[Merope]

How do you start a session? When I go to therapy, it goes something like this:

I go in, sit down, ask him something banal about his week and then...SILENCE. I panic and feel an immediate need to fill the silence by saying something--ANYTHING. Sometimes I prepare things I want to talk about in advance, but when I'm there I feel like they are stupid and I find it hard to just plunge straight into something deep. "Oh yes, the weather has been lovely, your car looks different, btw did I ever tell you about that time I [insert deep problem here]. My T isn't the small talk type...he's more the "i'll keep silent and give you space to choose what you want to talk about", which I appreciate but I also find quite hard. Sometimes I wish he would take control a little more. I kind of wish he'd ask me anything and not worry about how I'll react. I'm just not used to having control, I feel like whatever I choose will bore him. He doesn't take notes as often as he used to, which makes me feel self-conscious about the topics I bring into the room.

Of course, I should probably tell him all of this, but I can't quite bring myself to at the moment. I haven't been feeling like myself lately and I seem to have retreated in an extremely self-conscious and vulnerable space. I worry about being a burden to him and boring him and playing the victim. I'm scared he secretly thinks I'm seeking attention for being in therapy. I know, on some level, that this is my anxiety speaking, but I can't switch it off.

So I guess what I'm asking is if you guys have any tips on making the start of sessions less awkward? Just until I get the guts to be a little more open with him and bring this up? I definitely will, I just can't do it right now.

Thank you in advance.

[WarmFuzzySocks]

Hugs Merope.

We almost always start with small talk, unless I start dripping water from my eyes the second the door closes. I think my t does that naturally anyway to ease in and out, but I did at one point let her know that it's helpful. When you're ready, I wonder if it might help to approach it with him as problem-solving together: I'm finding that the silence in the beginning makes it difficult for me to transition. Do you have any suggestions/could we spend a few minutes in small talk before transitioning?


Mine rarely takes notes any more. I think it's just because we have an established relationship so she doesn't really need to.

[zoiecat]

Does your T do psychoanalysis? Your description reminded me of that modality.

Keep in mind my T is goal oriented and never allows me to just talk about whatever I feel like unless I am having an extreme stressor at the time. Even then he will steer the session toward skills and treatment plans such as CBT or EMDR to lessen the pain of the current situation. All of my sessions start exactly the same way. He gets me from the waiting room and I walk in and sit down. He immediately asks me how I am feeling. I say OK or horrible usually. If I say "horrible" or "better" he will ask what is making it that way. If I say OK he will ask what has been going on since the last session. By this, he doesn't really mean everyday life stuff. He is looking for ways I have used skills to deal with situations or what I have done toward my goals that are positive. If I start griping about someone or something he will stop me and say I hear you saying that this is horrible but what emotions does it bring up. He then steers the session into how to improve and deal with the situation using skills. If I ever start rambling about small stuff he will stop me and ask what I want to work on today, he usually gives suggestions such as EMDR or reframing about one of my traumas. He says people that just want to chit chat about everyday life are using therapy for support and it would not be ethical for him to allow that. Everything has to be moving toward a goal and improvement of my PTSD and depression.

Since your T seems to let you lead the session, why not bring up your concern and say you would really like for him to lead more. If you can't bring yourself to say it out loud, try writing it out and handing it to him at the start of session. I do that many times when I feel I can't express something in words. Although my T is strict, I really am glad that he doesn't leave everything up to me and pushes me for improvement. He knows I have a LONG way to go and progress will be slow. It is a love/hate relationship at times.

You may

When she calls (we live in different countries) i ask her how shes been doing and whats new with her. She asks how work is and things like that. Then we get into deep stuff

[ArtleyWilkins]

Because serious depression was such a factor for me, we tended to start with a check on my mood levels, sleep, anxiety, etc. We had sort of developed a number system that was personalized that really was an effective way of cutting to the chase. Often, by starting with this check in, it got us right to what we needed to focus on.

