It really depends for me. Sometimes, I know exactly what I need to talk about, or I've emailed T ahead of time, so we have a plan. Sometimes, I can do a little small talk and then get in to the real topics. Sometimes, I just sit there, and when T asks me what I need, I answer "I don't know."

Usually, on the days where I don't know, T will either help prompt me by asking questions, or she'll guide me through a grounding exercise so that I can quiet my thoughts enough to pick one out of the dozens that are racing through my brain.

Sometimes, I know what I want to talk about, but it's so hard for me to bring up that I tell T "I know what I want to talk about but I'm struggling to put it in to words." She'll help me get to the point that I can talk once she knows what I'm struggling with.

I don't think it's at all wrong to need help talking about things. You're sharing very private and difficult things with T, and sometimes people need help doing so. I usually tell my T when I need that help, though. I might say "I'm having a hard time talking about things today, can you prompt me with some questions?"