1.

Introduction: Engaging Clients for Meaningful Change (5 Minutes)

As Behavioral Health Technicians (BHTs), we play a vital role in creating a safe, supportive
environment where clients can explore their feelings, identify their motivations, and navigate
their path toward recovery. This training focuses on two powerful communication frameworks—
Motivational Interviewing (MI) and the Option Dialogue Process (ODP)—that equip us to foster
trust, deepen engagement, and empower clients in their journey.

Why Focus on These Techniques?

Clients often arrive in treatment feeling overwhelmed, isolated, or ambivalent about change.
While clinicians and therapists provide formal assessments and interventions, BHTs are on the
front lines, interacting with clients throughout their day-to-day lives. This consistent presence
allows us to:

● Meet Clients Where They Are: By engaging clients with empathy and curiosity, we
create a safe space for self-discovery.
● Strengthen Motivation: Through meaningful dialogue, we help clients clarify their goals
and renew their commitment to recovery.
● Build Connection: Our role bridges the gap between therapeutic sessions and daily life,
reinforcing clients' efforts in real time.

The Goal of Today’s Training

This session introduces tools and strategies that enhance your ability to connect with clients
meaningfully. By the end of this training, you will:

1. Understand how Motivational Interviewing fosters motivation and commitment to change.

2. Learn how the Option Dialogue Process encourages self-exploration through radical
acceptance and curiosity.
3. Explore how these techniques can be integrated into client interactions to promote trust,
engagement, and autonomy.

2. Explanation of Motivational Interviewing (5)

What is MI?
Developed by William R. Miller and Stephen Rollnick, MI is a collaborative, person-centred
approach for strengthening a client’s motivation and commitment to change. It helps resolve
ambivalence by inviting clients to articulate their own reasons for change.

Key Principles

1. Express Empathy
○ Empathy demonstrates genuine understanding and builds trust.
○ Reflective listening shows clients you’re paying attention and value their
perspective.
○ Example:
Client: "I don’t think I can stop using."
 Response: "It sounds like you’ve been struggling, and it’s hard to imagine a
different path."
○ Quote: “Acceptance facilitates change. Skillful reflective listening is fundamental
to expressing empathy.” – William R. Miller
2. Develop Discrepancy
○ Help clients explore the gap between their current behaviour and goals or values.
○ Example:
"How does continuing to use fit with the kind of future you want for yourself?"
○ Quote: “The goal of MI is not to solve a person’s problems for them but to help
them see the discrepancy between what they want and what they’re doing.” –
Stephen Rollnick
3. Roll with Resistance
○ Avoid arguing or pushing; instead, acknowledge the client’s resistance and
reframe it as an opportunity to explore their perspective.
○ Example:
Client: "I’ve tried everything, and nothing works."
Response: "You’ve been through a lot already. What do you feel has worked,
even if just a little?"
4. Support Self-Efficacy
○ Help clients believe in their ability to change by highlighting strengths and past
successes.
○ Example:
"You mentioned you stayed sober for six months last year. That’s a real
achievement—what helped you during that time?"

3. Explanation of the Option Dialogue Process (15)

What is the Option Dialogue Process?
Created by Barry Neil Kaufman as part of The Option Institute’s teachings, this method
emphasises unconditional acceptance curiosity, and empowering clients to explore their
thoughts and beliefs without judgment or guidance toward a specific outcome.

Barry Neil Kaufman, affectionately known as "Bears," is a writer, educator, and motivational
speaker whose work focuses on personal empowerment and emotional well-being. His journey
began as a response to personal challenges, particularly his son Raun's autism diagnosis.
Kaufman and his wife, Samahria, developed an innovative home-based program emphasising
acceptance, love, and nonjudgmental dialogue, helping Raun make significant developmental
strides. This experience became the foundation of their philosophy and inspired Kaufman’s
subsequent work.

Founded in 1983 in Sheffield, Massachusetts, by Barry and Samahria Kaufman, The Option
Institute is a teaching centre for self-growth and personal transformation. It offers programs and
workshops to help individuals improve their emotional well-being, build stronger relationships,
and achieve greater fulfilment. The teachings are rooted in unconditional acceptance, self-
inquiry, and empowerment.

The Institute also housed the Autism Treatment Center of America, home to the Son-Rise
Program. This program grew out of the Kaufmans’ work with their son and is internationally
recognised as a model for autism intervention.
The Option Dialogue Process (ODP) is a cornerstone of Kaufman’s teachings and is detailed in
his book To Love Is to Be Happy With. This conversational approach is designed to help
individuals explore their thoughts, emotions, and beliefs in a judgment-free environment.

