1. "Small" Problems
You may think that you are expected to talk about "big" or "serious" problems, but remember that in psychotherapy there is no such thing as a right or wrong topic to open up - you can talk to him about anything you want. It's certainly possible that you are interested in dealing with a certain issue that bothers you, such as anxiety or depression that you suffer from, but sometimes certain and even routine stages that you go through in life can require a conversation with another person who will help you deal with the change that comes with them.
So the first piece of advice is to simply understand that there is no such thing as a subject that is too small or is out of bounds. "People talk in therapy about everything possible - about hopes, dreams, fears, disappointments, pain, embarrassments, about mother, father, spouse, about what they perceive as parenting failures, about sexuality, about their dates - about everything", says Jessica Small, certified therapist and marriage and family counselor. Don't know where to start? Try to tell about what happened to you since the last time you met - the good and the bad - and see where it leads you.
2. Patterns of thought and behavior
Start following your thoughts and behavior patterns, and if necessary, write to yourself on notes things that you notice are repeating themselves. So you know what you want to talk about the next time you meet with your psychologist. You don't have to read directly from these notes during the session, because writing them will itself be an action that will allow you to emphasize them and remember them. Small gives an example of this: "A person can notice that they feel insecure in certain situations, and this is an excellent topic to open with the therapist."
3. What you're feeling during the session
It is possible that throughout the week you felt sad, angry or depressed, but if you do not feel that way when you arrive at the session, you do not have to start the treatment with that. Concentrate on the feeling you are experiencing in the present moment and the present, and simply express it - even if it's just something like "I wasn't looking forward to this session so much because it felt quite stuck in the middle of the day."
What you need from the therapist can change from day to day, and it's fine if you thought you would come and talk about a certain topic, but in the end you ended up talking for a whole hour about another topic. "Your session with the therapist should be tailored to what you need at the given moment," says Sol Rapoport, a family and relationship counselor at the University of California School of Medicine. "I tell my patients to think of the treatment as a kind of 'room of necessity', like from Harry Potter - there you get what you need at that given moment, and sometimes what is needed at that moment is simply someone who will allow us to unpack things."
4. Rumination
Depression and anxiety can bring with them rumination - a tendency to repeatedly focus on thinking about the causes, circumstances, results and symptoms of negative emotions and their consequences. If you had trouble falling asleep one night this week because you couldn't stop thinking about something you wanted to do or because you were worried about what was coming up, this is a great topic to start the session with
5. Relationships
The meaning here is not only the love of your life, but every relationship you have in life - with your spouse, family, friends or co-workers. Do you feel you have enough support at home? Do you feel that other people share your feelings with you? Or maybe you are struggling with the fact that it's difficult for you to open up to others, including the psychologist who treats you?
Your relationships are important for your mental health, and they play a significant role in your mood and how you feel on a daily basis. So if, for example, you avoided the phone calls with your mother, even though you love her very much, let your psychologist know about it, and you can both explore together the reason for that avoidance. It's even recommended to talk about relationships with which you feel good, because this will help you understand what is going right in your life and which people can support you besides your psychologist.
6. Past traumas
This may be a topic that sounds obvious, or perhaps it conjures up an image of a person lying on a couch and talking to his psychologist as in psychoanalysis, but the truth is that if you used to concentrate on the present in your sessions until now, you may achieve quite a lot if you go back in time a little. For example, it's possible that over the past few months you've told your psychologist about problems you've been experiencing in your current relationship, but you've never talked about the ones you had in the past and the people you used to date. You may discover that you harbor feelings and issues that you have not resolved until today and that affect your relationships even now.
7. New challenges in life
"Usually people have certain issues that they want to address with the help of the psychologist," says Nicholas Hardy, a psychologist from Houston, Texas. 'However, these issues are not always the problem. Sometimes it's a feeling or emotion they are unfamiliar with. As my patients enter a new stage in life, for example towards a birth, marriage or relocation, it can spark certain things that they need some help understanding. While it's not always easy to describe in words what the feeling is, it's possible to recognize that something is a little different.'
If something has changed in your life and it makes you feel a little different in one way or another, bring it up in the session. You don't have to talk only about "bad" changes, but also about good changes that bring good feelings with them. This will help you explore them safely and fully understand them.
