"Meet People Where They're At": What That Actually Means in Therapy

In my clinical work as a psychotherapist and sex therapist, I'm often asked to "meet people where they're at." That phrase sounds simple. It isn't.

Say it enough times in a training or a supervision session and it starts to sound like a slogan — the kind of phrase you nod along to without really unpacking. But it's actually a working instruction, and it only means anything if you know what "where someone's at" is even made of.

"Where someone's at" usually breaks down into three domains: biological, psychological, and sociological. This is the biopsychosocial model, and it's not new — it's been the backbone of how thoughtful clinicians assess a person since the late 1970s. What's changed is how much weight we put on each piece.

Biological covers the body a person is walking around in — genetics, neurology, chronic illness, disability, hormones, sleep, substance use, the whole physical substrate underneath everything else. Psychological covers cognition, temperament, attachment history, trauma, coping style — the internal architecture. Sociological covers everything external: family system, culture, class, community, access to resources, the water a person swims in without necessarily noticing it.

Each of these branches into sub-facets depending on context — a sociological assessment for a rural client looks nothing like one for someone in a dense urban network, and a biological assessment shifts entirely depending on age, ability, and medical history. There's no universal checklist. That's the point. "Meeting someone where they're at" means actually running this assessment for the individual in front of you, not applying a template.

We can bring IQ into that mix if we want. Honestly, though, it's rarely useful — unless I'm concerned someone falls meaningfully below average (under 70), where it becomes relevant for very practical reasons: safety, guardianship, appropriate level of care. Past that point, IQ starts to resemble BMI: technically measurable, not particularly meaningful, and outdated no matter how carefully you calculate it.

Both were built as population-level screening tools and both get misapplied constantly as verdicts on individuals. BMI can't tell you whether a person is healthy. IQ can't tell you whether a person is going to have a good life, a rich relationship, or a clear sense of who they are. It was never built to answer those questions, and treating it like it can is where the tool starts doing harm instead of just being limited.

Humans show enormous variance in presentation, life circumstance, and ability. A couple of composite examples, using "high IQ" and "lower average IQ" loosely, illustrate why the same treatment plan would fail one of them completely.

The high-IQ coder. Excellent at math. High-paying tech job, every creature comfort money can buy. Struggles with emotions — an intellectualizer, in the clinical sense: someone who processes feeling through analysis because analysis is the tool that's always worked. Difficulty with relationships, a pull toward simpler connections (dogs, cats, horses — beings that don't require the same emotional fluency to love well). Treatment here usually means getting them out of their head and into their feet — less analysis, more feeling, somatic work, anything that routes around the intellect long enough for the intellect to stop being the only tool in the box.

This is often the harder client to treat, counterintuitively. Intelligence becomes a very sophisticated hiding place. You can out-argue your own therapist. You can research your diagnosis better than half the field. None of that touches the actual feeling underneath, and redirecting a mind that sharp away from its favorite defense takes real patience on both sides.

The ironworker. Several learning disabilities, lower-average IQ by traditional measure. Genuinely good with people, enjoys art, works full-time and successfully in a blue-collar trade. Financially stable, hits most of capitalism's average expectations without particularly trying to. Believes things are "fine" most of the time — may or may not be fluent with emotions, but doesn't carry the same defended relationship to not knowing that the coder does. Treatment here usually leans on psychoeducation and solution-focused work to build pragmatic awareness around whatever's actually in front of them — less about excavating the past, more about naming what's happening now and building a next step.

A third, to round it out: the burned-out academic. Very high IQ by every formal measure, several advanced degrees, chronically underemployed relative to credentials, and quietly convinced that being understood correctly by another person is basically impossible. This client often arrives already fluent in the language of therapy — attachment styles, defense mechanisms, the works — and treatment can stall for months if the clinician mistakes vocabulary for insight. Knowing the word for a pattern and being free of the pattern are not the same skill, and a lot of very smart clients (and, frankly, a lot of clinicians) confuse the two.

None of these three is doing life "better" than the others in any way that matters clinically. They're just running on different operating systems, and the work looks different for each.

Any test built to measure intelligence is only as good as the people who built it. That's true across science generally: you can't measure something you don't know is there. And even when you can, perception can still miss the mark. I'd put "hard" and "soft" sciences in the same boat here — both are soft, in my opinion.

Consider how many kinds of intelligence a standard IQ test doesn't even attempt to touch: emotional intelligence, the capacity to read a room and adjust yourself inside it. Somatic intelligence, the kind that lives in a dancer's body or a surgeon's hands. Interpersonal intelligence, the specific skill of making another person feel deeply understood. Creative intelligence, which resists standardized measurement almost by definition, because the whole point of it is doing something no test bank anticipated. A test built around timed logic puzzles and vocabulary recall was never going to capture any of that — it wasn't designed to, and mistaking its narrow scope for a full picture of a person's mind is where a genuinely useful tool turns into a genuinely harmful label.

This matters clinically because plenty of people walk into a therapy room already having internalized a number from a test they took in third grade — as a ceiling, as an identity, as a verdict on what they're allowed to expect from their own life. Part of the work, sometimes, is just helping someone put that number down.

What I notice — in myself and in the people I treat — is that we gravitate toward whoever hears us best. Most often, that's someone whose intelligence sits close to our own, however you want to define that. Not necessarily the same kind of intelligence — a deeply somatic person and a deeply verbal person can absolutely hear each other — but a similar depth or pace of processing. Conversations that move at mismatched speeds tend to fatigue one party and frustrate the other, no matter how much genuine goodwill sits underneath.

This shows up everywhere, not just in romantic pairing. It's in friendships that quietly fade because one person always feels like they're either waiting or catching up. It's in the client-therapist relationship itself — part of why a good referral sometimes matters more than a good reputation. And it's in family systems, where a mismatch in processing style between a parent and child can get pathologized as defiance or as coldness, when it's really just two different operating speeds trying to run the same conversation.

I think every human has an intelligence kink. Whether we're actually vibing, though — that's a different story entirely. And it's usually the truer measure of whether two people belong in each other's lives than any test either of them ever took.

Well wishes, 🙏 Love C. Dialogos, LMFT, Buddhist Chaplain