What To Talk About In Therapy: What Stays Private

The short answer to what to talk about in therapy: whatever took up the most room in your head since your last session. It can be small. It can be embarrassing. You don’t need a list, and you don’t need a crisis.

But “you can say anything” is only half the answer. A 2016 study by Blanchard and Farber in Counselling Psychology Quarterly surveyed 547 adults in therapy, and 93% admitted they’d lied to their therapist at least once. People hold back for reasons. Fear of what happens next is one of the biggest.

What to Talk About in Therapy

What to talk about in therapy is whatever is affecting how you feel, think, act or connect with people right now: a hard week, a pattern you keep repeating, a relationship, a memory, a fear, or the therapy itself. No topic is too small. Your therapist uses what you bring to set goals and track progress.

If you’re stuck, start with one of these:

• The moment this week you felt worst, and what happened right before it
• A fight or conversation you keep replaying
• Something you did that surprised you, good or bad
• A memory that showed up out of nowhere
• A decision you keep putting off
• How therapy is going, including what isn’t helping

People hide that last one more than you’d think. In the same 2016 study, 72.6% of clients had been dishonest about at least one therapy-related topic, such as pretending therapy was helping. That costs you. A 2018 review in the journal Psychotherapy pooled 295 studies covering more than 30,000 patients and found that the working relationship between client and therapist is tied to better results. Telling your therapist what isn’t working is how you build that relationship.

What Should You Say in Your First Session?

Say why you’re coming now, what you want to be different, and what worries you about therapy. Privacy counts as a worry, so ask about it.

You won’t carry the session alone. Your therapist will ask most of the questions. Across our therapy services, first sessions are usually available within the same week, and individual sessions usually run 50 minutes. The limits of confidentiality under Florida law are explained in writing at intake.

That’s also an ethics rule. The American Psychological Association’s Ethics Code, Standard 4.02, has psychologists discuss the limits of confidentiality at the start of the relationship. So ask it out loud: “What would you have to report?” A good therapist will answer in plain words.

Bring 3 things: the reason you called, a recent example, and anything you’ve tried that didn’t help. If this is your first time with a psychologist, read what to expect when seeing a clinical psychologist.

What If You Have Nothing to Talk About?

Say so. “I don’t know what to talk about today” is a real opening, and therapists are trained to work with it.

A blank week usually points to one of 3 things. Life got better, and it’s worth studying what changed. You’re steering around something hard. Or you’re close to a natural pause in therapy.

Try one of these openers: what went better than expected, the thing you almost mentioned last time, or what you’d want to be different 6 months from now. If blank weeks pile up for a month, say that too. It may mean you’ve met your goals.

Why People Hold Back in Therapy

Shame is one reason. Fear of consequences is the other, and standard advice tends to skip it.

Blanchard and Farber’s 2016 survey found that 31% of clients had misled their therapist about suicidal thoughts at least once. A Columbia University study by the same lead researcher asked 107 clients who had hidden suicidal thoughts why they did it. Their top fear was involuntary hospitalization. Nearly half said they’d be more honest only if that threat felt reduced or under control.

The study concluded that people need clear, complete explanations of what triggers hospitalization and what else can follow a disclosure. I agree. A rule you can read is easier to trust than a promise.

What Stays Private in Florida Therapy

Nearly everything. Florida law makes what you tell a psychologist, licensed clinical social worker, marriage and family therapist or mental health counselor confidential, with a short list of exceptions.

The table shows what happens to what you say, by Florida statute.

