My T will help me start the difficult conversations if I email her the topic ahead of time and then tell her at the session that I need help starting. If I'm just completely blank on what I want to talk about, I'll tell T that and she'll ask me for status updates on some of the things we've been working on. That usually gets me talking. Sometimes she'll ask me why it's hard for me to start or have me do some mindful breathing to focus. So, yeah, my T is good at helping me to start talking, but I have to give her some indication of why it's hard to start or what direction I want the session to go first.