Business First: Take care of payment, scheduling and insurance questions at the start of the session. Nothing's more awkward than ending a session with a big revelation or emotional breakthrough followed by three minutes of check writing and calendar navigation. Get all those logistical issues out of the way at the beginning.
Forget the Clock: Show up early, but let the therapist be in charge of ending the session on time. You've got enough to think about during the session, the therapist can be responsible for wrapping up.
Make it Part of Your Life: Therapy works best when you take what you've learned and apply it to the rest of your week. Between sessions, notice areas in your life you'd like to explore. Maybe you'd find it helpful to engage in…
Relationship Next: Following those business items, issues regarding the relationship with your therapist (if there are any) come next. This could be anything - you're thinking about termination, you felt angry after the last session, you're worried what she thinks of you, you had a dream about her, etc. These relationship issues take top priority because they will impact all other areas of your therapy.
Say the Odd Thought: Therapy is one place where strange thoughts are acceptable. In fact, the odder the better. Have a sudden impulse? Say it. Flash to a certain memory? Talk about it. The phrase some things are better left unsaid doesn't apply here so speak freely and you might learn something interesting.
What do I Want? How do I Feel? These two questions are home base for clients who feel stuck. If you find yourself lost and don't know what to talk about, revisit these questions and you're bound to find material to discuss.
Go Deeper: If you find yourself running through mundane details of your week or hitting awkward silences, maybe there's a deeper issue you're avoiding. Ask what it is you're not talking about and talk about it. Discuss what you're discovering about yourself. Take the time to explore who you are, what you feel and why you do what you do. Push beyond it is what it is or whatever and tackle some deeper questions. Try: "I wonder why I ___" or: "Deep down, I really feel ___".
Don't Fear the End: From the beginning, talk about when you'll know you're ready to leave therapy. Rather than cut and run, let therapy be one experience of a truly good ending. All good endings help heal prior bad endings…and help you to create better endings in the future!
*Borrowed from Ryan Howes, 2010