OARS is the foundational skill set of motivational interviewing (MI), and it stands for Open-ended questions, Affirmations, Reflective listening, and Summaries. These four communication techniques work together to draw out a person’s own reasons for change rather than imposing advice from outside. The approach sounds simple on paper, but each skill has specific mechanics that research shows make a measurable difference in whether conversations actually shift someone’s motivation.
The Four Processes That Give OARS Its Structure
Before diving into each OARS skill, it helps to know where they sit within the broader MI framework. MI unfolds across four overlapping processes: engaging, focusing, evoking, and planning. Engaging is about building a genuine connection through active listening and empathic communication. Focusing narrows the conversation toward a shared agenda by exploring the person’s concerns and desires. Evoking is where the uniquely MI-specific work happens, using techniques to draw out “change talk” (the person’s own language in favor of change) while softening “sustain talk” (language supporting the status quo). Planning translates motivation into concrete action steps.1PubMed. Using motivational interviewing and brief action planning for adopting and maintaining positive health behaviors
OARS skills aren’t confined to one process. You use open-ended questions and reflective listening heavily during engaging, but you also use them during evoking when you’re trying to amplify someone’s own motivation. Affirmations thread through every stage. Summaries serve as bridges between processes, collecting what’s been said and transitioning the conversation forward. Think of the four processes as the roadmap and OARS as the vehicle you drive along it.
Open-Ended Questions
Open-ended questions are the ones that can’t be answered with “yes” or “no.” Instead of asking “Do you want to quit smoking?” you might ask “What would your life look like if you weren’t smoking?” The goal is to get the other person talking, exploring, and hearing their own thoughts out loud. Research on MI microskills in a college alcohol intervention found that a higher number of open questions was linked to more contemplation about change after the session, while a higher number of closed questions was linked to less.2PubMed Central. Questions and reflections: the use of motivational interviewing microskills in a peer-led brief alcohol intervention for college students
The evidence on open questions does come with a nuance worth knowing. A sequential analysis of MI sessions found that open questions were more likely to be followed by change talk when the person had just been expressing sustain talk. In other words, an open question can be especially powerful at pivoting a resistant moment into an exploratory one.3PubMed Central. A sequential analysis of motivational interviewing technical skills and client responses A separate study examining which specific therapist behaviors elicited change talk confirmed that change talk was significantly more likely to immediately follow an open question, while it was significantly less likely to follow a closed question or the therapist simply giving information.4PubMed Central. Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing?
Practically, good open-ended questions in MI tend to sound like invitations rather than interrogations. “What matters most to you about your health?” invites reflection. “Tell me about a time you succeeded at something difficult” invites the person to connect with their own strengths. “What would you like to be different?” opens the door without pushing through it. The key is resisting the reflex to ask a string of closed diagnostic questions, which turns a conversation into a quiz and shuts down the person’s internal exploration.
Affirmations
Affirmations in MI are not the same as praise or cheerleading. Telling someone “Good job!” is praise directed at an outcome. An MI affirmation is a statement that acknowledges a person’s strengths, efforts, or values. It might sound like, “You came here today even though you weren’t sure it would help, and that says something about your determination.” The distinction matters because praise positions you as the judge of someone’s behavior, while affirmation recognizes something genuine about who they are.
The mechanism behind this is illuminating. Research drawing on self-affirmation theory has found that when people feel affirmed, they become less defensive toward threatening health messages and more open to changing behavior. In alcohol intervention studies specifically, affirmation was linked to reduced defensiveness and increased intention to cut back on drinking.5PubMed. Self-affirmation and motivational interviewing: integrating perspectives to reduce resistance and increase efficacy of alcohol interventions The sequential analysis mentioned earlier also found that affirmations were one of the therapist behaviors significantly more likely to be followed by change talk, while sustain talk was actually less likely to follow an affirmation.4PubMed Central. Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing?
