purpose of summarizing or paraphrasing within the oars framework

OARS Motivational Interviewing and Skills

Learn how to use the OARS Motivational Interviewing approach to connect with your patients and help them achieve their goals.

By Priya Singh on Feb 29, 2024.

Fact Checked by Nate Lacson.

Motivational Interviewing is a powerful tool for helping people make positive changes in their lives. At the heart of this approach is the OARS (Open-questioning, Affirming, Reflecting, and Summarizing) model. In this guide, we will give you an overview of what OARS is, how to use it in professional practice, and why it is so effective.

What is OARS Motivational Interviewing?

OARS Motivational Interviewing is a collaborative conversation-style technique that encourages individuals to explore and address ambivalence around behavior change. It was initially developed in the 1980s by William R. Miller and Stephen Rollnick. The technique is based on four main principles: open-ended questioning, affirmation, reflection, and summarization.

Open-ended questioning involves asking questions that are not leading or judgmental, creating a space for your client to think and reflect on their answers. Affirming shows the client that you value them and recognize the positive aspects of their life. Reflecting conveys understanding and allows your client to be heard without interruption. Finally, summarizing aids in consolidating the core points and allows for a review of the conversation.

Besides OARS, Motivational Interviewing utilizes the Stages of Change Model (Prochaska & DiClemente, 1983). According to this model, people go through different stages as they make changes in their lives. These stages are pre-contemplation, contemplation, preparation, action, maintenance, and relapse. A different set of thoughts, feelings, and behaviors characterizes each stage.

Why is OARS Motivational Interviewing Helpful?

Using the OARS Motivational Interviewing approach can be helpful in a variety of ways:

It helps to create a safe, non-judgmental space for the client

OARS Motivational Interviewing encourages clients to explore their values and decisions. It also helps your client become more aware of the pros and cons of behavior change.

It encourages the client to take responsibility for their own behavior change

Through this method, your client can gain valuable insights into their behaviors and motivations, which will help them to make more informed decisions.

It helps you establish trust and build a strong relationship

The OARS Motivational Interviewing approach is incredibly effective for building rapport with your client. It will help create a safe and supportive environment where they can express themselves freely.

It helps motivate the client

When clients feel understood and supported, they will be more motivated to take small steps toward their goals. They’ll be more likely to stay on track and keep trying until they reach their desired outcomes.

Overall, OARS is a powerful approach that can help clients in many ways. You can also use Motivational Interviewing Questions alongside OARS to deepen the connection between you and your client and help them reach their goals.

The Four Core Motivational Interviewing Skills

The four core MI skills are open questioning, affirming, reflecting, and summarizing (Miller, W. R., & Rollnick, S. 2013). These skills are fundamental to the Motivational Interviewing approach and are used to facilitate and enhance the client's motivation to change.

Open questioning

This involves asking questions that invite your client to elaborate on their experiences, thoughts, and feelings. This helps you understand the client's perspective and explore their ambivalence towards change. 

An example of an open question could be, "What brings you here today?" This question allows your client to elaborate on their reasons for seeking help and provides you with valuable information about your client's concerns.

You can use this skill to acknowledge and validate your client's strengths, efforts, and successes. This helps build the client's self-esteem and confidence, which is essential for promoting change.

For example, if your client expresses concern about their ability to change, you could respond by saying, "It takes courage to seek help, and I appreciate the effort you are making to address your concerns."

It involves restating or paraphrasing what your client has said, which demonstrates empathy and helps them feel understood. This skill also allows your client clarify their thoughts and feelings and gain insight into their behavior.

For instance, if your client says, "I know I need to stop smoking, but it is hard," you might respond by reflecting, "It sounds like quitting smoking is something you are thinking about, but you are struggling with the process."

Summarizing

You can concisely summarize the session by pulling together the client's thoughts and feelings. This helps reinforce the client's motivation and commitment to change and provides a roadmap for the next session.

For example, at the end of a session, you might say, "So, we have talked about your concerns about quitting smoking, your desire to be healthy, and your challenges. Does that sound accurate?" This summary reinforces your client's motivation and commitment to change and provides a roadmap for the next session.

Other Motivational Interviewing Techniques include eliciting and responding to change talk, rolling with resistance, and supporting self-efficacy. These can help you work effectively with your clients and support them in making positive changes.

