You meter. You expose. You process. You look. You go "Hmmm". And you draw your conclusions.
Hmmm, that's not very scientific! ...
Yes, it's a bit of trial and error, but it doesn't mean that you can't do some tricks. First of all, you can do your own film speed tests and have a look at the results, at least with BW films(1). Once you do this, you know what fits the paper range and how things look under specific lighting conditions. With a bit of common sense, experience and fantasy, you can use elements of the zone system, even with roll films. And then there's the problem of proper metering. TTL is basically unreliable, incident is much better and spot meters are probably the best option,
if you know how to use them and
if you have the time to use them. Time can definitely be critical in some scenaria. Anyway, an incident meter can be substituted with TTL if you have a point of reference that is good enough for the task. I've used my palm as a point of reference (and adjust the reading) and I got nice results. Definitely better than following what the TTL meter says. Of course, finding the subject's brightness range requires a spot meter, but once you have a fair bit of experience you can guesstimate it, and using negative films makes the task a lot easier; you have the option to overexpose, that should do the trick. The worst thing that could happen would be to reach the film's shoulder and lose some highlight contrast(2).
Anyway, I don't pretend that I'm an expert, nor would I say that my method is foolproof. My gear imposes limitations and I have to take a "methodical" approach with what I have, in order to get good results without resorting to extreme tricks at the printing stage. But I can definitely say that my hit/miss ratio became far better once I understood how my equipment and materials work.
1 Barry Thornton's method is what I use.
2 Assuming that you use negatives, positives are a very different case.