Biserka Tomljenović, November 29, 2022

At its core, science is characterized by an openness to constant change, striving for the understanding of objective truth. At the same time, it contains an imperative to continually question already established truths. In this tension—between the pursuit of objectivity and generalization on one side, and the breaking down of dogmas on the other—a creative field opens up, one that allows for curiosity, experimentation, and access to new realities.

In this orientation toward the possibility of change, the here and now, and the discovery of the new, science and Gestalt psychotherapy are almost perfectly aligned. Gestalt therapists do not interpret, nor do they try to force the client into any theoretical or diagnostic framework. In psychotherapeutic work, we are, in a sense, constantly applying the scientific method: through experience, experimenting in the here and now together with the client, we observe, collect data, test assumptions, discover the new, and strive to find meaning that assists clients to find their way in a dynamic set of experiences, emotions, sensations, ideas and relationships we call life.

The moment we believe that only our perception is correct, we step out of the realm of science and into the domain of dogma and decree. Science is necessarily intersubjective—because it is practiced by people. And people cannot escape subjectivity. Even in the most rigorous research of the so-called “hard sciences,” the direction scientific inquiry takes and the choice of research design or method often depend heavily on the phenomenology and personality of the researcher, the interests of the research institutions, available funding, and the politics of science.

This raises an important question for every Gestalt psychotherapist who embarks on research: How aware are we that the research process can guide us toward self-awareness, learning, growth, and empowerment—but can also cast us into the role of a superior researcher, bearer of the only objective truth? If we fall into the trap of a narcissistic scientific position, our research becomes an instrument for avoiding personal or institutional narcissistic injury. And in doing so, we lose access to the most beautiful part of the research journey—the pure, unfiltered, playful, creative, childlike curiosity.

That is why it is vital to continuously remind ourselves of a frequently overlooked scientific principle: a disproven hypothesis is just as valuable a finding as a confirmed one. It is knowledge of equal worth, and we should present it to the world and celebrate it with the same enthusiasm.
In presenting our research results, our inner world meets the outer world. It is here that we encounter our shame, insecurity, narcissism, resistance—and from there, our intimate, creative adaptation begins. In this difficult moment, we can rely on a concept well-known in Gestalt psychotherapy: creative indifference.

Research in psychotherapy does not have to be dry, cold, quantitative, or rigid. I primarily experience it as a childlike exploratory game—full of curiosity, experimentation, playfulness, trial and error.

In the hope of encouraging you to undertake your own research endeavors, I will now share with you my personal process of working on an evaluative study of my own practice—a process I deeply enjoyed and through which I learned a great deal about myself and my work.

When the time came to write my final thesis to obtain a Gestalt psychotherapy diploma—which typically consists of a case study based on the therapist’s notes and recollections—I simply couldn’t bring myself to start writing. I resisted for months. Eventually, I realized that I had a serious problem with the case study format. What I missed was the excitement of genuine discovery.

I wanted to test my assumptions and compare them with the clients’ actual experiences. In the case study, I felt the client was missing. It felt like fantasizing about a fantasy. The idea of reviewing my notes and trying to fill in the gaps with my memory and quotes from literature seemed like a complete waste of time and energy. I didn’t feel I could learn or grow from it—or draw any real conclusions about how I practice therapy.

On the other hand, I was deeply curious and eager to find out what remained with my clients after our work had ended. I couldn’t wait to compare my own impressions—what I believed had happened and what I thought had stayed with them—with actual feedback from my clients, as well as the results of a more objective tool for measuring therapy outcomes.

I was genuinely interested to see whether these three perspectives would be in complete dissonance, or whether what I thought I was doing in therapy had at least some correlation with reality. I wanted the research process to surprise me, to motivate me, and to change me.

At that point, I came across the CHAP (Change After Psychotherapy) method for evaluating psychotherapy outcomes, developed by Rolf Sandell. CHAP is based on the idea that change does not necessarily have to be measured by comparing pre- and post-therapy states; instead, it can be assessed qualitatively through the client’s subjective experience of how they have changed during therapy.

The issue of evaluating therapy outcomes has been a relevant topic for years. Various approaches to measurement are used in both small and large studies.
My curiosity about what remained of therapy in my clients’ lives was the main driving force behind my decision to engage in the experience of evaluating my own work. I wanted to apply a methodology that was scientifically grounded, but also one I could keep as closely aligned as possible with Gestalt principles.
In my search for a suitable methodology, the CHAP model (developed by Rolf Sandell at the Institute for Psychotherapy in Stockholm) seemed closest to my vision of what lies at the heart of a psychotherapist’s work—facilitating and supporting the process of change.

