Sacred cows make gourmet hamburgers.
Brenda left a voicemail.
Pleasant voice. Measured cadence. The kind of person who puts a period at the end of her text messages. She and her husband have been married four years, have two kids, and things are—her word—“strained.” She’d like to come in. But first, she has a few questions.
She’d like to know my approach. She says she read my website, has seen great Google reviews, a friend in her Raleigh mom’s Facebook group offered my name one morning when the group was asking for the names of good couples therapists in the area. But she still has some questions.
Not what I charge.
Not whether I take her insurance.
Not whether I have availability on Tuesdays.
She wants to know my approach. My theoretical orientation. My philosophy of therapeutic change. Before I’m allowed to help her marriage, I need to first defend my epistemology to a woman who found me on Psychology Today while her kids were watching Big City Greens.
I have two higher education degrees, decades of experience helping people, but now I have to write a dissertation for Brenda. I can’t count it as continuing education.
This is a sacred cow in my profession and I’m not entirely sure why nobody questions it.
But nobody questions it.
I’ve raised this in meetings with other therapists I’ve attended, and they all look at me as if I have two heads.
A therapist gets a voicemail, and before a single session happens, before the client has described the problem or sat in the chair or done anything at all, the therapist must produce a dissertation—a compelling, concise, jargon-free personal manifesto that explains not just what they do but why they do it, how they arrived at it, what they believe about the human condition, and whether their worldview is compatible with a stranger’s undisclosed preferences.
Like I don’t know, Brenda, what’s your approach to marriage? Seems to me YOU have some questions to answer.
I have a master’s degree in marriage and family therapy. I’ve been married for 32 years, raised three daughters, have a 7 year old grandson. I’ve racked up thousands of clinical hours. A license from the state. I see hundreds of clients per year and have a 4.8 rating on Google. But Brenda needs to know if our vibes align.
Let’s follow the logic. Because if this is a reasonable thing to do before hiring a therapist, it should be a reasonable thing to do before hiring anyone.
Phone rings…..
“Bob’s Plumbing, how can I help you?”
“Hi Bob. So, I found you online and I just wanted to call and kind of talk and see if we’re a good fit.”
“A good fit.”
“Yeah. We’re looking for a plumber, and before we commit, I’d like to understand your approach.”
“My approach to plumbing.”
“Right. Like, what’s your philosophy? When you encounter a clog, what’s your framework?”
“My framework is I get the clog out.”
“Right, but where do you think clogs come from? Like, do you think it’s a systemic issue? Is it the pipes? Is it the family’s relationship with the drain? Because my last plumber was very solution-focused and honestly, I didn’t feel seen.”
“You didn’t feel seen. By your plumber.”
“He just came in and snaked it. No exploration of root cause. No curiosity about the pattern. We’ve had three clogs this year, Bob. Three. That’s not a coincidence. That’s a cycle.”
“Sir, do you have a garbage disposal?”
“See, that feels reductive.”
It gets better. Imagine calling a mechanic.
“Thanks for calling Dave’s Auto. What’s going on with the car?”
“So the check engine light is on, but before I bring it in, I’d like to know—are you more of a parts-based mechanic, or do you take a holistic approach?”
“A holistic approach. To your Camry.”
“Yeah. Like, I’ve read a lot about integrated automotive care, and I want to make sure you’re not just treating the symptom. The light is on, sure. But what’s the light trying to tell us? What’s the car’s check engine light really about?”
“Usually it’s about the gas cap.”
“Okay, but what if the gas cap is just the presenting issue? What if the car is acting out because of unresolved tension in the exhaust system? I had a mechanic once who told me it was the O2 sensor. But I didn’t feel like he really understood my vehicle’s story.”
“Your vehicle’s story?”
“It’s a 2019 Camry, Dave. It’s been through a lot.”
Now imagine a surgeon.
“So you’re recommending surgery to remove my appendix. Before we schedule, I’d like to understand your theoretical orientation.”
“My theoretical orientation is that your appendix is about to rupture and I’d like to remove it before it kills you.”
“Right, but do you lean more toward a biomedical model or are you open to a biopsychosocial framework? Because I think there’s an emotional component to this appendix.”
“There is not an emotional component to your appendix.”
“My therapist would disagree.”
“Your therapist is not a surgeon.”
“She’s not. But she’s very validating. That’s actually why I’m asking. She made me feel so heard that now I expect it from everyone. Even you. Especially you. You’re about to be inside me, and I think we should at least be aligned on our values first.”
The surgeon stares. A nurse in the background quietly unhooks her badge and walks out of the profession.
Here’s the thing.
Brenda is not unreasonable. Her instinct is right. Therapy is intimate. You’re going to sit in a room with another human being and hand them the parts of your life you can’t figure out on your own.
You want to know it’s safe.
But last year Brenda and her husband hiked Machu Picchu. She hopped on a plane, flew to Peru, woke up at five in the morning, joined a guide she’d never met, and walked down the side of a mountain through cloud forests, river crossings, and canyon trails she couldn’t pronounce. Not once did she mitigate that risk by interviewing the trail guide about his philosophy of hiking.
She didn’t ask for his orientation. She didn’t ask where he stands on altitude. She strapped on the boots and followed the guy down the mountain.
But Brenda has questions for me. She jumped into marriage after dating for 2 years, told her mom she didn’t need premarital counseling because she was in love and is still paying for the wedding. But she has some questions.
I’m the one taking the risk here, Brenda. Because you’re going to come in and try to convince me your husband needs to change, and I’m starting to get this creeping feeling that he’s going to tell me you don’t know what the fuck you’re talking about half the time. And I’m going to help you fix this marriage, Brenda. That’s what I do. Over and over and over again.
So yeah. I’m a good fit. Just book the appointment.