For my first couple of months of therapy I would write out all that I was feeling and wanted to address. I said very little during each session and only used nods and shrugs to communicate. Since I was uncomfortable talking, this worked well for me at that time.
Fortunately now I am more comfortable with talking to my t instead of giving her notes, usually. I did send her an email recently with a topic I couldn't verbalize and we talked about it next time.