Self-system therapy

1. Introduction

Version followed: the research version described by Vieth, Strauman, Kolden, Woods, Michels & Klein (2003, Clinical Psychology: Science and Practice): three phases (Orientation, Exploration, Transformation) across a prototypical 25-session individual course. The later Oxford "Treatments That Work" Therapist Guide and Client Workbook (Strauman, Eddington, Vieth & Kolden, 2017) reorganise SST into a 16-session plan with worksheets; its session-by-session contents are not reproduced here [uncertain].

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, advancement, making good things happen) or a prevention focus (oughts, duties, safety, stopping bad things from happening). Depression is understood to follow chronic failure to attain promotion goals, so that the gap between the actual self and the ideal self (an actual:ideal discrepancy) is large and chronically accessible, and promotion-focused striving collapses. Change happens by restoring effective self-regulation: re-engaging promotion-focused activity that produces success experiences, mapping the person's characteristic goals, strategies and self-beliefs, then narrowing the discrepancy (changing beliefs, standards or strategies) or compensating where change is not feasible. [source: Vieth et al. 2003 via ResearchGate full text; Div 12 SST page; Strauman & Eddington 2017 abstract]

SST was designed for a subgroup, not for depression in general: clients with a high chronic actual:ideal discrepancy and a strong promotion orientation, estimated by the developers at about a quarter to a third of clinically depressed people. It borrows techniques from cognitive therapy, interpersonal therapy and behavioural activation but organises them around the self-regulation formulation. [source: Vieth et al. 2003; Div 12]

2. Framework

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 [source: Duke Trinity book page; phase allocation within the 16 sessions not seen, uncertain]. Depression severity was tracked with the Beck Depression Inventory (self-report) and, in research, the Hamilton Rating Scale for Depression. [source: Vieth et al. 2003; Div 12]

Phase 1: Orientation (about sessions 1 to 5–7)

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.
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).
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. [source: Vieth et al. 2003; explicit criteria are not stated, these are inferred from the phase goals, synthesis]

Phase 2: Exploration (about 8 to 12 sessions)

Goals: examine the client's goals, strategies and regulatory style in detail; revise the formulation; select targets for the final phase.
Contents: basic self-monitoring (as in cognitive therapy), then Psychological Situation Analysis (about 4 to 6 sessions); Self-Belief Analysis (about 2 to 5 sessions); continued promotion activity and review of logs; reformulation; negotiation of targets (change beliefs, goals or strategies, or compensate).
Move on when: the phase "culminates in a detailed reformulation" with intervention targets the client has helped choose and agreed to. [source: Vieth et al. 2003]

Phase 3: Transformation (about the last 8 sessions)

Goals: reduce self-discrepancy and modify, or compensate for, the client's maladaptive regulatory style; consolidate and end.
Contents: discrepancy-reduction strategies; adjusting goals and standards (including perfectionism); daily promotion goals; skills building (for example assertiveness); compensatory strategies; in-session and between-session experiments; mindfulness as a process focus; termination and relapse prevention.
End when: targets have been worked on, symptoms have improved, and the client has a written outline of strategies, a self-monitoring plan and a setback/relapse response plan. [source: Vieth et al. 2003; ending criteria partly synthesis]

Session format

The published description does not give a fixed agenda. It does describe: homework constructed collaboratively from the first sessions; brief review of activity logs at each session with problem-solving as needed; worksheets supporting core concepts; asking for feedback each session. A practical agenda consistent with this: mood check (BDI or brief rating), review of homework/logs, main phase task, set and troubleshoot next homework, feedback. [source: Vieth et al. 2003; agenda order is synthesis]

3. Guiding principles

[source for all items unless marked: Vieth et al. 2003; Div 12]

