SRS

Definition

The SRS (Session Rating Scale) is a four-item instrument developed by Scott Miller, Barry Duncan, and Lynn Johnson as a process measure of the therapeutic alliance, complementary to the ORS. It is administered at the end of each session and the client evaluates:

1. The relationship: I felt heard, understood, and respected
2. The goals and topics: we talked about what I wanted to talk about and worked on what I wanted to work on
3. The approach or method: the way we worked made sense to me
4. The session overall: overall, today's session was right for me

Each item is scored on a 10 cm visual analog scale. The total score ranges from 0 to 40. A score of 36 or above indicates positive alliance. Scores below 36 signal areas of friction in the alliance that the therapist should explore.

Why the alliance matters (and why measuring it helps)

The therapeutic alliance is one of the most robust predictors of psychotherapy outcome, with an effect size of r ≈ .28 in meta-analyses across thousands of studies (Flückiger et al., 2018). Therapists who solicit and use alliance feedback have better outcomes, especially with clients at risk of dropout.

The problem is that therapists systematically overestimate the quality of alliance as perceived by the client, especially when the alliance is weak. The SRS allows clients to communicate dissatisfaction in a structured, non-confrontational format.

When it is used

The SRS is used at every session in feedback-informed treatment (FIT) models. It requires only two to three minutes at the end of the session. The therapist reviews any low-scoring item with the client: "I notice you marked a bit lower on the approach we used today. Is there something that would have been more helpful for you?"

When not to use the SRS

In acute crisis sessions or when the client is in a state of high emotional activation, administering the SRS at the end may interrupt the necessary therapeutic closure. In those cases, the scale can be skipped in that specific session.

Example of use in session

A therapist administers the SRS at the end of session 7. The client scores 32/40, with the "goals and topics" item at 6/10. The therapist notes it: "I see the item about what we talked about today is a bit lower. Was there something you wanted to explore that we didn't address?" The client mentions they wanted to discuss a specific family conflict. The therapist incorporates it for the next session and documents it in the note.

References

• Miller, S. D., Duncan, B. L., & Johnson, L. D. (2000). The Session Rating Scale 3.0. Chicago: Author.
• Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340.

Related terms

• ORS: outcome scale completed at the start of each session
• Therapeutic alliance