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Rapunzel said:
What do you open with, or how do you start your sessions, especially that works and gets you off on the right foot to have a good session? Particularly, do you have any ideas for starting a session if you don't feel like you made progress since the last time, or may even be backsliding?

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My sessions are not usually about reporting on progress I've made. I never actually thought that would be something I would want to focus on in my sessions, and T has never said to me, "I want to hear what progress you've made since last time." We actually rarely refer back to a past session. Each session stands alone. Sometimes T will ask me how I am or sometimes "how goes the journey?" But often times he just sits there and doesn't say anything, just looks at me expectantly, waiting for me to start. He has always let me pick the topic for each session, and this extends even to having me be the first one to speak. Other times he will sit across from me, smile with his eyes, and say "therapist at your service."

I just start with what is most important that I talk to him about that day. What is my most pressing concern? What do I want to work on? I only get the guy once a week for 50 minutes and I pay his full fee myself with no insurance, so I am darn well going to make use of his time and get the maximum benefit that I can. Sometimes it helps me if before the session, I can identify the most important thing I need help with from him or that I want to explore with him. Then at least I know how to start out. There have been times I did this exercise by myself before a session (complete the sentence), "if I could say only one thing to my therapist, I would say ________." And I try to think in as few words as possible what that one thing would be. Somehow, having to be concise helps me get to the heart of what I need him for that week. I don't do this everytime, but it has helped me.

Sometimes what I want to talk about is too difficult to broach, and leading off with a dream can be easier, because the dream deals with the topic I want to broach but in a more indirect way that will get us there without the impossibility of my having to pose it directly.

There are other times when I don't know what we will talk about, and I just let the moment lead me. Sometimes an emotion will overtake me, such as sadness, and we will just sit in the sadness together, and maybe not say much, and that is OK. Once I was so excited I was just bouncing off the walls and could not settle down and focus on anything. T said maybe what I most needed was to come see him and share my excitement and bounce off the walls and not focus on anything. I liked having his permission to just be what I was at the moment instead of trying to conform to this idea I had in my head of how therapy should go. All these ways of starting have resulted in some really good sessions.

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One was "progress that you have made," and another one was "confessions you would like to make." Out of those two, progress seems to be a much better choice, as confessions lead to being in hot water fast.

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Why does confessions lead to hot water? Are you keeping a lot of secrets that you are not yet ready to share with your T? If so, maybe you just need to give it more time. I actually think, given a certain degree of closeness between you and your T, the confessions angle could be kind of productive!