If your reason for entering therapy-- and IIRC, you've been at this current round for 1.5 years-- has something to do with your interactions with other people, then pretty much everything you say to the T, and every way you react to what she says to you, is relevant.

But if you are spending all your energy in T looking for her to lead and insisting on knowing whether and how a question or a topic is relevant to your specific reason, then I don't see how you can get very far with this approach. But then again, I'm sure you will respond back with you have your own way of doing things that is different than everyone else's and your T says that you are not doing it wrong. So I understand that nothing else will work for you other than what you are doing and that you have tried other approaches and they don't work. I'm not trying so much to comment on what you do-- which I know you are really defensive about-- it is merely my reaction to it that frames the other thing I'm going to say.

I take the lead almost all the time because I am unwilling to give up control to my T and allow her to decide what I should talk about. I'm typically not all that open to questions she asks, either. Sometimes I deftly (or not so deftly) avoid them and just start talking about something else. Once I asked her if she would help me figure something out by asking lots of assessment-oriented questions, and she was really good at it but she prefaced it by asking if I was really sure I wanted her to do it, because she didn't perceive that approach would be "welcomed."

But the way that I know what to take the lead about is that I'm really clear on what issue I want to work on. I have a very stable and easygoing life, although I have some occasional bouts of mild depression and conflicts over whether I want to continue working at the place that I do. I very rarely bring up issues of symptoms or career directly. Rather, my issue is centered around my interactions with my family (wife & kids) and having a desire for "cleaner" responses to them that have to do with the here-and-now and not old holdover response patterns from childhood. So I'm trying to identify the places in my life where my interactions are clouded with old stuff and then figure out ways to react and respond that don't include this old stuff.

So one thing that I regularly bring up is mindfulness. I report on occasions where I feel that I have been particularly mindful in stressful or emotional situations, or times when I haven't. We discuss those. I analyze how things have changed over time, and what's still difficult and what's gotten easier. My T responds with her own example from her life or notes patterns of change or points out what challenges might lie ahead. I usually come out of these discussions with an increased awareness of what I can do in the future or what kinds of things I want to be noticing in my interactions with others.

Another thing I regularly bring up is emotional reactions or behavioral reactions to small interactions in my family, usually with my spouse, a lot less often with my kids. For instance, I've been struggling with my wife's increasing workload bleeding into family time. I'm thrilled that she has made some major achievements/been promoted at work and she really loves her work and I want to support her. Yet, I don't get as much time with her as I'd like. So I've been talking about that with my T and trying to figure out ways to not see her workaholism as about me or our relationship and at the same time, find noncontrolling ways to ask her for what I need. There's always lots to talk about on my attempts to do this and my feelings around whether it worked or not.

There are other interactive issues that arise regularly too, in the context of work or interactions with people in my circle of friends or community. These usually start with some variety of "I noticed that [conversation with so-and-so] made me have [such-and-such] emotional and/or behavioral reaction. So I might comment on how I felt when someone made a critical comment about parenting, the sort of parenting that included things that I believe in and/or do. Or someone at work seemed to want to collaborate with me on a new project, but when I contacted them to follow up, they ignored me. Sometimes my focus is on my feelings, sometimes it is on my reaction (did I respond in a hurt fashion, did I let it roll off my back, did I not feel angry when I might have in the past)? For me, it's very helpful as I'm trying to change my interaction patterns to notice sometimes really tiny changes in how I talk, how I behave, the choices I make to do x, y, z or not, and how I feel about all of these things.