OARS Motivational Interviewing: Examples and a PDF Card

OARS motivational interviewing skills are the four things you do most in an MI conversation: ask Open questions, offer Affirmations, give Reflections and pull it together in Summaries. Most guides define the four letters and give an example or two of each. This one shows each skill done weakly and done well, follows one invented client through the four MI processes so you can watch each skill change its job, and gives you eight drills to practice between sessions. You'll also find how to write MI into a progress note, and a one-page OARS reference card: print this page or save it as a PDF.

If you want lists of questions for each MI task, our 80 motivational interviewing questions cover that. This article uses different examples and gives equal time to all four skills.

Every client in this article is invented. Any resemblance to a real person is a coincidence.

What OARS stands for in motivational interviewing

These are the core skills of MI in Miller and Rollnick's books, and SAMHSA's guide to motivational counseling teaches them under the same acronym (TIP 35, chapter 3). The Motivational Interviewing Network of Trainers (MINT) puts them in context: "MI has core skills of OARS, attending to the language of change and the artful exchange of information" (Understanding Motivational Interviewing).

The 2023 fourth edition keeps the letters. A note on the new edition's terms, on The Change Companies' page for its MI video series, says: "The 'OARS' are still Open question, Affirmation, Reflection and Summary." What's new is a split inside the A, between simple and complex affirmations (covered below), and more attention to directional questions (The Change Companies; Guilford Press).

OARS are skills, not MI on their own

Any good listener uses open questions and reflections. Two things turn OARS skills into motivational interviewing:

MINT is plain about the first point: MI "is not a way to 'get people to change' or a set of techniques to impose on the conversation." OARS used to steer a client toward your goal for them tend to backfire, because clients can feel it.

Open questions: inviting the client to talk

An open question leaves room for the client to answer in their own way. TIP 35 describes open questions as ones "that invite clients to reflect before answering and encourage them to elaborate." They usually start with what, how or "tell me about." Why is open too, but it can sound like an accusation, so point it toward change when you use it.

Open questions do two different jobs:

Guilford's description of the fourth edition lists the "strategic use of directional questions" among its new topics. Use exploring questions freely while you're getting to know someone; save directional ones until you've agreed what you're talking about.

More open question examples

Weak and strong open questions

Weak: "Do you want to stop betting?"

Stronger: "What would you like your betting to look like by the end of the semester?"

A yes or no closes the topic. The open version gets you a picture to work with.

Weak: "Don't you think your kids deserve a calmer bedtime?"

Stronger: "What do you want bedtime to feel like for your kids?"

A leading question argues for change, and clients tend to argue back.

Weak: "Why do you keep skipping cardiac rehab?"

Stronger: "What would you want cardiac rehab to do for you?"

The first asks for excuses, which is sustain talk. The second asks for reasons.

Weak: "Is it more stress or boredom when you open the app?"

Stronger: "What's usually happening right before you open the app?"

Multiple choice limits the answer to your two guesses.

Weak: "Can you tell me whether you cut down?"

Stronger: "Tell me how the week went with the betting."

The first sounds open but can be answered with "yes."

Weak: "How's work, are you sleeping, and did you call your sister?"

Stronger: One of those, then listen.

Clients answer the last part of a stacked question and drop the rest.

Closed questions still have a job: dates, doses, consent and, above all, safety. If a client mentions harming themselves or someone else, ask directly and follow your risk protocol. MI doesn't replace a risk assessment.

Affirmations: naming what is genuinely good

An affirmation names something real and positive about the client: something they did, tried, value or are. TIP 35 calls affirming a way "to express your genuine appreciation and positive regard for clients" and says it "supports and promotes self-efficacy." MINT ties affirmation to "strengths, efforts, and past successes."

Affirmations punch above their weight. In a study of 92 college students in a single-session alcohol intervention, affirming was the only therapist behavior followed both by more change talk and by less sustain talk (Apodaca and colleagues, 2016). It is one study in one setting, so treat it as a reason to use affirmations well, not as proof that they work everywhere.

Simple and complex affirmations

The fourth edition separates two kinds, according to the Change Companies note: simple affirmations, "commenting positively on a specific response," and complex affirmations "that highlight clients' enduring strengths and positive attributes."

Simple affirmations, about a specific action:

Complex affirmations, about a lasting strength:

Affirmation is not praise

TIP 35 warns that praise can be a roadblock to listening, especially general praise like "great job." It suggests framing affirmations with "you" rather than "I": instead of "I am proud of you," which focuses on you, try "You have worked really hard to get to where you are now in your life."

Weak and strong affirmations

Weak: "Great job!"

Stronger: "You stayed at the party for an hour, even though you wanted to leave in the first five minutes."

Name the behavior, so the client knows what you saw.

Weak: "I'm so proud of you."