Formulate in self-regulation terms. Explain the client's depression through their goals, strategies, standards and outcomes, not only through symptoms or distorted thoughts. Practically: every case conceptualisation names the goals being missed, the regulatory focus used and the discrepancy that results.
Select clients the model fits. SST targets depressed clients with large actual:ideal discrepancies and a strong promotion orientation. Practically: assess this at intake; if prevention/ought concerns and anxiety dominate, consider whether another treatment fits better [selection advice partly synthesis].
Get promotion activity going early. Success experiences in pursuing something desired are introduced from the first phase, not saved for later. Practically: by session 2 or 3 the client has a small, carefully structured, likely-to-succeed activity.
Idiographic, not generic. Goals, situations and self-beliefs are the client's own, discovered through the Self-in-Context Assessment and situation analyses. Practically: avoid importing standard goals; use the client's words.
Collaborative-educational stance. As in cognitive therapy, the therapist teaches, models the testing of beliefs and co-creates homework. Practically: explain the reason for each task and design homework with the client.
Supportive and appropriately directive. Warmth and empathy with clear structure and active guidance. Practically: respond empathically to the life story, but keep phases moving.
The session is a laboratory. The client's characteristic regulatory patterns appear with the therapist; share observations when they do. Practically: name in-session instances (for example over-accommodating the therapist) and use the relationship to practise new strategies.
Formulation is a tentative agreement, revised with data. Practically: present the first formulation as a hypothesis, keep what fits after the situation and belief analyses and change what does not.
Build on strengths. Name the effective strategies the client already uses. Practically: in every reformulation, point out at least one self-regulatory strength.
Change first, compensate when change is unlikely. Try modifying beliefs, standards or strategies; where the client cannot or will not change, arrange the environment or relationships to work around the vulnerability. Practically: compensation is a legitimate long-term solution, not a failure.
Weigh standards, do not attack them. With perfectionism the aim is to examine costs and benefits, not to eliminate high standards. Practically: ask whether the standard can be met and at what cost.
Flexible pacing within a fixed structure. Phase lengths vary with the client's needs and progress. Practically: do not move to Transformation without a reformulation the client agrees with.
Ask for feedback and attend to the alliance. Give clear rationales, set useful homework, and invite feedback each session.
Prepare for life after therapy. Relapse prevention and the client's ownership of the strategies are built into the ending.

4. Intervention inventory

Interventions are grouped by phase in the order they appear in Vieth et al. (2003). The 2017 Client Workbook supplies worksheets for many of them; those worksheets were not seen and are not reproduced [uncertain]. All example language is illustrative unless quoted and cited. [source for section: Vieth et al. 2003 via ResearchGate full text, unless marked]

4.1 Assessment and case selection (intake, before or at session 1)

Purpose: confirm that the client fits SST: a depressive episode or dysthymia, a large chronic actual:ideal discrepancy and a predominantly promotion orientation.
Steps: (1) Establish the depression diagnosis and baseline severity (the developers used the BDI and, in research, the HRSD). (2) Ask about what the client hoped to become and has not achieved, and what duties and obligations they feel they are failing. Note whether distress sounds like dejection (disappointment, sadness, feeling a failure: linked in the theory to ideal discrepancies) or agitation (worry, guilt, threat: linked to ought discrepancies). (3) Where available, an idiographic self-guide measure such as Higgins's Selves Questionnaire (actual, ideal and ought attributes, from the client's own and significant others' standpoints) or the Regulatory Focus Questionnaire can inform this. These are cited in the SST literature, but the paper does not say exactly how they were used clinically [uncertain]. Do not reproduce items; use licensed copies. (4) Record baseline for later comparison.
Example language (illustrative): "When you think about the person you hoped you would be by now, how far away do you feel from that? And when you think about what you should be doing, does that feel close or far?"
Watch for: a picture dominated by anxiety, guilt and duty (prevention/ought) rather than lost hopes; SST addresses comorbid anxiety but was not designed around it. Severe risk, psychosis or substance problems need assessment and treatment in their own right [synthesis].

4.2 Psychoeducation about depression

Purpose: label the problem as depression, normalise it, set expectations about course and pace, and give the client a way to track symptoms.
Steps: (1) Describe depression as a recognisable condition with typical symptoms and an episodic course that usually improves with treatment. (2) Go through the BDI item by item using a blank copy (as in the published case) so the client recognises their own symptoms as parts of depression rather than personal failings. (3) Give a written fact sheet. (4) Explain the expected pace of treatment and that improvement tends to be gradual and uneven. (5) Re-administer the BDI periodically to track change.
Example language (illustrative): "Low energy, trouble concentrating and feeling you've let everyone down are all part of depression. They're not proof that you're a weak person, and they are the things we expect to shift as treatment goes on."
Watch for: the client using the symptom list as further evidence of failure; reframe it as information. Working: client begins to describe symptoms as "the depression" and reports BDI changes without self-blame.

