Unpacking Your Thoughts: What to Discuss in Therapy

When considering what to discuss in therapy, it helps to know that the space is open for anything affecting your well-being. Common topics include:

• Present feelings and emotions: Anxiety, stress, homesickness, joy, frustration.
• Relationships and social connections: Family dynamics, partner issues, friendships, loneliness.
• Recurring patterns and habits: Procrastination, people-pleasing, self-sabotage, coping mechanisms.
• Past experiences and traumas: Childhood, grief, significant life events.
• Life challenges and transitions: Career changes, personal growth, difficult decisions.
• Self-esteem and self-talk: Negative inner critic, confidence, self-image.
• Unspoken or sensitive topics: Shame, guilt, fears, internal conflicts.
• Your experience of therapy itself: Feelings about your therapist, progress, or discomfort.

Starting therapy is a significant step towards understanding yourself better, especially when you are an expat building a new life in Barcelona, Valencia, or Madrid. It’s natural to feel a bit unsure about where to begin or what is “appropriate” to bring up. Many people wonder if their problems are “big enough” or if certain thoughts are too personal.

But therapy is a unique and confidential space designed for exploration, healing, and self-discovery. It’s a place where even a minor annoyance can reveal deeper emotional patterns, and where simply naming your uncertainty about what to discuss can be a valuable starting point. This guide offers proven ways to help you identify meaningful topics, making your sessions more focussed and effective.

7 Proven Ways to Decide What to Discuss in Therapy

This section will break down seven key areas of your life that can provide rich material for therapeutic exploration. These are starting points to help you tune into what matters most to you right now.

1. Start with Your Present Feelings and Emotions

When you first sit down with your therapist, perhaps in a comfortable office in Barcelona or online from your home in Sevilla, it’s completely fine to simply start with how you are feeling in that very moment. Your current mood, whether it’s anxiety, stress, frustration, or even an unexpected sense of joy, is always a valid starting point for what to discuss in therapy.

Many expats, for instance, experience homesickness, a complex emotion that can manifest as sadness, irritability, or a lack of motivation. These feelings, and the physical sensations that often accompany them – a knot in your stomach, a tightness in your chest – are crucial clues to your inner world. Your therapist can help you explore what triggers these emotions and how you typically react to them. Naming your emotions, even if they feel messy or confusing, is the first step towards understanding them.

For example, if you are feeling overwhelmed by the demands of expat life, perhaps struggling with cultural adjustment or the language barrier, articulating this can lead to strategies for emotional regulation. Therapy offers a unique opportunity to express your feelings in a safe environment, acknowledge them without judgment, and learn relaxation techniques such as deep breathing or progressive muscle relaxation. This process, often explored in individual therapy, allows you to develop healthier coping mechanisms and fosters a deeper connection with yourself.

2. Examine Your Relationships and Social Connections

Our relationships are often a mirror reflecting our inner lives, and they frequently become central to what to discuss in therapy. Whether it’s the dynamics with your family back home, challenges with a partner, forming new friendships in a foreign city like Málaga, or even workplace interactions, these connections significantly impact your mental well-being.

You might find yourself struggling with communication patterns, setting boundaries, or feeling lonely despite being surrounded by people. Expats, in particular, often face unique challenges in forming new social circles and maintaining existing relationships across distances and cultures. Perhaps you’re in an intercultural relationship, and understanding each other’s backgrounds feels like a constant negotiation. These are all incredibly relevant topics for discussion.

Therapy provides a space to explore these interpersonal dynamics, understand your role within them, and develop more effective communication and listening skills. For couples, couples counselling can help moderate conversations and facilitate active listening, changing cycles of anger due to bad communication into understanding. The goal isn’t just to solve immediate conflicts, but to cultivate empathy and build stronger, more fulfilling connections.

3. Look at Recurring Patterns and Unhelpful Habits

Have you ever found yourself doing the same thing repeatedly, even when you know it’s not serving you? This could be procrastination, people-pleasing, avoidance, or even self-sabotage in your career or personal life. These recurring patterns and unhelpful habits are excellent material for what to discuss in therapy.

Many of these habits are linked to deeper issues like negative self-talk or low self-esteem. For instance, constantly telling yourself you’re not good enough can lead to avoidance behaviours, preventing you from pursuing opportunities. Therapy helps you understand why certain habits are more challenging to break. It allows you to develop strategies and tools so you can make real change. Research shows that forming habits is key to lasting behaviour modification. Simply put, it’s easier to change your ways when you have support and accountability – both things that therapy provides.

