Motivational Interviewing Techniques: OARS and Change Talk
Motivational interviewing techniques are the conversational moves that help a person talk their own way into change rather than being argued into it: open questions, affirmations, reflections, and summaries. This printable sheet lays out the OARS skills, the four processes, the difference between change talk and sustain talk, and the traps that stall the conversation.
Reviewed byMichael Callans, MSWOARS: the four core skills
The four processes, in order
- Engaging: build a working relationship. If the person does not want to be in the conversation, this is the only task.
- Focusing: agree on what the conversation is about. It is often not the reason they were referred.
- Evoking: draw out the person's own motivation for that specific change, using open questions, reflections, and summaries.
- Planning: only once they are leaning toward it. Ask permission before giving information or options, and keep the plan theirs.
- Expect to loop. A plan that stalls usually means going back to engaging or focusing rather than pressing harder on planning.
The spirit of the method
Partnership
Two experts in the room: you on the conversation, them on their own life. The work happens with the person, not on them, and the balance of talking should reflect that.
Acceptance
Respect for the person's worth, their autonomy, and their right to decide, including the right to decide against change. Acceptance is not agreement with every choice.
Compassion
Working for the other person's welfare rather than for a target, a quota, or your own discomfort with the risk they are carrying.
Evocation
Assuming the motivation and the reasons are already present and need calling out, instead of assuming a deficit you must fill with information.
Change talk and sustain talk
Traps that stall the conversation
- The righting reflex: the pull to correct, warn, and supply reasons. It feels helpful and it hands the other person the case against change.
- The question and answer trap: a run of closed questions that teaches the person to give short answers and wait.
- The assessment trap: letting required paperwork set the agenda for the whole first conversation.
- The expert trap: taking the posture of the one with the answers, which invites passivity or a fight.
- The premature focus trap: pushing toward the change you think matters before agreeing on what the conversation is about.
- The labeling trap: needing the person to accept a word such as alcoholic or addict before anything else can happen.
- The blaming trap: letting the conversation become about whose fault it is.
- The chat trap: comfortable, aimless conversation with no direction, which is pleasant and goes nowhere.
Questions that tend to evoke change talk
- What makes you think it might be time for a change?
- If you did decide to change, how would you do it?
- What are the three best reasons to do it?
- On a scale of 0 to 10, how important is this to you? And why is it not a lower number?
- Suppose you carry on exactly as you are now. What does your life look like in five years?
- What was it like before this started? What has it cost you since?
- What do you hope for, for yourself, that this is getting in the way of?
- Then listen for the answer and reflect it back rather than approving of it.
Reflections: the part worth drilling
Most people new to the method under-reflect and over-question, because questions feel like progress. A reflection is a statement, said with a falling tone, that offers your understanding back for correction: you are not convinced this is a problem, and you are here anyway. Keep the reflection shorter than what the person said. When you guess at something they have not quite said, you are using a complex reflection, and being wrong costs little as long as you let them put you right.
Two moves are worth having ready. A double-sided reflection holds both halves of the ambivalence in one sentence, ending on the change side: it helps you get through the evening, and you do not like what it is doing to your memory. An amplified reflection states the sustain side a little more strongly than they did, without sarcasm, and often prompts them to pull it back themselves. Overdone, it reads as mockery and damages the relationship, so use it sparingly and drop it if the tone sours.
When someone pushes back
Pushback is information, not an obstacle. If the person is arguing for the status quo, check whether you just argued for change. If the friction is about you rather than the behavior, that is discord, and the repair is to go back to engaging: apologize for getting ahead of them, affirm their autonomy, ask what they want out of the time. Emphasizing that the decision is theirs is not a trick to get a different answer, and it only works if it is true.
There are limits to holding this stance. If someone is at immediate risk, driving while intoxicated, withdrawing from alcohol without medical support, or caring for someone who is unsafe, the conversation gives way to the duty to act, and most clinicians have a legal or professional obligation in those moments. Information can still be offered inside the method: ask permission, give it plainly, and ask what they make of it.
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About this tool
Motivational interviewing techniques are the specific conversational moves of a counseling style developed by William Miller and Stephen Rollnick for talking with people who are of two minds about changing something. Miller first described the approach in 1983, writing about problem drinkers and arguing that what gets labeled denial or lack of motivation is often produced by the conversation itself. The method is defined by what the practitioner does not do: no lecturing, no warning, no accumulating of reasons on the person's behalf. The work is to draw out the person's own reasons and let them hear themselves say them.
