a small thing is simply a small thing that you want support with. That's allowed too.

You don't need to prove that something is serious enough to deserve space in therapy.

What If I’m Not Sure Therapy Is Helping?

Not knowing what to talk about occasionally is normal. But if you regularly leave therapy feeling like you're filling time, don't know what you're working toward, or aren't getting what you need, it's worth talking about.

Therapy is collaborative, and feedback can be useful information. You can tell your therapist that you'd like more structure, want to revisit your goals, aren't connecting with a particular approach, or aren't sure what you're supposed to be getting out of your sessions.

A good therapeutic relationship should have room for conversations about therapy itself.

Sometimes a small adjustment can make sessions more useful. Other times, you and your therapist may decide that a different approach—or a different therapist—is a better fit.

You Don’t Have to Know Where to Start

One of the reasons people come to therapy is because they're trying to understand something they don't already have figured out.

You don't need to arrive knowing exactly what's wrong, what you want to change, or what you should talk about. You can bring a list. You can bring a vague feeling. You can bring something that happened five minutes before your appointment. You can make art. You can ask your therapist to help you find a starting point.

Therapy can begin with, “I'm not sure what to talk about today.”

Looking for Telehealth Therapy in Washington?

I provide individual telehealth counseling and art therapy for adults and teens throughout Washington State, with a particular focus on LGBTQIA+ and neurodivergent-affirming care. My approach is collaborative and flexible, and we can work together to find ways of communicating and participating in therapy that work for you.

If you're considering therapy but aren't sure where to begin, I offer a free 15-minute consultation where you can ask questions, tell me a little about what you're looking for, and see whether we might be a good fit.

[Schedule a free 15-minute consultation →]

About Beryl Olson
Beryl Olson, MS, LMHCA, ATR-P, is an art therapist and mental health counselor based in Olympia, Washington. She provides LGBTQIA+ and neurodivergent-affirming therapy via telehealth throughout Washington State.