In therapy, you can learn about the patterns and thoughts that lead to negative self-talk, and find coping tools to rebuild confidence and self-compassion. This process involves replacing unhealthy inner dialogue with kinder self-talk, which can ease feelings of being down, reduce feelings of anxiety, and improve overall mental health. Exploring these habits in a safe space allows you to understand the “why” behind your behaviours, develop healthy coping mechanisms, and ultimately create more positive patterns. This is a core part of the work covered by our services, customised to your unique needs.

4. Reflect on Your Past and How It Shapes Your Present

The past is never truly past; it lives within us, shaping our present thoughts, behaviours, and emotional responses. Exploring your past is a powerful way to understand what to discuss in therapy. This doesn’t mean dwelling on old wounds, but rather understanding how childhood experiences, past relationships, significant life events, grief, loss, or even trauma continue to influence you today.

Perhaps there are “sticky” memories that resurface, or unresolved issues from your upbringing that manifest as current fears or triggers. For example, a painful breakup from years ago might still affect your ability to trust in new relationships, or unresolved childhood experiences might contribute to current feelings of anxiety. Leigh Matthews, founder of Therapy in Barcelona and an Australian Psychologist with over 20 years of experience, often sees how past experiences, especially those related to cultural transitions, impact expats. As an expat herself, Leigh profoundly understands these challenges.

Therapy offers a safe and controlled environment to process these memories and experiences at your own pace. As Emily Maynard, MA, LMFT, advises, it’s about talking about things that still feel ‘sticky’ in your mind or disturbing in your body. This processing can lead to profound healing and help you break free from patterns that no longer serve you. This exploration is particularly vital in adolescent therapy, where formative experiences heavily influence future development, but it’s equally transformative for adults seeking to heal and grow.

5. Consider Your Goals and What You Want for Your Future

Sometimes, the most significant topic for what to discuss in therapy isn’t a problem, but a question: “What do I want for my future?” If you are feeling stuck, uncertain about your career direction, or managing major life transitions, therapy is the perfect place to explore these questions.

Many expats find themselves redefining their identity and purpose while living abroad, which can be both exciting and disorienting. Therapy can help you clarify your values, make difficult decisions without guilt or doubt, and reignite your sense of purpose. A meta-analysis of personalised treatment goals in psychotherapy highlights the importance of setting clear, individualised goals to make therapy effective.

Whether you’re pondering a career change, striving for personal growth, or simply seeking more meaning in your daily life in Zaragoza, your therapist can provide support and guidance. They won’t tell you what to do, but rather help you explore your options and align your choices with your authentic self. This collaborative process empowers you to take actionable steps towards the future you envision, changing feelings of being stuck into a clear path forward.

6. Acknowledge What’s Hard to Say Out Loud

There are always things we hold back, often due to shame, guilt, embarrassment, or deep-seated fears. These unspoken thoughts, internal conflicts, or “secrets” are often the most important topics for what to discuss in therapy, precisely because they are so difficult to articulate. Jonathan Green, PhD, a licensed psychologist, advises, “Talk about the thing or things you don’t want to talk about.”

Therapy provides a non-judgmental space where vulnerability is not just accepted but encouraged. Starting with phrases like “I don’t know how to say this, but…” or “This feels messy, but…” can open the door to profound therapeutic breakthroughs. For instance, issues related to intimacy, desire, or sexual identity often fall into this category. Sex therapy, for example, offers a specialised, confidential environment to explore these sensitive topics with understanding and expertise.

Sharing these difficult subjects, even just the fear of sharing them, builds trust and authenticity within the therapeutic relationship. It’s in these moments of vulnerability that true healing often begins, allowing you to release the burden of unspoken thoughts and move towards greater self-acceptance and peace.

7. Review Your Experience of Therapy Itself

The therapeutic relationship is a powerful tool, and discussing your experience of therapy itself is a crucial part of what to discuss in therapy. How you feel about your therapist, whether you feel connected, understood, or even if something feels “off,” is all valid and important feedback.

