I tend to slow down and try to figure out exactly what I want her to understand. Rather than throwing all kinds of nasty things at her or talking around the issue and hoping she will guess, I try to identify exactly what I want her to know and say that. For example:

She responded to something I had said in a way that felt dismissive and flippant. I was extremely hurt, and even considering quitting therapy, etc... I wanted to throw all kinds of nasty things at her, like I feel like she doesn't understand me and she is ignoring me, and I'm sure she hates me. But I stopped and realized what I wanted her to know was that her response caused me pain and I felt hurt and dismissed by it. So that's what I ended up saying.