Self-system therapy

Domain II · Behavioural & cognitive · Strauman, Vieth, Kolden · 2003

What it is

Self-system therapy (SST) is a brief, structured individual therapy for depression built on E. Tory Higgins's self-discrepancy theory and regulatory focus theory. It treats depression as a disorder of motivation and goal pursuit: people pursue goals either in a promotion focus (ideals, hopes,…

Format

• Format: individual, outpatient, weekly sessions; research versions averaged 20 to 25 sessions, with a prototypical 25-session course. Phase lengths are approximate and the developers explicitly allow tailoring to each client's circumstances and progress. The 2017 Therapist Guide uses 16 sessions.…
• Contents: psychoeducation about depression; the sick role; Self-in-Context Assessment (spread over roughly 3 to 6 sessions); promotion-focused activity scheduling with mood monitoring; initial formulation, initial goals and a concrete plan (for example activity logs, problem-solving).

Who practises it, and how they are trained or regulated

• Goals: identify and explain the depression; link depression to self-regulation; get promotion-focused activity going early; build a tentative formulation and agree a plan.
• Move on when: the client has a working understanding of depression and of the self-regulation rationale, some promotion activity is under way, a tentative formulation has been shared and agreed, and the client has been told what the next phase involves and has committed to it.
• Goals: examine the client's goals, strategies and regulatory style in detail; revise the formulation; select targets for the final phase.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• passive agreement. Working: the client corrects or adds to the formulation in their own words.
• mindfulness becoming another performance standard. Working: client reports catching discrepancy-related moods earlier.
• choosing a critical informant first; start with people likely to be fair. Working: belief ratings drop and the client acts on the revised view.
• reassurance in place of evidence; let the client generate the information. Working: lower rated discrepancy, less dejection when the domain comes up.
• the client experiencing goal change as giving up on who they are; frame it as choosing. Working: fewer simultaneous goals, more goals met, more pride.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.