OARS stands for Open questions, Affirmations, Reflective listening and Summaries, and it is the shorthand for what a motivational interviewing conversation is made of. The more useful thing to know before you sit in one is what those four are arranged around: this approach works by deliberately not arguing for the change you are considering.
Almost everything written about OARS is training material for practitioners, which is an odd thing to hand somebody who has just been referred for four sessions of it. This is the view from the other chair.
Why arguing for a change makes people argue against it
Push somebody who is undecided towards a decision and they tend to say the counter-argument out loud. Having said it, they believe it slightly more, because people are persuaded by their own sentences far more reliably than by anybody else’s.
You will recognise this, probably from a relative. Somebody tells you that you drink too much, or work too late, or should have left that job by now, and you hear yourself defending the exact thing you were privately worried about an hour earlier. Nothing is resolved. What has happened is that you have now made the case for staying as you are, in your own voice, and it has become a little more true than it was.
Motivational interviewing takes that seriously enough to build the whole method on it. The research distinguishes between change talk, meaning anything a person says in favour of changing, and sustain talk, meaning anything they say in favour of things staying as they are. A counsellor who supplies the argument for change reliably draws the other half out of the client, so the practitioner’s job is defined partly by what they refuse to say. [miller-rose]
The point of the refusal is not politeness. It is that the argument only counts if it comes out of your mouth.
What OARS stands for
OARS is Open questions, Affirmations, Reflective listening and Summaries: the four things a good conversation about change contains. They describe what the counsellor does rather than what you are supposed to do, which makes them a workable test of whether you are getting the real thing.
- Open questions. Questions you cannot answer with yes, no or a number. “What would have to be different in a year for you to call this worth it” rather than “do you want to stop drinking”.
- Affirmations. Naming something you actually did. “You rang three places, got a straight answer from none of them, and rang a fourth” is an affirmation. “Well done, that’s great” is encouragement, which is a different and much weaker thing.
- Reflective listening. Saying your own position back to you, sometimes with a small extension on the end, so that you hear it. The experience clients most often describe is mildly uncomfortable: hearing something you said, with no argument attached to it, and then disagreeing with yourself.
- Summaries. Gathering up what you have said at intervals, and choosing what to gather. This is where the steering is most visible, because the counsellor is deciding which of your sentences to place next to which.
That is the entire acronym, and it matters less than the people who teach it suggest. Technique without the stance underneath it, that the case for change is yours to make, produces something that feels like being handled.
How it differs from the usual advice about changing
The difference is in who supplies the reasons, and in what mixed feelings are taken to mean. Ordinary advice treats your reluctance as the obstacle; this treats it as the subject.
| What most conversations about change do | What this does instead |
|---|---|
| Supply the reasons for changing | Ask what your reasons are, then stop talking |
| Treat mixed feelings as something to get past | Treat mixed feelings as normal, and as the actual material |
| Correct the inaccurate thing you just said | Let it stand, and ask what else is true |
| Offer advice as soon as the problem is clear | Ask permission before offering any |
| Read reluctance as denial or lack of commitment | Read it as a sign the conversation moved too fast |
| Aim at a decision by the end of the session | Aim at one sentence you had not said before |
The right-hand column is what people find strange at first and useful later. It is also why the approach is difficult to run on yourself, since you cannot easily withhold your own arguments from yourself.
Where the evidence is strongest, and how strong it is
Substance use and health behaviour change: drinking, drug use, smoking, taking medication as prescribed, diet and exercise. The effects there are real and small, and honest accounts of the research say so plainly.
A Cochrane review of motivational interviewing for substance use found it may reduce substance use compared with no intervention over a short follow-up, and probably reduces it slightly compared with assessment and feedback at medium and long-term follow-up. Compared with other active interventions, it found no difference at any follow-up point, on low-certainty evidence throughout. [schwenker-cochrane]
A meta-analysis of 119 studies, covering substance use, health behaviours, gambling and engagement with treatment, found an average effect in the small range against weak comparison conditions and a non-significant one against specific active treatments. [lundahl-2010] In medical settings the picture is similar: across 48 randomised trials and 9,618 participants, the advantage over usual care was statistically clear and, in the authors’ own description, modest. [lundahl-2013]
Read together, those three say something specific. This approach beats doing nothing, and beats being told what to do and handed a leaflet. It does not clearly beat a proper course of another treatment. That is why it is usually attached to something else, commonly as a short front end of one to four sessions before or alongside the main work, which is how it most often appears in the services described in our guide to what addiction treatment involves.
It is a style, not a school of therapy
Motivational interviewing is a way of conducting a conversation rather than a body of theory about why people are the way they are. That is the difference between it and cognitive behavioural therapy (CBT), which comes with an account of how thoughts, feelings and behaviour interact and a set of tasks that follow from it.