In practice, good affirmations require you to actually notice something specific. “You’re really brave” is vague. “You’ve kept showing up for your kids even when things were falling apart around you” lands differently because it reflects a particular strength the person has demonstrated. Affirmations work best when they’re genuine and when they connect to the person’s values. If someone values being a good parent, affirming their parenting efforts has more motivational weight than affirming something unrelated.
Reflective Listening
Reflective listening is the workhorse of OARS, and the skill most people underestimate. At its simplest, a reflection is a statement (not a question) that mirrors back what the person said, capturing the meaning you heard. It communicates “I’m with you” without requiring the person to answer another question. But reflections come in different levels of depth, and the difference between a simple reflection and a complex one is where much of MI’s therapeutic power lives.
A simple reflection essentially repeats or slightly rephrases what the person said. If someone says “I know I drink too much,” a simple reflection might be “You’re aware your drinking has gotten out of hand.” A complex reflection goes further, adding meaning, emphasizing a particular emotional undercurrent, or making an inference. You might say “It sounds like part of you is ready for something different.” Complex reflections require more skill because you’re making a guess about what’s underneath the person’s words, and you can be wrong. But when you’re right, they accelerate the conversation dramatically.
The research supports this distinction. In sequential analysis of MI sessions, complex reflections were associated with greater odds of change talk following sustain talk, meaning they could help shift the direction of a conversation that was headed toward resistance.3PubMed Central. A sequential analysis of motivational interviewing technical skills and client responses Both simple and complex reflections were significantly more likely to be immediately followed by change talk compared to closed questions or information-giving.4PubMed Central. Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing?
One common mistake is turning a reflection into a question by raising your voice at the end. “So you’re feeling stuck?” puts the person on the spot. “You’re feeling stuck” (with a downward inflection) gives them space to either agree, correct you, or elaborate. The subtle difference in tone changes the entire dynamic.
Summaries
Summaries are essentially collections of reflections bundled together. They serve three main purposes in an MI conversation. A collecting summary gathers several things the person has said, often from different parts of the conversation, and presents them back as a bouquet: “So far you’ve told me that you’re worried about your blood pressure, that exercise used to make you feel good, and that your schedule has been overwhelming.” A linking summary connects two things the person has said that might seem contradictory or complementary: “On one hand you enjoy the way drinking helps you relax, and on the other hand you’re noticing it’s affecting your sleep and your mornings.” A transitional summary signals a shift in the conversation, wrapping up one topic before moving to the next.
Linking summaries are especially useful for highlighting ambivalence, which sits at the heart of MI. When you lay out both sides of someone’s internal conflict in a nonjudgmental way, you’re not pointing out their contradiction. You’re showing them that you’ve heard both parts of their experience, and that both are real. This tends to free people up to lean into the side that favors change rather than getting locked into defending the side that doesn’t.
A good summary ends with an invitation. After collecting what the person has said, you might add “What else?” or “Where does that leave you?” This keeps the conversation moving and puts the person back in the driver’s seat.
The Reflection-to-Question Ratio
One of the most concrete benchmarks for MI quality is the ratio of reflections to questions. MI coding systems generally consider a ratio of about one reflection per question to be “basic competency,” while proficient MI practitioners aim for at least two reflections for every question asked. This ratio matters because it shapes the conversational feel. A session dominated by questions feels like an interview or intake assessment. A session with more reflections feels like a genuine conversation where the practitioner is truly listening.
Hitting this ratio is harder than most people expect. In a fidelity evaluation of an MI-based wellness program for caregivers, the group’s average reflection-to-question ratio only approached basic competency, and just a third of the interviews actually reached that standard.6PEC Innovation. Mixed-method evaluation of fidelity of motivational interviewing-based coaching in 5Minutes4Myself Wellness Program for caregivers of children with autism That finding is typical across MI training research: even well-intentioned practitioners tend to default to asking questions because it feels like the natural way to gather information. Shifting toward reflections requires deliberate practice and ongoing self-monitoring.