The therapeutic alliance – the collaborative relationship between you and your therapist – is widely recognised as a significant factor in the success of therapy. If you feel stalled, question if therapy is working, or even have negative feelings towards your therapist, bringing this up can lead to significant insights. These feelings often mirror patterns in your other relationships and can be incredibly valuable to explore.

A good therapist welcomes this feedback. It allows them to adjust their approach, clarify misunderstandings, and strengthen your working relationship. This open communication fosters trust and ensures that your therapy remains customised to your evolving needs, helping you maximise the benefits of each session.

Your First Session and Beyond: What to Expect

Understanding the therapy process can ease any anxiety and help you feel more prepared. Here’s a look at the journey from your first conversation to your last.

Preparing for Your First Appointment

Your first therapy session, whether in person at our offices in Barcelona or online, is primarily an opportunity for assessment and connection. Your therapist will typically begin by asking “what brought you to therapy at this specific time?” and gather some background information about your life, history, and current challenges. This initial conversation isn’t about solving all your problems at once; it’s about understanding your story and your hopes for therapy.

It’s also your chance to ask your therapist questions. Inquire about their approach, their experience with issues similar to yours, and how they envision your therapeutic journey. This helps you determine if you feel a good rapport and can build trust. At Therapy in Barcelona, our dedicated team of therapists are all psychology-trained and many are expats themselves, offering a unique understanding of international life. We prioritise matching you with the right professional, so don’t hesitate to share your preferences and concerns.

Crucially, your therapist will also explain confidentiality, outlining its boundaries and any legal or ethical exceptions. This ensures you understand how your privacy is protected, allowing you to feel safe and secure in sharing your thoughts.

Making the Most of Your Sessions

Therapy is not a passive process; it’s an active collaboration. To make the most of your sessions, engage as an active participant. Be honest about your thoughts and feelings, even if they seem contradictory or uncomfortable. As the American Psychological Association explains in Understanding psychotherapy and how it works, it’s about dialogue and working together to find alternative ways of thinking, behaving, and managing feelings.

Many clients find it helpful to keep a journal between sessions, noting down thoughts, feelings, or significant events. This “self-work” can provide valuable material for discussion and helps you track your progress. Practise the new skills or insights you gain in therapy in your daily life, whether it’s setting boundaries, challenging negative self-talk, or trying new coping mechanisms.

Positive changes take time, so be patient with the process. Building a trusting relationship with your therapist, where you feel heard and understood, is key. This consistent effort, both inside and outside the therapy room, consolidates your gains and helps you apply what you learn to real-life situations, making your therapy experience truly transformative.

Knowing When It’s Time to Graduate from Therapy

Psychotherapy isn’t meant to last forever. There often comes a point when you feel you’ve gained what you needed, and that’s a sign of success. A 2019 study of adolescents found that those who ended therapy because they felt they “got what they needed” had better outcomes than those who left due to dissatisfaction. This highlights the importance of ending therapy mindfully.

It might be time to consider concluding your sessions if you’ve accomplished your initial goals, feel equipped with a robust set of coping skills, and are confidently applying them to your challenges. Perhaps the sessions no longer provide the same fresh insights, or you find yourself struggling to identify new topics to explore.

You don’t need to stop abruptly. Discuss with your therapist the possibility of gradually reducing session frequency, perhaps moving from weekly to monthly check-ins. This allows you to test your newfound skills and offers a safety net if new challenges arise. Ending therapy on a positive note, with a sense of closure and gratitude, reinforces your growth and provides a foundation for maintaining your well-being independently.

Finding the Right Therapist for You as an Expat

The connection you have with your therapist is one of the most significant factors in your success. For expats, finding someone who understands your unique context is vital.

Comparing Your Options in Spain

When seeking therapy in Spain, you’ll encounter a few main avenues. The public healthcare system, while accessible, often involves long waiting lists and may offer limited choices in terms of therapeutic modalities or language options. You might find yourself facing a language barrier if you’re not fluent in Spanish or Catalan, which can be a significant hurdle when trying to discuss sensitive issues.

Then there are large online therapy platforms. These can offer convenience but often lack the personalised touch or deep cultural understanding that expats need. The service can feel impersonal, you might not have control over who your therapist is, and with some large platforms, there can be concerns about data privacy and how your personal information is handled.

