Can patients really give honest feedback on the ORS and SRS Scales?

| January 23, 2013
ORS and SRS scales, client feedback

One of the three most commonly asked questions about the ORS and SRS scales is “How can patients really give honest feedback to their therapists sitting right in front of them?”

This question, like so many posed towards innovative tools like MyOutcomes, is really a question about reliability and validity. Though the question isn't very scientific, the author is asking if the ORS and the SRS are reliable and valid instruments. They want to know if the information from the tools can be trusted and used. There are, of course, numerous studies that have clearly demonstrated the reliability and validity of the ORS and the SRS.

The difficulty of this question, though, isn't whether it is an unscientific question asking for scientific information. The author of this question is probably unaware that what they are asking threatens the very foundation of psychotherapy. One of the basic premises of psychotherapy is that, in order to achieve successful outcomes, it is essential to create an environment where honest and intimate discussions can take place. These discussions involve the client's past and current feelings and experiences. Of course, all memories, whether of recent events or more distant moments, are “tainted” by the subjective interpretations of the client. It would be great, particularly for the therapist, to get a purely objective view of the past. But that can never happen. Psychotherapy, by its very nature, is a subjective experience.

The SRS and the ORS provide subjective information from the client which typically isn't part of traditional therapeutic practices. The information provided by these tools is part, in fact a very important part, of the therapeutic puzzle that will help the client, along with their therapist, to achieve their therapeutic goals.
The author of the question is really asking whether the subjective information provided by the ORS and the SRS can be considered to be a true representation of reality. Though it probably isn't their intent, they are equating “Truth” with objective reality. Of course, objective reality is not anymore true than subjective reality. The difference between them rests in how they can be measured. The problem, however, is far more fundamental. If the therapeutic bond between the therapist and the client, that is necessary for creating a trusting, safe and honest environment, is so fragile that it breaks down while reporting subjective feelings and experiences with the SRS and the ORS in the presence of the therapist, then how can any of the subjective information that is exchanged during a session be considered to be “honest”? And, if the therapist can't create an honest environment, then how can psychotherapy ever be successful?

We know, of course, that psychotherapy does work. It works because it doesn't matter if the reports of feelings and experiences are objectively true. What matters is that they are subjectively true. The SRS and the ORS are subjective tools designed to facilitate the opportunity to achieve therapeutic goals. The question shouldn't be, ‘why would a client be honest' but rather, ‘why wouldn't the client be honest'? If a client feels comfortable discussing with their therapist about sensitive information in a frank and honest manner, they will certainly approach the SRS and the ORS, which are tools designed to give the client a bigger voice in achieving their goals, in the same honest and frank manner.

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Category: ORS/SRS

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