[Mopey]

I had a sort of agreement with my therapist that I would start off babbling and eventually would get to some point or other that I needed to discuss. But she wouldn't just sit there coldly. She was actively listening and that encouraged me, because I really felt that she cared. Eventually she might ask me a question or make a remark if it seemed appropriate, but the main thing on her part was a projection of receptiveness. That would gradually calm me down so I could get to the hard stuff.

[Omers]

T comes out to get me and says hi. Sometimes he has to grab something while he is out of his office and sends me in before him. Other times he flies right back into his office which is usually my first clue he has something new in mind to try. When I get into his office I have to tell him how I have been feeling emotionally and what I am needing from session. He usually asks where I want to sit (he sits in different places depending on where I sit). Then he lets me know if he has any distractions because I pick up on them and trigger if we don’t just put it out there. A few times he has mentioned something that parallels my own stuff that week or brings up stuff for me and then we just go with it.
Lately I have been doing art projects during the week between sessions to help me tell T stuff and let him in more. I have a list right now of things I need to talk to him about that we haven’t gotten to do currently silence isn’t an issue. If I don’t have something then T will look at my need and start guiding the session from that need... which usually works. I have learned that some words have very different meanings for him than they do for me so I am cautious with those. If T has a blog post on that word/need use with caution! Lol.

[nottrustin]

It really depends. Usually it starts with both of is asking how the other is doing. Sometimes I will delve into something that has happened and we will discuss it. Other times Oi eill get quiet and I think she recognizes my facial expressions and she will ask me questions to get a conversation startee.

[~Christina]

My T works through a company and before each session he has to ask questions like .. since you were here last do you wish you were dead or not wake up .. do you want to check out , do you have a plan etc etc. each answer can lead to a new question..

I find it annoying but it’s a tool the company uses to help catch people, depending on the answers you can be put on the “ Pathway” its a piece of paper that is basically a safety contract and crisis plan... I’m on this Pathway more often than not, I complain about poor trees dying because anytime I “ qualify” I have to sign a new one. We both agree we should just laminate one.

But based off those handful of questions is how we start. If I wished I had died in my sleep since last session well that’s were we start.

So there’s never any awkward moments , which I’m grateful for

[Merope]

Originally Posted by WarmFuzzySocks

Hugs Merope.

We almost always start with small talk, unless I start dripping water from my eyes the second the door closes. I think my t does that naturally anyway to ease in and out, but I did at one point let her know that it's helpful. When you're ready, I wonder if it might help to approach it with him as problem-solving together: I'm finding that the silence in the beginning makes it difficult for me to transition. Do you have any suggestions/could we spend a few minutes in small talk before transitioning?


Mine rarely takes notes any more. I think it's just because we have an established relationship so she doesn't really need to.

Thank you for this. It definitely feels more natural to start with small talk....but i just end up overthinking that too. Do I talk about the weather? About his new jumper? I love therapy, but it's such a weird relationship.

I like your point about notes...I guess he knows me enough by now not to write down everything.

[Merope]

Originally Posted by zoiecat

Does your T do psychoanalysis? Your description reminded me of that modality.

Keep in mind my T is goal oriented and never allows me to just talk about whatever I feel like unless I am having an extreme stressor at the time. Even then he will steer the session toward skills and treatment plans such as CBT or EMDR to lessen the pain of the current situation. All of my sessions start exactly the same way. He gets me from the waiting room and I walk in and sit down. He immediately asks me how I am feeling. I say OK or horrible usually. If I say "horrible" or "better" he will ask what is making it that way. If I say OK he will ask what has been going on since the last session. By this, he doesn't really mean everyday life stuff. He is looking for ways I have used skills to deal with situations or what I have done toward my goals that are positive. If I start griping about someone or something he will stop me and say I hear you saying that this is horrible but what emotions does it bring up. He then steers the session into how to improve and deal with the situation using skills. If I ever start rambling about small stuff he will stop me and ask what I want to work on today, he usually gives suggestions such as EMDR or reframing about one of my traumas. He says people that just want to chit chat about everyday life are using therapy for support and it would not be ethical for him to allow that. Everything has to be moving toward a goal and improvement of my PTSD and depression.