Key features of the Option Dialogue Process include:

Core Principles

1. Radical Acceptance: Fully embracing the individual’s perspective without judgment or

the intention to change it.
2. Curiosity Without Agenda: Asking open-ended questions to encourage self-reflection
and insight, allowing individuals to uncover their own truths and solutions.
3. Empowerment Through Validation: Affirming the validity of the individual’s feelings
and experiences, fostering a safe space for exploration and growth.

1. Radical Acceptance
What is Radical Acceptance?
Radical acceptance is fully acknowledging and embracing a client’s feelings, beliefs, and
experiences without judgment. It does not mean agreement or approval; instead, it means
recognising the client’s experience as valid and worthy of attention. This principle removes
resistance and creates a safe environment where the client feels seen and heard.

Why It Matters:

● Our clients often face internalised shame or societal judgment, making it harder for them
to open up.
● Radical acceptance removes barriers of defensiveness by meeting the client exactly
where they are.
● Accepting the client’s reality creates the foundation for trust and deeper exploration.
When we step into someone else’s world, instead of making them step into ours, we
value their lived experience.

Practical Example:

● Client: “I’m so broken, and I don’t think I’ll ever be okay.”

● Radical Acceptance Response: “It sounds to me like you’re feeling overwhelmed and
defeated. That must be an incredibly hard place to be.”

This response doesn’t deny or minimise the client’s experience. Instead, it communicates that
their feelings are valid and understood, which can open the door to further dialogue.

Key Tip: Avoid rushing to reassure or fix the situation. Radical acceptance is about holding
space for the client’s emotions without imposing a solution.

Quote from Barry Neil Kaufman:

“When we meet someone with total acceptance, we tell them, ‘You are enough, just as you are,
in this moment.’ That kind of love changes lives.”

2. Curiosity Without Agenda

What is Curiosity Without Agenda?
This principle focuses on asking open-ended questions that encourage clients to explore their
thoughts, feelings, and beliefs. The key is approaching the client’s experience with genuine
interest and no desire to guide them toward a specific conclusion or solution. The goal is to
have the client explore themselves and work out their feelings.

Why It Matters:

● It allows clients to take ownership of their thoughts and emotions.

● Encourages self-reflection, helping clients uncover insights and motivations that may
have been hidden or ignored.
● Build rapport by demonstrating that you value their unique perspective.

Practical Example:

● Client: “I don’t know why I keep making the same mistakes.”

● Curiosity Response: “What do you feel when you think about them and the situation that
led up to them? ”

This approach doesn’t aim to solve the issue but gently invites the client to explore their own
experience.

To highlight the difference between probing questions and curiosity without agenda, let’s look at
examples of each.

Probing Questions

Probing questions often come across as leading, judgmental, or overly direct. They can make
clients feel defensive or pressured to justify their thoughts or actions.

● Probing Question: “Why didn’t you go to group therapy yesterday?”

○ Why it’s probing: It focuses on past behaviour in a way that could feel
accusatory rather than supportive.
● Probing Question: “Don’t you think staying in treatment is best for you?”
○ Why it’s probing: It implies a judgment and suggests a specific answer, which
may make the client feel cornered.
● Probing Question: “How long have you made these bad decisions?”
○ Why it’s probing: It frames the client’s choices negatively, creating a sense of
shame or defensiveness.

Curious Questions Without Agenda

Curious questions are open-ended and nonjudgmental. They invite the client to explore their
thoughts and feelings without feeling pressured or judged.

● Curious Question: “How were you feeling about group therapy yesterday?”
○ Why it’s curious: It focuses on the client’s emotions and perspective,
encouraging them to share their experience.
● Curious Question: “What are your thoughts about staying in treatment?”
○ Why it’s curious: It allows clients to explore their feelings about treatment
without pushing them toward a specific conclusion.
 ● Curious Question: “What comes to your mind when you think about your choices?”
○ Why it’s curious: It invites reflection without judgment or labelling the choices as
good or bad.

Key Tip: Phrase questions to allow clients the freedom to choose what and how much they want
to share.

Quote from Barry Neil Kaufman:

“True curiosity is not about seeking answers but about honoring the journey of discovery. It
says, ‘I care enough to want to understand you.’”

3. Validation
What is Validation?
Validation affirms the client’s emotions, thoughts, or experiences as understandable and
legitimate. It is not about agreeing with their perspective but about showing them that their
feelings are real and deserving of acknowledgement.

