Psicoterapia e Scienze Umane


Rolf Sandell,

Change After Psychotherapy (CHAP):
A method for measuring change
after the termination of psychotherapy.

Psicoterapia e Scienze Umane, 2015, 49 (4): 595-628.

DOI: 10.3280/PU2015-004004

Go to the on-line edition of the CHAP


Go to the Italian edition of a version of the CHAP that researchers can use


Go to the Italian version of this page



The Italian version of the CHAP Manual appeared on pp. 595-628 of issue no. 4/2015, Vol. 49, of the quarterly journal Psicoterapia e Scienze Umane ("Psychotherapy and the Human Siences"), simultaneously with the English edition that appeared in issue no. 2/2015 of Research in Psychotherapy: Psychopathology, Process and Outcome (RIPPPO), the official journal of the Italian chapter of the Society for Psychotherapy Research (SPR). The CHAP scales appeared for the first time in four articles in issue no. 1/1987 of the journal Psychotherapy and Psychosomatics, and the version of the manual published here is based on a 1997 manuscript that has been slightly modified and updated by Rolf Sandell, with the suggestion of Paolo Migone.



Below there are the Abstract and the References as they appear in issue no. 4/2015 of Psicoterapia e Scienze Umane and in issue no. 2/2015 of Research in Psychotherapy: Psychopathology, Process and Outcome (RIPPPO)

Abstract. Change After Psychotherapy (CHAP): A method for measuring change after the termination of psychotherapy. Change After Psychotherapy (CHAP), formulated by Rolf Sandell in 1987, is a method to measure change after the termination of a psychotherapy, without comparing pre- and post-treatment variables. The CHAP five scales are described (Symptoms, Adaptive Capacity, Self-insight, Basic Conflicts, and Extra-Therapeutic Factors), with data on reliability and norms. One of the interesting aspects of CHAP is that it allows to identify variables not present at the beginning of treatment, i.e., that could not be included in pre-post measures since they might appear due to therapy itself. This manual, which was never published before, is an update of a 1997 manuscript. [Key words: psychotherapy research, psychotherapy outcome, post-treatment evaluation, quantitative research, qualitative research] 


American Psychological Association (2013). Recognition of psychotherapy effectiveness. Psychotherapy, 50, 1: 102-109. DOI: 10.1037/a0030276 (Italian translation: Riconoscimento dell'efficacia della psicoterapia. Psicoterapia e Scienze Umane, 2013, XLVII, 3: 407-422. DOI: 10.3280/PU2013-003001).

Bereiter C. (1967). Some persisting dilemmas in the measurement of change. In: Harris, 1967, pp. 3-20.

Bersani F. (2008). La riproducibilità nella scienza: mito o realtà? Psicoterapia e Scienze Umane, 2009, XLIII, 1: 59-76. DOI: 10.3280/PU2009-001004.

Chambless D.L. & Ollendick T.H. (2001). Empirically supported psychological interventions: controversies and evidence. Annual Review of Psychology, 52, 1: 685-716. DOI: 10.1146/annurev.psych.52.1.685 (Italian translation: Gli interventi psicologici validati empiricamente: controversie ed evidenze empiriche. Psicoterapia e Scienze Umane, 2001, XXXV, 3: 5-46) (see a document by Dianne L. Chambless et al. of 1998).

Fonagy P. & Target M. (1993-2000). Attaccamento e funzione riflessiva. Milan: Raffaello Cortina, 2001.

Fonagy P., Gergely G., Jurist E.L. & Target M. (2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press (Italian translation: Regolazione affettiva, mentalizzazione e sviluppo del Sé. Milan: Raffaello Cortina, 2004).

Fonagy P., Steele M., Steele H. & Target M. (1998). Reflective Functioning Manual, Version 5.0: For application to Adult Attachment Interviews. London: University College London.

Fornaro M. (2009). Perché la ricerca in psicoterapia non può esaurire le peculiarità della clinica. Per un'integrazione epistemologica. Psicoterapia e Scienze Umane, XLIII, 2: 191-214. DOI: 10.3280/PU2009-002003.

Fornaro M. (2013). Come validare le interpretazioni e le spiegazioni in clinica senza ricorrere alla ricerca empirica. Psicoterapia e Scienze Umane, XLVII, 4: 601-620. DOI: 10.3280/PU2013-004002.

Harris C.W., editor (1967). Problems in Measuring Change. Madison, WI: University of Wisconsin Press.

Horowitz M.J., editor (1991). Person Schemas and Maladaptive Interpersonal Patterns. Chicago, IL: University of Chicago Press.

Lord F.M. (1967). Elementary models for measuring change. In: Harris, 1967, pp. 199-211.

Luborsky L. & Crits-Christoph P. (1990). Understanding Transference: The CCRT Method. New York: Basic Books (Italian translation: Capire il transfert. Milan: Raffaello Cortina, 1992).

Luborsky L. (1984). Principles of Psychoanalytic Psychotherapy. New York: Basic Books (Italian translation: Princìpi di psicoterapia psicoanalitica. Turin: Bollati Boringhieri, 1989).