Miller and Rollnick describe the underlying stance as the spirit of motivational interviewing, and in the third edition of their manual they name four parts: partnership, acceptance, compassion, and evocation. Partnership means the conversation is a collaboration between two experts, one on the method and one on their own life. Acceptance includes respecting the person's right to decide. Compassion means the practitioner's aim is the other person's welfare, not a target. Evocation means assuming the motivation is already there to be called out rather than installed. Technique without that stance turns into a polite way of pushing, and people can tell.
The core skills carry the acronym OARS: open questions, affirmations, reflections, and summaries. Open questions invite more than a yes or a number. Affirmations name a specific strength or effort rather than handing out praise. Reflections are the heavy lifting of the method: you say back what you understood, sometimes close to the words used, sometimes a step beyond them, and the person either confirms it or corrects it. Summaries gather what has been said, especially the parts that lean toward change, and hand them back. Skilled practitioners reflect far more often than they ask.
A second idea runs underneath the skills: ambivalence is normal, and the two sides of it sound different out loud. Change talk is anything the person says in the direction of change, and the familiar mnemonic sorts it into desire, ability, reasons, and need, then into the stronger forms of commitment, activation, and taking steps. Sustain talk is the argument for staying the same. Both are ordinary. The practitioner's job is to notice which one they are feeding, because taking up the case for change reliably recruits the other person to argue the other side.
Read the diagram as text
Two matched panels each show the same beam on the same fulcrum, with staying the same on the left pan and change on the right. In the first panel a neutral arrow presses the change pan from the side, from outside, an accented arc runs from that pan across to the other one, and the person's own accented marks sit on the stay pan, which has settled low. In the second panel there is no arrow from outside: an accented loop leaves the change pan and returns to it, the person's marks sit there, and that pan leans a little low. The accent is the person's own talk and the move that hands it back. On the phone layout the panels stack.
Two minds, and where the practitioner's move lands
Illustrative pair, nothing is counted
The same two sides sit in the same places in both panels, and the only weight on the beam is the person's own talk.
The practitioner argues the case for change: The person's own talk goes to the other side, and the beam settles on staying the same.
The practitioner reflects the person's own change talk back: What the person hears is the part of their own speech that leans toward change, and the beam leans that way.
The third edition organizes a session into four processes rather than stages: engaging, focusing, evoking, and planning. Engaging establishes a working relationship, and nothing else is possible without it. Focusing settles what the conversation is actually about, which is often not the referral question. Evoking draws out the person's own motivation for that particular change, and it is the part most specific to this method. Planning is only entered when the person is ready, and leaving it too early is one of the commonest errors. The processes recur rather than running once.
On the evidence, motivational interviewing has been studied heavily and the picture is modest rather than striking. Lundahl and colleagues pooled 119 studies in 2010 and reported a small but durable advantage over weak comparison conditions, averaging g of 0.28, with no significant difference when it was compared against other specific active treatments. Frost and colleagues went wider in 2018, reviewing 104 reviews that contained 39 meta-analyses, and found that most of the meta-analytic evidence was graded low or very low quality, with moderate-quality evidence of small, mainly short-term benefits in 11 of 155 comparisons.
The mechanism evidence is more awkward still, and worth knowing before anyone claims too much. Magill and colleagues tested the method's own causal model in 2014 and found that practitioner behavior consistent with motivational interviewing was associated with more change talk, while the moves that cut against the method were associated with less change talk and more sustain talk. Sustain talk predicted worse outcomes, while change talk on its own did not predict behavior change, though the studies that pooled client language into a single measure did show a small positive relationship with it. In other words, the part that most reliably matters may be avoiding the moves that generate argument, rather than extracting hopeful statements. That is a good argument for the traps list on this sheet.
Most of this page is written for the person running the conversation: clinicians, recovery workers, nurses, and anyone whose work involves talking with people about behavior they are not sure they want to change. It can also be used on your own ambivalence, and two of our worksheets are built from the method directly: Motivation & Confidence Ruler asks how important a change is and how confident you feel on scales of 0 to 10, then asks why the number is not lower, and Decisional Balance Worksheet lays out the costs and benefits of changing and of staying the same without forcing a conclusion.
Motivational interviewing is not a technique for getting compliance, and it is not neutral dressing for persuasion. It is also not a complete treatment: it is usually brief, often used at the front of care to resolve ambivalence, and then followed by something else. It does not replace medical management of withdrawal or dependence, and competence in it is not acquired by reading, including by reading this page. Practitioners learn it with recorded practice, coding, and feedback, and fidelity reporting was one of the weaknesses Frost and colleagues singled out in the review literature.