4.3 Socialisation to the self-regulation model (psychoeducation on regulatory focus)

Purpose: give the rationale for SST: depression as a breakdown in goal pursuit.
Steps: (1) Define self-regulation simply, as the ongoing process of setting goals and trying to achieve them [source: Vieth et al. 2003 paraphrase]. (2) Explain that when important goals can no longer be reached, people feel down, lose motivation and stop striving. (3) Distinguish two ways of pursuing goals: working toward hopes and ideals (promotion) versus meeting duties and avoiding mistakes (prevention), and the typical feelings when each goes wrong (disappointment/dejection versus worry/agitation). (4) Link this to the client's own story and to what the treatment will do: restart goal pursuit, understand the client's goals and strategies, then change or work around what is not working. (5) Check understanding and invite questions.
Example language (illustrative): "Most of what we do every day is about setting goals and trying to reach them. Depression often starts when the goals that matter most to you keep slipping out of reach, and after a while you stop trying. This therapy is about getting that system working again."
Watch for: the client hearing "your goals are wrong." Emphasise that the aim is to make pursuit work better. Note: the published text does not give a script for explaining promotion versus prevention; the wording above is synthesis grounded in Higgins's theory as summarised by the authors [uncertain].

4.4 The sick role

Purpose: temporarily reduce demands so the client can put energy into recovery and stop accumulating failure experiences. SST borrows this from interpersonal psychotherapy (Klerman et al., 1984).
Steps: (1) Introduce it early, ideally in the first session or two. (2) Explain that depression is a condition that legitimately reduces capacity, like a physical illness. (3) Agree with the client on specific obligations to reduce temporarily (for example some housework, optional commitments). (4) Agree how the reduction will be explained to others if needed. (5) Revisit later: clients often resist or quietly resume obligations.
Example language (illustrative): "While you're recovering from depression, it makes sense to set some things down for a while, the way you would with a bad case of flu. What's one thing you could do less of this week?"
Watch for: guilt and refusal, especially in clients whose self-worth depends on meeting others' needs; in the published case the client agreed to reduce housecleaning only after "much encouragement." Working: reduced load, less exhaustion, no rise in self-criticism.

4.5 Self-in-Context Assessment (SCA)

Purpose: discover where the client learned which ways of being produced good or bad emotional outcomes, revealing their personal standards (ideals, oughts), regulatory focus and the origins of their discrepancies. It also builds the alliance.
Steps: (1) Spread over roughly 3 to 6 Orientation sessions. (2) Review significant relationships in turn, beginning with parents and caregivers and moving to other important people. (3) For each relationship ask: what kind of person the client was in it (behaviour, way of relating); what kind of person they wanted to be or not to be; what the other person wanted them to be; what happened emotionally and interpersonally when they did, or did not, behave that way. (4) If relationships are hard to recall, extend to salient life events. (5) Respond empathically to the story. (6) Note recurring themes: hoped-for selves (ideals), required selves (oughts), feared/undesired selves, and whether rewards came from achieving positives or avoiding negatives. (7) Feed these into the initial formulation.
Example language (illustrative): "Growing up with your mother, what kind of person were you with her? What kind of person did she hope you'd be? And what happened, how did it feel, when you were that person, or when you weren't?"
Watch for: the SCA turning into unstructured life review; keep returning to the three questions. Working: recognisable self-guides emerge and the client starts to connect current distress to long-standing standards.

