OARS

Guiding patients towards change requires focused collaboration - listening to what they see as important and what changes they want to make in their lives. There are some simple tactics you can use to support and invite collaboration: open-ended questions, affirmations, reflections, and summaries, collectively known as the “OARS” techniques.

Open Ended Questions

Open-ended questions require more than a yes-or-no answer and encourage individuals to share their feelings, experiences, and perspectives.

Examples of Open Ended Questions

"How often do you drink alcohol?"

"How do you spend your free time?"

"What kind of steps could you take to stay healthy and safe?"

Affirmations

Affirmations highlight an individual's specific strengths and values that may lead them to make positive changes. Avoid phrasing affirmations as positive judgments, like "You're doing great!" which suggests that you are in a place of authority to determine what is good and bad.

Examples of Affirmations

"It takes a lot of strength to say 'no' to marijuana when so many of your friends use it."

"You've really been working hard at this!"

"School is important to you, so you don't want alcohol to get in the way of good grades."

Reflections

Reflections are statements that summarize the individual's narrative without adding any judgment. Reflecting change talk gives it more prominence in the discussion and encourages the adolescent to continue with even more change talk.

There are several types of reflections. A simple reflection is a paraphrase of what the person said and may emphasize or draw out the feelings behind their words.

Example of a Simple Reflection

Teenager: But I don't want to quit drinking, I mean, all of my friends drink.

Provider: Your point is that quitting drinking doesn't sound like a good idea to you because you spend a lot of time with others who drink.

Teenager: Right, I feel like I wouldn't fit in...

Double-Sided Reflection

A double-sided reflection starts with the statement that supports sustaining the behavior and ends with a previous consequence expressed by the person.

It's important to end the reflection with change talk so that it prompts further discussion on the topic.

Example of a Double-sided Reflection

Teenager: But I don't want to quit drinking, I mean, all of my friends drink.

Provider: You like drinking with your friends, and at the same time you're worried about how it's affecting you.

Teenager: Yeah, I have to balance my health and my social life

Amplified Reflection

An amplified reflection can be used when you hear sustain talk, as it exaggerates what the person said to the point where they might disagree with it. However, it's important not to overdo it or sound judgmental, which can make the person upset.

Example of an Amplified Reflection

Teenager: But I don't want to quit drinking, I mean, all of my friends drink.

Provider: You don't want to quit drinking because your friends will stop hanging out with you.

Teenager: Well, I don't think they'd stop hanging out with me. They wouldn't do that.

All these reflections show the adolescent you're listening and trying to understand, encourage them to keep sharing, and create a judgment-free space where they feel free to explore their pro-change attitudes.

Summaries

Summaries combine different points made by the patient. They check your understanding of what the person has said and are useful transitions between various points of the conversation.

Example of a Summary

"So marijuana helps you relieve stress, and at the same time you are worried about the amount of money you've been spending on it. You're concerned that your dad might find out about your smoking and ground you. And you're also worried that you might lose your job if you keep smoking this often."