Where it sits alongside other tools: Stages of Change Worksheet maps the readiness model that grew up next to this method and is often taught with it, though they come from different research groups and the stage model has its own critics. If the question underneath the conversation is whether a substance problem exists at all, the Drug Addiction Test is a brief screening questionnaire for self-reflection, not a diagnosis, and a licensed clinician can take it further.
References
- Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press; 2013.
- Miller WR, Rollnick S. Motivational Interviewing: Helping People Change and Grow. 4th ed. Guilford Press; 2023.
- Miller WR. Motivational interviewing with problem drinkers. Behav Psychother. 1983;11(2):147-172. doi:10.1017/S0141347300006583
- Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Res Soc Work Pract. 2010;20(2):137-160. doi:10.1177/1049731509347850
- Frost H, Campbell P, Maxwell M, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One. 2018;13(10):e0204890. doi:10.1371/journal.pone.0204890
- Magill M, Gaume J, Apodaca TR, et al. The technical hypothesis of motivational interviewing: a meta-analysis of MI's key causal model. J Consult Clin Psychol. 2014;82(6):973-983. doi:10.1037/a0036833
Cite this source
Psychology.com. (2026, November 6). Motivational Interviewing. Psychology.com. https://psychology.com/tools/motivational-interviewing
Motivational Interviewing FAQ
What are the main motivational interviewing techniques?
The main motivational interviewing techniques are the four OARS skills: open questions, affirmations, reflections, and summaries. Around them sit a set of evocative questions that invite the person's own reasons for change, the importance and confidence scales, and specific reflection forms such as the double-sided reflection. Just as important is a list of things not to do, including correcting, warning, labeling, and supplying reasons on the person's behalf. Practitioners trained in the method typically reflect more often than they ask questions.
What does OARS stand for in motivational interviewing?
In motivational interviewing, OARS stands for open questions, affirmations, reflections, and summaries. Open questions invite more than a yes or a number. Affirmations name a real strength or effort rather than offering general praise. Reflections state back what you understood so the person can confirm or correct it, and they carry most of the work. Summaries pull several threads together, giving extra room to anything said in the direction of change, and mark the move from one part of the conversation to the next.
What are the four principles of motivational interviewing?
The four principles people usually mean come from the second edition of Miller and Rollnick's manual: express empathy, develop discrepancy, roll with resistance, and support self-efficacy. The third edition, published in 2013, replaced that framing with the spirit of the method, which is partnership, acceptance, compassion, and evocation, plus four processes: engaging, focusing, evoking, and planning. Both are in wide circulation, so training materials differ depending on which edition they were written from. The underlying stance did not change.
Does motivational interviewing work?
Motivational interviewing has a real but modest evidence base. Lundahl and colleagues pooled 119 studies in 2010 and found a small, durable advantage over weak comparison conditions and no significant difference against other specific active treatments. Frost and colleagues reviewed 104 reviews in 2018, judged most of the meta-analytic evidence low or very low quality, and found moderate-quality evidence of small, mostly short-term benefits in a minority of comparisons. It is reasonable to use and worth learning well. It is not a strong intervention on its own.
What is the difference between change talk and sustain talk?
Change talk is anything the person says that leans toward changing: wanting it, being able to do it, reasons for it, needing it, and the stronger forms of committing and taking steps. Sustain talk is the case for staying the same. Both are normal halves of ambivalence rather than signs of denial. The practical point is that arguing the change side tends to produce more sustain talk from the other person, and in Magill and colleagues' 2014 analysis it was sustain talk, not change talk, that predicted worse outcomes.
Can I use motivational interviewing on myself?
Partly. You cannot give yourself the relationship half of it, but you can use the structure. Ask yourself the evocative questions in writing rather than in your head, rate importance and confidence from 0 to 10 and then ask why the number is not lower, and write both sides of the ambivalence out without forcing a conclusion. The motivation ruler and decisional balance worksheets on this site are built for exactly that. If you find yourself only arguing one side, that is worth noticing rather than fixing.
Is motivational interviewing only for substance use?
No. Motivational interviewing began in work with problem drinkers, which is why it is filed under substance use here, but it has been applied to medication adherence, diet and exercise, smoking, gambling, care of long-term conditions, and work with people who did not choose to be in the room. The common ingredient is ambivalence about a change rather than any particular behavior. The evidence is spread thinly across those areas, and effects vary considerably by setting and by how faithfully the method was delivered.