4.6 Promotion-focused activity scheduling with mood monitoring

Purpose: restart promotion-focused striving early and produce success experiences of "moving closer to making something good happen" (Vieth et al., 2003).
Steps: (1) Identify activities the depression has disrupted that the client used to find rewarding or that move toward a hoped-for goal. (2) Agree which to restart or increase before the next session. (3) Structure them carefully so success is likely: small, specific, scheduled. (4) If the client is very depressed, start with simple choices, such as choosing between two appealing options. (5) Ask the client to note mood during and after each activity, so any satisfaction is noticed. (6) Review the activity log briefly at every session and problem-solve obstacles. (7) Frame activities as approaching gains, not as duties to complete.
Example language (illustrative): "Instead of another evening of TV, would you rather call your friend or spend half an hour in the garden? Whichever you pick, notice how you feel while you're doing it and afterwards."
Watch for: activities turning into obligations (prevention framing) or being set too large, producing more failure. In the case example, phone calls to a friend and gardening replaced TV. Working: client reports moments of satisfaction or pride and spontaneously adds activities.

4.7 Initial formulation and treatment plan

Purpose: close the Orientation phase with a shared, tentative understanding and a concrete plan.
Steps: (1) Draw together the SCA themes, current stressors and depressive episode. (2) Present a tentative formulation in self-regulation terms: which important goals are blocked, what standards are in play, how the client characteristically pursues them. (3) Ask for the client's feedback and amend. (4) Agree initial goals and concrete steps (for example ongoing activity logs, problem-solving a specific stressor). (5) Describe the Exploration phase so the client knows what is coming and commits to it.
Example language (illustrative): "Here's my best guess so far, and I want you to tell me where it's off: a lot of what matters to you is being there for others, and lately, with your mother's illness and the new boss, there's been no way to meet that standard and nothing left over for you."
Watch for: passive agreement. Working: the client corrects or adds to the formulation in their own words.

4.8 Basic self-monitoring (preparation for situation analysis)

Purpose: make sure the client can notice and record thoughts, feelings and events before the more demanding Psychological Situation Analysis.
Steps: (1) At the start of Exploration, check whether the client can already monitor thoughts and feelings. (2) If not, teach simple self-monitoring as in cognitive therapy: record a situation, what went through the mind, and the feeling with an intensity rating. (3) Practise one example in session, then assign a few between sessions. (4) Move to PSA once records are reasonably complete.
Example language (illustrative): "This week, when your mood drops, jot down where you were, what was going through your mind and what you felt. Just the facts; we'll make sense of it together."
Watch for: records that contain only feelings or only events; shape with in-session practice. The intensity-rating detail is drawn from standard cognitive therapy, not specified in the SST text [synthesis].

4.9 Psychological Situation Analysis (PSA)

Purpose: identify the client's "characteristic psychological situations" (the recurring kinds of situation in which their self-regulation goes wrong) and their modal regulatory style.
Steps: (1) Runs over about 4 to 6 Exploration sessions. (2) Each week the client chooses a recent interaction, or a memory of one, that affected their mood. (3) The client analyses it with four questions (paraphrased): What was I trying to achieve? How did I go about it? How did it turn out? How did I end up feeling about myself, including relative to others? (4) Review the analysis together in session, clarifying the goal (was it an ideal-type hope or an ought-type duty?), the strategy (approaching a gain or avoiding a loss; effective or not) and the emotion (dejection or agitation). (5) After several analyses, look across them for repeating patterns and name them together. (6) Note effective strategies as well as failures.
Example language (illustrative): "Let's take Saturday's phone call with your sister. What were you hoping would happen? What did you actually do? How did it go? And afterwards, how did you feel about yourself?" ... "This is the third time we've seen you agree to more than you can do so that nobody's let down, and end up feeling worn out and a failure. Does that pattern fit?"
Watch for: client choosing only dramatic events (ask for ordinary ones too) or analysing others' motives instead of their own goals. Working: the client starts recognising the pattern as it happens. In the published case PSA showed a pattern of going to extremes to please others; her all-or-nothing exercise strategy was revised to moderate sessions twice a week, with her husband handling his own dinner on those nights.

