Q: How do I get training in LST/BCT?

A: There are several available methods to get exposure and training in LST/BCT. First, members of the Addiction and Family Research Group provide trainings and presentations throughout the US and around the world; upcoming trainings are announced on our web site. Second, speaking of the web site, procedure and training manuals are available free of charge. Third, there is now an on-line training through the IRETA web site: Behavioral Couples Therapy in Alcoholism and Drug Abuse Treatment that those interested can take free of charge or can, for a fee, complete for Continuing Education Units.

Q: In looking at the available manuals on your web site, there appear to be several different versions of LST/BCT, including a standard version, a brief version, versions that focus exclusively on alcohol abuse, a multiple couple group version, and so forth. Which do I choose?

A: As you can imagine, both patient and clinic characteristics tend to dictate the choice of LST/BCT. For example, many clinics prefer to provide their interventions in a group therapy context; in such instances, the group-based version is likely the most appropriate. For clients who have custodial children, the Parent Training version has certain advantages because it attempts to address the all-too-often parenting deficits we observe among these clients. Other clinics, due in large part to financial constraints, exclusively provide brief treatment; in such cases, the abbreviated BCT would be the couple-based intervention of choice.

Q: After reading the manuals, I was struck by their general "rigidity." More specifically, they outline in fairly great detail, a step-by-step approach to working with clients. However, clients come in with a variety of issues and problems that are likely to require a departure from these procedures. Is this acceptable?

A: In short, it is not only acceptable, but expected that therapists will deviate from the manuals as necessary. The manuals provide detailed procedures because they evolved from our carefully controlled clinical trials, where part of the goal is to monitor therapist adherence to the manualized procedures. However, in several programs where LST/BCT is offered, the manuals are used as a general guide as examples of how to operationalize certain general principles, such as (a) promoting sobriety from a marital and family perspective, (b) enhancing relationship quality via well-validated behavioral strategies, and (c) partner-involved relapse prevention and maintenance of treatment gains. Although we do advocate close adherence to the manuals when possible, we do recognize that, in certain circumstances, this may not be desirable or possible. LST/BCT should be viewed as flexible, meeting the needs of clients and their families as they are identified.

Q: Are there couples for whom LST/BCT is not appropriate?

A: Although the vast majority of couples in which a partner is seeking treatment for alcoholism or other drug abuse are appropriate candidates for LST/BCT, there are certain couples that are not good candidates. These include couples who (a) report engaging in severe intimate partner violence in the last year (e.g., which there was a significant injury, one partner is fearful of the other); (b) are separated and one or both partners is not interested in reconciliation; and (c) both abuse drugs or alcohol and are not motivated to cease their use. We are in the process of developing an intervention for couples in which both partners use drugs or alcohol (sometimes referred to as "double trouble" couples), but we are only in the initial stages of therapy development.

Q: In reviewing the research on LST/BCT, it appears that most of the work has been done with alcoholic and drug-abusing men and their female partners. Is LST/BCT a viable treatment option for female substance-abusing patients? How about gay and lesbian couples?

A: It is indeed correct that the vast majority of LST/BCT research has been conducted with male clients and their non substance-abusing partners. However, results from more recent trials support the efficacy of LST/BCT for female drug-abusers, female alcoholics, and gay couples.

 

 

 

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