I'm a big believer in the blurt. Just spitting it out without much thinking. Also one of my favorites is "I was __________ in the waiting room, now I'm just ________". That usually helps to get the ball rolling a bit too.

However, my all time favorite trick to open up is to take my hands (which are usually still clinched or wringing) and turn my palms toward my therapist.

For me, it is hard to describe the opening the single gesture causes, but it really works, at least when I do it.