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
Frequently asked questions about the ORS / SRS
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.