For me, it depends on why I'm running out of things to say. If it's because I'm stuck in my head and struggling to just get words out, I will tell T that I need some prompting because I have all these thoughts that I just can't put in to words. She'll ask me some questions which usually generate conversation.

If I just really don't have much to say, and that stays consistent for several weeks, then we'll talk about switching to appointments every other week for a while.

Recently, my T has asked me to fill out a pre-session assessment form, in which I detail my mood ranges for the preceding week, note down areas where I'm doing well and areas where I'm struggling, and note down some goals for the session. Sometimes, I find it very helpful to fill out, and sometimes I find it an annoyance. I do think it has helped to focus my sessions some, though.