My therapist keeps asking me how she can help me out better. We were doing DBT for half the session and a general check-in the other half which was helping, but now I'm in a dbt group so she doesn't want to go over the same stuff I'm learning in the group.

I find it hard to open up unless I'm inebriated or manic so that's a big obstacle. Some things I want to work on are shame, trust issues, fear of abandonment, self-destructive behaviors (drug use, self-harm, stopping my meds, bulimia, jumping into and out of and back into abusive or at the very least unhealthy relationships), and impulsivity. I just don't know HOW she can best help me out here, and she doesn't know either because I have a really hard time bringing these topics up (shame) and I can't show up drunk again because I have a conditional discharge that says no substance abuse.

She doesn't do email or texting and phone calls are strictly for scheduling purposes btw.

So, how should I try to ask my therapy to be structured? Right now she just sorta asks what's been going on and about my symptoms/behaviors/relations with others and that takes up about 15 minutes because I don't elaborate and then there's really nothing left to say that I don't want her to say "well, she's a hopeless case."

I'm stupid when it comes to therapy. I grew up "if you have bad thoughts, drink a beer and forget it." I don't know how to just say "I'm suffering. I need help," on the spot.

I want to get better. How do you do therapy?