"I don't know where to start": more than enough for a first session

You are sitting in the waiting room or in front of a screen, your first therapy session starts in a minute — and your mind is a blank wall. Everything that has been weighing on you for months, everything you could put so clearly to yourself in bed at night, has evaporated. One sentence is left: “I don’t know where to start.”

If you recognise yourself in that, I have good news for you, and I mean it literally: that sentence is entirely enough. It is not an emergency exit, not a sign that you are unprepared — it is one of the most common and most honest beginnings of therapy I know. In this piece I want to show you why you do not need a tidy story, why confusion is valuable information in itself, and with which very concrete sentences a session can begin when it seems there is nowhere to begin.

How a first session otherwise unfolds — from the frame to the questions — I have described in the piece on the first session. Here we stay with one single thing: that moment when you are supposed to speak and do not know what to say.

Why you do not need a tidy story

Many people prepare a “report” at home before therapy: a chronology, a list of topics, almost a defence speech. Behind it lies an understandable idea that the account has to be orderly so the therapist can do something with it — as at the doctor’s, where you list symptoms and receive a diagnosis.

But therapy does not work that way. Leading the conversation is the therapist’s craft, not yours. Their job is to know how to ask, to sense where something is hiding, and to wait where you are in a hurry, not where they are. You bring the raw material — they help meaning emerge from it. The clinical literature on leading a conversation (Hill, 2020) describes exactly this as the core of the therapist’s skill: exploring with open questions, responding to what is alive rather than to what is tidy.

More than that: an over-smoothed story can even be an obstacle. A story you have told a hundred times — to yourself, to friends, in your head — is worn smooth like a stone in a river; there are no surprises left in it. The most valuable moments of a session usually happen outside the prepared text: in a sentence that slips out, in a theme that creeps in, in tears at a place that “wasn’t on the list”. So being prepared is not a condition. Curiosity about what comes is worth more than any notes.

What the therapist does when you fall silent

Part of the fear of the blank page is the idea that in the session you will be solely responsible for the flow of the conversation — as in a meeting, where you have to have your points ready, or on a visit, where silence is awkward. So let us say it plainly: in the therapy room silence is not your failure and the conversation is not your responsibility.

When you fall silent, what happens in me is not impatience but attention. Silence in therapy is rarely empty: something is going on in it — a word is being searched for, a feeling is rising, something is being weighed. Sometimes I will leave you in the silence, because I can see you are working; sometimes I will offer support: “What is happening right now, in the quiet?” Sometimes I will ask about the body, sometimes about the past week, sometimes I will simply summarise what I have heard so you can check whether it fits. These are craft tools that I carry — you do not have to. A therapist’s silence does have its own logic and purpose; I have described both in the piece on the therapist’s silence.

Put differently: the session is our shared space, but care for its structure is mine. You are responsible for what is true, I am responsible for the route. That is why “I don’t know where to start” is a perfectly usable beginning for me — it tells me we start with how you are right now, confusion included.

Confusion is not an obstacle — confusion is information

“I don’t know where to start” often does not mean “I have nothing to say”. It means: there are so many things in me at once that none of them takes shape. And for a therapist that is valuable data — it says there is a great deal of inner material, and that it has not yet had a space in which to sort itself out.

The philosopher and psychotherapist Eugene Gendlin coined the term felt sense for this unclear inner mass: a bodily perceptible but not yet worded knowing about one’s own situation. His research on the therapy process showed something surprising: people who could stay with that unclarity in sessions — “there is something, I don’t yet know what” — and feel their way into it slowly with words had better outcomes than those who told their story smoothly and neatly. Unclarity at the start is not a sign that therapy will not work; often it is a sign that it is only now really beginning. Neuroscience bears this out too: putting things into words is itself calming and ordering — naming emotions measurably lowers amygdala activity (Lieberman et al., 2007). So the words do not have to be ready in advance; the ordering happens while you speak, not before.

In practice this means I do not try to tidy the confusion away as fast as possible. When someone says “I don’t know where to start”, I do not push them to choose a topic; I would rather ask what this confusion looks like up close. Is it a dense cloud? Ten voices at once? An emptiness? Describing the confusion is already the beginning of the work — and often it is precisely from that description that the first theme emerges, more reliably than any list prepared in advance would have found it.

The ball of yarn: you pull one thread and the rest follows

The image that helps me most here: what goes on inside you is a ball of yarn. The threads are interwoven — work with your relationship, the relationship with childhood, childhood with tiredness, tiredness with work again. That is exactly why it seems there is no beginning: wherever you take hold, everything else comes with it.