Benefits of OARS Motivational Interviewing

OARS Motivational Interviewing has many benefits for both you and your client. Some of these advantages are:

It improves engagement in treatment

OARS Motivational Interviewing can improve engagement in treatment by making individuals feel more comfortable and heard. A randomized controlled trial found that Motivational Interviewing, which includes the OARS technique, was associated with higher engagement in treatment for individuals with substance use disorders (Carroll et al., 2006).

It helps patients understand their conditions better

In a randomized controlled trial by Chien et al. (2015), adherence therapy that utilized OARS Motivational Interviewing effectively improved various aspects of treatment outcomes for individuals with schizophrenia spectrum disorders.

Compared to those who received usual care, participants who underwent this therapy reported significant improvements in comprehending their illness and treatment, psychosocial functioning, symptom severity, number of re-hospitalizations, and medication adherence. Moreover, the study boasted a low dropout rate, with only 3.5% of participants leaving the trial prematurely.

It helps you make more informed decisions

According to a two-stage pretest-posttest empirical study conducted on nurses working in Special Care Units, Motivational Interviewing, including OARS, can improve nurses' moral sensitivity.

Ghafari et al. (2020) found a significant difference in the mean score of moral sensitivity in nurses one month after the intervention compared to before. This suggests that Motivational Interviewing can help healthcare providers better understand moral challenges and make more ethical decisions, ultimately improving healthcare quality. 

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Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping people change (3rd ed.). Guilford Press.

Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., Kunkel, L. E., Mikulich-Gilbertson, S. K., Morgenstern, J., Obert, J. L., Polcin, D., Snead, N., & Woody, G. E.; National Institute on Drug Abuse Clinical Trials Network. (2006). Motivational Interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and Alcohol Dependence, 81(3), 301-312. https://doi.org/10.1016/j.drugalcdep.2005.08.002 

Chien, W. T., Mui, J. H., Cheung, E. F., & Gray, R. (2015). Effects of Motivational Interviewing-based adherence therapy for schizophrenia spectrum disorders: A randomized controlled trial. Trials, 16, 270. https://doi.org/10.1186/s13063-015-0785-z

Ghafari, S., Shahrokhi, R., Mosavy, F., & Mohamadi Armandi, M. (2020). The effect of Motivational Interviewing on the moral sensitivity of nurses working in intensive care units. Journal of Intensive and Critical Care Nursing, 3(2), 1-6.

Prochaska, J., & DiClemente, C. (1983). Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.

Commonly asked questions

OARS stands for open-questioning, affirming, reflecting, and summarizing. These are the four core skills of Motivational Interviewing that a practitioner must master to effectively engage with clients and assist them in making positive changes.

OARS Motivational Interviewing is a popular approach practitioners use in various fields, such as healthcare, social work, psychology, and counseling.

OARS Motivational Interviewing relies heavily on the practitioner’s ability to build a trusting relationship with the client. If this is not achieved, then there is a risk that the client will not be comfortable sharing personal thoughts and feelings, which can ultimately hinder their treatment progress.

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OARS Model—Essential Communication Skills Job Aid

The OARS (open-ended, affirming, reflective listening, summarizing) model helps to establish interactive encounters with clients focused on their goals, needs, and preferences. OARS is intended to be simple, comprehensive, and to improve communication and counseling skills.

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Communication Techniques - OARS

OARS is a skill-based model of interactions adapted from a client-centered approach used in Motivational Interviewing. These skill-based techniques include verbal and non-verbal responses and behaviors. Both verbal and non-verbal techniques need to be adapted to be culturally sensitive and appropriate.

OARS stands for:

O = Open Ended Questions

A = Affirmations R = Reflections S = Summaries

As a health care professional it is your role to utilize each of these skills with intention. To be intentional is the rationale for you to choose a specific response at a specific time. Without intention the health care professional is having a conversation with the patient, but not a professional interaction or intervention. Three reasons for using this skill are:

To acknowledge the patient and demonstrate respect which establishes rapport and

To help the patient explore and gain information and insight.

To challenge the patient to view his or her situation differently or to take alternative

action in their decisions.

Using OARS will help to establish an atmosphere of acceptance and trust and aid the patient in exploring their hopes and fears. Remember: Open-ended questions, Affirmations, Reflections and Summarizing statements are not used in any order and can be used throughout a patient- provider interaction.

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How to Use the OARS Technique to Build the Coaching Relationship

By Jeffrey E. Auerbach, Ph.D., MCC

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We all know that good listening skills, being empathetic and giving advice only sparingly, are key elements in strong coaching presence. But what are some best practices in doing this well? One effective method to have strong coaching presence is the effective use of the "OARS" technique to communicate empathetically which has multiple positive benefits to the client and the coaching relationship.

