I first had to journal my thoughts and hand her what I had written in order to make some progress. I would spend the entire session using only body language and short answers to communicate with her. I still journal, but now I make a list of topics I would like to discuss and we go from there. Or, if I can't verbalize what I'd like to discuss because it is too painful or embarrassing, I will email her the details, so we can work on it in the next session.
I have been through cbt for my bp diagnosis, and now we are spending more time focusing on ptsd from csa.