...and it normally starts with a picture.
After that I decide what colour scheme I want to go with and what cardstock I to use for the back (in this case My Mind's Eye Stell&Rose, 'Hattie' "Remember" Roses). I cut it down to size (8.5x8.5) and then I sketch. Now, let me warn you, this isn't always pretty.
I pull out every scrap of paper that I have that will match the chosen colour scheme. (EVERYONE) Then I weed those down to the papers I will use...and can fit. I pull out embellishments, think of my title, and hand write any journaling. (It's a thing, I have to write it first- even this, I hand-wrote it first.)