In terms of options in how one communicates in therapy, there can be a wide range of things. I have read on here where the communication is in written form during session - maybe not all the time but when things get tough. Others do a distraction activity while they talk, play games, take walks...ect.

I write in a journal between sessions and I give portions of the journal to my T and she reads them between sessions. Periodically, I will ask her about her thoughts on what she's read and periodically, she will make a comment that indicates that she's read the journals; however, she rarely brings up something from the journal to talk about. Sometimes I read to her parts of the journal or have her read them in session if I want to talk about them. I have also had "play" sessions where a portion of the session was play - being read to and playing remote control cars. We've also started moving the furniture creating a more enclosed setting and sitting on the floor. All of these activities have been things I've asked for and are ways to experience and open communication. I don't completely know what the sitting on the floor is about, I have some sense as to what it is and I know it is something I needed/wanted. Those sessions feel different.

As my T says, the time is mine, how do I want to spend it... your time is yours, what do you want to get out of them and what will help you get there, put you at ease to get there?