4.10 Self-Belief Analysis (SBA)

Purpose: examine the specific beliefs about the self that drive discrepancies and maladaptive regulation, and judge which are inaccurate or carry heavy regulatory costs.
Steps: (1) Runs over about 2 to 5 Exploration sessions. (2) Collect key self-beliefs from the SCA, PSA and session material. (3) For each, identify: its standpoint (the client's own view, or how they think a significant other sees them); its valence (positive or negative); its developmental origins; and its type (a description of the actual self, an ideal standard, an ought standard, or an undesired self). (4) Explore how long it has been held, how important it is, what its consequences are, the evidence for and against it, and what it implies about the client's regulatory style. (5) Judge together its accuracy and its regulatory significance, marking candidates for change in the Transformation phase.
Example language (illustrative): "You said 'a good daughter never puts herself first.' Is that your own standard, or one you feel your mother holds for you? How long have you lived by it? What does it cost you, and what does it give you?"
Watch for: turning SBA into disputation too early; at this stage the task is mapping, not challenging. In the case example themes were being a "good daughter" and the belief that wanting time for herself was selfish. Working: the client can state which beliefs are standards, whose standards they are, and which ones are hurting.

4.11 Reformulation and choice of targets

Purpose: produce the detailed reformulation that ends Exploration, and agree what Transformation will target.
Steps: (1) Revisit the tentative formulation, keeping hypotheses the PSA and SBA support and revising the rest. (2) Restate the problem in terms of specific self-regulation difficulties (which goals, which standards, which strategies, which situations). (3) Name strengths: effective strategies the client already uses. (4) For each problem decide the route: change beliefs, change goals or standards, change strategies, or compensate where change seems unlikely or unwanted. Targets may continue earlier goals or move to new domains. (5) Agree targets with the client and get explicit agreement to the plan.
Example language (illustrative): "Putting it all together: you're very good at taking care of everyone else, and that's a real strength. The trouble is that the standard is so high there's never a moment where you've done enough, and your own hopes keep getting pushed aside. For the next stretch, which of these do you want to work on: easing the standard, sharing the load, or making room for things you want?"
Watch for: the therapist choosing targets alone. Working: the client can say the formulation back and names targets that matter to them. In the case, revised targets were more promotion activities, handing some responsibilities to her sister and husband, adjusting expectations of her boss, and prioritising goals.

4.12 Ongoing relationship and homework work (all phases, emphasised in Exploration)

Purpose: sustain the alliance and the collaborative-educational frame.
Steps: (1) Give a clear rationale for every task. (2) Construct homework with the client (written assignments, self-monitoring, behavioural tasks, later experiments). (3) Review homework every session. (4) Ask for feedback on the session and on the therapist each time. (5) When the client's characteristic pattern appears with you (for example agreeing to everything to please you), gently name it and explore it as live data.
Example language (illustrative): "I noticed you agreed to three assignments very quickly. I wonder if that's the same 'don't let anyone down' pull we've been looking at. Which one do you actually want to do?"
Watch for: homework framed as an obligation for the therapist; it then becomes another ought to fail. Working: homework is completed and the client reports why it was useful.

4.13 Discrepancy reduction: changing self-beliefs

Purpose: narrow the gap between the actual self and the client's goals by changing how the actual self is seen.
Steps: (1) Pick a target discrepancy from the reformulation. (2) Use one or more of three routes the authors describe: (a) bring in new positive information about the actual self (recent successes, others' feedback, PSA examples where strategies worked); (b) shift attention from negative to positive self-beliefs that are equally true; (c) test the importance or consequences of the belief or standard (what actually happens if it is not met). (3) Record evidence across sessions. (4) Link each shift back to mood and motivation.
Example language (illustrative): "You've told me you're 'not a capable person.' Let's list what you actually handled this month, including the hospital visits and the deadline at work. What would someone watching from outside conclude?"
Watch for: reassurance in place of evidence; let the client generate the information. Working: lower rated discrepancy, less dejection when the domain comes up.

4.14 Testing self-beliefs against others' views (broadening the view of self)

Purpose: check beliefs about how significant others see the client, and place the self in a wider context than the client's own harsh standpoint. Div 12 lists this as "broadening one's view of the self within a wider context."
Steps: (1) Identify a belief held from another's standpoint (for example "my family think I'm selfish if I take time for myself"). (2) Agree a plan to gather data: ask specific people specific questions. (3) Rehearse the questions in session. (4) Client carries out the interviews between sessions. (5) Debrief: what was said, what it means for the belief and for the standard. In the case example, the client interviewed her husband and friends, which let her "recalibrate her gauge" and feel more justified in taking personal time.
Example language (illustrative): "Would you be willing to ask your husband and one friend: 'If I took two evenings a week for myself, would you think I was being selfish?' Then we'll look at what they say."
Watch for: choosing a critical informant first; start with people likely to be fair. Working: belief ratings drop and the client acts on the revised view.

