Mostly I decide. If she has something important to bring up (i.e. homework, scheduling, talked to my Pdoc, etc.) then she'll bring it up at the start. Otherwise it's "How are you doing?" and moving onto what I want to talk about. And if we run out of things to talk about, then we have the DBT workbook to turn to.

We share talking about 50/50. It's like having a normal conversation with someone. She is actively involved asking questions and giving commentary.

You should be able to bring up whatever you want to in session. It's your therapy. It shouldn't mess up the "flow". I mean what happens if something spontaneous happens? You cry? You get upset? Someone tells a joke and you laugh? You never get side-tracked? Sometimes it makes therapy better. Try it out. Just tell her from the start that there's something you want to get to.