What happens in psychotherapy sessions?

There are many different psychotherapy techniques and psychotherapists'  techniques differ depending on their training and personal views.  My way of doing psychotherapy has come from my training, personal background and clinical experience; bear in mind that although I have tried to keep this article simple and easy to understand, it has a solid basis in accepted / respected theory and my own clinical experience – it’s my job to have done the training and know this stuff (though of course, questions are always welcome, it’s my job to preserve confidentiality but not to hide behind theory books).  Here's what you can expect in therapy sessions with me.

At the start of psychotherapy with me, we would do some necessary administration and discuss the reason(s) for your wanting psychotherapy.  Although the first one or two sessions are a little more structured than subsequent ones because of the administrative details, normally you can consider yourself having begun therapy as soon as the session begins (or even as soon as you decide to meet with me).
During the sessions, we normally sit opposite but not quite facing each other (the 'patient on couch' scenario is still used but not usually by me) and discuss what you had presented as your current area(s) of difficulty.  We would initially talk in detail about the things you feel are causing you trouble.

As we discuss your issues, the level of detail we go into might seem unusually tiny.  If for example, you find yourself repeatedly breaking up with partners because they refuse to marry you or don't want children then I might ask you: What's important to you about getting married or having children?  Another example: if you're afraid of flying, I might ask you what you fear about it; what goes through your head and what bodily sensations do you feel when you imagine getting on a plane? 

'Well of course I want children' or 'Well, of course it's scary flying, everyone is afraid of flying aren't they?' might be common knee-jerk answers to questions like these but in therapy, nothing is assumed, nothing is 'Well of course...'.  Even if there are accepted social or cultural norms around things like families, clothing, employment, gender, sexuality or money, in therapy with me, we'll look at your personal take on these things (and more) and I think that's where we begin to find clues about what makes you feel at odds with some aspect(s) of the world around you.

As we talk, using my training and experience, I watch your posture, listen to your tone of voice and look for anomalies in the things you say.  I also try to stay aware of how the things you say impact me because chances are, the kinds of things that happen between you and other people will, over time, happen between you and I during therapy sessions. 
Based on things you say and (very importantly) things you don't say, I might ask more questions or make an observation about something I think could be significant and invite you to think about it or 'see how it sits with you'.  For example, if you were 'thinking out loud' in a session and said, 'Maybe it's got something to do with...' (trailing off into silence), then I might encourage you to continue or  ask you what the 'it' is – in other words, put as many of your thoughts and feelings into clear words as possible.