Reading: OARS and change talk
Open questions, affirmations, reflections and summaries, and how to hear and strengthen change talk.
Reading: OARS and change talk
What you’ll learn
- Use open questions, affirmations, reflections and summaries in a conversation.
- Recognize change talk and sustain talk, and respond to each.
- Avoid the common roadblocks to listening.
The core skills of MI go by the acronym OARS: open questions, affirmations, reflective listening and summaries. You use them in every process, from the first minute of engaging to the end of planning. Counselors who use them consistently see more engagement and less discord.
Open questions
Open questions invite the client to think before answering and to tell their story. Closed questions get short answers and can make clients feel they’re being tested for the right one. A statement like “Tell me about…” works as an open question too.
- “So you’re here because you’re concerned about your drinking, correct?”
- Try“What brings you here today?”
- “How many children do you have?”
- Try“Tell me about your family.”
- “On a typical day, how much marijuana do you smoke?”
- Try“Tell me about your marijuana use on a typical day.”
- “Do you think you use amphetamines too often?”
- Try“In what ways are you concerned about your use of amphetamines?”
- “When do you plan to quit drinking?”
- Try“What do you think you want to do about your drinking?”
| Instead of | Try |
|---|---|
| “So you’re here because you’re concerned about your drinking, correct?” | “What brings you here today?” |
| “How many children do you have?” | “Tell me about your family.” |
| “On a typical day, how much marijuana do you smoke?” | “Tell me about your marijuana use on a typical day.” |
| “Do you think you use amphetamines too often?” | “In what ways are you concerned about your use of amphetamines?” |
| “When do you plan to quit drinking?” | “What do you think you want to do about your drinking?” |
You’ll sometimes need closed questions, for example during a screening. Even then, open questions often get you the same information while building the relationship. Watch for the question-and-answer trap, where a string of questions turns the session into an interview. A good rhythm is one open question followed by two or three reflections. A higher ratio of reflections to questions predicts better outcomes.
Affirmations
An affirmation recognizes something genuinely good about the client: a strength, a past success, or an effort to change, however small. It says, in effect, “I see you, and what you do matters.” Affirmations build confidence, and they consistently predict better outcomes.
Affirming isn’t the same as praising. “Great job” is general and puts you in the role of judge. Focus on specific behaviors, describe rather than evaluate, and frame it with “you” rather than “I.” Instead of “I’m proud of you,” try “You kept going to your meetings even after a hard week. You’re persistent.” People from different cultures and backgrounds respond to affirmations differently, so watch the client’s reaction, and ask if you’re unsure: “How was that for you to hear?”
Reflections
Reflective listening is how you show empathy. It isn’t just staying quiet while the client talks. You form a guess about what the client means, say it back, and watch how they respond. If they keep talking and go further, you’re on track. If not, you adjust.
For example, a client says, “I drink because I’m lonely.” Lonely could mean they lost a partner, find it hard to make friends, or don’t know what to say around family. Think about what they’ve said so far, make your best guess (“It’s hard for you to make friends”), and let them correct you.
- Simple
- Client says“My wife is nagging me about my drinking.”
- You might say“Your wife is pressuring you about your drinking.”
- Feeling
- Client says“I’d like to quit smoking pot so the smoke won’t make my daughter’s asthma worse.”
- You might say“You’re afraid her asthma will get worse if you keep smoking.”
- Meaning
- Client says“I read that secondhand smoke can make asthma worse, and I don’t want that for her.”
- You might say“You want to protect your daughter.”
- Double-sided
- Client says“I know I should give up drinking, but I can’t imagine life without it.”
- You might say“Giving up drinking would be hard, and you recognize it’s time to stop.”
- Amplified (use sparingly)
- Client says“My cocaine use just isn’t a problem.”
- You might say“There are absolutely no downsides to using cocaine.”
| Type | Client says | You might say |
|---|---|---|
| Simple | “My wife is nagging me about my drinking.” | “Your wife is pressuring you about your drinking.” |
| Feeling | “I’d like to quit smoking pot so the smoke won’t make my daughter’s asthma worse.” | “You’re afraid her asthma will get worse if you keep smoking.” |
| Meaning | “I read that secondhand smoke can make asthma worse, and I don’t want that for her.” | “You want to protect your daughter.” |
| Double-sided | “I know I should give up drinking, but I can’t imagine life without it.” | “Giving up drinking would be hard, and you recognize it’s time to stop.” |
| Amplified (use sparingly) | “My cocaine use just isn’t a problem.” | “There are absolutely no downsides to using cocaine.” |
Summaries
A summary pulls together several things the client has said and hands them back as a fuller picture. You choose what to include. A collecting summary gathers related statements. A linking summary connects something the client just said to something earlier. A transitional summary wraps up one topic before moving on. An ambivalence summary acknowledges sustain talk but highlights change talk.
End a summary by asking what you missed. And notice the effect: the client hears their change talk once when they say it, again when you reflect it, and again when you summarize it.
Change talk and sustain talk
Change talk is anything the client says in favor of change. Sustain talk is anything in favor of staying the same. Both will be present whenever someone is ambivalent. The acronym DARN-CAT names the kinds of change talk to listen for.
- Desire
- Change talk“I want to cut down on my drinking.”
- Sustain talk“I love how cocaine makes me feel.”
- Ability
- Change talk“I could cut back to one drink with dinner on weekends.”
- Sustain talk“I can manage my life just fine without giving it up.”
- Reasons
- Change talk“I’ll miss less work if I cut down.”
- Sustain talk“Getting high helps me feel energized.”
- Need
- Change talk“I have to cut down. My doctor says it’s putting my health at risk.”
- Sustain talk“I need to get high to keep me going every day.”
- Commitment
- Change talk“I promise to cut back this weekend.”
- Sustain talk“I’m going to keep using.”
- Activation
- Change talk“I’m ready to do something about the drinking.”
- Sustain talk“I’m not ready to give it up.”
- Taking steps
- Change talk“I only had one drink with dinner on Saturday.”
- Sustain talk“I’m still using every day.”
| Type | Change talk | Sustain talk |
|---|---|---|
| Desire | “I want to cut down on my drinking.” | “I love how cocaine makes me feel.” |
| Ability | “I could cut back to one drink with dinner on weekends.” | “I can manage my life just fine without giving it up.” |
| Reasons | “I’ll miss less work if I cut down.” | “Getting high helps me feel energized.” |
| Need | “I have to cut down. My doctor says it’s putting my health at risk.” | “I need to get high to keep me going every day.” |
| Commitment | “I promise to cut back this weekend.” | “I’m going to keep using.” |
| Activation | “I’m ready to do something about the drinking.” | “I’m not ready to give it up.” |
| Taking steps | “I only had one drink with dinner on Saturday.” | “I’m still using every day.” |
You don’t need to sort change talk into types during a session. Just notice it, reflect it, and ask for more: “What else?” When you hear sustain talk, reflect it rather than arguing with it. Arguing turns sustain talk into discord.
The client offers a little change talk. Write a reflection that strengthens it.
ClientI guess I’d have more money if I wasn’t buying weed every week.
Show a model answer
“Money matters to you, and you can see how much of it is going to weed.” Then ask for more: “What would you do with that money?” Reflecting the change talk and asking the client to elaborate lets them hear their own reason again.
Key takeaways
- Ask one open question, then reflect two or three times before asking another.
- Affirm specific strengths and efforts, framed with “you,” not “I.”
- Listen for change talk. Reflect it, ask for more, and summarize it back.
Adapted from SAMHSA, TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (2019), chapter 3. Public domain. Open TIP 35, core skills: OARS