What to Say When You Don’t Know How to Start Therapy

If you’ve ever found yourself staring at your therapist, unsure what to say, you’re not alone. Many people struggle to know how to start therapy sessions or what to talk about first — especially when every thought seems to vanish the moment the session begins.

There’s a particular kind of dread that can settle in right at the top of a therapy session. You log on or sit down, take a breath, and your therapist smiles and says something like,

“Where should we start today?”

“What’s on your mind?”

or just — “Hi.”

And suddenly… nothing. Blank. Empty. Every thought evaporates. You’re sitting there wishing for a script, a menu of options, something. You want help. You wish your therapist would just start talking - anything to pull you out of the silence.

If this sounds familiar, you’re not alone. Many people wonder, often privately, “Whose job is it to start the session?”

The Psychology of the First Word

Those opening seconds of a session are never just empty. They’re loaded with meaning: the wish for the therapist to start might reflect a longing to be taken care of, to feel guided, to not have to hold it all together. It might also reveal a fear: If I’m in charge of where we begin, what if I choose wrong?

In other words, the silence isn’t a failure of conversation- it’s a moment full of unconscious communication. The therapist’s gentle “Where should we start?” isn’t laziness or lack of direction; it’s an invitation for you to notice what comes up when you have to take the first step.

It’s Not Actually About Talking First

The goal of therapy isn’t to perform insight or to have tidy answers- it’s to experience yourself in a relationship.

So when you feel dread or blankness at the start, that feeling is the material. It’s the lived experience of what happens when you’re asked to show up and take initiative.

Do you freeze? Get anxious? Wait to be rescued? Try to guess what the “right” thing to say is?  Fill the space with small talk or humor.  Start reporting on the minutiae of your week? All of that is deeply revealing- not of your conversational skills, but of how you approach closeness, vulnerability, and agency.

If You’re Sitting There Thinking, “I Don’t Know Where to Start”

Say that.

Say exactly that out loud.

“I never know how to start. I wish you’d just tell me what to talk about.”

It may feel small or even embarrassing, but it’s actually an honest entry point — a wish to be understood. Bringing the wish itself into the room is far more meaningful than forcing yourself to come up with content.

Because the wish to have your therapist take the lead often mirrors something larger: how you’ve learned to relate to care, to uncertainty. By naming it, you’re letting your therapist see the part of you that wants to surrender the role of “the one who figures things out.”

There’s No Wrong Door Into a Session

If you’re ever stuck, remember: you don’t need a perfect opening line. You can start with a sigh, a joke, or a simple “I don’t know how to start.”

You can start by talking about your resistance to starting. And even the blankness, the silence, the dread-  those are parts of you that deserve to be met with curiosity, not judgment.

Starting Can Be the Work

At Therapists of New York, we will meet you right in these moments of not-knowing, the pauses, the blanks, the places where something important is waiting to be found.

Therapy doesn’t begin when you have the right words. It begins the moment you notice what it feels like not to.

If you’ve been thinking about starting therapy but aren’t sure how, that’s okay. We can start there. Learn more about navigating those first moments of therapy sessions with a therapist at TNY.