Client-Directed Outcome-Informed Therapy

Client-directed outcome-informed therapy (CDOI) was co-developed by Scott Miller and Barry Duncan. This innovative and simple technique involves posing a series of questions to a client, both before and after a therapy session. The emphasis of this therapy is not on the talk therapy processes, but rather the alliance formed between the therapist and client and the client’s evaluation of the experience as a compass for further treatment techniques. "Client directed" therapy started with Barry Duncan's 1992 book, Changing the Rules: A Client Directed Approach, which was influenced by Michael Lambert's rendition of the common factors in John Norcross' 1986 Handbook of Psychotherapy Integration. Changing the Rules attempted to operationalize the common factors commensurate to their relative impact on outcome. "Client directed" spoke to the influence of clients on outcome: their resources, strengths, and resiliencies, their view of the alliance, their ideas and theories of how they can be helped, and their hopes and expectations. The common factors, in other words, make the case that clients should direct the therapeutic process—their views should be the privileged ones in the room. "Client directed" became "client directed, outcome informed" in 2000 with the publication of Barry Duncan and Scott Miller's book, Heroic Client. Shortly thereafter the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) were developed to be used in clinical practice.

First Formal Scale of CDOI: Outcome Rating Scale

The first formal scale, called the Outcome Rating Scale (ORS), is administered to the client at the beginning of a therapy session. This tool is composed of four short questions and is used to gauge the progress a client has made since his or her last session. Vital information is gathered from the client and this information is extremely useful to the therapist in determining if any external influences or environmental situations have delayed or enhanced the client’s progress.

Second Formal Scale of CDOI: Session Rating Scale

The second formal scale, called the Session Rating Scale (SRS), is a four-question assessment administered at the conclusion of a session and used to assess the client’s overall therapy experience. This form of assessment has proven to be a very effective system for determining the progress of a client. In addition, the SRS allows the therapist to evaluate the current approach being used and decide if a change of course would better assist the client in achieving a positive outcome. This immediate feedback serves both the client and therapist in streamlining and focusing the therapy in such a way as to facilitate the desired results as quickly as the therapy will allow.


Last updated: 07-02-2015

Advanced Search


Mental health professionals who meet our membership requirements can take advantage of benefits such as:

  • Client referrals
  • Continuing education credits
  • Publication and media opportunities
  • Marketing resources and webinars
  • Special discounts

Learn More is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on