I understand that, but that's not how it works for our appointments.
I walk in and it's 'hello! how's the x suiting you?' Or 'has y calmed down?' Etc
It's never 'so what's today about' which is what makes it more difficult, I'm not bouncing into other stuff first by choice, it's to reply and not be rude and so on. It would be easier sometimes if it was 'so, what's today' but usually I see or speak to him every 2 weeks (not being needy, I have to) so it would be a little bit ridiculous to do it every time. We cut a lot of time just getting down to what we need to discuss.
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