Session Rating Scale SRS
Session Rating Scale SRS overview
Creator and Context
The Session Rating Scale (SRS) is a four item measure of the therapeutic alliance, completed by the client at the end of every session.
It was authored by Lynn Johnson, Scott Miller and Barry Duncan in 2000, with validation published by Duncan, Miller and colleagues in 2003. It is the alliance half of Feedback Informed Treatment, alongside the Outcome Rating Scale.
The licence for paper use is free to individual practitioners. Electronic and digital use is not permitted under that licence and requires a separate arrangement.
Presenting Conditions
The four items map onto the components of the therapeutic alliance:
Relationship: did the person feel heard, understood and respected
Goals and topics: did the session work on what they wanted to work on
Approach or method: was the therapist's approach a good fit
Overall: was the session right for them
The four items load on a single factor and should be read as a global alliance score, not as four independent subscales.
Administration
Completed by the client at the end of every session, in under a minute, then scored and discussed immediately with the therapist. Each item is a 10 centimetre visual analogue line, marked between a negative anchor on the left and a positive anchor on the right.
The recall window is the session that has just finished.
Desired Audience
Young people from around 13 and adults. A Child Session Rating Scale, using faces rather than words, is used for ages 6 to 12, and group versions exist for both.
The alliance is the single most reliable predictor of therapy outcome, and clients who are unhappy with it usually vote with their feet rather than say so. The SRS asks the question directly, every session, while there is still time to do something about it. That is the entire point, and it is why the discussion matters more than the score.
Considerations
Ceiling effects are intrinsic. Clients rate all alliance measures highly, which is exactly why the threshold sits at 90 percent of the maximum. A high score tells you very little. Any dip is the signal.
The score is worthless without the conversation. Collecting it and not discussing it defeats the purpose.
The 2003 validation covered the adult version. The child version was not validated in that study, and its threshold is developer guidance rather than a peer reviewed finding.
The free licence explicitly does not permit electronic or digital use. Digital administration requires a licence through an authorised vendor or, in the UK, through NHS Digital.
How to score the Session Rating Scale SRS
Conducting the assessment
The client marks each of the four lines. The marks are measured to the nearest centimetre and summed.
Interpretation
The four items are summed to give a total from 0 to 40.
From the original paper: any score lower than 36 overall, or lower than 9 on any single scale, could be a source of concern and it is therefore prudent to invite the client to comment.
Because clients tend to score alliance measures highly, the therapist should address any suggestion of a problem rather than waiting for a low score.
Clinical Considerations
Score it in the room and talk about it. A score filed without discussion is worse than not collecting it, because it looks like feedback was invited and then ignored.
Treat a drop from 40 to 37 as information, even though both are above threshold.
Watch the pattern across sessions rather than any single reading.
Session Rating Scale SRS use cases
Monitoring the therapeutic alliance session by session
Detecting and repairing alliance ruptures before the person disengages
Feedback Informed Treatment, alongside the Outcome Rating Scale
Practitioner development and supervision
Category
Feedback
Research Summary
Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D. A., Reynolds, L. R., Brown, J., & Johnson, L. D. (2003). The Session Rating Scale: Preliminary psychometric properties of a working alliance measure. Journal of Brief Therapy, 3(1), 3 to 12.
Johnson, L. D., Miller, S. D., & Duncan, B. L. (2000). The Session Rating Scale 3.0. Chicago: Authors.
Murphy, M. G., Rakes, S., & Harris, R. M. (2020). The psychometric properties of the Session Rating Scale: A narrative review. Journal of Evidence-Based Social Work, 17(3), 279 to 299.
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Scale To Assess Therapeutic Relationships STAR-P
A guide to the STAR-P, the 12 item measure of the therapeutic relationship in community mental health care. Covers the three subscales, the 0 to 48 scoring and the absence of a cut off.
Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