When we communicate with clients in an empathetic, non-judgmental manner, we create conditions where a client can identify their own hesitancy to change—and the costs this ambivalence may have. The following principles can help coaches increase a client's awareness about one's natural hesitation to change and help increase motivation to take constructive action.

What is OARS?

There are four important micro-skills we engage in when interacting with a client in an empathetic, supportive manner and they are called "OARS." OARS is an acronym used to describe some of the micro-skills involved in expressing empathy with clients. "OARS" stands for Open-ended questions, Affirmations, Reflective listening, and Summarizing. In my twenty years of training coaches, we have found that effective coaches use OARS in a conversational style in their coaching interactions.

O   Open-ended Questions A   Affirmations R   Reflective Listening S   Summarizing

These four micro-skills lead to the client experiencing you as an empathetic supportive coach. By expressing empathy, you are using reflective listening to convey an understanding of your client's perspectives and underlying drives.

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Within the container of an empathetic coach-client relationship, we can increase a client's readiness to change and motivation to take constructive actions by:

• Developing the discrepancy between the client's deeply held values and their current behavior.
• Managing ambivalence, by responding with empathetic understanding, rather than confrontation.
• Supporting self-efficacy, by helping the client recognize their internal and external resources, including their strengths, to help them move forward.

Express Empathy Using OARS

When the coach utilizes empathy well the client feels that the coach can see the world as the client does, understand things the way the client perceives them and feel the way the client feels. It is as if the coach is sharing the client's experience. This skill of using empathy is a critical element in coaching because when clients feel understood and supported, they are better able to open up to their own ambivalence and possible self-defeating behavior. When the coach listens deeply and empathetically to the client, the client feels validated, which helps the client share their world view, and their situation with the coach. When the coach-client interactions are characterized by an empathetic relationship, the coach then can draw out the client's own goals, identify what strengths the client may need to dial up or dial down, and what new skills they may benefit from learning. As a result of the empathetic relationship, clients' defensiveness is disarmed, and they are more open to honest self-reflection and often become more open-minded to possibilities and actions they can take that will make a difference in their lives.

How You Can Use OARS in Your Coaching Conversations:

Open-ended Questions When coaching a client, ask open-ended questions, which usually will begin with "what" or "how." Ensure you are asking questions in a way that allows your client to open up.

Affirmations Make comments that help your client feel valued and appreciated. Appropriate praise for constructive behaviors often leads to positive reinforcement of goal related actions.

Reflective Listening Reflect back what your client says occasionally and then check to make sure you are hearing how your client feels accurately.

Summarizing Occasionally, and briefly, summarize what you have understood in terms of the content of the conversation.

Once we have communicated in an empathetic manner we have likely created a bond with our client. This supportive relationship can create the conditions where we can help a client see discrepancies between where they are now and where they want to be without feeling judged or put down.

Identifying Discrepancies

Coaches often help their clients develop awareness of the discrepancies between their current behaviors and ideal behaviors. Once clients see these discrepancies more clearly, and feel supported by their coach, it is easier for the client to adopt attitudes which enhance their motivation to initiate new, constructive actions in line with their goals.

The coach can use motivational rulers to bring discrepancies to the surface. For example, we can ask the client to rate their readiness to take a particular step they have identified on a scale of 1 to 10, with 1 being "not at all interested in taking this step," and "10" meaning "I have already taken this step." This motivational ruler can help the client talk honestly about their motivation and what might contribute to staying where they are and what might help them make valuable changes.

The empathetic, supportive relationship the coach created with OARS helps these type of honest coaching conversations flow naturally.

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What Is The OARS Method? An Effective Template For Communication

What is the oars method.

The OARS method is a common way for motivational interviewers to ask questions and provide feedback. OARS stands for open-ended questions, affirming, reflective listening and summarizing, and the technique encourages you to think about your feelings regarding your work openly and honestly.

It also allows the interviewer to help you navigate a problem you’re struggling with.

They ask questions about your situation that help you imagine potential outcomes and remember what sparks you to feel positive and motivated about your work.

O.A.R.S. is a skills-based model of interactive techniques adapted from a clientcentered approach, using motivational interviewing principles.

These skill-based techniques include verbal and non-verbal responses and behaviors. Both verbal and non-verbal techniques need to be adapted to be culturally sensitive and appropriate.

The OARS Model includes four basic skills:

O = open questions, a = affirmations, r = reflective listening, s = summarizing.