4.15 Adjusting goals and standards

Purpose: change the goals themselves when they are unattainable, too numerous or too costly.
Steps: (1) For each target goal, examine how important it is and how often it is activated (accessibility). (2) Explore what would happen if it were only partly met. (3) Consider lowering the priority of some goals, restating others in attainable terms, and prioritising among competing goals. (4) Shift some effort toward goals that offer more opportunities for positive emotion (the 2017 Therapist Guide description emphasises this [source: Duke Trinity book page]).
Example language (illustrative): "If you managed this at 80 percent instead of 100, what would actually happen? Who would notice?"
Watch for: 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.

4.16 Daily promotion goals

Purpose: build a habit of setting and reaching small promotion-focused goals, extending the early activity scheduling.
Steps: (1) Each day the client sets one promotion goal (something they want to make happen). (2) At day's end they review how well it was achieved. (3) They note any obstacles. (4) Review the record in session, problem-solve obstacles and adjust the size of goals. Worksheets were used for this in the published programme.
Example language (illustrative): "Each morning, write one thing you'd like to make happen today, just for you or toward something you care about. In the evening, note how it went and what got in the way."
Watch for: goals written as duties ("must clean the kitchen"); help reword them toward gains. Working: steady goal attainment and the client enjoying the process.

4.17 Working with perfectionism

Purpose: help the client weigh the costs and benefits of perfectionistic standards. The aim is not to eliminate perfectionism.
Steps: (1) Identify the domains in which the client is perfectionistic. (2) Trace where each standard came from (link to SCA and SBA). (3) For each, ask two questions: can it be achieved, and at what cost? (4) Decide per domain: relax the standard, keep it, or compensate. Compensation options: reduce the number of domains held to a perfectionistic standard; relax standards in low-priority domains; tell family or coworkers about the tendency so they can help.
Example language (illustrative): "Let's list everywhere you hold yourself to 'perfect.' For each, is it actually reachable? And what is it costing you in sleep, time and mood?"
Watch for: the client defending all standards as essential; start with a low-priority domain. Working: fewer perfectionistic domains, less agitation and dejection after imperfect performance.

4.18 Building self-regulatory skills

Purpose: give the client new strategies where poor strategy, not the goal, is the problem (for example social or assertiveness skills).
Steps: (1) Identify the skill deficit from PSA (for example inability to make requests). (2) Teach the skill: break it into steps. (3) Rehearse in session with role-play, with the therapist giving feedback. (4) Assign graded real-world practice. (5) Debrief and repeat. Expect several sessions: the case client needed repeated practice before making an assertive request of her sister.
Example language (illustrative): "Let's practise asking your sister to take Thursdays. I'll be her. Say what you need in one or two sentences, without apologising first."
Watch for: avoidance of the real-world step; rehearse more, make it smaller. The specific role-play steps are standard assertiveness-training practice rather than SST-specific instructions [synthesis].

4.19 Compensation strategies

Purpose: provide a long-term solution to a specific self-regulatory failure when changing the belief, standard or strategy is not feasible or the client does not want to.
Steps: (1) Confirm change has been considered and declined or failed. (2) Identify the situation where the vulnerability bites. (3) Arrange the environment or relationships to reduce exposure or add support. Published examples: choosing a job with fewer presentations; telling coworkers about a difficulty; sharing responsibilities with family; telling others about one's perfectionism. (4) Test the arrangement and adjust.
Example language (illustrative): "You've said being a good daughter isn't something you want to change, and that's fine. So let's work out how you can be that daughter without doing everything yourself. Who else could take part of it?"
Watch for: compensation used before change has been tried, or presented as second best. In the case, the client would not change her "good daughter" standard, so work moved to compensation (sharing care with sister and husband).