If you’re learning OARS, tracking your own reflection-to-question ratio in recorded sessions is one of the fastest ways to identify where your practice is drifting. Many people discover they’re asking three or four questions for every reflection, which creates an interrogation dynamic that works against the spirit of MI.
Working With Ambivalence Rather Than Against It
A misconception about MI is that your job is to eliminate ambivalence and push someone toward a firm decision to change. Actually, MI treats ambivalence as normal and expected. The OARS skills are designed to explore it, not crush it. When a person says “I want to eat better but I also don’t want to give up the foods I love,” both halves of that statement deserve reflective attention.
Research on early-session language patterns offers a useful insight here. A study analyzing ambivalent language found that clients who expressed more ambivalence early in the session showed a greater increase in their proportion of change talk as the session continued. Surprisingly, clients whose early language reflected readiness to change actually showed a decrease in their change talk over the remainder of the session.7PubMed Central. What can clients tell us about whether to use motivational interviewing? An analysis of early-session ambivalent language This challenges the intuition that you should celebrate when someone sounds ready right away. Sometimes early readiness is surface-level, and there’s unspoken ambivalence underneath. The OARS toolkit is built for exactly this kind of complexity: open questions to explore what’s underneath, reflections to name it, affirmations to support the person through it, and summaries to hold it all together.
What Happens in the Brain During Change Talk
One of the more compelling lines of MI research involves neuroimaging. An fMRI study of young binge drinkers compared two conditions: one group generated their own change talk and sustain talk during an actual MI session, while the other group simply repeated pre-written statements about change. Both groups then heard their own statements played back inside the scanner. The self-generated group showed significantly greater activation in the left inferior frontal gyrus, the anterior insula, and the superior temporal gyri compared to the group that repeated scripted lines.8PubMed Central. Brain-based origins of change language: a beginning
Those brain regions are involved in self-perception, attitude change, and the experience of cognitive dissonance. The finding reinforces a core principle behind OARS: it matters that the person generates their own language about change. When you ask an open-ended question and reflect back someone’s own words, you’re not just being polite. You’re activating neural circuits tied to how people process and potentially revise their own beliefs. This is why lecturing, advising, and persuading tend to be less effective. Even if the advice is technically correct, it doesn’t engage the brain in the same way as hearing yourself articulate your own reasons for change.
Does MI Actually Produce Better Outcomes
The OARS skills are compelling in theory, but the pragmatic question is whether MI delivered with these techniques leads to real-world results. A Cochrane systematic review of MI for substance use found a small-to-moderate effect compared to no intervention right after treatment, with the benefit weakening over longer follow-up periods. At medium-term follow-up, MI still showed a significant advantage, but at long-term follow-up the difference was no longer statistically significant.9PubMed Central. Motivational interviewing for substance use reduction This pattern is consistent with what you’d expect from a brief intervention: it shifts people in the right direction, but the effect fades if there’s no ongoing support.
Beyond substance use, a systematic review and meta-analysis of MI’s impact on medication adherence across chronic diseases found a positive pooled effect, meaning people who received MI were more likely to stick with their medications.10International Journal of Epidemiology. Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis The effects are modest rather than dramatic, which is worth acknowledging. MI isn’t a magic bullet. But it consistently outperforms doing nothing and often outperforms simple advice-giving, which is remarkable given that MI sessions can be quite brief.
Learning OARS and Keeping the Skills Sharp
Reading about OARS gives you the conceptual framework, but actually doing it well requires deliberate practice. A meta-analysis of MI training studies found that workshops produced meaningful skill gains initially, with a moderate-to-large effect on MI proficiency. The more sobering finding was what happened afterward: when trainees received no post-workshop feedback or coaching, their skills eroded over the following six months. In contrast, trainees who received ongoing feedback and coaching maintained their gains.11PubMed. Sustaining motivational interviewing: a meta-analysis of training studies
A longitudinal study tracking clinicians over two and a half years found wide variation in MI skill between practitioners, and individual clinicians’ performance fluctuated over time rather than following a steady upward trajectory.12PubMed Central. Clinician acquisition and retention of Motivational Interviewing skills: a two-and-a-half-year exploratory study The takeaway is that MI skill isn’t something you acquire once and keep forever. Like any complex communication skill, it requires maintenance. Practical options include peer supervision groups where you review recorded sessions, regular coding of your own sessions using MI fidelity tools, or periodic booster workshops.