Local private practices, like Therapy in Barcelona, offer an alternative that prioritises your needs. We pride ourselves on providing customised care, focusing on a bespoke therapist matching process to ensure the right fit. Unlike some larger platforms, we guarantee strict confidentiality and never sell client data. While it is a private-pay service, some therapists offer sliding scale fees for those with financial need, and prospective clients are encouraged to inquire about this. This approach allows for greater flexibility, choice, and a more personalised therapeutic experience, making it easier to find a professional who is truly the right fit for you.

The Value of Culturally Sensitive, Personalised Care

For expats living in cities across Spain, from the vibrant streets of Barcelona to the sunny coasts of Málaga or the historical charm of Alicante, finding a therapist who genuinely understands your journey is invaluable. This is where culturally sensitive, personalised care truly shines. Leigh Matthews, an Australian Psychologist and expat herself, founded Therapy in Barcelona in 2011 precisely because she recognised this need. She understood the challenges of cultural adaptation, language barriers, and the stresses of living away from home.

Our approach at Therapy in Barcelona is built on bespoke therapist matching. We don’t just assign you to the next available professional. Instead, we carefully consider your unique needs, preferences, and the specific challenges you face as an international. Our team comprises highly qualified, psychology-trained therapists, who are expats themselves. This shared experience means they bring a deep, empathetic understanding of issues like cultural adjustment, isolation, homesickness, and shaping a new identity in a foreign country. This culturally informed care is essential for effective therapy.

We are committed to strict confidentiality, providing a safe and compassionate space for internationals. As Leigh Matthews envisioned, Therapy in Barcelona has become a hub of support, ensuring that clients receive unparalleled guidance from professionals who not only understand the breadth and depth of the mind but also the unique nuances of expat life. Our goal is to empower you to face challenges, accept self-acceptance, and build a more fulfilling life, whether you’re in Barcelona, Gran Canaria, or connecting with us online from anywhere in the world.

Frequently Asked Questions about what to discuss in therapy

Is any topic “too small” or “too big” for therapy?

No topic is ever “too small” or “too big” for therapy. If something is causing you distress, confusion, or simply occupying too much space in your mind, then it is absolutely valid to discuss. Sometimes, a seemingly minor annoyance – like a recurring frustration with a neighbour or a small disagreement with a colleague – can reveal deeper patterns of communication, boundary issues, or underlying feelings of anxiety. Therapists are trained to work with a wide range of issues, from everyday stressors to significant trauma. The goal is to explore what’s bothering you, understand its impact, and help you develop strategies to manage it more effectively.

What if I cry during my session?

Crying in therapy is not only normal but often a healthy and natural emotional release. It’s a sign that you are connecting with your feelings and allowing yourself to be vulnerable in a safe space. Your therapist will not judge you; instead, they will provide a supportive and empathetic environment for you to express all your emotions freely. Many clients report that crying during a session, especially when discussing difficult subjects, can be incredibly cathartic and lead to a deeper sense of relief and understanding. It’s a fundamental part of processing feelings, and your therapist is there to hold that space for you.

How much do I have to share, and how is my privacy protected?

You are always in control of how much you share and when you choose to share it. Therapy is a process of building trust, and it’s completely natural for clients to share more as they feel safer and more comfortable with their therapist. You set the pace.

Regarding privacy, therapists are bound by strict ethical codes and legal obligations to maintain confidentiality. This means that what you discuss in your sessions is private. Your therapist will explain the limits of confidentiality upfront, typically in your first session. These exceptions are rare and generally relate to situations where there is a clear and imminent threat of harm to yourself or an identifiable third party, or in cases of suspected child or elder abuse. Outside of these very specific circumstances, your privacy is rigorously protected, allowing you to speak openly without fear.

Deciding what to discuss in therapy is a journey, not a test. The most important thing is to start where you are, with whatever is on your mind, knowing that even the smallest thought can lead to profound insights. The therapeutic space is a sanctuary for exploration, growth, and healing.

For internationals living in Spain, whether you’re in Barcelona, Valencia, Alicante, or beyond, having a therapist who understands the unique challenges of the expat experience can make all the difference. This shared understanding, from navigating cultural nuances to managing homesickness, creates a foundation of trust, allowing for deeper, more effective work. At Therapy in Barcelona, our team of expat therapists offers culturally sensitive, personalised care, providing that essential connection for your well-being.

If you’d like support, book a Free Discovery Call today. Our online therapy services are available worldwide.