So what is the purpose of referring to the OARS model?

Artists, writers and creative types are often shy and reserved people – not always – but many are.

It’s vital that you want to make a living from your artwork, you must learn good communication skills.

1) The OARS method provides us with a common “template” when using our communication skills.

2) the oars method can act as an ongoing ‘checklist’ of skills so that we can use self-assessment to learn and improve., 3) the oars method gives us a way to be intentional and relatable when dealing clients which ultimately leads to more sales..

Using skills intentionally helps us become more efficient in the work that we do.

So let’s dive into the OARS method head first and example what each phase really means…

O = OPEN QUESTIONS

As a professional, one of the most important skills (techniques) you will use with clients is open ended questions. Using this skill effectively can save a lot of time in each client session.

When you use open questions effectively, your client is usually doing most of the talking. Additionally, closed questions are sometimes appropriate.

The purpose of using open questions is to:

Establish a safe environment, and build trusting and respectful relationship.

Explore, clarify and gain an understanding of your client’s world., learn about the client’s past experience, feelings, thoughts, beliefs, and behaviors., gather information – client does most of the talking., help the client make an informed decision..

Using Who, What, How and Where questions tend to be better than Why quetions.

Because it can put someone on the defensive. It depends on the topic and situation, of course, but in general why questions should be used sparingly.

A = AFFIRMATIONS

The skill (technique) that is often forgotten in effective communication is using a simple affirmation statement to a client about what he or she has already done, or a personal strength, or ability.

This isn’t shmoozing or lying or being disingenuous. It’s genuine acknowledgement of someone else’s character and/or ability.

An affirmation takes very little time, but it does require that you listen very carefully to what a person/client is telling you and find opportunities to acknowledge the positive aspects of  their life.

Using affirmative statements builds rapport, demonstrate empathy, and allows for some exploration into the potential client’s world; their thought process.

It also affirms the ability that we are all responsible for our own decisions and lives. Which connects people in a way that is equitable and garners respect from both sides.

R = REFLECTIVE LISTENING

For some people, the most challenging part of the OARS method is to listen reflectively.

This skill requires that you listen very carefully, observe your client’s body language and behavior and reflect using your own words and perceptions.

Using this skill effectively promotes the most movement in the persons’s/client’s awareness.

The purpose of using reflective listening is to:

Demonstrate to the person that you are listening and trying to understand his situation

Reflect the person’s thoughts, feelings and behaviors

Reflect the person’s general experiences and create a genuine human connection

The following are types of reflective listening:

1. Simple reflection (repeat the person’s words)

2. Reflecting feelings (reflect what the person might be feeling)

3. Reflecting behavior (state observation about the person’s behavior) A format for reflecting behavior might be, “I noticed you just _____.” “What are you thinking?”-or- “What are you feeling right now?”

4. Amplified reflection (rephrase the client’s words – exaggerated)

5. Double-sided reflection (person’s words + note ambivalence – and point out discrepancy)

6. Shifting focus (going back to something else or changing the direction)

7. Rolling with resistance (accept the client’s perception)

8. Reframing (invite client to examine his/her perception in a new way)

S = SUMMARIZING

Summarizing, which can be considered paraphrasing to a certain extent, is the skill that will help the speakers  move through a conversation to transitions & closure.

Summarizing can be demonstrated in three (3) variations:

1. A collective summary —“So let me see if I understand what we’ve talked about so far.”

2. A linking summary —“Ok, so maybe now we can talk about how we can make this work…..”

3. A transitional summary —“So you here’s my information or you can give me your card and we can set up a time to go over some samples…”

Summarizing skills keep you and your potential client ―on the same page throughout your session.

In addition, summarizing the session will help you close your session with your prospect’s plan of action.

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Motivational Interviewing: Open Questions, Affirmation, Reflective Listening, and Summary Reflections (OARS)

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Motivational Interviewing provides a foundation for assisting individuals with developing the rationale for beginning change in their lives. This resource provides basic information about the principles of communicating using motivational interviewing.

Motivational Interviewing: The Basics, OARS

(Adapted from handouts by David Rosengren and from Miller & Rollnick, Motivational Interviewing, 2nd Edition, 2002)

Motivational Interviewing is an “empathic, person-centred counselling approach that prepares people for change by helping them resolve ambivalence, enhance intrinsic motivation, and build confidence to change.” (Kraybill and Morrison, 2007)

Open questions, affirmation, reflective listening, and summary reflections (OARS) are the basic interaction techniques and skills that are used “early and often” in the motivational interviewing approach.

