We often start off sessions with a little chit chat. He will often share something from his life, and I like this--builds reciprocity and connectedness. We have 90 minute sessions so can afford to do that. When I had 50 minute sessions, I had to jump right in or lose a lot in productivity. The family T I went to often started with, "what's going on in your world today?"

I do make sure to always tell my T the truth. If my T asks how I am, and I am not good, I do not tell him I am good. That is not helpful to him. He is looking to know what I need help with and how to do that. If I tell him I am good when I'm not, he will learn nothing about those things. If my T asks a question, and I don't feel able to tell the truth immediately, I will sit in silence a little while and think how best to answer or try to connect with how I am inside. Sometimes in typical conversation (with other people), there is pressure to immediately respond, and so we get used to firing out canned responses like, "Oh, I'm fine." Raceka, if you gave yourself permission to slow down a little and give yourself time to think how to respond accurately, do you think it might be easier to say what is true?

My typical responses in therapy to a "how are you?" question are:
good (and I mean it! things are going well)
okay (he knows this means I have not been all good, especially when I say it with some reluctance)
not good or not so great (he knows things have been pretty bad for me)

I doubt he will think this. If you say you're terrible, he will probably be glad to have that information so he can help you.