Most do use TVSS devices, usually MOV's, as described above. These have an energy rating. If your surge has more energy than the rating, then it may weaken or even blow up the TVSS. Then you have no more protection.
The standard drill seems to be run a MOV between all lines, neutral, and ground. In a house this would be:
L1-L2
L1-N
L2-N
L1-G
L2-G
N-G
This may seem silly on the last one since N & G are bonded, but bonded by what? A wire? The transient surge is a fast event, a wire is an inductor, and at high frequency (a fast event) an inductor has a high impedance.
Placement is key with all connections. The wires tend to behave as inductors and you want to shunt the Voltage spike quickly.
The MOV's connected as above will make the spike common to all incoming lines (no big Voltage difference to blow stuff) as well as try to dump its energy into the ground.
Your own connection may vary as the TVSS unit may have other stuff.