At the start of every appointment, my therapist asks, “What’s on your agenda?”
I’ve been seeing the same therapist for about eight years, so there’s been plenty of time to develop a routine. I treat my regular therapy sessions like a job, a training program, or a religious service. I do what I can to maximize the efficiency and efficacy of our sessions together, including pre-session journaling to help me set the agenda before each appointment.
Knowing where I want to go saves precious appointment time, creates a record of what issues keep coming up over and over again, and gives me a starting point for reflection and follow-up after the session. I’m going to share with you the pre-session planning strategy that helps me organize thoughts and maximize time with my therapist—if for no other reason than to avoid those awkward silences while you try to come up with something to talk about.
Bare minimum therapy prep
So you barely have time to schedule therapy, much less a pre-therapy planning session. I have weeks like that, too. On the days that I show up with no agenda, my therapist is still able to draw out some useful thread to pursue. However, even a little preparation—five to 10 minutes before I log on for a video appointment—can ensure we get to what’s actually bothering me.
Question one: What’s the biggest issue on my mind right now?
This question saves me from two therapy mistakes: First, talking about what I think I’m “supposed” to talk about in therapy, and second, continuing wherever we left off in the last session, even if it’s no longer the most pressing matter. I like to start fresh with whatever situation, feeling, or problem is taking up the most space in my mind on that day. Even if it’s trivial, the discussion often leads to broader topics that can tie back to areas we’ve worked on in therapy before.
The deeper questions to ask yourself
Keeping a therapy journal is not for everyone, but for me it is essential. At its leanest, my therapy journal has a response to the question above, notes taken during the session, and tasks and thoughts to pursue afterward.
When I have more space and time, my therapy journal is full of daily reflections that help me work through issues on my own or have more insight about what I want to bring up at my next session. Here are some questions I ask myself for weekly or daily therapy journaling:
Question two: What emotions am I feeling?
This question seems simple, but identifying my emotions doesn’t come easily. I tend to answer, “How are you doing?” with “OK” and expect my inflection to communicate the details.
If precise emotion words don’t pop to mind easily for you either, keep a feelings wheel handy at all times (I have one in my notes app). Identifying your feelings before therapy gives you the vocabulary to start a conversation with your therapist rather than expecting them to interpret your cryptic “OK.” Noting your emotions throughout the week will help you recognize patterns and get even more practice identifying your emotions.
Question three: Is there anything left hanging from my last session?
Sometimes you are vibing in therapy, the buzzer goes off, and you just want to keep following that thread. Or maybe something related has happened and you just want to keep your therapist in the loop. I usually try to make a note in my journal if there is a topic i want to come back to at the next session.
Question four: How have I coped this week and what worked?
This question is most clarifying during hard patches. If things have been hectic and I coped by doing things that made me ultimately feel worse, bringing it up in therapy will help us come up with alternative strategies. If I coped with hard days by doing things that really helped, this exercise reinforces what my go-to, feel-better activities should be.
Question five: Is there anything I’m reluctant to bring up in therapy?
This is sort of a trick question, but a purposeful one! It can help you identify what your most tender topics are and consider whether you want to maintain a boundary around them or start to open up about them with your therapist. Avoidance can hold back progress, so take a moment to confront any topics you’ve been reluctant to address. This can really lead to breakthrough moments.
I always use this prompt as a challenge. Is there something I’m hesitant to talk about? To me, that is a good clear indication that I need to bring it into the light and deal with it. I feel safe doing this because I have such a long, trusting relationship with my therapist. Protecting boundaries with tough topics is also a valid choice.
Tailor your therapy prep to your needs and bandwidth
Self reflection to prepare for therapy can be as simple or as intensive as you like it. I like to journal about these questions a few times a week and spend a few minutes before therapy highlighting my priorities. You could simply take five minutes to ask yourself the first question on this list.
Even if your approach is minimal, I suggest keeping a therapy journal to track answers to these questions and reflect on progress over time. We will all have weeks when there’s no time or energy to prepare, but regularly showing up to therapy with no plan at all can mean missed opportunities to do deeper work.
