Sessions: Standalone episodes, serial arcs, or some mix of the two?

I'm just curious as to how others generally do therapy. Do you work on the same topic/plot from one session to the next until you feel you're "done" with it, then move onto something else? Do you generally do that unless something pressing comes up in your life? Or is each session more self-contained, about a particular topic or topics that may not come up again? Or is it a mix of the two?

In my Monday session, a topic came up partway through that probably wasn't "finished." It could have easily been pursued more in today's session. But I had something else on my mind from some news I got Monday regarding my H needing (relatively minor) hip surgery, so I switched to that, and we focused on that and other topics that came out of that (including some recurring themes) for the rest of the session. I feel like that was what I needed to talk about today.

But then right at the end of session, I said how I knew there was more to discuss regarding my mom from last session, that maybe we could take that up next session, and he said OK.

I wonder if it would have been better if I'd just continued with that until I felt more "done" with it? Or if it made more sense to do what I did and discuss the topic most pressing on my mind at the moment (and that is also affecting my day-to-day life)? My T generally lets me lead sessions and choose the topic, which I like. Though I know other T's can be more directive (I imagine this would be the case with something like EMDR and maybe CBT or DBT, but not sure if it is in other types of therapy).

So just curious as to how others tend to handle it in their therapy? And if you think one way is better than the other, or if it depends on the circumstance?

I put sometimes continuing from last session, sometimes new topics each session.


Generally there is some discussion of how I am doing with SH. And recently there has been a lot of worry on my part about my niece who is struggling with anxiety/depression and we have spent a lot of time in therapy talking about that. T seems to do some sort of assessment on me every time like how I am sleeping? Am I taking anything for sleep? Am I using any substances? Etc We sort of take turns leading the session. Sometimes she leads sometimes I lead. If I have something pressing on my mind I will bring it up and we will talk about that even if I was talking about something important last session. I can always come back to that topic at a later date. That's how I do it.

I put other. Our sessions are both structured and free flowing. At the start we always do our check-in: feeling most present, safety, sleep, smoking, pain, and business or general updates. Then we continue a conversation, start on a new one, or just focus on connecting (games, questions, etc.). If we need to, we also do grounding exercises. Then the end is structured as well: reassurances, I love you's, hug, thank you's, wave goodbye.

I checked both the sessions change based on what is most important at the moment AND sometimes continuing sometimes new topics (seem more or less the same thing to me I guess).

We tended to go with what was most pressing in the moment which may or may not be a continuation - but often thematically, even if the topic is different, the basic theme was the same if that makes sense. I mean, let's face it, most of us are creatures of habit and no matter what is going on with us, we have patterns and habits that are thematic in our lives.

FYI: even when doing CBT, etc., this question still very much is relevant and applicable; we still made decisions about what to discuss based on whatever was going on. I never found our sessions particularly structured in some certain way. I've never done EMDR, but my sense of it is that even there, the client generally takes the lead in how that session is going to proceed.

The only therapy where I personally felt like the sessions were more therapist-driven and planned out were in group therapy which sort of makes sense when a therapist is negotiating multiple people at a time. They usually started with a plan for the session. But even then, the therapist might start in one place and then follow the trend in the group as discussion developed.

The majority if my sessions all involve EMDR but we do spend about 10-15 minutes at the start to check in with how I am feeling, any pressing issues, and a quick review of my DBT diary card. Mt T is very structured and does not usually allow "talking" throughout the entire session unless it includes some type of therapeautic intervention like CBT, etc.

I wouldn't say this always makes me happy but I have to admit I have made a ton of improvement.

Hi LT,

Thanks for the brilliant poll! R follows my lead. Sometimes it's a new topic per session (if something big has come up) other times sessions continue on from one another. This week we'll be returning to a recurring theme, after breaking last week to discuss a family member's health crisis and the fallout from that.

We normally talk about the same 3 issues and what has happened during the past week regarding those issues. And she is very strict about staying on topic. If like a current event went on sometimes we brefily will talk about it but again shes pretty strict about what we work on.

Clip shows and the same plot over and over again.

It was a clueless mishmash of pointless goo. Week after week.

I can't remember where I heard it laid out like this, maybe from my T or maybe somewhere else, but my order of priority for topics goes like this:

1) Any issues with my T or our relationship. If I'm upset with her (even if I'm hiding it well), the session won't be productive until I deal with that.

2) Any important present day topics, like something that's really bothering me or something I'd like her input on, problem-solving, etc. If I'm stressed, I'm probably not stable enough to want to delve into trauma work anyway.

3) Deeper themes, trauma work, childhood stuff. If the other two things are well-managed, I try to dig into the deepest, darkest recesses of my "stuff." These are my favorite sessions, but they only happen when I'm in a place to tolerate ruining my own day.

I've been re-watching Buffy lately, and it's kind of like a season of that. There is a "big bad" with a story arc that progresses through multiple episodes across the season, but there are also self-contained episodes where the main villain is mentioned only in passing or not at all.

Like a roundabout with 30 exits, a flyover, an underpass and a million traffic lights. That's how I feel the 'progress' or 'journey' of therapy has been for me. Bewildering, mind boggling and infuriating. I've been round and round and round in circles so much I'm surprised I haven't twisted myself in knots (or maybe I have, who knows!!) And even when I steadfastly wanted each session to be linear from one to the next and following a structured and definite plan, there was simply no chance of this happening, because yeah, stuff happens and in a way it's all connected. So sometimes you gotta hop off the roundabout and go under the underpass only to come up on the opposite side of the roundabout going in exactly the same direction (or even the opposite direction) you were going in before, with half an eye and one leg on the flyover at the same time!!!!

Most times it's different topics each week, though often they do have something to do with each other. We might discuss something in session, then I think about it more over the weekend and realize things about other experiences or other aspects of the same topic and we usually discuss that. We rarely talk about the same exact topic for two weeks in a row, usually this is requested by my T when we do.

My life isn't interesting enough to have a new topic to speak about every week. I regurgitate the same self-pitying introspection every week. Or, as others have more positively framed it, we work on things thematically and these themes are life long and woven through all aspects of my self. In that sense, topics are rarely "done".

I knew I'd left out a poll option!

Bit of both - sometimes I would continue an 'old' important topic, which I only started doing recently. I wish my T were more... interested in continuing some topics they *know* is central but I guess it is up to me to do so.

Sometimes new stuff comes up that takes precedence. I do wish sessions were longer (like 1.5 hours... minimum!), then maybe that would allow for theme-shifting!

for me it depends on the type of therapy. for example, right now my therapist and I are doing IFS together, In IFS you pick up where you left off on the last session.

it's a highly structured, but natural integration therapy for all kinds of problems and disorders, that has a specific way of starting a session, As the session progresses the topics needing covered are worked on in a structured way, the ending of that session again is done in a structured way so that the next session it is easy to pick up where the last one left off.

Wow, that sounds like something I could use, structure. Easy to start. Same way of ending sessions. I'll have to have a look at that.