How to Use OARS Skills in Motivational Interviewing

Helping people change their behavior can be challenging, especially when they are unsure or conflicted about it. That’s why motivational interviewing is such a useful technique. It is based on the idea that people are more likely to change when  motivated by their values and goals, rather than external pressure or persuasion. To achieve this, practitioners use techniques to build trust, empathy, and understanding with their clients. One of these motivational interviewing techniques is known as OARS. In this article, we will dive into what OARS represents in motivational interviewing and how to use it effectively.

What is OARS in Motivational Interviewing?

In motivational interviewing, there are four key techniques known as micro-skills. These micro-skills are conveniently represented by the acronym “OARS”:

• Open-ended questions
• Affirmations
• Reflective listening
• Summaries

To better grasp the significance of the OARS acronym, it may be helpful to draw a parallel between the function of oars in a boat and the purpose of these micro-skills.

Just as oars pull water to propel a boat forward, the four OARS skills serve as a way to guide your progress with the client, helping them move toward the change they want to make.

By utilizing open-ended questions, affirmations, reflective listening, and summaries, healthcare practitioners can effectively facilitate conversations that promote positive change.

The four key skills OARS in Motivational Interviewing

Open-ended questions

In motivational interviewing, open-ended questions play a vital role in fostering an atmosphere of respect, acceptance, and trust. These types of questions allow for a wide range of possible answers and serve as a foundation for employing other techniques.

By utilizing open-ended questions, clients can generate and justify their motivation for progress. While closed-ended questions have their place and can sometimes be necessary, open-ended questions generate momentum that can be harnessed to support individuals in exploring change. As a counselor, you should prioritize active listening, allowing the client to do most of the talking.

Affirmations

In motivational interviewing, eliciting affirmations involves recognizing and appropriately highlighting the strengths and efforts of the individual.

When individuals come to therapy after facing challenges in their previous attempts to change, they often feel demoralized or skeptical about the possibility of change. As a mental health professional, it is your role to instill a sense of possibility and capability in them. Affirmations serve as a powerful means to highlight client strengths, especially when they recognize their weaknesses and setbacks.

Affirmations not only help establish rapport with clients but also serve as a potent tool, particularly for those dealing with substance use disorders. However, it is crucial to be authentic and congruent in delivering affirmations. If they come across as insincere, clients will notice, and it may harm the rapport that has been established.

Reflective listening

Reflective listening is a fundamental practice in motivational interviewing that involves actively listening to your client’s words, interpreting the underlying meaning, and then expressing your understanding through a statement.

While seemingly simple, reflective listening is the most crucial and challenging skill in motivational interviewing. It goes beyond merely staying silent and being a good listener — the key lies in how you respond to what the person is saying. The ability to sustain a conversation through skillful reflection is a hallmark of effective motivational interviewing, as it allows clients to hear their own thoughts about change. In general, you will use reflective statements more frequently than any other skill, aiming to have at least twice as many reflections as questions.

A well-formed reflective statement is more likely to elicit elaboration on the topic under discussion because it serves as a verbal mirror for the client. By hearing their thoughts echoed back to them, they are prompted to delve deeper into what is driving these thoughts.

To engage in reflective listening, you must cultivate reflective thinking. This means constantly being aware that your interpretation of what someone else means may not necessarily align with their true intentions. It’s important to remember that you are offering an interpretation, which may or may not be accurate.

The general rule is to allow the client to let you know if your reflection is accurate or not. You should then adjust your interpretation accordingly.

Summaries

As clients engage in conversation, they often express a blend of change talk (reasons to pursue change) and sustain talk (reasons to maintain the status quo). Summaries serve multiple purposes, but in general, they offer an opportunity for you to present the information back to the client in a more organized manner and encourage them to reflect on its significance.

All summaries typically involve three basic steps:

• Announce your intention to summarize.
• Provide the summary, selecting relevant information based on the purpose of the summary.
• Conclude with an open-ended question to invite further thoughts from the client.

There are two important types of summaries. Here’s how they are used:

• Collecting summaries: These summaries slow down the conversation and verify your understanding of what you have heard and how the statements are interconnected. While it is important to acknowledge the presence of sustain talk, collecting summaries generally focus more on highlighting change talk. After presenting the key points, you ask an open-ended question to encourage additional thoughts on the same topic.
• Transitional summaries: Similar to collecting summaries, transitional summaries also involve summarizing the client’s statements. However, instead of seeking more information on the same topic, you pose an open-ended question that encourages the client to explore a different direction. This can be a helpful strategy when you wish to shift the client’s focus.

