One of the basic principles of Motivational Interviewing’s communication skills are OARS, active listening with open questions, affirmations (or praise), reflective listening and summarizing.  These skills are used to gain more information in order to understand any ambivalence in change.  Carers can then continue to help nudge their loved ones in the direction of considering change.  

The use of OARS…

Ask OPEN questions – not short-answer, yes/no, or rhetorical questions

AFFIRM the person – comment positively on strengths, effort, intention

REFLECT on what the person is saying:  ‘active listening’

SUMMARIZE:  collecting what the person has been saying and offering it back in a basket.

for example…

Open questions: 

I’m confused – how can we work together to ensure that I provide you with the best support?

How do you feel about that?


That must have been very difficult for you…thank you for sharing that with me.

That looks as if it has been really challenging.  Your efforts are impressive.

I can see that you find this difficult and I’m so proud of you for making such an effort.  However, be careful of using “I” as it can be interpreted as patronizing or of having parental overtones which may result in resistance.

Reflective listening:

If I’m hearing you right, it sounds like you’re saying that you don’t deserve to ………

Sounds as if going out with the family on your birthday will cause quite a bit of anxiety for you.

From what you’ve said, you’re very frightened of going back to school/work because ……

Summarizing:  “do you mind if I run that back by you, just to check on my understanding of what you’ve just told me……”

Reflective listening…

Carers are encouraged to use reflective listening as an implicit mark of listening which may encourage their loved one to pause for thought.  Their loved one may be better able to hear what they themselves are thinking and then continue to elaborate. Reflections convey empathy. Complex reflections move the conversation forward and to direct it towards change by drawing upon emotional energy, enhance self-efficacy or emphasing effective change strategies.  Think of simple and complex reflections like an iceberg.  A simple reflection is limited to what shows above the water, the content that has already been expressed, whereas a complex reflection makes a guess about what lies beneath the surface.

Edi:  I just feel so alone in all of this, like there’s no future…no way out

Carer:   You feel there’s no way out right now

(Simple reflection involves repeating back, not adding much to utterance)

Carer:  Sounds to me like you’re feeling trapped and alone in all of this

(Complex reflection involves adding more strength, coach’s interpretation of utterance)                         

Open and closed questioning techniques…

Closed questions which elicit monosyllabic answers should be avoided in favour of open questions which open the opportunity for the patient to speak and elaborate on how he/she is feeling.  Overall questions should be limited (never more than 3 in a row), otherwise it may feel like an interrogation exercise.  Voice tone is also important when working with open questions.  When using motivational interviewing in a professional setting, therapists aim for a ratio of 2:1 reflections:questions. 

Edi:  I just feel so alone in all of this, like there’s no future…no way out

Carer:   Do you feel there’s no way out?

(Closed question eliciting a yes/no anwer)

Carer:  What makes you feel so alone and trapped?

(Open question eliciting greater elaboration)