8. Thoughts and conflicts you avoid
There are things you may not want to deal with on a daily basis, but therapy is the place to explore them. It could for example be something you are ashamed to even think about or something you think is "stupid" to worry about. We all censor ourselves to one degree or another and judge our feelings, but psychological therapy is the place to explore all the thoughts and feelings that arise in us, even the ones we don't want. It's okay to feel what you feel, and it's okay to talk about it.
"Sometimes I ask my patients what they would most like not to talk about today," says Rapoport. "It's usually a good sign of where there's a problem." It's quite logical if you think about it - we usually avoid what we don't like, what hurts us or what's difficult for us. And yet, if we ignore these things they will only grow inside us. Remember that the psychological treatment is a safe place where you can talk about anything - even about what you would like to avoid.
9. Difficulties with opening up
If you find it difficult to open up to your psychologist in a session and you don't know why, tell him about it. There may be something to explore there. "Even if you don't come to any significant topic right away and at that moment, it's important to understand what the barrier is that prevents you from opening up to other people or about a certain topic," says Hardy.
For example, when you suffer from depression, you will often lose interest in things that once gave you pleasure and feel that your energy levels are low. If you feel that the current or previous treatment was unusually difficult and you are not sure why, your psychologist can help you unload the baggage that is sitting on you and understand what is wrong.
10. Feeling uncomfortable during session
It takes time to build trust with other people, and it's not easy to share your thoughts and feelings with a stranger. If it's hard for you to trust your psychologist and that's what prevents you from opening up to him, know that it's completely normal, and you have nothing to be afraid of talking about it. The psychologist will be able to work with this information and create a foundation of trust that will allow you to open up even more later.
"Psychological therapy is a relationship between therapist and patient," says Small. "If the patient has difficulty opening up, it means that you still need to work and develop trust in this relationship. I try to create a safe environment for my patients, where they can feel safe to be vulnerable, and it helps them to open up to me and for me to help them.'
11. That you're not being helped
If you really don't feel comfortable with your psychologist, he may not be right for you, and that's okay. Remember that the psychologist is also a human being in the end, and each therapist has a different background, and there are many different types of psychological treatments. "Think about how comfortable you feel asking your therapist for exactly what you need," says Rapoport. "Some people prefer conversations and nothing else, while others need tools to help them deal with anxiety, for example. Others may want to talk about a certain topic and look for a therapist who has as much knowledge about it as possible. Make sure the therapist meets your needs and talk to him about what you need.'
If you are not getting what you need, if you do not feel that the therapist is challenging you in a way that is good for you or if you feel that your treatment is not progressing anywhere, talk about it. It's also possible that you would like your therapist to be of the same gender as you or have the same ethnic background. There is no right or wrong - you need to make sure that your therapist really fits your needs.
12. When to end the therapy
Psychotherapy isn't meant to last forever, so if it used to be easy for you to find something to talk about with your therapist, and now it's not really flowing, it may be a sign that it's time to end the treatments. It's perfectly normal to feel like you don't need sessions anymore after a while. "As a therapist, my goal is ultimately to make sure that the patient no longer needs therapy," says Small. But before you stop the treatments, make sure you do it happily and because you really got what you needed - not because you are not satisfied with your therapist. Such a case simply requires a change of therapist, as suggested in the previous section.
So how do you know when it's right to end the treatment? Rapoport recommends thinking about your first session: "Do you feel like you achieved what you wanted? If so, have you identified new goals along the way that you would like to achieve? If you feel that you continue to learn about yourself more and more, or if you gain new tools and resources at each session, this is usually a good sign that the treatments are still helping you. If, on the other hand, you feel that you are not achieving anything new from the treatments that you could not achieve from a conversation with another person, it may be time to stop.'
You also don't need to stop sharply and suddenly. You can talk to the therapist about longer time intervals between treatments and see how you feel about it. If, for example, you currently meet once a week, you can start session once a month, and if something comes up that you would like to talk about and the next session is still far away, you can always schedule another, closer session. You already have a good foundation with your therapist and you know that you can trust him, so don't cut off this relationship right away - he can still help you later.
