ORS / SRS
Outcome Rating Scale / Session Rating Scale
Two four-item visual-analog scales used together every session: ORS tracks client wellbeing, SRS tracks alliance.
What it measures
ORS: individual, interpersonal, social, and overall wellbeing for the past week. SRS: relationship, goals/topics, approach/method, and overall sense of the session just completed.
Scoring and bands
Cutoffs
ORS reliable change index ≈ 5 points; clinical cutoff ≈ 25. SRS scores below 36 (out of 40) suggest the alliance needs explicit attention — this is the point of the SRS.
How to talk about the score
The SRS is built to be discussed. A score below 36 isn't a problem — it's an invitation. 'Looks like something didn't quite land today. Can you tell me what would have made this hour more useful?'
Limitations
- Less psychometrically detailed than longer measures
- Easy to administer perfunctorily — loses value when not actually discussed
- Self-report with social-desirability bias on SRS
Best used for
- Routine feedback-informed treatment
- Practices invested in alliance monitoring
- Reducing dropout via real-time alliance repair
FAQ
Does feedback monitoring actually improve outcomes?
RCT evidence on routine outcome monitoring suggests modest but consistent improvement in outcomes and reduced dropout, particularly for clients not progressing.
How do I bring up a low SRS without making the client feel bad?
Thank them genuinely, then get curious. The whole point of the SRS is to make alliance ruptures discussable — your tone teaches the client whether honest feedback is safe.