A phenomenology-based way to assess change in psychotherapy

The measurement of change is being discussed in the context of psychotherapy, the discussion typically revolves around “content”—that is to say, which psychological functions or variables are the most relevant, interesting or desirable to change, and hence to measure? At the 1975 Waskow and ParlofF conference on psychotherapy change measures the participants selected “a small group of instruments that made "empirical sense"... that, in aggregate, could provide basic information about the patient’s status at the beginning and end of therapy and that would not be offensive to researchers and clinicians of diverse theoretical orientations. For example, CHange After Psychotherapy (CHAP), operationalizes an experiential point of view on change. It is a post-therapy qualitative interview format linked to a set of quantitative rating scales. The interview has a free format, much like a therapeutic session, although there is a specific guide for the interviewer. The interview is recorded and transcribed. On the basis of the interview the extent of change is rated on four scales: Symptoms, Adaptive Capacity, Self-Insight, and Basic Conflicts. Explicitly, this is not to estimate an increment of some psychological function but rather to evaluate how radical, extensive or thoroughgoing the "judge" perceives the patient's experiences of having changed to be. The CHAP has found extensive clinical use in Sweden over the years and a recent study by Sandell and Wilczek, which will be summarized below, suggests that CHAP ratings may be performed with satisfactory reliability and validity by adequately trained raters.