Background:Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.Aims:Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.Method:Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.Results:We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.Conclusions:Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.

中文翻译：

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克服在为双相情感障碍提供综合动机访谈和认知行为治疗方面的挑战并伴有酒精使用：治疗师的观点

背景：酒精滥用在双相情感障碍中很常见，并且与更糟糕的结果相关。最近的一项研究评估了双相情感障碍和酒精滥用的综合动机访谈和认知行为疗法，在提供治疗的可行性和参与者的可接受性方面取得了可喜的结果。目的：在这里，我们介绍了治疗师和主管在试验中的经验确定与该客户群体合作的关键挑战以及如何克服这些挑战。方法：四名治疗师和两名主管参加了一个焦点小组。每个治疗师在治疗结束时为每个客户完成的挑战和障碍的总结为该小组的主题指南提供了信息。相对其他问题；双相情感障碍对治疗的影响；避免和克服它的重要性；与羞耻和正常使用有关的良好平衡；和“说话”相对'walking the walk'。结论：调查结果表明，即使客户还没有准备好改变饮酒方式，他们也可能愿意探索饮酒的动机，并且他们可能需要帮助解决一系列心理健康问题。情绪和行为上的回避可能是该客户群体维持酒精使用的关键因素，治疗师应该意识到客户减少滥用的意图与其实际行为之间可能存在的差异。