Step-by-Step

Domain V · Systemic, relational, group & community · 2018

What it is

Step-by-Step is not a therapy a clinician delivers face to face. It is a WHO self-help programme for depression: five short sessions, delivered mainly by smartphone app or web, told as an illustrated story and supported by brief weekly contact from a trained non-specialist "e-helper". It was…

Format

• Session format. Versions differ. The 2018 description gives about 30 minutes per session in two roughly 15-minute halves: the illustrated story (about 50 slides in the original), then interactive coaching and exercises. WHO's account of the Lebanon trial version gives three parts per session, about…
• One session per week is expected, so the core programme runs about five to seven weeks including the introduction.

Who practises it, and how they are trained or regulated

• Training, supervision and permission to deliver. No formal certification, licence or accreditation scheme is described on the WHO publication, news or programme pages cited, nor in the trial papers. Trial helpers were non-specialists: psychology and public health graduates in the pilot (6 days of training on the intervention, mental health conditions, communication skills and working with distressed people), and in…
• Version followed: WHO Step-by-Step (SbS) as described for the Lebanon programme (Carswell et al., 2018, mHealth; Lebanon pilot, Harper Shehadeh et al., 2020; Lebanon RCT protocol, van 't Hof et al., 2021; Lebanon trial report, Cuijpers et al., 2022; WHO EMRO trial news page), with the self-guided "contact-on-demand" variant tested with Syrian refugees in Egypt (Burchert et al., 2024) noted where it differs. The…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• 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

• helper drift into therapy, over-involvement, or secondary distress.
• referral used to end contact with someone difficult rather than for their benefit.
• no entries (practice not happening, or technical problems); a worsening weekly category (B4).
• drifting into a different therapy when delivered face to face; keep to the programme content.
• users who can name no strengths; offer a prompt such as something a friend would say they do well.

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.