We kind of have a routine where he comes to the waiting room door and opens it and just smiles at me. I sometimes say hi, and sometimes I just smile back at him. He stops on the way back to his office to get a glass of water for me and then comes in and hands it to me, and I say thank you. So, I guess it's me that speaks first.

But, in terms of getting started, there's a ritual for that also, and he starts it. He asks me about my mood, if I have any thoughts about the session last week, and then asks me about my focus for the current session. He used to use the word "agenda." I use an agenda at work to list stuff I have to FINISH for the week. Using the word "agenda" in therapy bothered me because then I feel useless that I haven't "finished" the stuff on the agenda and it's the same stuff over and over. After we talked about that a couple of times, he finally starting using the word "focus" instead of agenda. I thought it was pretty nice of him to change a habit he's had for the last 25 years to accommodate my discomfort with the word "agenda."