Stronger: "You've worked hard for this."

Keep the focus on the client, not on your approval.

Weak: "You're so brave."

Stronger: "You told your manager about the panic attacks, knowing it might change how she sees you."

A label is easy to brush off. A specific act is harder to argue with.

Weak: "Good, you're finally taking your medication."

Stronger: "You found a way to remember the morning dose, even on workdays."

"Finally" carries a judgment, and the first version affirms what you wanted rather than what the client did.

Weak: "At least you tried."

Stronger: "You tried twice this week, and you found out which evenings are hardest."

"At least" turns an affirmation into consolation.

Keep affirmations sparing and true. TIP 35 notes there "may be ethnic, cultural, and even personal differences in how people respond to affirming statements," and suggests checking: "How was that for you to hear?" If a client brushes one off, don't repeat it louder. Notice it, and affirm something smaller next time.

Reflections: saying back what you heard

A reflection is a statement that tells the client what you understood. MINT calls reflection "a foundational skill of MI and how we express empathy," made by "repeating, rephrasing or offering a deeper guess about what the person is trying to communicate."

Say it as a statement, with your voice going down at the end. "You're worried about money?" asks the client to confirm. "You're worried about money" shows you understood, and the client tends to keep talking.

Simple and complex reflections

TIP 35 separates simple reflections, "repeating or rephrasing a client statement," from complex ones, "using different words to reflect the underlying meaning or feeling." Complex reflections move a conversation further, and each one is a guess. TIP 35's method: form a hypothesis about what the client means, offer it, and watch the response. If the client keeps talking and expands, you were close. If not, guess again.

Each type below uses a different invented client:

What you reflect steers the conversation

Open questions and reflections draw out both kinds of talk. In a meta-analysis of 36 studies, MI-consistent therapist skills were linked with more change talk and also with more sustain talk, and more sustain talk was linked with worse outcomes (Magill and colleagues, 2018). So the choice of what to reflect matters. When a client gives you both in one breath, reflect the change side, or use a double-sided reflection that ends on it.

Sam: "I'm fine, honestly. I just don't want to ask my parents for rent again."

Weak and strong reflections

Weak: "So you feel guilty?" with your voice rising.

Stronger: "You feel guilty about it."

The first is a question. The second shows you understood.

Weak: "What I'm hearing you say is that you feel like your manager doesn't respect you."

Stronger: "Your manager doesn't take you seriously."

Drop the preamble. Shorter reflections are easier to hear.

Weak: "You're an addict, and part of you knows it."

Stronger: "You're starting to worry about how much you're betting."

Labels and overstatement invite pushback. A reflection that slightly understates gives the client room to say more.

Weak: "Your dad gambled, so that's why you bet."

Stronger: "Your dad comes to mind when you think about this."

TIP 35 lists "interpreting or analyzing" among the roadblocks to listening. Stay with the client's meaning, not your theory.

Weak: A word-for-word replay of everything the client just said.

Stronger: The one part that matters most.

How many? TIP 35's guidance: "Ask one open question, and follow it with two or more reflective listening responses." To check your own balance against coding thresholds, see how to check your question use.

Summaries: pulling it together

A summary is a longer reflection that gathers several things the client said. TIP 35 calls it a form of reflective listening that "distills the essence of several client statements," chosen on purpose rather than simply collected. MINT says summarizing "ensures shared understanding and reinforces key points made by the client." TIP 35 also gives the best reason to bother: "Clients hear change talk once when they make a statement, twice when the counselor reflects it, and again when the counselor summarizes the discussion."

A summary has three parts:

Five kinds of summary

TIP 35 lists five, from Miller and Rollnick. The examples use Nadia, the invented nurse, who has worked extra night shifts for a year to pay off a debt.

Weak and strong summaries

Weak: "...and you want to see more of Mia's games, but you really need the money."

Stronger: "You really need the money, and you want to see more of Mia's games."

Same facts, different last word. End on the change side.

Weak: "So the real problem is that you can't set boundaries."

Stronger: "You've said yes to every extra shift this year, and you're starting to want some of those evenings back."

A summary is the client's material, not your conclusion.

Weak: A summary followed straight away by your next question.

Stronger: A summary that ends with "What did I miss?" or "What stands out to you?"

Weak: "So you know the shifts are hurting your health, which means you should cut back."

Stronger: Stop before the "which means." Hand it back and let the client reach the conclusion.

Weak: One long summary in the last two minutes.

Stronger: Short summaries whenever a topic closes, and a transitional one near the end.

How the four skills work together

OARS aren't used one at a time. A common rhythm is a question, two reflections, an affirmation when it's earned, and a summary that ends in the next question. Here it is with Grace, invented, 67, a retired school bus driver whose husband died eight months ago. She sang in her church choir for twenty years and hasn't been back.

