What Intervention Right Now? — Clinical Decision Flowchart
When something shifts in a session and you are not sure what to do next, this flowchart helps you orient in seconds. Start at the window of tolerance. Follow the branches. Trust your read.
What is in this flowchart
Window of tolerance assessment — how to quickly read whether the client is regulated enough to do meaningful work, with specific signs of hyperarousal and hypoarousal and what to do for each.
Emotion decision tree — when emotion is present, three branches: reflect and name, deepen, or follow. What each one looks like and when each one applies.
Problem-solving, narrative, and psychoeducation modes — when the session is not primarily emotional, how to identify what kind of work is wanted and how to join it without losing the clinical thread.
Session derailment branches — when a client drops something significant, when there is a rupture or something felt off, when you lost the thread. What to do in each case.
Countertransference check — five seconds before you pick an intervention: what am I feeling, why am I moving to act, what would I say if I weren’t managing my own discomfort?
Quick-scan reference card — a one-page summary table matching observable signals to first moves.