I keep a journal throughout the week, and then review it before going in. I am really good at forgetting what happened during the week and would miss some pretty significant observations and experiences if I relied on remembering. It also helps me talk better about how I processed our discussion during the course of the week, because where I was when I left the session and where I am when I arrive for the next session are often very very different. My journaling notes are sometimes just little jots about how I'm feeling, recurring images or thoughts I need to put on paper to try and stop thinking about, or sometimes notes about what is really standing out from the previous session and really resonating.

When I have really needed to open up about painful things (the first session, talking about why I was there, and the issues that we would have to work on, the fourth session where I needed to talk about feeling like talking about csa but not feeling ready to say more than that, for example), I have rehearsed how I would bring it up and what I would say, to introduce the topic but I try not to plan beyond the initial disclosure.