Where do I start (in my therapy session)?

Where Do I Start (in my therapy session)?

My clients often express uncertainty about where to begin in a session. Sometimes they have so much on their mind that they have a hard time deciding where to focus. Other times, I feel them scanning my face and body language to give them some clue of what I'm hoping that they will talk about or what is the 'right' thing to bring to therapy.

Let me respond to this dilemma...

The truth is, there is no right or wrong place to start. (How do you like that for a therapeutic response!?). That said, here are a few options:

Something about yourself you wish would change:

Some people come to therapy because they are wanting to make a change. What do you wish were different? How do you wish it were instead? Any mixed or conflicting feelings about making this change? This starting place can lead into many sessions of rich exploration and even lead to clarity about what's been getting in the way of making the change.

An emotion or a feeling that you are curious about:

Hard as we might try, sometimes there are feelings or emotional reactions we just can't control (anger, shame, low self-esteem). They pop up in both expected and unexpected ways. These familiar and repetitive emotional states can be a great place to get curious about what is triggering them, what meaning they hold, or how to understand their purpose. When we can slow down, get curious, and pay attention in a way that helps us learn about our reactions, often we discover that there is, in fact, a pattern that makes sense. This can lead to feeling much more in control and gives us increased choice.

A behavior that you can't stop doing:

Similarly, sometimes we feel we can't control an action or behavior: biting nails, binging (on food, Facebook, Netflix), rolling our eyes at our partner, etc. Part of us knows that the behavior is not helpful and may even be harmful, yet it's like something else takes over the control panel. Before we know it, we're doing it AGAIN! Very helpful to explore this in therapy and get clear about how this behavior is serving a function (I guarantee you that it is!). With mindfulness, compassion, and clarity, we can address (and heal) the root cause of the behavior itself.

Something you just can't stop thinking about:

Whether it is an interaction you had yesterday that you just can't stop thinking about or a traumatic experience that happened years ago, if it is looping in your mind, bring it in! Therapy can be a great place to better understand why this incident has left such a lasting impression on you and work on healing any internal wound that may have resulted.

IF ALL ELSE FAILS, let your therapist know you need some help getting started. We're very used to this request and it makes sense that it can be difficult! It helps us to understand that you're struggling with this part of therapy so we can better support you!

Interested to know more? Subscribe to my newsletter to receive future blog posts, insights, and self-help tips straight to your inbox or contact me so we can talk more.

© Ellie Vargas, LCSW


Ellie Vargas, LCSW is a wife and a mama of two girls, a trekker on the bumpy trail of personal growth, and a Trauma-Informed Psychotherapist. In that order.