The CHAP method is based on the idea that change does not necessarily have to be measured by comparing pre- and post-therapy states; instead, it can be assessed qualitatively through the client’s subjective experience of how they have changed during therapy. This method involves a semi-structured interview with the client after the conclusion of therapy, focusing on the client’s perception of change across various aspects of life.

I won’t go into a detailed description of the CHAP model, but I do believe it’s important to present the main concepts it is built upon. Rolf Sandell, in his paper on the CHAP model, explains it wonderfuly:

“There is a curious paradox in the traditional way of measuring psychotherapeutic change by the difference between a patient’s pre- and post-treatment scores. When initially a patient asks for a psychotherapy, claiming that s/he suffers, is unhappy, etc., researchers seldom doubt that this could be true, rather taking the patient’s statements for granted. However, the same researchers typically would not rely on the patient’s statements about his/her improvement due to therapy, although they might have expected that at the end of his/her psychotherapy the patient would have gained even more of introspective self-awareness than before. So why, in our role of researchers, should we adopt these double standards? There are even more important problems related to measurement of psychotherapy outcome. The traditional way of measuring change is to apply a measuring device to an object before some kind of treatment, an intervention or an event, and again apply the same device to the same object after the treatment and then calculate the difference between the two readings on the measuring device (Sandell, 1987a). This is based upon the idea that change is to move along a continuum which is qualitatively the same after the treatment as it was before. Another way to put this is that if the measured value is the same after the treatment as the measured value before, the two identical values have the same meaning (Lord, 1967). According to the same logic, different values represent a purely quantitative change on a single dimension of meaning. There are few things as disputable in psychological measurement theory –and few things have been discussed so much– as this way of measuring change (Harris, 1967). The discussion has mainly been about making the difference between the postmeasurement and the premeasurement independent of the premeasurement, that is the person’s baseline, and how reliability attenuation could be avoided (Bereiter, 1967).  

But to measure quantitative change is not only disputable from a mensurational point of view but also from a substantial point of view. The critical assumption is that whatever it is that one wishes to measure after the intervention is qualitatively the same as whatever it was that one measured before. It is built upon the premise that learning and other kinds of change comes about through quantitative steps of progress or regress of qualitatively the same kinds of knowledge and abilities and corresponding functions. A convenient model for this is building a wall by adding layers of identical bricks to each other. But when one is learning things or when one is changing in other ways, it is more often the case that the change is qualitative. One changes by being or doing something in some other way than before, not by being or doing whatever it was one was doing more or less than before. It is true that one may find or invent quantitative aspects of this kind of change, for example, that something is being done more speedily or more accurately after an intervention than before, but the important point about viewing learning the qualitative way is that the new ability is constituted differently, is structured or organized differently. This is a very important difference between the quantitative and the qualitative way of regarding change, that the function that has changed is not more but different. In everyday life there are lots of examples that may serve as a model, for instance when you redecorate your home, when you change your clothes or buy new ones, or when you are rewriting a text.  

It is exactly because of this “differentness” rather than “moreness” that the quality of change is not so easy to quantify when psychotherapeutic change is concerned. True, level of functioning is a quantitative concept, and so is severity of disturbance or symptoms, hence also changes in these respects. When personality change is concerned it is different, though. The really relevant parameter is “radicalness,” meaning that qualitative change may be more or less radical, extensive, or thorough. If you redecorate a room by moving a chair, it is certainly less radical a change than if you move all pieces of furniture around. If you reorganize all paragraphs in a text, it is certainly more radical than if you move only one. So, how radical a change has a person undergone and how may this be quantified, in a loose sense or in a more exact way? There is a rather concrete criterion for such a kind of change that is quantifiable, at least in the subjective sense, like all kinds of sensory or perceptual experiences are, and that is to what extent the observer does not recognize himself or herself, maybe becomes surprised or astonished, impressed or disappointed, proud or frustrated, or whatever it is that one becomes when one stands before someone who has changed for the better or the worse. This last also implies that whatever degree of surprise that one experiences may be valued in a positive or negative way. Alternatively, in the case of no change, one may become bored or impatient or irritated or whatever, when one recognizes that everything is exactly as it was before, feels a kind of disappointment in one’s hopes for a change, distrust and hopelessness because of the lack of change. It is not only the independent observer that may feel this way, also the subject, the person who is changing or is not changing as the case may be, may have such feelings in relation to his/her own change or lack of change.  

