Elise Sutton Procedure -

: The high level of maintenance required for strict protocols can lead to burnout. Many find that long-term success in power exchange requires flexibility and the ability to adjust rules as the relationship evolves.

This is the most distinctive phase of the procedure. The therapist constructs a 20-step exposure hierarchy. However, unlike standard ERP, the exposure is not merely imaginal or in vivo —it is symbolic. High-level examples might include: elise sutton procedure

: Reassigning labor to the male partner to demonstrate his service to the "Head of Household." : The high level of maintenance required for

Critics argue that the procedure lacks empirical validation. Dr. Helen Margolis (Johns Hopkins behavioral health unit) stated in a 2023 review: "The Elise Sutton procedure is pseudoscience dressed in clinical language. It has no mechanism of action verified by neuroimaging or controlled trials. Its reliance on 'dominance scripts' borders on unlicensed coaching." The therapist constructs a 20-step exposure hierarchy