Why It Matters:

● Many clients come from environments where their emotions or struggles have been
dismissed or invalidated.
● Validation helps reduce feelings of isolation and shame, creating a sense of connection
and safety.
● It reinforces the client’s sense of worth and helps them feel supported in their journey.

Practical Example:

● Client: “I feel like I’ll never get better, no matter what I do.”
● Validation Response: “It sounds to me like you’re feeling stuck and hopeless right now.
That's tough, and I understand why you’d feel that way about everything you’ve gone
through.”

By reflecting on their emotional experience without judgment, you demonstrate that their
feelings are seen and accepted, which can help reduce emotional intensity and foster trust.

How It Differs From Reassurance:

● Validation doesn’t attempt to “cheer up” the client or change their feelings.
● Instead, it holds space for their emotions, allowing them to feel fully heard and
understood.

Examples of Validation vs. Reassurance

Validation and reassurance are both supportive, but they serve different purposes. Validation
acknowledges and affirms a client’s feelings or experiences as real and understandable.
Reassurance attempts to comfort the client by minimising their distress or focusing on a positive
outcome. While reassurance has its place, it can sometimes overlook the importance of fully
hearing and understanding the client’s current emotional state.

Examples of Reassurance
Reassurance communicates, “It’s going to be okay,” but can sometimes bypass the client’s
deeper emotions and can feel dismissive.

● Client: “I feel like a failure. Nothing I do ever works.”

○ Reassurance Response: “You’re not a failure—you’re doing your best, and that’s
what matters.”
■ Why it’s reassuring: It attempts to comfort by challenging the client’s
negative self-assessment, but it may feel dismissive of their underlying
struggle.
● Client: “I’m always so angry, and I hate that about myself.”
○ Reassurance Response: “You’re not angry—you’re just going through a tough
time.”
■ Why it’s reassuring: It tries to reframe the client’s feelings positively but
doesn’t fully engage with their deeper frustration or self-judgment.
● Client: “I’m terrified I’ll relapse. I don’t think I can handle this.”
○ Reassurance Response: “You’ve got this. You’re stronger than you think.”
■ Why it’s reassuring: While encouraging, it skips over the client’s fear
and vulnerability, potentially leaving them feeling misunderstood.

Examples of Validation

Validation communicates, “Your feelings and experiences make sense, and I see you.”

● Client: “I feel like a failure. Nothing I do ever works.”

○ Validation Response: “It sounds like you’re feeling really discouraged and
frustrated with yourself right now. That must be a heavy burden to carry.”
■ Why it’s validating: It reflects the client’s emotions without minimizing or
dismissing them, creating space for the client to feel heard.
● Client: “I’m so angry all the time, and I hate that about myself.”
○ Validation Response: “It makes sense that you’d feel angry after everything
you’ve been through. And it’s hard to deal with those feelings when they feel so
overwhelming.”
■ Why it’s validating: It acknowledges both the anger and the client’s
struggle with that anger, affirming their experience.
● Client: “I’m terrified I’ll relapse. I don’t think I can handle this.”
○ Validation Response: “That fear makes sense—you’re facing a big challenge,
and it’s natural to feel unsure about it. You’re not alone in feeling this way.”
■ Why it’s validating: It normalizes the client’s fear and shows
understanding of their vulnerability.

Key Differences

● Validation: Focuses on fully acknowledging and accepting the client’s current emotions
and experiences. It shows empathy and understanding.
○ Impact: Helps the client feel heard and valued, reducing feelings of isolation or
shame.
● Reassurance: Focuses on comforting and encouraging the client, often with a focus on
positive outcomes.

Key Tip: Use reflective statements to mirror the client’s emotions, and follow up with open-
ended questions if appropriate.
Quote from Barry Neil Kaufman:
“Validation is the simplest, yet most profound, way to say to someone, ‘You matter.’ It is the
foundation of love and connection.”

Summary of the Three Levels

1. Radical Acceptance: Fully embrace the client’s experience without judgment.
2. Curiosity Without Agenda: Use open-ended questions to encourage self-discovery
and exploration.
3. Validation: Affirm the client’s feelings and experiences as real and deserving of
acknowledgement.

4. Integrating MI and the Option Dialogue Process (20)

How the Option Dialogue Process Supports Self-Determination

The Option Dialogue Process is particularly powerful in treatment scenarios because it is built
on unconditional acceptance and curiosity. This approach creates space for the client to:

1. Determine their own status: By exploring their thoughts and feelings without judgment,
clients can articulate their current emotional and mental state.
2. Discover their solutions: Rather than imposing advice, the ODP facilitates self-
reflection, helping the client identify their own path toward stability and re-engagement.