Since your T seems to let you lead the session, why not bring up your concern and say you would really like for him to lead more. If you can't bring yourself to say it out loud, try writing it out and handing it to him at the start of session. I do that many times when I feel I can't express something in words. Although my T is strict, I really am glad that he doesn't leave everything up to me and pushes me for improvement. He knows I have a LONG way to go and progress will be slow. It is a love/hate relationship at times.

You may

Thank you for this. We started out doing CBT, but after a while he changed tactic. I'm not sure what we do now, but it feels a lot more relationship-focused. He's an integrative therapist, so I guess he uses bits of different approaches.

I like that your T asks how you are feeling/doing. Mine doesn't. I guess if he did I'd be compelled to say "fine thanks" like i do in real life and would defy the purpose of therapy.

I'll bring it up with him at some point. I don't think I can write it down and hand it to him though. No idea why, but the thought makes me feel uncomfortable.

[Merope]

Originally Posted by ~Christina

My T works through a company and before each session he has to ask questions like .. since you were here last do you wish you were dead or not wake up .. do you want to check out , do you have a plan etc etc. each answer can lead to a new question..

I find it annoying but it’s a tool the company uses to help catch people, depending on the answers you can be put on the “ Pathway” its a piece of paper that is basically a safety contract and crisis plan... I’m on this Pathway more often than not, I complain about poor trees dying because anytime I “ qualify” I have to sign a new one. We both agree we should just laminate one.

But based off those handful of questions is how we start. If I wished I had died in my sleep since last session well that’s were we start.

So there’s never any awkward moments , which I’m grateful for

That's really interesting, thank you. I didn't know companies could get involved in the structure of sessions like that. i guess it wouldn't leave much space for awkward silences or small talk. I'm glad this works for you.

[TeaVicar?]

Mine doesn't do small talk either and I've learned just to dive in. If it's something I'm avoiding or difficult, I might talk about something else a bit more mundane first. Sometimes you've just got to dive in... you're paying by the hour after all.

[LonesomeTonight]

We generally start with small talk as well. It might be something about the weather, me (during football season) commenting on how the team I follow and/or my fantasy team did over the weekend, me sharing something that happened with D that morning, talking about his fish, T telling me something, any number of things. T will often ask how I'm doing. I tend to be more honest in there about how I'm actually doing. There are times that we start right in with something, particularly if I'd emailed him or if there was a "to be continued" ending to the previous session. But most of the time, it's more small talk at the start. I find it helps me ease into things and work toward more difficult content. Like reaffirming the connection.

None of the T's (including my former marriage counselor) I've seen, even going back like 15 years, ever just started the session with silence and waiting for me to begin. That would drive me crazy. I mean, I know in some forms of therapy, it might be part of "the frame," but it would just feel odd and uncomfortable to me. I would want at least a "How are you doing?" or "How was your weekend?" or something to help get the dialogue going. My T will also generally say "Hello" or "Hey" when I walk past him when he gets me from the waiting room. I guess ex-T never said anything to me until I went back to her office, though ex-MC would generally say something before we got back there.

[nottrustin]

Originally Posted by TeaVicar?

Mine doesn't do small talk either and I've learned just to dive in. If it's something I'm avoiding or difficult, I might talk about something else a bit more mundane first. Sometimes you've just got to dive in... you're paying by the hour after all.

With me both my Ts realized I need a bit of small talk. I can't go in and dive right in. I need the small talk to warm up and get comfortable. Sometimes it can take me a while. Sometimes it requires her to talk small talk about her life. Fortunately I am her last appointment of the day and we always go over our hour schedule. Usually , we go at least 15 minutes late

[SlumberKitty]

We usually start with a bit of small talk as well, and then the question T asks is "how have you been feeling?" or something like that and then we get on topic. With Pastor T, there's very little, if any small talk. We usually start out with the homework from last week.