Like Seth I start with a blank page, and look for something interesting in the default Power Fractal. So I'm swinging that camera around from the start to find a pov that has potential, and then I start tweaking scales, displacements, noise flavours. And as your messing around like this a scene gradually takes form in your mind. It's at this point that I may recall a photo or an inspirational Matte work I've recently seen, and that may inform my further progress with the scene.
Wetbannana alluded to a tool for sculpting terrains. I have recently begun to use a Power Fractal as a Blend by Shader mask on the main Power Fractal terrain to sculpt that terrain. That's how I got that weird Stupa-like peak that features in my latest "Mangas Coloradas" scene.
So, the Zen, open mind approach works best for me.
John