Many therapists like the idea of client feedback.
The harder question is how to use it without making therapy feel like paperwork.
That is where the Outcome Rating Scale and Session Rating Scale can help.
The Outcome Rating Scale, or ORS, gives therapists a quick way to understand how the client is doing across key areas of life. The Session Rating Scale, or SRS, gives clients a brief way to share how the session felt and whether the work fit their needs.
A simple way to understand the difference is:
ORS asks: “How are you doing?”
SRS asks: “How did today’s session work for you?”
This blog is not just about defining ORS and SRS. It is about how therapists can use them in the natural flow of a session.
ORS and SRS work best when clients understand why they are being used.
If the therapist simply hands over a measure, the client may assume it is paperwork for the clinic or record. That can make feedback feel disconnected from therapy.
A better introduction might be:
“I use these brief check-ins to help us understand whether therapy is helping and whether each session feels useful to you. Your honest feedback helps me adjust the work to better fit what you need.”
This makes the purpose clear.
It tells the client that feedback is not a test. It is a way to make therapy more collaborative
The ORS is usually most useful near the beginning of the session.
It helps the therapist understand how the client has been doing since the last meeting. This can guide the session focus.
For example, a client may begin by talking about work stress, but their ORS score may show a drop in relationships. The therapist might say:
“I hear that work has been stressful, and I also notice your relationship score is lower this week. Should we make space for that today?”
Or a client may say, “Things are fine,” while the ORS suggests they are struggling more than before.
The therapist might ask:
“You said the week was mostly okay, but this score is lower than last time. What do you think that reflects?”
This is how ORS becomes useful. It does not control the session. It sharpens the therapist’s curiosity.
Once ORS feedback is reviewed, the therapist can use it to guide the conversation.
If scores improve, the therapist can ask: “What do you think helped this week?”
If scores decline, the therapist can ask: “What made this week harder?”
If scores stay flat over several sessions, the therapist can ask: “We have been meeting consistently, but things do not seem to be shifting much yet. How are you experiencing the work so far?”
These questions help therapists avoid continuing automatically when the client may need something different.
The value of ORS is not just tracking progress. It is helping therapists talk about progress while therapy is still happening.
The SRS is usually completed at the end of a session.
It helps the therapist understand whether the client felt heard, whether the session focused on the right topics, whether the approach fit, and whether anything important was missing.
This matters because clients may not always volunteer concerns directly.
A client may say, “Thanks, see you next week,” while privately feeling that the session missed something.
The SRS gives the therapist a chance to ask before the client leaves:
“I noticed the goals and topics area was lower today. Did we miss something you wanted to focus on?”
Or:
“Was there anything about today that did not fit for you?”
These are simple questions, but they can prevent small misalignments from becoming larger ruptures.
One score can be useful, but patterns over time are often more important.
A client’s ORS may drop after a stressful event. A client’s SRS may dip after a difficult but necessary conversation. A single score should always be understood in context.
The better question is: “What pattern are we seeing?”
Common patterns might include:
- ORS improving and SRS staying strong
- ORS staying flat while SRS is high
- ORS declining while SRS remains high
- SRS dropping suddenly
- SRS staying high while progress does not change
Each pattern can guide a different conversation.
For example, if SRS is high but ORS stays flat, the therapist might say: “It seems like our sessions feel supportive, but things may not be changing much outside therapy. Should we review our goals or approach?”
That kind of question helps connect feedback to clinical decision-making.
ORS and SRS are simple tools, but they still need to be used thoughtfully.
One common mistake is collecting scores without discussing them. If clients complete measures but nothing changes, the process may feel meaningless.
Another mistake is only paying attention to low scores. High scores can also be useful. A therapist can ask: “What made today helpful?”
A third mistake is treating the score as the whole story. Scores should lead to conversation, not replace it.
The most important mistake is becoming defensive. If a client gives lower feedback, the therapist’s response matters. Curiosity keeps the door open.
Yes.
ORS and SRS can be used alongside tools such as PHQ-9, GAD-7, RCADS, or other mental health assessments.
Symptom-specific tools can help track depression, anxiety, or child and adolescent symptoms. ORS and SRS help monitor broader functioning and session experience.
Together, they can support a more complete view of care.
MyOutcomes helps therapists and organizations use ORS, SRS, and other feedback tools consistently.
With MyOutcomes, clinicians can:
- collect session-by-session feedback
- track client progress over time
- monitor therapeutic alliance
- view outcome patterns
- support supervision and reporting
- use feedback in daily clinical workflows
The goal is not to add more paperwork.
The goal is to make client feedback easier to collect, understand, and use.
ORS and SRS are most useful when they shape the next clinical question.
The ORS helps therapists ask, “How are things going?”
The SRS helps therapists ask, “Did this session work for you?”Together, they help therapy stay connected to the client’s experience.
For MyOutcomes, the practical value is clear:
ORS and SRS help therapists turn client feedback into better clinical conversations.
