The therapeutic alliance, awareness, and medication compliance in the treatment of schizophrenia

Abstract

Schizophrenia is one of the most debilitating and costly of the major illnesses in the UJ?ited States. Individuals diagnosed with schizophrenia are at-risk for impaired awareness, poor therapeutic alliance, and, failure to comply with medication regimens. Although awareness has been related to medication compliance, and the therapeutic alliance has been suggested as an explanation of medication compliance when individuals are not aware of their illness· symptoms, treatment response or social consequences of · their mental illness, findings of previous studies have been unclear concerning the influence of the therapeutic alliance on the relation between awareness and medication compliance. This cross-sectional correlational study was designed to test a hypothesized model in which the therapeutic alliance inflμences the relation between awareness and medication compliance in the treatment of a sample of individuals diagnosed with schizophrenia. The.settings for the study were two day treatment programs. Adults diagnosed with o!le of the types of schizophrenia and their primary therapists were invited to participate. Seventy-six patients and 12 primary therapists were offered the opportunity to participate, with 70 patients and 10 therapists who completed the·study. It was hypothesized that the therapeutic alliance would influence the relation . between awareness and medication compliance. Data were analyzed using hierarchical multiple regression anaiyses. The hypothesis was partially supported. The therapeutic alliance and awareness had significant main effects on medication compliance, but their interaction was not significant. In this sample, both the therapeutic alliance and awareness hc;!d additive effects on medication compliance, but their interaction did not significantly add to the prediction of medication compliance. The study suggests that primary therapists should spend time on both developing the therapeutic alliance and on improving patients' awareness of illness symptoms, treatment response, and social consequences of their mental illness in order to have the greatest effect on medication compliance for individuals diagnosed with schizophrenia.