Migone P. (2008). Psicoterapia e ricerca "scientifica".  Psicoterapia e Scienze Umane, 2009, XLIII, 1: 77-94. DOI: 10.3280/PU2009-001005 (see a version on the Internet).

Parloff M.B. (1985). Psychotherapy outcome research. In: Michels R. & Cavenar J.O. Jr., editors, Psychiatry. Philadelphia, PA: Lippincott, vol. 1, ch. 11 (Italian translation: Stato attuale della ricerca sui risultati della psicoterapia. Psicoterapia e Scienze Umane, 1988, XXII, 3: 9-39).

Pfeffer A. (1959). A procedure for evaluating the results of psychoanalysis. Journal of the American Psychoana­lytic Association, 7, 3: 418-444. DOI: 10.1177/000306515900700302.

Sandell R. (1987a). Assessing the effects of psychotherapy. I: Analysis and critique of present conventions of estimating change. Psychotherapy and Psychosomatics, 47, 1: 29-36. DOI: 10.1159/000287995.

Sandell R. (1987b). Assessing the effects of psychotherapy. II: A procedure for direct rating of psychotherapeutic change. Psychotherapy and Psychosomatics, 47, 1: 37-43. DOI: 10.1159/000287996.

Sandell R. (1987c). Assessing the effects of psychotherapy. III: Reliability and validity of "Change After Psychotherapy". Psychotherapy and Psychosomatics, 47, 1: 44-52. DOI: 10.1159/000287997.

Sandell R. (1987d). Assessing the effects of psychotherapy. IV: The incompatibility between the logic of the experiment and the nature of psychotherapy. Psychotherapy and Psychosomatics, 47, 1: 53-58. DOI: 10.1159/000287998.

Sandell R. (1997). Psychotherapeutic change is predictable, spontaneous change is not. Journal of Clinical Psychology, 53, 8: 925-933.

Sandell R. (1997 [2015]). Rating the outcomes of psychotherapy or psychoanalysis using the Change After Psychotherapy (CHAP) scales. Manual and commentary. Research in Psychotherapy: Psychopathology, Process and Outcome (RIPPPO), 2015, 18, 2. DOI: 10.7411/RP.2015.111.

Sandell R. & Wilczek A. (2016). Another way to think about psychological change: Experiential vs. incremental. European Journal of Psychotherapy & Counselling, 18, 3: 228-251. DOI: 10.1080/13642537.2016.1214163.

Schafer R. (1968). Aspects of Internalization. New York: International Universities Press.

Schlessinger N. & Robbins F. (1974). Assessment and follow-up in psychoanalysis. Journal of the American Psychoanalytic Association, 22, 3: 542-567. DOI: 10.1177/000306517402200305.

Shedler J. (2010). The efficacy of psychodynamic therapy. American Psychologist, 65, 2: 98-109. DOI: 10.1037/a0018378 (Italian translation: L'efficacia della terapia psicodinamica. Psicoterapia e Scienze Umane, 2010, XLIV, 1: 9-34. DOI: 10.3280/PU2010-001002).

Wallerstein R.S. (1986). Forty-two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy. New York: Guilford.

Weiss J. (1993). How Psychotherapy Works. New York: Guilford (Italian translation: Come funziona la psicoterapia. Preface by Paolo Migone and Giovanni Liotti. Turin: Bollati Boringhieri, 1999).

Weiss J., Sampson H. & the Mount Zion Psychotherapy Research Group (1986). The Psychoanalytic Process: Theory, Clinical Observation, and Empirical Research. New York: Guilford (Italian translation of chapter 1: Weiss J., Introduzione al lavoro del "San Francisco Psychotherapy Research Group". Psicoterapia e Scienze Umane, 1993, XXVII, 2: 47-65).

Westen D., Morrison Novotny K. & Thompson-Brenner H. (2004). The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130, 4: 631-663. DOI: 10.1037/0033-2909.130.4.631 (Italian translation: Lo statuto empirico delle psicoterapie validate empiricamente: assunti, risultati e pubblicazione delle ricerche. Psicoterapia e Scienze Umane, 2005, XXXIX, 1: 7-90) (see a synthesis of some parts on the Internet).

Westen D., Shedler J., Bradley B. & DeFife J.A. (2012). An empirically derived taxonomy for personality diagnosis: Bridging science and practice in conceptualizing personality. American Journal of Psychiatry, 169, 3: 273-284. DOI: 10.1176/appi.ajp.2011.11020274 (Italian translation: Una tassonomia delle diagnosi di personalità derivata empiricamente: colmare il divario tra scienza e clinica nella concettualizzazione della personalità. Psicoterapia e Scienze Umane, 2012, XLVI, 3: 327-358. DOI: 10.3280/PU2012-003001).

Zilberg N.J., Wallerstein R.S., DeWitt K.N., Hartley D. & Rosenberg S.E. (1991). A conceptual analysis and strategy for assessing structural change. Psychoanalysis and Contemporary Thought, 14, 2: 317-342.


Go back to the home page of Psicoterapia e Scienze Umane

Web Editor: Paolo Migone