4.20 Behavioural experiments and in-session practice

Purpose: test new beliefs, goals and strategies in real conditions during Transformation.
Steps: (1) Define the change to test and a prediction. (2) Rehearse first in session, using the therapeutic relationship as a safe place to try new ways of relating (for example disagreeing with the therapist, making a request). (3) Assign a between-session experiment. (4) Review the outcome and what it means for the formulation.
Example language (illustrative): "Your prediction is that if you say no to the extra project, your boss will see you as unreliable. Let's test it with something small this week and see what actually happens."
Watch for: experiments designed so the client cannot fail or cannot succeed; aim for informative. Prediction-writing is borrowed from cognitive therapy practice [synthesis].

4.21 Mindfulness as a process focus

Purpose: help the client attend to the process of goal pursuit rather than only outcomes, and notice when self-discrepancies are activated, with less automatic reaction. The authors cite mindfulness-based relapse-prevention work (Teasdale et al., 2000) and DBT (Linehan, 1993).
Steps: (1) Introduce mindfulness and link it explicitly to SST: noticing activated discrepancies and staying with the process. (2) Suggest readings and practice. (3) Help the client build practice into daily life. The source text does not specify particular exercises [uncertain].
Example language (illustrative): "When that 'not good enough' feeling switches on, see if you can notice it: 'there's the gap again,' and come back to what you're doing, rather than judging how it'll turn out."
Watch for: mindfulness becoming another performance standard. Working: client reports catching discrepancy-related moods earlier.

4.22 Termination and relapse prevention

Purpose: prepare for life after therapy and consolidate gains.
Steps: (1) Review the course of treatment and progress (including BDI change). (2) Summarise the formulation and key concepts. (3) Write an outline of strategies the client can refer to later. (4) Teach detection of early depressive symptoms. (5) Agree regular mood self-assessments and periodic checks on how well self-regulation is working (the case client agreed to monthly self-assessments). (6) Distinguish ordinary setbacks from relapse and write a response plan for each. (7) Plan for anticipated difficult situations. (8) Actively ask about concerns about ending (for example fear of sliding back without support); respond genuinely and empathically while conveying confidence in the client.
Example language (illustrative): "A bad week isn't a relapse. Let's write down what a bad week looks like for you, what tells you it's turning into more than that, and what you'll do at each point."
Watch for: the ending activating abandonment or failure themes; name them. Working: client can describe their pattern, their warning signs and their plan without prompting.

5. Handling problems

The SST sources address only a few difficulties directly (unwillingness to change standards, perfectionism, comorbid anxiety, assertiveness deficits, termination concerns, depression itself impairing self-regulation). Items marked [synthesis] are my own guidance, built from the SST model and general CBT/IPT practice.