How to apply OARS to your Motivational Interviewing

Now that we understand the concepts that underpin the OARS technique in Motivational Interviewing, let’s review how to apply each of these skills.

How to use open-ended questions in Motivational Interviewing

Typically, open-ended questions begin with “How” or “What.”

For instance:

• “How would your life be different if you could stop smoking?”
• “What has worked for you in the past when you have made a difficult change?”

On the other hand, closed-ended questions limit the available choices for answers. They can often come across as leading or subtly aimed at  educating clients. It’s important to recognize the contrast between using closed-ended questions instead of open-ended ones. Examples of close-ended questions are:

• “Would your life be better if you could stop smoking?”
• “When you think about your kids, does that inspire you when it gets difficult?”

Notice how these differ from the open-ended questions given above.

How to use affirmations in Motivational Interviewing

Affirmations must be genuine and congruent. Here are some examples:

• “You possess remarkable resilience.”
• “That’s a truly insightful suggestion.”
• “Your dedication to finding a solution is commendable.”
• “Dealing with that amount of stress would be challenging for most people.”

To identify sources for affirmations, delve into their past endeavors to bring about change. For instance, if someone managed to stay sober for a week following treatment, inquire about the strategies they employed to achieve that milestone.

Additionally, contradictions between their expressed reluctance and their actual actions can serve as a source for affirmations. If a client expresses reluctance about attending therapy but still shows up, acknowledging their strength in facing an unpleasant task can be impactful.

How to apply reflective listening in Motivational Interviewing

By utilizing the various types of reflective listening statements, you can enhance your ability to effectively navigate conversations and support clients in exploring their ambivalence and motivations for change. Let’s review how to implement the different types of reflective listening.

• Simple reflection: This involves repeating or paraphrasing the client’s statement without adding any intentional meaning. This type of reflection acknowledges that the client has been heard and demonstrates your acceptance and non-argumentative stance. It can be a simple yet effective strategy to encourage further contemplation and thoughts from the client.
  • • Example:
      • Client: “All my friends drink! I can’t quit drinking.”
      • You: “You feel that quitting is challenging because all your friends drink.”
      • Client: “That’s right. But maybe I should consider quitting.”
• Amplified reflection: Similar to simple reflection, amplified reflection involves exaggerating or magnifying the client’s statement. This technique provides a space for them to argue for the other side of their ambivalence. However, it’s crucial to avoid overdoing it to prevent the client from feeling mocked or patronized, which could result in anger.
  • Example:
    • Client: “All of my friends use. I can’t quit using!”
    • You: “So, if you were to stop using, you would be completely isolated from any social interaction.”
    • Client: “Well, as long as I don’t pressure my friends to quit, I could still hang out with them. It might feel awkward though because they don’t do much else.
• Double-sided reflection: This type of reflection summarizes both sides of the client’s ambivalence, including their sustain talk and their change talk. It is beneficial for developing   It is generally more effective to conclude the statement with the change talk.
  • Example:
    • Client: “All of my friends drink! I can’t quit drinking.”
    • You: “You’re torn because you can’t imagine giving up drinking with your friends, but at the same time, you’re concerned about the impact of drinking on your life.”
    • Client: “That’s right. I guess my feelings are a bit mixed up.”

How to apply summaries in Motivational Interviewing

When you get to the summaries stage, there are two types of summary techniques at your disposal:

• Collecting summary
• Transitional summary

By employing these different types of summaries, you can enhance the clarity and coherence of the conversation while inviting the client to delve deeper into their thoughts and considerations.

Here’s an example of how to use a collecting summary:

“Let me check in about what I hear so far. It seems like you’re feeling quite upset about your weight, and you have been attempting to lose weight through exercise. Previously, gyms have been effective for you, but now that you have relocated, there are no convenient options nearby. On the bright side, you enjoy walking, although it doesn’t seem to be shedding the pounds at the moment. Can you share what other strategies you have tried?”

Now, let’s look at an example of a transitional summary:

“Let me pause for a moment to summarize and determine our next steps. I understand that you had reservations about attending today because you have been on weight loss programs before, and they have resulted in regaining more weight than you initially lost. You recognize that your health would improve if you could lose weight, but you are uncertain about the possibility of maintaining long-term success. Considering all of these factors, I’m curious, what motivated you to come in today?”