I look within and listen to what is there and then I know what is important to talk about that day. This listening within may take some practice. I was encouraged in this approach by my T, who told me early on, "only you know what you need to heal." So I trust that somewhere inside I know what I need, and I try to be patient with myself and let what is needed come into my consciousness so I know what we need to discuss that day. Early in therapy, I used to do a self-devised exercise before therapy where I would fill in the blank: if I could talk about just one thing in therapy today, it would be __________. That helped me find the most important thing before therapy so I wouldn't spend time in session figuring it out. But usually I don't do that. I just let what needs to be discussed come to the surface. Sometimes I am surprised by what comes up!