After I come into T's office and she closes the door, I generally make just a bit of small talk because I also have trouble just jumping right in to the difficult issues. Just a brief exchange of how are you? how was your holiday? I like your sweater, etc.
Then she will ask me, "What do you want to focus on today?"
If we kind of left off in the middle of an issue in a previous session I ask if I can bring it back up. But sometimes I have to come up with something new... sometimes it's very awkward! Sometimes I feel like I don't have anything new to say, yet I don't feel okay or like I have no issues. But lucky for me, I always seem to be doing something dumb, so that's generally a good starting point for me