Shrinking the Stigma

Who decides what we talk about?

Welcome to the blog of Roya Dedeaux, Marriage and Family Therapist. You are reading one of the posts in my “Shrinking the Stigma” series – where I will answer questions people have about the logistics and process of therapy. Because of its confidential nature, we tend to shroud the therapy process in so much mystery! My blog attempts to dispel that mystery and make it easier for you to use it as the wonderful resource it can be. Check out the other blog posts at

“Who decides what we talk about in therapy?”


The short answer to this question is: you. You decide what to talk about. The long answer? It depends…

As a therapist who has worked in private practice, clinic, and academic settings, I’ve seen a pattern for when an individual seeks out therapy. Usually, there is a catalyst of some kind – a fight, a loss, one panic attack too many. There is a specific *thing* that occurs that leads the individual to finding a therapist. When you first get to therapy, you get to say — “look, THIS is why I’m here. Let’s start with that.”

Your first few sessions with a new therapist might not be focused on that catalyst, though. Therapists have to get the whole picture of who you are. In clinic or medical settings they frequently have intake or assessment paperwork they are required to fill out which covers just about every potential issue under the sun. You might have gone to therapy because you are dealing with the loss of your best friend, and your therapist asks you questions about your alcohol use, if you have ever had a psychotic episode, or other topics that do not feel relevant.

You an ask about that. If the questions seem really far left-field, ask what they are for. In my private practice I have more leeway. I spend the first session mostly on what you bring up with short pauses for clarifications. I always tell my new clients right off the bat that the first session or two are big-picture information gathering. I ask my client to tell me what brings them to therapy, and let them know at the beginning that I may stop them to ask other questions. We might not dive into the really important/urgent things during our first day, but that I will note what seems critical and make sure we go back there.

One reason for this is that a therapist only has a relatively short time to gather information that first session, and also – you don’t have a therapeutic relationship yet! It’s hard to talk about deep, personal things with someone you’ve just met. Part of why I ask more directive questions the first session is to provide more structure for a new client. It feels safer that way. It also helps me make sure there aren’t any huge red flags that I should have spotted. I ask about substance use, trauma, or self-injury from the beginning so that I can take appropriate cautionary measures if I need to. Clients in my private practice are typically very open and honest – they sought me out! They know it behooves them to tell me everything. I have had, though, clients who tell me they don’t want to talk about something. I tuck that in the back of my mind, and we keep going.

Very often, the cataclysmic occasion that prompted therapy is not the real meat of what we will end up exploring. In delving into that issue, we uncover a lot more – things you might not have planned on talking about, or realized needed talking about. In a good therapeutic relationship, this comes from both the therapist and the client. The therapist helps point out patterns or makes connections to things you’ve said that may lead in a different or deeper direction, and the client does the same.

Sometimes I have an idea that during our session we are going to talk about a specific topic, say, the client’s relationship with their sister – but they come in with something that happened that week instead. In my modality, I go with what you bring in to the session. Mine will keep. Or, I will see a connection between the two and point out that pattern. I take my cue from you.

There are different treatment modes that  will determine some of this as well. The most extreme on this spectrum is client-centered, (sometimes called person-centered therapy). Many therapists incorporate aspects of this therapeutic model into their therapy. The idea is that I, as your therapist, am not the expert in your life, you are. I can help guide, be a resource, be a sounding board, and I can do that best by accepting you as exactly who you are and focus on the person sitting across from me in the room. That also translates into talking about what it is that you want to talk about.

…or not talk about. I have also had sessions where we sat in mostly silence. I’ve had sessions where we played cards or with clay, and did not do much speaking. I’ve had sessions where my client said, “I don’t want to talk about that” and I asked, “what’s that like, feeling unable to speak about it?” and we talk about it without talking about it.

You get to decide what you talk about in therapy. Find a therapist who’s opinion you value, and who you trust to lead you down into foreign territory, but all the material and content really comes from you.

“What if I don’t like my therapist? How do I find a good one?” Look for answers to these questions and more in other blog posts here at!

Roya Dedeaux is an Marriage and Family Therapist with a private practice in Los Alamitos, California. She works with children, teens, adults, families and couples to help everyone express themselves better and lead more congruent lives. She specializes in working with individuals who feel like they don’t quite “fit the mold,” and helping them reduce the barriers to accomplishing their goals. To make an intake appointment, call (657)464-ROYA or email

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