OARS in motivational interviewing, with examples

OARS stands for open questions, affirmations, reflections and summaries, the four core skills of motivational interviewing. You use them to understand the other person and to help them hear their own reasons for change. Most practitioners rely on reflections the most, with questions in a supporting role.

Why OARS matters

OARS are listening skills, and plenty of approaches use them. What makes them MI is direction. In an MI conversation you choose what to ask about, what to affirm and what to reflect, and you lean toward the parts of the conversation where the person talks about change. If you're new to the approach, start with what motivational interviewing is.

The examples below come from clinics and workplaces. The same skills apply in a patient visit and in a one-on-one with someone on your team.

O: open questions

An open question invites a story. It usually starts with what, how, or tell me about. A closed question can be answered with yes, no or a single fact.

Is the traffic why you've been late?

What have mornings been like since the bridge construction started?

The closed version guesses at the cause and invites a one-word answer. The open version lets the tech tell you what's going on, which may include things you'd never have guessed.

A few useful open questions:

• "How have things been since we changed the schedule?"
• "What worries you most about the new medication?"
• "What would you like to be different about how month-end goes?"
• "Tell me about a week when this went well."

Closed questions still have a place. You need them for medication lists, dates and safety screening. The trouble starts when they're the main tool. Five closed questions in a row turn a conversation into a form. The open-ended questions guide has dozens of closed-to-open rewrites.

A: affirmations

An affirmation names something specific and real about the person: a strength, an effort, a value or a good intention. It keeps the spotlight on them.

Praise is different. "Great job" and "I'm proud of you" are about your approval. They can feel nice, but they put you in the role of judge and they don't tell the person anything about themselves.

Here's a front desk lead after a hard encounter.

I almost lost it with that guy. I kept telling myself he was scared, not mad at me.

Great job!

You stayed patient by looking for what he was going through. That takes steadiness.

And a patient who has struggled with a change:

I only made it to two of the walks this week.

You got out twice in a week when your knee was bothering you. You're sticking with it.

Good affirmations share a few features:

• They're specific. Name the behavior or quality you saw.
• They're true. People can tell when you're manufacturing a compliment, and it costs you trust.
• They often start with "you." "You care about getting this right" lands better than "I think you're conscientious."

Affirmations work well when someone feels discouraged, when you're about to raise something hard, and when a person describes an effort, even a failed one.

R: reflections

A reflection is a statement that says back what you heard. It's not a question, so your voice goes down at the end. Reflections are the main skill in MI, and the one that takes the longest to build.

There are two broad kinds.

• A simple reflection stays close to the person's words. It shows you heard them and lets them keep going.
• A complex reflection adds meaning. It might name a feeling, connect two things they said, or guess at what's underneath.

I keep picking up extra shifts because nobody else will. I don't mind, really. It's just that my kids are starting to notice.

You keep picking up the extra shifts.

You care about the unit, and you're starting to feel what it's costing your family.

The simple reflection is accurate and safe. The complex one moves the conversation, because it names the tension the nurse hinted at and invites them to explore it.

Reflections do something questions can't. A question asks the person to answer you. A reflection hands their own words back to them so they can hear them and keep going. That's why MI asks you to reflect more than you ask. For levels of reflection, double-sided reflections and more examples, see simple vs complex reflections.

S: summaries

A summary is a longer reflection that gathers several things the person has said. It shows you've been listening across the whole conversation, and it lets them hear their story laid out in one place.

There are three common types.

Collecting summaries

These gather what you've heard so far, then invite more. Use them every few minutes in a longer conversation.

Let me see if I've got it. The coding changes are confusing, the denials are piling up, and you haven't wanted to add to anyone's load. And you don't want Maria stuck with this while you're out. Did I miss anything?

Linking summaries

These connect something said now to something said earlier. "You mentioned last month that you wanted more time with your grandkids, and now you're saying the fatigue is getting in the way of that."

Transitional summaries

These wrap up one part of the conversation before you move on, often into planning. Lead with any sustain talk you heard, and end on the person's reasons for change so those are the last thing they hear.

You're worried the new check-in will be hard for older patients, and you also see the paper forms aren't working. You get why it matters. Where would you like to go from here?

End a summary with an invitation: "What did I miss?" or "What would you add?" That keeps it a check of understanding rather than a verdict.

OARS working together

Here's a short exchange with a patient who smokes, showing how the skills combine.

My doctor keeps bringing up the smoking. I've cut back some.

You've already made a change on your own.

I'm down to half a pack. Mostly I smoke on breaks at work.

How did you manage to cut back?

I stopped buying them at the gas station on the way in. If they're not in the car, I don't smoke on the drive.

You've found that changing your routine works better than willpower.

Yeah. Breaks are harder, though. Everyone goes out together.

So you cut back to half a pack by keeping them out of the car, and breaks at work are where it's tougher because it's social. What do you make of that?

Notice the ratio: one question, one affirmation, two reflections including the summary. The patient did most of the work, and the nurse never had to argue for quitting.

Common OARS mistakes

• Question stacking. "What happened, and was it the schedule, or did something else come up?" Ask one question and wait.
• Questions disguised as advice. "Have you thought about using a planner?" is a suggestion with a question mark. If you want to suggest something, ask permission first.
• Reflections that rise at the end. "You're frustrated?" sounds like a question and makes the person defend their feeling. Say it as a statement.
• Generic affirmations. "You're doing great" doesn't tell the person anything. Name what they did.
• Summaries that become lectures. If your summary adds your opinion or a plan they didn't mention, it's advice.
• Reflecting everything equally. In MI you choose what to reflect. When a person says both "I can't" and "I want to," lean toward the "want to."

How to build these skills

Knowing what OARS stands for takes five minutes. Producing a good complex reflection in a tense conversation takes practice. Work on one skill at a time, in short sessions, with feedback on each attempt. Start with open questions, then simple reflections, and move to complex reflections and summaries once the first two feel automatic. If you teach OARS to a group, see how trainers use the app to give learners short drills between sessions.