The practical consequence is that you may meet this style anywhere. Inside CBT, in a fifteen-minute appointment about blood pressure medication, in a physiotherapy clinic, in an addiction service, from a nurse. Very few people describe themselves as motivational interviewers, so asking whether somebody “does” it is a poor question. A better one, and it works on any practitioner, is how they usually handle a client who is not sure they want to change. Our comparison of what a psychiatrist, a psychologist and a therapist can each actually do covers who you are likely to be sitting in front of when you ask it.
What it feels like from your side, and why people leave
The commonest complaint is that it feels evasive. You arrive wanting to be told what to do, you ask a direct question, you get a question back, and after two sessions of that a reasonable person concludes the counsellor is either withholding or not very good.
That reading is understandable and it is wrong, and there are two things worth knowing before you decide.
The first is that the counsellor is not forbidden from giving you information. The method has an explicit move for it: ask your permission, give the information plainly, then ask what you make of it. So saying “I would like your actual opinion on this” is not rude and does not break anything. A competent practitioner will answer you.
The second is that if what you want is instruction rather than exploration, say so in the first session rather than the fourth. Somebody who has already decided and wants a plan is poorly served by four sessions of being asked how they feel about a decision they made in March. At that point the question has stopped being motivation and started being structure, which is the distinction our piece on motivation versus discipline is about.
Ambivalence is treated as normal, not as a problem with you
Being in two minds is the expected state of a person thinking about a change, rather than evidence of denial or weak commitment. Practitioners treat it as the material to work with, not as an obstacle standing in front of the material.
This is the reverse of nearly every other message anybody gets about changing, and it is the part readers tend to find most relieving. The usual framing says that wanting to stop and not stopping is a contradiction you should be embarrassed about. This one says both halves are genuinely yours, that most people sit in that position for a long time before anything moves, and that the way out runs through describing both sides accurately rather than through picking one and declaring it.
That single reframe is often what makes the conversation possible, because a person who expects to be judged for the ambivalent half will simply not mention it.
Is this approach likely to suit what you want right now?
Tick anything true. This is a reflection prompt rather than a test, and it produces no diagnosis.
0 of 6 ticked
Being genuinely in two minds, bristling at instruction, and knowing the reasons without moving are the conditions this style was designed around, and they are the ones ordinary advice handles worst. When you book, say that you are undecided rather than that you want to change, because it is more accurate and it points the first session at the right thing.
Ask any practitioner how they usually work with somebody who is not sure they want to change, and listen for whether the answer is about persuading you. In the room, say plainly whether you want to explore the decision or be given information, because both are available and the second one has to be asked for.
Nothing here matched, which often means the decision is already made and what is missing is a plan rather than motivation. That is a different problem with different answers, and spending several sessions being asked how you feel about a settled question is a slow way to discover it.
No screener on this site measures readiness to change, and none covers motivational interviewing, so there is no quiz here that will tell you whether it suits you. What the free self-assessment screeners do cover is anxiety, depression, stress, insomnia, burnout, self-esteem and loneliness, which is frequently what is sitting underneath the thing you are ambivalent about.
What it is not: a way of getting somebody else to change
It is not a technique you can run on a relative, and the attempt usually produces the exact pushback the method exists to avoid. This is the question a lot of people arrive with, so it is worth answering directly.
Two reasons it fails in a family. The stance is what does the work, not the technique, so asking careful open questions while privately holding a fixed outcome is an interrogation with a pleasant voice, and people detect it quickly. The people who have known you longest detect it fastest. And a counsellor’s usefulness comes partly from having nothing at stake in your decision, which is not a position a partner, a parent or an adult child can occupy, however well they behave.
What does transfer is the smaller, negative half. Say the worried thing once, plainly, and give it a date and a detail rather than a character judgement. Then stop supplying reasons. Ask what they think and let the silence sit, and do not answer their objection for them, because answering it is what hands them the argument to defend. That is a long way short of motivational interviewing, and it is the part that reliably helps.
When to seek help
Speak to a doctor or a therapist if a habit you have tried to change on your own has stayed put for months, if it is affecting your sleep, your work or the people around you, or if you have found yourself defending something you privately want to stop. Say when you book that you have not decided yet, because it is true and because it puts you in front of the right kind of conversation. Our guide to finding a therapist covers costs, licences and what to do when nobody answers the phone.
Go sooner if alcohol or drugs are involved, if a physical health condition depends on the change, or if low mood or anxiety is underneath the habit rather than beside it. Treating what is underneath frequently does more for the behaviour than any conversation about the behaviour does.
Contact your local emergency services or a crisis helpline if you feel unsafe or have thoughts of harming yourself.
How MyFreud can help
MyFreud is a mobile app that helps you find solutions to problems that have affected your mind and productivity. Live coaching sessions give you somewhere to say the argument for changing in your own words, which is the thing this whole approach turns on, and each one ends with an actionable plan rather than encouragement. Daily tracking shows whether the habit you are ambivalent about is costing you what you think it is, which is harder to argue with than a memory. The notepad is where the sentence you meant to say in the appointment can wait until the appointment.
Download MyFreud and start today: App Store or Google Play.