Client will not change a core standard (for example "a good daughter always comes first"). Do not push. Move to compensation: keep the standard, change how it is met (share tasks, set limits on time, tell others). This is the route the authors took in their case example. [source: Vieth et al. 2003]
Perfectionism makes every goal extreme. Use cost-benefit analysis per domain (can it be achieved, at what cost), reduce the number of perfectionistic domains, relax low-priority standards first, and enlist family or coworkers. [source: Vieth et al. 2003]
Depression itself is blocking goal pursuit (too low to act). The authors note that depressive symptoms impair self-regulation and maintain the episode. Shrink promotion activities to the smallest step, use simple two-option choices, strengthen the sick role, and review the BDI to show change. [source: Vieth et al. 2003; the step-shrinking detail is synthesis]
Prominent anxiety, guilt or agitation (prevention/ought profile, comorbid anxiety). The authors flag comorbid anxiety as a treatment challenge and link it to actual:ought discrepancies. In SBA, separate ought standards from ideals; target ought standards with the same importance and consequences testing; avoid framing homework as duties. If anxiety is the main problem, consider a disorder-specific anxiety treatment alongside or instead. [source: Vieth et al. 2003 for the link; responses are synthesis]
Assertiveness or social skill deficit stalls compensation (client cannot ask for help). Plan several sessions of rehearsal before the real request, grade the requests, and debrief each attempt. [source: Vieth et al. 2003]
Fear of ending and of sliding back. Ask about it directly, respond genuinely and empathically, and convey confidence; write the strategy outline and setback plan; agree self-assessment check-ins. [source: Vieth et al. 2003]
Stuck in Exploration (endless analysis, no targets). Set a session by which the reformulation will be drafted; summarise PSA patterns yourself as a hypothesis and ask the client to amend; choose one target to start Transformation while analysis continues. [synthesis]
SCA becomes a painful life review or uncovers trauma. Keep the three SCA questions as structure, slow the pace, attend to safety and stabilisation, and assess whether trauma-focused treatment is needed before or instead of continuing SST. [synthesis]
Resistance to the self-regulation rationale ("my problem is my situation, not my goals"). Validate the stressors; show how stressors blocked important goals (the case client's new boss and mother's stroke); position SST as helping goal pursuit work under these conditions. [synthesis]
Non-adherence to homework. Check whether homework has become an ought imposed by the therapist; redesign with the client, make it smaller, link it explicitly to a goal the client wants, and review it every session without criticism. Treat non-completion as PSA material (what was the goal, strategy, outcome, feeling). [synthesis, consistent with the collaborative homework principle in Vieth et al. 2003]
Alliance rupture (client feels judged about goals or criticised for standards). Name the rupture, take your share of responsibility, restate that the goals are the client's to choose, and use the episode as live laboratory material about how the client handles disappointment in relationships. [synthesis; laboratory framing from Vieth et al. 2003]
People-pleasing with the therapist (agreeing to everything, reporting only success). Comment gently on the pattern when it shows; invite disagreement and reward it. [source: in-session observation principle, Vieth et al. 2003; specifics synthesis]
Promotion activities turn into duties. Re-frame toward gains ("something you'd like to make happen"), let the client choose between appealing options, and check mood during and after. [source: Vieth et al. 2003 for the activity principle; reframing synthesis]
Family or others undermine changes (for example criticise the client for taking time). Use belief-testing interviews with fair informants first; coach the client toward non-critical, reinforcing responses to family members; consider a joint session. [source: interviewing and coaching from Vieth et al. 2003; joint session is synthesis]
Worsening depression, hopelessness or suicidal thinking. SST sources do not specify risk procedures. Assess suicide risk at intake and whenever mood worsens using your service's standard assessment, build a safety plan with the client, include lethal-means counselling (secure or remove access), involve supports, and step up care (psychiatric review, more frequent contact, crisis services) as risk requires. Repeated failure experiences in goal work are a risk period: keep goals small during deterioration. [synthesis]
Client does not fit the SST profile after all (no clear ideal discrepancy or promotion orientation emerges). The authors describe SST as intended for a subgroup. Consider switching to a broader evidence-based depression treatment such as cognitive therapy or behavioural activation. [source: Vieth et al. 2003 for the subgroup intent; switching advice is synthesis]

Sources

Sources:

Books and papers cited:

Vieth, A. Z., Strauman, T. J., Kolden, G. G., Woods, T. E., Michels, J. L., & Klein, M. H. (2003). Self-system therapy (SST): A theory-based psychotherapy for depression. Clinical Psychology: Science and Practice, 10, 245–268. (Primary source followed.)
Strauman, T. J., Eddington, K. M., Vieth, A. Z., & Kolden, G. G. (2017). Self-System Therapy for Depression: Therapist Guide and Client Workbook. Oxford University Press (Treatments That Work). Not drawn on beyond publisher descriptions [uncertain].
Strauman, T. J., & Eddington, K. M. (2017). Treatment of depression from a self-regulation perspective: Basic concepts and applied strategies in self-system therapy. Cognitive Therapy and Research, 41, 1–15. Abstract only.
Strauman, T. J., Vieth, A. Z., Kolden, G. G., Woods, T. E., Klein, M. H., Papadakis, A. A., et al. (2006). Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy. Journal of Consulting and Clinical Psychology, 74, 367–376. Not drawn on.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94, 319–340. Not drawn on; cited for theory.
Higgins, E. T. (1997). Beyond pleasure and pain. American Psychologist, 52, 1280–1300. Not drawn on; cited for regulatory focus theory.
Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal Psychotherapy of Depression. Basic Books. Cited by Vieth et al. for the sick role.
Teasdale, J. D., et al. (2000) and Linehan, M. M. (1993), cited by Vieth et al. for mindfulness.

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