My therapist has a whole file folder of paintings . When I sit home alone with no pressure, no objective and paint it gets formed there, then we approach it in office through the asking of questions. He will suggest we stop at times if he sees it's going to go too much to agitated and not productive conversation. Either way, painting works for me. Sometimes I take his pen and his clipboard and comment there. Other times he says something and I may nod or just look at him. Sometimes what he emails to me is the best because I can read it a thousand times until I make sense of it and it's so much less threatening.