The Outcome Rating Scale and Session Rating Scale, key components of the Partners for Change Outcome Management System (PCOMS), are not only reliable measures of psychotherapy benefit and the therapeutic alliance, but also have been shown to improve outcomes and reduce dropouts. These brief, four-item scales are designed to increase efficacy by involving the client and therapist in a true partnership, whereby the client is an active participant in all decisions affecting his/her care.
Here are five tips for using the Outcome Rating Scale and Session Rating Scale effectively:
1. Discuss the Outcome Rating ScaleThe Outcome Rating Scale (ORS) assesses personal or symptomatic distress, family interactions, and larger social relationships. It is critical that clients are on board and understand two points: the ORS ensures that client voice remains central, that his or her view of benefit will call the shots in therapy; and the ORS will used in each and every meeting to monitor benefit so we can regroup if therapy is not helping. This introduction of the ORS builds a feedback culture in the first session and sets the client up for success.
2. Use the ORS in SessionClinicians should not only introduce the ORS in the first session, but also take the opportunity to bring client responses into the conversation throughout the session. Connecting the client’s marks on the ORS to his or her reasons for service allows for a clear and concise discussion of the issues at hand and the client’s goals for service. In doing so, the ORS becomes a meaningful measure of benefit tailored to the client’s individual experience of distress.
3. Discuss the Session Rating ScaleLike the ORS, the Session Rating Scale (SRS) should be introduced in the first session and every session thereafter. Introducing the SRS in the first session sets the tone of the therapeutic relationship and further reinforces the client’s important role and agency in the process. The great thing about the SRS is that it not only monitors the alliance and solicits feedback to improve the client’s experience, it builds the alliance at the same time.
4. Use the SRS DataThe SRS provides the opportunity for discussing the alliance and giving it the attention that research suggests it deserves. The SRS is administered toward the end of each session and ensures that clients leave with a positive experience--setting the table for a return to the next meeting. In its essence, the SRS says, “Your experience is important to me, our alliance is important to me, and I am willing to change what I do to better fit your expectations.”
5. Monitor Changes
Monitoring changes in ORS and SRS scores allows both clients and therapists to know what is working and what is not. Both measures enable an individually tailored client experience and serve as an early warning device for clients who are not benefiting and/or have alliance concerns--those at risk for dropout or a negative outcome. PCOMS improves outcomes and reduces dropouts as demonstrated in six randomized clinical trials. The PCOMS measures, the Outcome Rating Scale and Session Rating Scale, are empirically proven outcome and alliance tools for clinicians -- and for clients.