What you say in therapy	What a Florida therapist does	Florida law
Feelings, fears, sex, drug use, affairs, past mistakes, thoughts you’re ashamed of	Keeps it confidential	ss. 490.0147, 491.0147
Suicidal thoughts	Asks about your plans and safety. An involuntary exam requires a 2-part legal test	s. 394.463
A specific threat to seriously injure or kill an identified or readily available person, with apparent intent and ability to act right away	Must report it to law enforcement and may warn the person at risk	ss. 490.0147, 491.0147
Known or suspected abuse, abandonment or neglect of a child	Reports it to the central abuse hotline immediately	s. 39.201
Known or suspected abuse, neglect or exploitation of a vulnerable adult	Reports it to the central abuse hotline immediately	s. 415.1034
Your mental health is part of your own claim, such as an emotional injury lawsuit	Records tied to that condition can lose their protection	s. 90.503(4)(c)
Anything said in a court-ordered evaluation	Not private from the court	s. 90.503(4)(b)
Court-ordered therapy	Reports what the order requires, such as attendance and progress	Your court order
You sign a written release	Shares only what the release allows	ss. 490.0147, 491.0147

Will my therapist Baker Act me?

Saying a suicidal thought out loud doesn’t meet the legal test by itself. Florida requires 2 things before an involuntary exam.

Under Florida’s Baker Act, section 394.463, both parts must be true. First, the person refuses a voluntary exam after it’s explained, or can’t decide whether they need one. Second, without care there’s a substantial likelihood of serious bodily harm to themselves or others in the near future, shown by recent behavior. Serious harm from self-neglect can also count. A therapist can start an exam with a certificate after seeing you within the past 48 hours, and the exam can last up to 72 hours.

Now look at who starts them. In fiscal year 2023-2024, Florida recorded 161,576 involuntary exams for 107,560 people, according to the University of South Florida’s Baker Act Reporting Center. Law enforcement started 52% of them. Health professionals started 45%, mostly physicians. Mental health counselors, clinical social workers, marriage and family therapists and psychologists started about 1 in 10 exams statewide.

Those numbers describe who starts exams, not your personal risk. My advice is still to say the thought. Your therapist will ask about plans, means and safety, and that conversation is part of treatment. If you’re in crisis right now, call or text 988 to reach the Suicide and Crisis Lifeline, or call 911.

Threats, abuse and mandatory reports

Florida requires a therapist to report in 3 situations: a specific, imminent threat to seriously hurt someone, suspected child abuse, and suspected abuse of a vulnerable adult.

Since 2019, section 490.0147 has required psychologists to report to law enforcement in a specific situation. A client makes a specific threat to seriously injure or kill an identified or readily available person. The psychologist judges that the client has the apparent intent and ability to act right away. Section 491.0147 applies the same rule to licensed clinical social workers, marriage and family therapists and mental health counselors. The therapist may also warn the person at risk. The law enforcement agency that gets the report must act to prevent harm, such as by warning the intended victim or seeking a risk protection order.

Older summaries online still call this optional. It isn’t anymore. The law targets a specific threat with apparent intent and ability. Angry venting with no plan or intent is a normal part of therapy.

Abuse works differently. Section 39.201 requires anyone who knows or has reasonable cause to suspect that a child is being abused, abandoned or neglected to report it to the central abuse hotline immediately. Section 415.1034 puts the same duty on mental health professionals when the person at risk is a vulnerable adult, such as an older adult who can no longer protect themselves.

Can therapy records end up in court?

Florida gives you a privilege over what you say in therapy, your records, your diagnosis and the advice you get. Section 90.503 lists 3 exceptions.

The privilege doesn’t apply in proceedings to hospitalize you, in court-ordered exams, or when you rely on your mental or emotional condition as part of your own claim or defense, such as an emotional injury lawsuit. If you’re in a divorce or custody case, read about therapy during court cases before you decide to wait.

Court-ordered work runs on different rules. Nothing you say in a court-ordered evaluation is private from the court. In court-ordered therapy, the order sets what gets reported. At FC PsychExperts, that means dated attendance records, a progress or treatment summary, and a completion letter. We don’t report anything your order and your signed release don’t cover, and we tell you in writing what gets reported before you begin.

How to Bring Up Something Hard

Say the fear before the thing. “There’s something I want to tell you, and I’m nervous about it” gives your therapist a way in.