Therapist: Tell me about choir, before. (open question)

Grace: Thursday nights, twenty years. Walter drove me and waited in the car with the radio on.

Therapist: Choir and Walter go together. (complex reflection)

Grace: That's the thing. I can't picture going without him outside.

Therapist: Going back would mean noticing he isn't there. (complex reflection)

Grace: Yes. But Ruth from the altos calls every week. She says they've kept my seat.

Therapist: You've picked up Ruth's calls every week, even in the hardest months. (affirmation)

Grace: I'd miss it terribly if I gave it up for good.

Therapist: So choir was your Thursdays for twenty years, it's tangled up with Walter, going back would hurt, and you'd miss it terribly if you let it go. And Ruth is still keeping your seat. What stands out to you, hearing it all together? (summary, then open question)

Grace: Maybe I could go once, if Ruth picked me up.

What the therapist did: one question to open, two reflections that went a step past Grace's words, one affirmation tied to something she actually did, and a summary that ended on her reasons to go back. She never suggested going back. Grace did.

OARS across the four MI processes

Miller and Rollnick describe four processes (the third edition's word) or tasks (the fourth edition's): engaging, focusing, evoking and planning. They overlap, and you return to earlier ones whenever you need to; MINT notes that planning "is optional and may not be required." The four OARS skills run through all of them, but each skill does a different job in each one. Here is one invented client across his first three sessions.

Luis, 39, is a warehouse supervisor who moved to night shifts four months ago. His shift starts at 10 p.m., so he puts his two children, 7 and 10, to bed before he leaves. He came in for stress. Nothing in his sessions suggests a safety concern at home; if it did, assessing safety would come before any of this.

Engaging: building the working relationship

Session 1. MINT describes engaging as establishing "a productive working relationship through careful listening."

Therapist: What's the hardest part of the switch to nights? (open question)

Luis: Sleep. I get four hours if I'm lucky. Then I'm a mess at home.

Therapist: You're running on almost nothing, and home is where it shows. (complex reflection)

Luis: My wife says I'm a different person. She's right.

Therapist: And you came in anyway, on four hours of sleep. Your family matters a lot to you. (affirmation)

Luis: I've got two kids. I can't keep going like this.

Therapist: So nights have cut your sleep to almost nothing, you're short with everyone at home, and you're here because your kids matter too much to let it go on. What did I miss? (summary)

Focusing: agreeing where to go

Later in session 1. MINT describes focusing as negotiating an agenda "that draws on both the client and practitioner expertise to agree on a shared purpose."

Therapist: You've mentioned sleep, the bedtime blowups, the energy drinks and the tension with your wife. Which would you like to start with? (summary, then open question)

Luis: The kids. Bedtime is when I lose it.

Therapist: Bedtime is the worst hour of the day. (reflection)

Luis: Every work night. They stall, I yell, then I feel terrible.

Therapist: You've already pinpointed the moment it goes wrong. (affirmation) So we'll start with bedtime on work nights. Would it be all right if we came back to the energy drinks another day? (transitional summary, asking permission)

Evoking: drawing out his reasons

Session 2. MINT describes evoking as helping "the person to build their own 'why' of change."

When change talk appears, MINT's EARS sheet lists four responses: elaborating, affirming, reflecting and summarizing. That's OARS with the question turned into "tell me more."

Therapist: Picture a bedtime that goes well. What happens? (directional open question)

Luis: No crying. I'd read to them like I used to. My son used to ask for the dragon book every night.

Therapist: You miss being the dad who reads the dragon book. (complex reflection)

Luis: I do. But I'm too wiped out to be patient.

Therapist: You're exhausted on four hours of sleep, and you still want to be that dad. (double-sided reflection, change side last)

Luis: I want to stop yelling. They don't deserve it.

Therapist: You want to stop, because they don't deserve it. (simple reflection of change talk)

Luis: And I don't want them to remember me like that.

Therapist: Let me pull that together. You miss reading to them, you want to stop yelling, they don't deserve it, and you don't want that to be what they remember. (collecting summary)

The therapist never said "you should stop yelling." Luis did, and then heard it twice more.

Planning: from why to how

Session 3. MINT describes planning as exploring "the 'how' of change," with a plan "based on the person's own insights and expertise."

Therapist: Last time you said you miss reading to the kids, you want to stop yelling, and you don't want that to be what they remember. Where would you like to go from here? (recapitulation summary, key question)

Luis: Maybe my wife does bedtime on my work nights. On my nights off I do it, with the dragon book.

Therapist: You've worked out something that fits your schedule. (affirmation) What could knock it off course on your nights off? (open question)

Luis: Stalling. That's when I lose it. Maybe I give them a five-minute warning, and step into the hall if I feel it building.

