The Session Rating Scale (SRS) is a simple, four-item visual analogue scale designed to assess key dimensions of effective therapeutic relationships. The SRS is administered, scored and discussed at the end of each session to get real time alliance feedback from young people and carers so that alliance problems can be identified and addressed (Miller, Duncan, & Johnson, 2002).

The SRS translates what is known about the alliance into four visual analogue scales each 10cm long to assess the clients’ perceptions of:

  • Respect and understanding
  • Relevance of the goals and topics
  • Client-practitioner fit
  • Overall alliance
Property Definition SRS
Reliability Degree to which respondents in a similar sample had similar scores Research on the SRS has demonstrated good reliability (Campbell & Hemsley, 2009; Duncan et al., 2003)
Test-retest reliability Degree to which the same respondents have the same score after period of time when trait shouldn’t have changed The SRS has demonstrated good test re-test reliability (Duncan et al., 2003)
Concurrent validity Correlation of the measure with others measuring the same concept Research on the SRS demonstrates good concurrent validity (Campbell & Hemsley, 2009; Duncan et al., 2003)
Discriminant validity Lack of correlation with opposite concepts No information available


The SRS is used with young people aged 13 to adults. The Child Session Rating Scale (CSRS) is for young people aged 6-12 (Duncan, et al. 2003). There is also a Group Session Rating Scale (GSRS) for ages 13 to adults, and Child Group Session Rating Scale (CGSR) for ages 6–12.

For children 5 or under there is also the Young Child Session Rating Scale (YCSRS), which has no psychometric properties, but can be a useful way of engaging small children regarding their assessment of the alliance.


Users may also obtain the measures in English and languages other than English at www.scottdmiller.com.

Scoring and Interpretation

The SRS is scored by  summing the marks made by the client measured to the nearest centimeter on each of the lines of the four scales. Based on a total possible score of 40, the authors advise that any score lower than 36 overall, or 9 on any scale, could be a source of concern and therefore prudent to invite the client to comment.

Clients tend to score all alliance measures highly, so the therapist should address any suggestion of a problem (Duncan et al, 2003).


Licenses for the following measures are available from the developer, Scott D. Miller:

Terms of use

The SRS and CSRS measures are licensed by Scott D. Miller and ICCE. 

If you are planning to use this measure for the delivery and improvement of health and/or social care, a license to incorporate it into electronic systems can be obtained from NHS Digital. Please note that licenses obtained via this route may be restricted to particular territory (e.g. England, UK). If planning to use the measure outside of England, you may wish to contact NHS Digital to clarify the geographical scope of the licence.

Working remotely with SRS

Scott D. Miller, Ph.D. founder of the International Center for Clinical Excellence an international consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health services has shared a statement relating to Covid-19

ICCE Certified Trainers provide instructions and examples for oral administration of the Session Rating Scale.

Find out more here

Further information

Additional information can be found here.


Campbell A., & Hemsley S., (2009). Outcome Rating Scale and Session Rating Scale in psychological practice: Clinical utility of ultra-brief measures. Clinical Psychologist, 12, 1–9.

Duncan B. L., Miller S. D., Sparks J., Claud D., Reynolds L., Brown J., Johnson L., (2003). The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3 (1), 3–12.

Miller, S.D., Duncan, B.L., & Johnson, L.D. (2000). The session rating scale 3.0. Chicago, IL: Authors.

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