But what looks like the problem is in fact the solution. Because everything is connected to everything, it does not matter where you start. Any thread will lead you to the core, if we follow it long enough. You start with insomnia — three sessions later we are at what you must not let out of your hands. You start with your boss — a month later we are at your father. In systemic therapy we say that the pattern is not hidden in one theme but repeats in all of them; you can see it through any door. So choosing the first theme is not a decision with large consequences that you have to weigh up. It is simply the place where you first take hold of the ball.

Three reliable beginnings when there are none

If it helps you to have something to hold on to, here are three entry points that always work — because they require no story, only a look at what is here now:

• The body. “Right now my heart is pounding and my stomach is in a knot.” The body is always in the present and never has a blank page. Bodily sensation is often the shortest route to what still escapes words — which is why, in body-oriented psychotherapy, part of which my approach comes from, this is the standard opening question (more in the piece on body psychotherapy).
• The past week. “On Wednesday I felt awful in a meeting and I don’t know why.” You do not need a life story — one fresh, concrete moment carries a whole pattern in it, the way a drop carries water.
• Whatever is on top. “I’ve been thinking all day about what I’m going to say to you.” That is a beginning too — an excellent one. Whatever is most on top at this moment, even if it is nerves about the session, is always a legitimate first theme.

Notice that none of these beginnings requires even an answer to the question “what is my problem”? All it requires is a willingness to say what is true. Everything else is our shared work.

The preparation that helps — and the kind that does not

Does this mean any preparation is superfluous? No — only the right amount and the right kind count.

Preparation that helps is light and curious. If your thoughts scatter, you can note a word or two in your phone or on a scrap of paper in the days before the session, whenever something stings — not an essay, just an anchor: “Sunday, lunch at my parents'”, “that feeling at work again”. You need not even look at the note during the session; simply having noticed things has already brought them closer to the surface. A simple question you can put to yourself on the way there helps too: “Of everything I’m carrying, what would be hardest to say out loud today?” — the answer is almost always a good first thread, even if you do not have to pull it the first time.

Preparation that does not help is the kind that wants control: a script drawn up in advance, mental rehearsals of answers, arranging your story into a coherent whole so it “won’t come out strange”. That effort goes in exactly the wrong direction — instead of opening you, it locks you into the role of narrator watching their own performance. If you catch yourself doing this, stop and tell yourself: ordering is the therapist’s job. You bring the material, scattered as it is.

And if you arrive with nothing at all — no note, no anchor, just that blank wall — that is material too. “Today my head is empty” is a legitimate and often very fruitful beginning: an empty head is never really empty, the door is just closed for the moment. Together we will look for the handle.

“But my problem isn’t bad enough”

Beneath “I don’t know where to start” another, quieter sentence often hides: “I don’t know whether what I have is even worth therapy.” Other people have traumas, losses, serious diagnoses — while you “only” sleep badly, are “only” tired of everything, “only” have something pressing on you that you cannot name.

I have devoted a whole piece to why people come to therapy, so here just the essence: distress is not a competition, and you do not get a ticket only at a certain level of suffering. On the contrary — research on the dose-effect relationship shows that people who come earlier usually need less time. An unclear, “too small” theme that does not seem worth “taking up time” with is often an early signal of something that will be loud in two years. If you feel that something is there — that is enough. We will find the name together.

First sentences that are entirely enough

To close the practical part — a few real kinds of first sentences with which sessions actually begin. Each of them is entirely enough:

• “I don’t know where to start.” (Yes — this one counts. From here we lead together.)
• “There’s too much of everything and nothing is bad enough for me to point at it.”
• “A friend told me to come, and I think she’s right, but I don’t know why.”
• “For the last few months I’ve just been tired. Not sad — tired.”
• “Something in me closed and I don’t know when.”
• “I’m nervous because I don’t know what to expect.”

None of these sentences is an analysis. Every one of them is a door. Look at them again: what they have in common is that they do not explain but describe — they say how it is, not why it is. That is the whole art of beginning. Explanations, causes and connections come later, through the process; at the start a description of the state is enough, even if the state is “I don’t know”. And if beneath your uncertainty there is also some fear of the session itself — of what I will think, of whether you will cry, of whether you will manage — I have given that its own piece, on the fear of therapy. That fear may come into the room with you too; more than that, said out loud at the start it is often the best icebreaker.

The beginning is my concern, not yours

If you take one single thing from this piece, let it be this: you do not have to bring an answer to the question of where to start to a first session. That question is my job. As a therapist in training in marriage and family therapy, under supervision, I run individual sessions of fifty minutes, in person in Ljubljana or online — the details are on the services page.

Your job is only to come. You may come with a blank page and a white wall in your head — with exactly the sentence this piece began with. Write to me, and we will start where you are. That, after all, is the only place it is possible to start.