Again as a model, when we go out in the street with a new set of clothes, who does not try to look at himself or herself in the shop windows, feeling different, sometimes embarrassed, sometimes proud, but in any case changed some way. This experience one might call, a bit awkwardly, the experience of the state of having changed, in order to emphasize that it is not about the change itself but about the consequences of it on the experiential level. 

This is an experience that some patients have while in psychotherapy or after. One may feel more or less different than before, for instance when one realizes that the way one is doing or feeling now has not been done or felt that way before or when one realizes that one cannot understand how one could do or feel the way one did before. In a way one is feeling a kind of strangeness or alienation in relation to the person one used to be. One may feel surprised, glad, proud, curious before one’s new way of being and thinking. Simply, one has a more or less new image of oneself. This is an essential feeling, because feeling different than before is so important an aspect of one’s present, new self image. As part of one’s new self image and, above all, as an agent of the change of the self image, the psychotherapy and its consequences obtain an important role in the revision or rewriting of one’s history which more and more scholars are regarding as the essential process in many psychotherapies”.

Initially, my intention was to follow the CHAP model, in which an independent interviewer conducts sessions with clients. These interviews are then transcribed and sent to independent evaluators who assess the level of change in symptoms, adaptability, capacity for self-reflection, and core conflicts—based on a standardized manual.

The idea was that I would then reflect on the results, which would be presented in numerical tables, and offer my own interpretations of the process.

It all sounded great—until I realized that this approach would deprive me of a deeper, more reflective learning process. In essence, my entire project would have been reduced to my reaction to the evaluation results—commentary on numbers I didn’t even understand how they came to be.

I kept asking myself—what’s missing? What do I need? I knew that the dominant feeling I had in relation to the case study was resistance—resistance to what I perceived as one-way communication.

And finally, after some time, I clearly recognized that both “I” and the Client were missing in the context of an encounter between two realities. What I needed was the I – Though Dialogue between two equal participants.
Finally, I became aware of my deep need to clarify and connect with my own authentic perspective about the client and the therapeutic process—independent of the CHAP evaluation model. I wanted to discover who “I” was before coming into contact with the perspective of the client or the evaluator.

The case study came back with a vengeance! Instead of writing just one, I now had to write four case studies—since I had four clients in my sample.
But this time, surprisingly, I immediately felt a surge of creative energy, because suddenly the process of writing case studies began to feel meaningful.
That moment—so similar to the closing of a gestalt—was my signal that I was on the right path.

In the end, I accepted that unless I adapted the methodology to fit my own needs, the process simply wouldn’t work for me. So I decided to surrender to the experience of adjusting the CHAP methodology and let it evolve spontaneously—for as long as my emerging needs required it. I also chose not to read the interviews or evaluation results until I truly felt that my own introspective and reflective process was complete. In a way, I allowed my methodology to unfold according to the principles of organismic self-regulation. And the results turned out to be quite satisfying.

To structure my introspective and reflective processes in a way that was both comprehensible and methodologically consistent, I decided to create a framework that I then applied to all four clients.
This structure evolved during the writing process, as I kept adding new segments along the way.

The introspective self-evaluation—written before I had read or learned anything about what the clients said in their interviews—consisted of revisiting my memories, reports, and notes about the clients and the therapeutic process.
The main purpose of this part was to answer the question: “What part of the relationship stayed with “Me” after the client left?”

At a certain point during the introspective process, I realized that the structure of my self-evaluation didn’t align with the CHAP evaluation model, which is focused on measuring change within specific dimensions.
I wanted to create at least some shared foundation—a space for comparing my own perspective with those of my clients, within the CHAP framework.

So I returned to the CHAP methodology and, while rereading the interview questions, realized how interesting it would be to answer some of the same questions that the clients would be answering—and later compare them.

I selected comparable questions from the CHAP model and responded to them before reading any of the client interview transcripts.

Working on the self-reflection took more time than I had expected, because I kept going back and discovering new things. Still, it proved to be very useful—it gave me insight into how I distinguish between the “more relevant” and “less relevant” parts of the therapeutic process. I was often surprised by how well I remembered certain facts about the client and the process, even before rereading my notes and reports, while other things had simply vanished from memory. I wasn’t particularly surprised to realize that the thing I remembered most clearly was the Contact—how it developed, what disrupted it, and how it affected me.
As for the interventions, I only remembered those that led to those “magical” moments with clients—or those that left behind an unfinished gestalt in me.

On the other hand, it was sometimes difficult to recall detailed background information about the clients, and I was often very frustrated with my notes, which were written too sloppily and unsystematically. My most reliable source ended up being the supervision reports.

