Six Things People Talk About in Therapy

If you’re like most people, you are curious what other folks talk about during their one near-hour of undivided attention per week, either because you’ve never been to therapy, or because you wonder if you’re “doing it right” or missing out on anything.  Many of my clients are talking about anxiety and/or depression.  Behold a sampling of greatest hits beyond/underlying that:

1. Sex. Haha, kidding, people don’t talk about this unless asked. A lot. Not across the board; I do have clients who were raised more sex-positively, are very extraverted, and/or are therapy veterans who have come to trust that therapy really is a place to talk about anything (and they will talk about sex until they’re blue in the face). But otherwise, it’s something that many folks fear to broach, especially those who feel awkward about or intimidated by unmet sexual desires, both women and men. I see a fair number of clients who are experiencing libido or performance issues in part because of years of repression and internalized shame. People can be understandably reticent to unearth these things, but those who do often experience life-changing shifts.  If your therapist isn’t comfortable talking about sex, find one who is, or get a referral to a certified sex therapist for specific concerns while you continue to see your primary clinician.

2. Money. Again, kidding; despite its primacy in our lives, this is also often a no unless asked. Which can be particularly tricky if there is a significant real or perceived difference in SES between client and therapist. Research suggests that similarity of SES is a strong factor impacting the success of the therapy relationship. People don’t want to feel that their clinician has too much or too little money to relate to them.  But since we know money is funny and can fuck with our heads, it’s vitally important to introduce it into the mental health conversation. And remember, therapists are professionally trained and ethically obligated to withstand awkward moments in pursuit of therapeutic gains! (And nothing ventured, nothing gained.)

3. Relationships. Clients spend more therapy minutes on relationships than anything else. Even people who are exceptionally career-oriented want space to explore talking about loving and being loved. (Rarely, this comes about only through pressure; their fed-up spouses, children, etc. demand that they pay attention or else.) Clients who are single by choice may talk about friendships, siblings (for most of us, the single longest relationship of our lives), or how to navigate the changing relationship to parents as we age. People discuss loved ones and pets who are deceased as well. As my very wise former supervisor Richard Dunn, LMFT once told me, “Death ends a life, not a relationship.”

Since I see many folks in their 30s and 40s, how to make friends in adulthood is also a frequent topic. What may have been a  passive process when we lived in the dorms and/or relied on super-social coworkers to just invite us out should eventually become an intentional, active, reciprocal practice (especially if you WFH). Knowing how to pick and make and be a good friend supports agency and healthy self-esteem as well as making for more satisfying and durable friendships.

4. Self. The relationship to oneself, identity, self-esteem, the narrative we create around the events of our lives… All classic therapy material. And the exploration of self can be as thinky or feely or abstract or practical as desired. In general I’m a more present-focused therapist, but that doesn’t mean it isn’t sometimes highly practical to talk about our earliest memories, or the first time we remember being embarrassed to receive a compliment, or what we thought marriage would be like when we were twelve. In general, I think of the self at three levels: innate temperament, our circumstances and coping skills, and the mindset we've adopted. The latter two we can change; the former is to be accepted.

5. Values clarification. People usually don’t announce, “Hey, I wanna work on values clarification.” Often the need presents as ambivalence around priorities: should I be more ambitious in my career or less, expect more from my romantic partner or less, be more flexible as a parent or less? While a therapist will never tell you what to do and who to be (if they do, run), therapy can help weigh the pros and cons of various choices. Often this is happening for the very first time with my clients in their 20s, but for some late bloomers, it’s new beyond that. Otherwise, transitions throughout the lifespan make it worthwhile to revisit values and priorities as often as necessary: marriage, moving, aging, births, deaths, career change, major illness, pandemic, elections… many changes can catalyze a rethink that makes life work better.

6. Goal-setting. Once we clarify values, we set goals based on them, either informally or formally (as in SMART goals). On a concrete level, people generally want to swipe, scroll, drink, and emotionally eat less and exercise, meditate, read, and spend quality face-to-face time with loved ones more.  But we can’t do it all (er, I think I was doing “it all” for like five seconds once?). So often it takes deep looks at what we’re actually willing to sacrifice in order to sustain change, and radical acceptance that not everything can be highest priority. On a more subtle level, we may develop goals around how to be the kind of partner, friend, or parent we want to be, how to talk to people who have different points of view, or how to behave ethically in a world in climate crisis…  If it’s on your mind, we can break things down and identify opportunities for growth.

Other common therapy topics include body image, agita around birthdays/holidays/family visits, compulsive behaviors like overspending, porn misuse, and lying, sexual orientation questioning, and trauma, including bullying and neglect.

What do you wish you’d brought up in therapy but haven’t yet?