If you’re just starting out, one useful approach is to focus on one OARS skill at a time. Spend a week concentrating on open-ended questions. The next week, emphasize reflections. Record yourself (with consent) and listen back. You’ll catch your own habits quickly, like asking three closed questions in a row or defaulting to advice-giving when a reflection would have worked better.
Using OARS in Remote and Digital Settings
OARS skills were developed for face-to-face conversations, but they’ve been adapted for remote delivery with interesting results. A study that transitioned home-based MI sessions to remote formats during the pandemic found that video calls outperformed phone calls for building rapport and creating space for meaningful reflection. Participants described video sessions as more focused and intentional, giving them better opportunity to reflect on their values and set health goals.13PubMed Central. Transitioning a home-based, motivational interviewing intervention among families to remote delivery during the COVID-19 pandemic: Key lessons learned
Even more surprising, MI principles have been adapted for text messaging. A trial delivering brief MI through instant messaging to smokers who had no intention of quitting found that the intervention group had three times the rate of biochemically confirmed smoking abstinence at 12 months compared to the control group. The intervention group also showed significantly higher rates of quit attempts and intention to quit at several follow-up points.14npj Digital Medicine. Instant messaging-delivered brief motivational interviewing for noncommunicable disease patients with no intention to quit smoking A systematic review of technology-delivered MI across chronic conditions also found a small but significant benefit when the analysis accounted for study quality.15European Journal of Cardiovascular Nursing. Technology-delivered motivational interviewing to improve health outcomes in patients with chronic conditions: a systematic review of the literature
Text-based MI obviously can’t rely on vocal tone for reflections or the body language cues that guide face-to-face OARS. Practitioners adapting to text tend to use more summaries (collecting what the person has written) and lean heavily on open-ended questions that invite elaboration. Affirmations translate well to text since they’re already verbal statements. Reflective listening requires more care because without tone, a reflection can read as flat repetition rather than empathic mirroring. Adding a tentative phrase (“It sounds like…” or “I’m hearing that…”) helps signal the reflective intent in writing.
Adapting OARS Across Cultures and Contexts
MI was originally developed in the context of addiction treatment in Western clinical settings, which raises a reasonable question about whether OARS skills translate across cultures. A systematic review of culturally adapted MI found that studies achieving significant outcomes had adapted along three key dimensions: the content of the intervention (what was discussed), the concepts used to frame it (how change and health were understood), and the context in which it was delivered (where and by whom).16PubMed Central. Cultural Adaptations of Motivational Interviewing: A Systematic Review Surface-level changes like translating materials into another language were less consistently linked to success than these deeper structural adaptations.
MI has also moved well beyond clinical therapy rooms. Research has examined MI-based coaching in schools, where coaches use OARS skills to help teachers adopt evidence-based practices. Sequential analysis of those coaching conversations found that the same dynamics observed in clinical MI held in educational settings: MI-consistent language from coaches was associated with teacher change talk, while confrontational or directive language was associated with sustain talk.17PubMed. Leveraging Motivational Interviewing to Coach Teachers in the Implementation of Preventive Evidence-Based Practices: A Sequential Analysis of the Motivational Interviewing Process This finding suggests that the mechanics of OARS work not because of something specific to clinical encounters, but because of something fundamental about how people respond to feeling heard versus feeling pushed. Whether you’re a therapist, a health coach, a manager, or a teacher mentor, the same basic principle applies: people are more likely to move toward change when they feel their autonomy is respected and when they hear their own voice articulating the reasons.