Objectives: The therapeutic alliance is the arena in which psychopharmacological and other therapeutic interventions occur. The nature and quality of the therapeutic alliance may influence treatment adherence and the realisation of the benefits of effective pharmacological treatment in clinical practice. This is an area that has not been systematically investigated, despite the available evidence suggesting that it plays a measurable role in clinical outcomes.
Methods: A literature search was conducted using Medline, Ovid, Psychinfo and Science Direct between 1975 and 2004. The following keywords were used: bipolar disorder, patient compliance, non-compliance, compliance, doctor-patient relationship, doctor-patient communication, therapeutic alliance, chronic disease management, collaborative care, self-management, health beliefs, self-efficacy, self-determination, autonomy support, motivational interviewing.
Results: Psychosocial interventions have shown positive effects on adherence problems. Research on the impact of the therapeutic alliance on outcomes in mental illness indicates the potential for fruitful research in this area in bipolar disorder. Different theoretical models of changing health-related behaviours may influence approaches to the therapeutic alliance.
Conclusions: The results suggest the utility of a collaborative treatment alliance approach. Attention should be given to the development of intervention models that target modifiable risk factors for non-adherence and incorporate patient-, clinician- and disease-related variables to increase adherence to treatment recommendations in the treatment alliance. Refinement of these models through controlled real-world evaluation can lead to integration into healthcare delivery systems.