Therapist: A warning for them, and a way out for you. (reflection)

Therapist: So the plan, in your words: your wife does bedtime on work nights. On your nights off you read the dragon book, give a five-minute warning, and step into the hall if you feel it building. How does that sound when you hear it back? (summary of the plan)

Luis: Like something I can actually do.

If Luis had answered the key question with "I don't know, I'm just so tired," the therapist would go back to evoking, or back to focusing on sleep, rather than push a plan.

Eight OARS drills for therapists

You learn OARS the way you learn an instrument: short, regular practice with feedback. MINT points out that MI "has observable practice behaviors that allow clinicians to receive clear and objective feedback from a trainer, consultant or supervisor." These drills take 5 to 20 minutes.

Drill 1: closed-to-open rewrites (alone, 5 minutes)

Take ten questions from your intake form or your last few sessions. Rewrite each closed one as open, then check: could the answer still be yes, no or a number?

Drill 2: three reflections for one statement (alone, 10 minutes)

For each statement, write a simple, a complex and a double-sided reflection before you read the sample answers.

Drill 3: a reflection-only conversation (with a colleague, 10 minutes)

Your colleague talks about a real, low-stakes change they feel mixed about: clearing out the garage, a running habit, calling an old friend. For five minutes you may only reflect: no questions, no advice. Then switch. Afterward, each of you names the moment you most wanted to ask or fix something.

Drill 4: affirmation spotting (a transcript or recording)

Find three moments in a session worth affirming. Write one simple and one complex affirmation for each. Check every one: does it start with "you," name something specific, and would the client agree it's true?

Drill 5: summary checkpoints (in session)

Plan two summaries before the session: a collecting summary about 15 minutes in and a transitional summary in the last five minutes. End each with "What did I leave out?" Afterward, write down whether the client added anything. Often they do.

Drill 6: change talk ear training (recording, 10 minutes)

Listen to ten minutes of a recorded session and mark every time the client argues for change. Then look at what you did right after each one: did you reflect it, ask for more, affirm it, summarize it, or move on to your next question?

Drill 7: count your OARS (recording, 20 minutes)

Tally open questions, closed questions, affirmations, simple reflections, complex reflections and summaries across 20 minutes. Compare your reflections to your questions: TIP 35 suggests two or more reflections after each open question, and the MITI coding thresholds are in our motivational interviewing questions article. For drills 6 and 7, get the client's written consent to record. A recording is protected health information: protect it as you would your notes, and delete it according to your setting's policy.

Drill 8: coded feedback from someone else

Ask a supervisor or an MI trainer to code a recording and talk it through with you. MINT's trainer listing is a place to start. MINT says membership itself "is not a certification of training competence" (Choosing a MI Trainer), so ask how much coding a trainer has done.

How to print this page or save it as a PDF

If you came for a motivational interviewing OARS PDF, the card below is built to be one.

OARS reference card

Keep it on your side of the desk, or off camera. One skill in mind beats four on paper.

O: Open questions

A: Affirmations

R: Reflections

S: Summaries

Across the four processes

Watch for

End of the card.

How to document MI in a progress note

A progress note should show what you did and how the client responded. "Used MI" or "used OARS" shows neither. For an MI session, record:

Leave out labels like "resistant," "in denial" or "unmotivated." They are readings without evidence, and MI's own vocabulary (sustain talk, discord) describes what you heard instead. Tallies you keep for drills 6 and 7 are training material, not part of the note.

A DAP note for an MI session

Here is Luis's evoking session as a DAP note. Delete what you don't use and keep the order.

Weak and strong note lines

Weak: "Used OARS. Client resistant."

Stronger: "MI, evoking: open questions and reflections on reasons to change. Client voiced sustain talk about fatigue ('I'm too wiped out to be patient'). Responded with a double-sided reflection; client then named a reason to change ('they don't deserve it')."

Weak: "Client motivated to change."

Stronger: "Importance 8/10, confidence 4/10. Client said, 'I want to stop yelling.'"

Weak: "Educated client on sleep hygiene."

Stronger: "With client's permission, offered information on sleep after night shifts (ask-offer-ask). Client chose to try blackout curtains."

Where MI goes in each format

Our progress notes cheat sheet has more intervention and response wording to borrow.

How this works in TranqBay

TranqBay is practice software for therapists in private practice. Here is where it touches an MI conversation:

practice.tranqbay.health shows a therapist adding a section on their approach to a practice website, the booking page a new client would use, and a session from the video call to the note, if you want to see where an MI conversation would sit before you set anything up.

Frequently asked questions about OARS in motivational interviewing

Before your next session

Pick one skill for your next three sessions. If it's reflections, aim for two after every open question. If it's summaries, plan the 15-minute one. Then record a session, with consent, and count.

If you also want your practice website, booking, video sessions, client forms and session notes in one place, look at a practice website template and the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.

Sources