Other openers that work:

• “Before I say this, what would you have to report?”
• “I’m not ready to talk about it, but I want you to know it exists.”
• “I’ve been telling you things are fine. They aren’t.”
• “I want to talk about how therapy is going.”

Raise it in the first 10 minutes so there’s time to work with it. If saying it feels impossible, type it on your phone and read it out. If you’re part of a court case, it’s fair to ask how sessions are documented.

When to Switch Therapists or Stop

Switch when you still can’t say what’s true in the room after a fair try. Stop when you’ve met your goals and blank weeks keep stacking up.

Leaving early is common. A 2012 meta-analysis in the Journal of Consulting and Clinical Psychology covered 669 studies and 83,834 clients and found that about 1 in 5 adults, 19.7%, dropped out of therapy early.

Say it out loud before you go. In the 2016 study, the most extreme dishonesty involved hiding romantic or sexual feelings toward the therapist and not admitting a wish to end therapy. Your therapist can’t fix a fit problem they don’t know about. If you’re unsure whether you need a counselor or psychologist, ask during a free call before you commit.

Stopping doesn’t have to be sudden. You can move from weekly sessions to every other week and see how it feels.

Book a Session in Jupiter or by Video

Therapy at FC PsychExperts is available in person at 210 Jupiter Lakes Blvd in Jupiter or by secure video anywhere in Florida, and first sessions are usually available within the same week.

Therapy cases are led by Jessica T. Aloise, LCSW, who has more than 20 years of practice, and I direct clinical care. Start with a free 15-minute call, where our office matches you to the right service, confirms fees and sets a first session. You can contact our team online or call (561) 834-5849, and you can see how individual therapy in Jupiter works before you book.

If you’re still not sure what to talk about in therapy, say exactly that in your first session. It’s a good place to start.

Frequently Asked Questions

How do I decide what to talk about in therapy each week?

Start with the moment that hit you hardest since your last session, then say what happened right before it. If nothing stands out, talk about how therapy is going. Individual sessions at FC PsychExperts usually run 50 minutes, so a solid starting point is enough.

What to talk about in therapy when nothing feels wrong?

Talk about what’s working so you can keep doing it on purpose. You can also set a new goal or discuss moving to every other week. About 1 in 5 adults leave therapy early, according to a 2012 meta-analysis of 669 studies. Naming a lull lets you and your therapist plan the next step together.

Is there anything you can’t tell a therapist?

You can tell a therapist anything, and nearly all of it stays confidential under Florida law. The exceptions are a specific, imminent threat to seriously hurt someone, suspected abuse of a child or vulnerable adult, a risk that meets the Baker Act test, and certain court situations. In a 2016 survey, 93% of 547 therapy clients admitted lying to their therapist at least once, so knowing these limits can make honesty easier.

What does a therapist have to report in Florida?

Since 2019, Florida therapists must report to law enforcement when a client makes a specific threat to seriously injure or kill an identified or readily available person and appears to have the intent and ability to act right away. They must also report known or suspected child abuse, and suspected abuse of a vulnerable adult, to the central abuse hotline immediately. These duties come from sections 490.0147, 491.0147, 39.201 and 415.1034 of the Florida Statutes.

Will I be Baker Acted if I tell my therapist I’m suicidal?

Saying the thought alone doesn’t meet Florida’s legal test. The Baker Act requires that a person refuse a voluntary exam or be unable to decide, and that there be a substantial likelihood of serious harm in the near future shown by recent behavior. In fiscal year 2023-2024, counselors, social workers, marriage and family therapists and psychologists started about 1 in 10 of Florida’s 161,576 involuntary exams. If you’re in crisis now, call or text 988.

Can my therapy records be used in a custody case?

They’re protected by default, because Florida’s psychotherapist-patient privilege in section 90.503 covers what you say, your records, your diagnosis and the advice you get. The privilege has 3 exceptions: hospitalization proceedings, court-ordered exams, and cases where you rely on your own mental or emotional condition as part of a claim or defense. Anything you say in a court-ordered evaluation is not private from the court.