How to Address Outcome Rating Scale Scoring in Therapy

The Outcome Rating Scale (ORS) is used by the client to rate three domains: individual (personal well-being), interpersonal (family/close relationships), and social (work/school/friendships) as well as an overall rating. Once the scale is completed by the client, results are shared and discussed openly.

Adding Flesh to Bone

The three domains mentioned above act as a “skeleton” of the human experience, to which clients can add “flesh” through the therapeutic conversation. For instance, the interpersonal scale could represent conflict with a spouse or concerns about an ailing parent. Likewise, the social scale could represent being laid off a job or anxiety in social situations. By subsequently sharing their stories, the measure comes to represent the flesh and details of the client’s unique life experience.

Using the ORS, the client determines what the score means to them and what it represents in their life. The ORS differs from other validated instruments in that it isn’t a list of symptoms or problems. Instead, it’s an instrument that’s individualized by each client to represent his or her experience and reasons for service.

ORS scores are also an opening for therapists to inquire about the impact of the problem in the client’s life and thoughts on general directions to resolve the problem. The domain that the client scores the lowest usually represents the reasons for service making it a great starting point for the session.

Reaching a Shared Understanding

Outcome Rating Scale scoring helps the client and therapist to reach a shared understanding of the issue at hand and of what success could look like. Following the first session, the client and therapist can compare the most recent score with those from previous sessions and raise the critical question: “Are things better or not?”

When ORS scores are not increasing—things are not better—the therapist engages the client in a collaborative conversation to chart a different therapeutic course. If a lack of change continues, “checkpoint” conversations are conducted in the third to sixth meeting and “last chance” conversations in the sixth to ninth meeting to ensure that all possible options are considered. If no change persists, moving the client to a different therapist is discussed.

The ORS also helps with psychotherapy quality assurance and discharge planning. When a client reaches a plateau or maximum benefit from service, the ORS stimulates a conversation about next steps including increasing the time between sessions, termination, and continued change after therapy.

Acquiring This Important Tool

The ORS is an important tool in the therapist’s tool box which indicates when action is needed to prevent a negative outcome and informs discussions about stepping down or terminating services. To add this tool to your practice today, visit the PCOMS Measures page of this website or request a free trial of Better Outcomes Now.