Systematic treatment selection

Domain VI · Brief, integrative, trauma, hypnosis & coaching · Larry E. Beutler, Clarkin · 1990

What it is

STS is not a therapy with its own technique set. It is an integrative, technically eclectic decision framework: the clinician assesses a small number of patient dimensions, then chooses the intensity, mode, format, focus, degree of directiveness and level of emotional arousal of whatever treatment…

Format

• STS has no fixed phases or session count; treatment length and frequency (intensity) are themselves outputs of the assessment. The structure below is the decision sequence the authors describe, followed by ongoing monitoring.]
• Stage A. Patient evaluation (intake, usually first 1–2 sessions). Goal: rate the patient on the STS dimensions. Patient predisposing variables in the 1990 model: diagnostic considerations, personal characteristics, and environments and circumstances. In the 2016 statement these are grouped as (1)…

Who practises it, and how they are trained or regulated

• Stage D. Tailoring strategies and techniques. Goal: select focal targets of change, the level of intervention and mediating goals, then conduct the work with the fitted focus (symptom change vs insight/awareness), directiveness (directive vs evocative) and affect regulation (affect control vs affect discharge/arousal).

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

• low compatibility signals early; consider transfer before a rupture.
• principle-of-the-week becoming abstract; tie each to a named patient decision.
• drift from the plan you set. Working when process ratings match the intended fit.
• education given as a lecture to a reactant patient; keep it brief and invite questions.
• pushing action-oriented work on someone not yet ready (which can look like resistance).

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.