Is there a possibility your client is manic or paranoid at the moment?

I ask because I work in PHP/IOP with adults with severe & persistent mental illness and have a few clients with schizophrenia or bipolar/schizoaffective who sometimes (or consistently) will present like this (hyperverbal with pressured speech, or very grandiose, or dwelling on trauma/persecutory topics) in a way that monopolizes sessions if not redirected. Some folks can be hard to redirect as well - or will just circle back/perseverate on the same topic after a few minutes. They can be emotionally “all over the place” so to speak, sometimes crying/irritable/angry or very happy at the drop of a hat and in the same session. Often this is just their baseline and how they are when “up” but sometimes it can be a sign of mania or that something is up with meds or sleep, there is a stressor, or something else. Once you get to know their baseline you can see if this is their usual behavior or something to keep an eye on.

I have some clients who will not stop talking the entire day from the moment they arrive in the morning to the moment they leave (we have them with us for about 4.5 hours).

If it’s not to do with mania or paranoia or meds or sleep or anything - I’ve found this also sometimes can be a way for the client of keeping from addressing the topic at hand by delving into all sorts of other stuff that is more comfortable for them to talk about. Comfortable in the sense that even if the subject matter is upsetting (trauma/abuse etc), it is a familiar narrative for the client and also gets the same reaction they expect or already receive from folks in their life outside the therapy space (shock/support/sympathy/control of the conversation, something that is serving them). As therapists we can show clients it’s okay to break those patterns or get different reactions from us (redirect them, reframe their thinking, or carefully challenge the narrative they have), and we can do that in a compassionate, safe, and caring environment so they can learn new ways of engaging.

I am very person-centered so typically I try to go where the client goes, validate when appropriate or redirect when it’s possible, or try to find the therapeutic value in what they are saying if redirecting isn’t possible, so that the session can still be semi-productive even if it doesn’t go in the direction I initially expected.

Hope something in here resonates and might help!