O ARS: Open Questions

Open questions invite others to “tell their story” in their own words without leading them in a specific direction. Open questions should be used often in conversation but not exclusively. Of course, when asking open questions, you must be willing to listen to the person’s response.

Open questions are the opposite of closed questions. Closed questions typically elicit a limited response such as “yes” or “no.” The following examples contrast open vs. closed questions. Note how the topic is the same, but the responses will be very different:

• Did you have a good relationship with your parents?
• What can you tell me about your relationship with your parents?

More examples of open questions:

• How can I help you with ___?
• Help me understand ___?
• How would you like things to be different?
• What are the good things about ___ and what are the less good things about it?
• When would you be most likely to___?
• What do you think you will lose if you give up ___?
• What have you tried before to make a change?
• What do you want to do next?

O A RS: Affirmations

Affirmations are statements and gestures that recognize client strengths and acknowledge behaviours that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one’s ability to change. To be effective, affirmations must be genuine and congruent.

Examples of affirming responses:

• I appreciate that you are willing to meet with me today.
• You are clearly a very resourceful person.
• You handled yourself really well in that situation.
• That’s a good suggestion.
• If I were in your shoes, I don’t know if I could have managed nearly so well.
• I’ve enjoyed talking with you today.

OA R S: Reflective Listening

Reflective listening is a primary skill in outreach. It is the pathway for engaging others in relationships, building trust, and fostering motivation to change. Reflective listening appears easy, but it takes hard work and skill to do well. Sometimes the “skills” we use in working with clients do not exemplify reflective listening but instead serve as roadblocks to effective communication. Examples are misinterpreting what is said or assuming what a person needs.

It is vital to learn to think reflectively. This is a way of thinking that accompanies good reflective listening. It includes an interest in what the person has to say and respect for the person’s inner wisdom. Listening breakdowns occur in any of three places:

• Speaker does not say what is meant
• Listener does not hear correctly
• Listener gives a different interpretation to what the words mean

Reflective listening is meant to close the loop in communication to ensure breakdowns don’t occur. The listener’s voice turns down at the end of a reflective listening statement. This may feel presumptuous, yet it leads to clarification and greater exploration, whereas questions tend to interrupt the client’s flow. Some people find it helpful to use some standard phrases:

• So you feel…
• It sounds like you…
• You’re wondering if…

There are three basic levels of reflective listening that may deepen or increase the intimacy and thereby change the affective tone of an interaction. In general, the depth should match the situation. Examples of the three levels include:

• Repeating or rephrasing : Listener repeats or substitutes synonyms or phrases, and stays close to what the speaker has said
• Paraphrasing : Listener makes a restatement in which the speaker’s meaning is inferred
• Reflection of feeling : Listener emphasizes emotional aspects of communication through feeling statements. This is the deepest form of listening.

Varying the levels of reflection is effective in listening. Also, at times there are benefits to over-stating or under-stating a reflection. An overstated reflection may cause a person to back away from their position or belief. An understated reflection may help a person to explore a deeper commitment to the position or belief.

OAR S : Summaries

Summaries are special applications of reflective listening. They can be used throughout a conversation but are particularly helpful at transition points, for example, after the person has spoken about a particular topic, has recounted a personal experience, or when the encounter is nearing an end.

Summarizing helps to ensure that there is clear communication between the speaker and listener. Also, it can provide a stepping stone towards change.

Structure of Summaries

1) Begin with a statement indicating you are making a summary. For example:

• Let me see if I understand so far...
• Here is what I’ve heard. Tell me if I’ve missed anything.

2) Give special attention to Change Statements . These are statements made by the client that point towards a willingness to change. Miller and Rollnick (2002) have identified four types of change statements, all of which overlap significantly:

• Problem recognition : “My use has gotten a little out of hand at times.”
• Concern : “If I don’t stop, something bad is going to happen.”
• Intent to change : “I’m going to do something, I’m just not sure what it is yet.”
• Optimism : “I know I can get a handle on this problem.”

3) If the person expresses ambivalence, it is useful to include both sides in the summary statement. For example: “On the one hand…, on the other hand…”

4) It can be useful to include information in summary statements from other sources (e.g., your own clinical knowledge, research, courts, or family).

5) Be concise.

6) End with an invitation. For example:

• Did I miss anything?
• If that’s accurate, what other points are there to consider?
• Anything you want to add or correct?

7) Depending on the response of the client to your summary statement, it may lead naturally to planning for or taking concrete steps towards the change goal.