The next emerging need was to incorporate my emotional reactions into the introspective process.
Doing so helped me become aware of my need to create a sense of closeness and emotional connection—something that helps me feel more relaxed in my work. This was a very important realization for me. I understood that, with some clients, fulfilling this need had made it harder for me to maintain the position of an observer of the process and the relationship.

By the end of the entire process of tuning into my needs and adding new elements, the introspective section came to include the following chapters/information:

1. Duration of therapy
2. General information and the client’s main diagnostic characteristics
3. Therapy goals as stated by the client
4. The client’s background
5. My perspective on the key points in the therapeutic relationship with the client
6. Termination of therapy
7. My responses to selected questions from the CHAP model
8. My emotional reactions during the process of remembering and reflecting on the work with the client.

Once I had completed that part, I allowed myself to read the client interviews.
I was struck by the intensity of my emotional and physical reactions—even before opening the first transcript.
I hadn’t given much thought to what my clients might have said in the interviews before reading them. I had been too occupied and immersed in the introspective work and reflection on our process.
When the moment finally came to read the interviews, I was surprised by the emotions that surfaced. They resembled the kind of feelings I have when I need to talk about something important with people I care about.
The excitement, paired with bodily restlessness, felt much like what one experiences before a first date—or a high-stakes job interview.

When I started reading the interviews, everything shifted—different emotional and bodily reactions began to arise. At first, I was overwhelmed by a sense of warmth and closeness—almost intimacy—as if I were entering a conversation with an old, very dear friend I hadn’t spoken to in years.
It was, in fact, a re-establishing of contact and relationship—but from a different perspective.
It was the perspective of an engaged and attentive observer whose task was to focus on the therapist (myself) and the quality of the therapeutic process, by facing the truth about the differences between the client’s and my perception of reality—by identifying blind spots and weaknesses, while at the same time enjoying the evidence of positive outcomes.

Reading the interviews created space for a renewed sense of contact and relationship with my clients—while still allowing for enough distance that I could focus solely on my own internal processes.
Reading the transcripts gave me the opportunity to return to the material multiple times and move through different phases of emotional response to the text:

1. Initial intense excitement, with no capacity for analytical thinking
2. Moderate excitement, which allowed for some analysis, but with a tendency to focus either on very positive aspects of my work or very negative ones—mistakes
3. Emotional calm, which enabled the highest level of analytical processing and, more importantly, the ability to clearly and precisely identify areas of my work that needed further development.

It became clear to me that aspects of my schizoid personality style were affecting my reluctance to give proper attention to the importance of closing the therapeutic relationship with clients.
I tended to rush through the endings of therapy because, on some level, they felt too painful.
I was inclined to shift the responsibility for the relationship onto the client—even in cases where it would have been more helpful for them had we had more thorough conversations, either about my reasons for not continuing therapy with some of them or about my frustration when they did not follow through on our agreement to continue.

I discovered that I am genuinely skilled at creating a safe environment for my clients and at keeping the focus on their story. I was also struck by the vividness and fluidity of the different realities—how clients incorporated me into their reality, and how I, in turn, incorporated them into mine.

I could never have reached this level of learning simply by reading final numerical results or by writing a case study without the feedback I received from my clients. Confronting the interviews was, for me, the most valuable part of the entire evaluation process.

Once two colleagues from the UK—whom I had never met—agreed to rate the interview transcripts using the CHAP model, alongside a colleague from Croatia, I finally felt satisfied with the entire concept.

The ratings came in, and after reviewing them, I was pleased to see that the assessors’ conclusions were, more or less, aligned with my own assessment of the outcomes for each individual client.
Having access to the client interviews, answering some of the same CHAP model questions, and engaging in introspection and self-evaluation before facing the numbers gave me solid ground under my feet.
It allowed me to accept the numerical outcome data as less frightening and ambiguous.
It was easy for me to understand the numbers and to recognize where certain results were influenced by differences in the assessors’ approaches and/or by a lack of additional context about the clients.
Had I only been confronted with numbers—without my own evaluations and the subsequent analysis of the interviews—those numbers alone would not have offered me the kind of insight into my work that I now feel encouraged to explore and develop further.

This way of conducting the CHAP process is aligned with the fundamental Gestalt principles of dialogue, the I-Thou relationship, and field theory. The permission I gave myself to adapt the methodology to suit my own needs led me to feel, very clearly, that the research I was conducting emerged from my personal motivations—that it was mine, authentic, and meaningful. This type of research is an example of inquiry that honors the researcher’s authenticity, acknowledges the intersubjective nature of the research process, fosters creativity within that process, enhances the sense of purpose for the researcher, and enables deeper, more layered learning.

I truly hope that one day, you will experience it too!