Here's what I did in therapy to make sure we got to the important issues, and not wasted our time on things that didn't help me.

In my first (and sickest) years I wrote it all down, pages of it, and just handed it to my therapist, who would read it and respond. Sometimes the mere act of writing it helped me see my own resolutions. (sometimes I even wrote her letters in between appointments, but you have to ask permission before you can do that.)

In later years (with a therapist who wouldn't let me hand her 5 sheets of paper) I made a list of the things I needed to discuss and handed her the list. This way, she could see what the issues were and tackle the harder/more important ones first.

If you have a T who won't read the list, keep it anyway and make sure you cover everything on it. If your latest shopping trip is not on the list, remind yourself that you only have one hour to cover everything, and you'd better get cracking.

Now, that said, there will be times when you spend the whole hour on one issue and don't get to the others. Don't beat yourself up over it. Just save the list and see if you can work it in next week. See if it's even still important to you next week.

(This list also works well with my pdoc and gp, so I don't forget to get a med refilled or a symptom overlooked.)

Good luck!