Practical Application in a Crisis

● A client expresses frustration: “I don’t even know why I’m here. No one cares what I
think.”
● Instead of correcting this belief, you might respond:
○ Radical Acceptance: “It sounds like you’re feeling really unheard and frustrated
right now. That’s understandable in a situation like this.”
○ Validation: “It makes sense to feel this way. You’re here because things have
been difficult, and it’s okay to be upset about that.”
○ Curiosity Without Agenda: “What do you feel you need to feel heard right
now?”

This interaction does not aim to fix the client’s frustration but acknowledges their feelings, helps
them reflect, and creates an opportunity for further dialogue.

Motivational Interviewing: Reigniting Engagement

While the Option Dialogue Process focuses on the client’s internal journey, Motivational
Interviewing (MI) offers tools for guiding clients toward action by addressing ambivalence and
nurturing motivation. In the context of acute care, this means:

1. Reengaging with Treatment: MI helps clients reconnect with why they came to
treatment and explore their values and goals.
 2. Building Confidence: Through reflective listening and affirmations, you can remind
clients of their strengths and past successes, reinforcing their capacity for change.

Example of Reengagement

● Client: “This program isn’t going to help me. Nothing ever does.”
● MI-Driven Response:
○ Reflective Listening: “It sounds like you’re feeling pretty discouraged about
treatment right now.”
○ Develop Discrepancy: “What does staying in this program mean for the goals
you’ve mentioned in the past, like being there for your family?”
○ Support Self-Efficacy: “You’ve been through hard things before and kept going.
What helped you then?”

This approach invites the client to consider their own reasons for continuing treatment while
affirming their ability to succeed.

Combining the Two Approaches

By integrating the principles of the Option Dialogue Process and MI, BHTs can provide a
holistic, client-centred approach to care:

1. Start with Acceptance and Curiosity (Option Dialogue): Create a safe space where
clients can express their emotions and explore their beliefs. This reduces resistance and
builds trust.
2. Transition to Motivation and Change (MI): Once trust is established, use MI
techniques to explore ambivalence and guide clients toward actionable steps aligned
with their goals.
3. Focus on Empowerment: Both methods emphasise that the client is the expert on their
own life. The BHT’s role is to support, not direct, the process.

Integrated Example Scenario

Scenario: A client refuses to participate in group therapy.

Option Dialogue Process

Radical Acceptance

● BHT: “You don’t feel like group therapy is the right fit for you right now, and that’s okay.”
● Client: “Yeah, I just don’t see the point. Sitting around listening to other people’s
problems doesn’t help me.”

Validation

● BHT: “It’s understandable to feel hesitant, especially when things are overwhelming.”
● Client: “Exactly. I’ve got enough going on in my head—I don’t need to hear about
everyone else’s issues.”

Curiosity Without Agenda

 ● BHT: “What’s on your mind about the group? Can you tell me more about what makes it
feel difficult for you?”
● Client: “I guess I just feel like I won’t get anything out of it. And honestly, I’m not great at
sharing in front of people.”

Motivational Interviewing
Reflective Listening

● BHT: “It sounds like you’re worried that the group might not be helpful.”
● Client: “Yeah, exactly. I feel like I’ll just sit there, not say anything, and leave feeling
worse than when I went in.”

Develop Discrepancy

● BHT: “How do you think attending group could help you with your goals here?”
● Client: “I mean, I do want support. I guess I just haven’t thought about how a group
could actually help with that.”

Support Self-Efficacy

● BHT: “You’ve mentioned before that you’ve opened up in the past and found it helpful.
Do you think this group could help you find that strength again?”
● Client: “I guess I could try to talk a little. I don’t know—it’s scary, but I’ve done it before,
and it wasn’t so bad.”

Through this integrated approach, the client feels heard and supported while being gently
guided toward re-engagement.

5. Wrap-Up and Key Takeaways (5 minutes)

● Summarise the training:
○ MI helps clients resolve ambivalence and take steps toward change.
○ The Option Dialogue Process builds a foundation of trust and acceptance.
○ Together, they create a holistic approach to client care.
● As BHTs, the relationships we build and the time we spend with clients are invaluable.
Integrating these techniques into our daily interactions fosters an environment where
clients feel seen, heard, and capable of change. Remember, small moments of
connection and trust can lead to profound transformations.
● Closing Quote:
“Change happens in the presence of acceptance and the invitation to explore.