Strategies to develop a therapeutic alliance for medication adherence

A therapeutic alliance denotes a cooperative and trusting bond established between a patient and their healthcare provider, built upon respect, empathy, and shared objectives for treatment¹.
Therapeutic alliance alters the patient attitude towards medication and promote mediation adherence².

How to establish therapeutic alliance?

The concept of therapeutic alliance can be understood through three main components: goals, bond, and tasks¹:

Goals: The therapeutic alliance involves establishing shared treatment goals between the therapist and the patients. Both parties work together to identify and define the objectives of therapy. The therapist helps the patient explore their needs, desires, and aspirations, and then they collaboratively develop a plan to address the patient’s concerns and work towards achieving these goals. Having clear and agreed-upon goals provides direction and focus for the therapy process¹.
Bond: The bond component refers to the network of positive personal attachment between patient and therapist. This will resolve the issues such as mutual trust, confidence and acceptance³.
Tasks: The task refers to the patient and therapist counseling behavior that create the basis of counseling process. Patient and therapist should perceive these tasks as relevant and efficacious, and each one of them must accept the responsibility to perform these tasks³.

Therapeutic alliance consists of three important elements: agreement of the goals of the treatment, agreement on the tasks, and the personal bond development between patient and therapist. When patient and therapist share beliefs to achieve the goals of the treatment, optimal therapeutic alliance can be achieved¹.

Role of therapeutic alliance in medication adherence

The therapeutic alliance plays a crucial role in medication adherence, which refers to a patient’s ability and willingness to follow their prescribed medication regimen as directed by their healthcare provider. It involves a collaborative relationship between the patient and their healthcare professional, characterized by trust, empathy, communication, and shared treatment goals. The following points highlight the significant role of therapeutic alliance in medication adherence:

Trust and communication: Therapeutic alliance can predict rehospitalization rate, cognitive therapy, medication adherence and patient recovery rate. The key components for therapeutic alliance are trust, promise, good communication, and interaction between patients and therapist².
Empowering patients: Therapeutic alliance encourages patient empowerment. By involving patients in their treatment decision-making process, healthcare providers acknowledge their autonomy and individuality. When patients feel like active participants in their care, they are more likely to take ownership of their health and adhere to their medication regimens⁴.
Addressing barriers to medication adherence: A strong therapeutic alliance allows healthcare professionals to identify and address potential barriers to medication adherence. Patients may experience challenges such as forgetfulness, side effects, or financial constraints. By having open conversations, healthcare providers can develop personalized strategies to overcome these barriers and improve adherence⁵.
Improved outcomes: An interaction during a sessions between patient and therapist lead to increase therapy outcomes, and patient often feel well understood and close to therapist⁶.

Building and maintaining a strong therapeutic alliance should be a priority for healthcare providers to support patients in achieving successful medication adherence.

How to build a strong therapeutic relationship?

Developing a strong therapeutic alliance is essential for effective and successful therapeutic outcomes. The therapeutic alliance denotes a cooperative and confident connection established between a therapist and their patient. It lays the foundation for open communication, shared goals, and a safe space for personal growth. Here are some key strategies to foster a strong therapeutic alliance¹:

Empathy and active listening: The therapist must display authentic empathy and adept active listening abilities. By understanding the patient’s emotions and perspectives without judgement, the therapist can create a supportive and validating environment².
Establishing rapport: Developing a positive rapport is essential for patients to feel comfortable and connected. This can be accomplished through mutual respect, warmth, and discovering shared interests⁵.
Family member’s engagement: Family members (parents and youths) involvement in the building shared alliance suggest the importance of developing therapeutic alliance with therapists. This relationship build a strong therapeutic alliance between patients and therapist⁵.
Collaborative goal setting: Involving patients in the goal setting process empowers them and enhances their commitment to therapy. Patients are more likely to engage actively when they have a voice in their therapeutic journey¹.
Education: Education is an essential component of therapeutic alliance. Healthcare professionals should take the time to explain the rationale behind prescribed medications, potential side effects, and the expected benefits of treatment. When patients have a comprehensive understanding of their medications, they are more likely to adhere to the regimen⁷.
Cultivate trust and safety: Confidentiality and a non-judgmental atmosphere are pivotal for patients to feel secure in sharing their deepest concerns. Trust is earned over time through consistent support and genuine care^1,3.
Shared decision making: Involving patients into the decision-making process empowers them to take ownership of their health. Patients feel a sense of responsibility towards adherence when healthcare providers acknowledge their preferences⁴.
Transparency and boundaries: Therapists should openly communicate about their therapeutic approach and limitations. Establishing clear boundaries ensures a professional relationship is maintained⁸.
Addressing resistance: It is obvious for patients to experience resistance during therapy. Skillfully addressing these challenges with patience and understanding can deepen the therapeutic alliance⁵.
Empowerment and strength-building: Focusing on patients’ strengths and empowering them to take charge of their growth instills a sense of agency and self-efficacy⁹.

A strong therapeutic alliance is built on empathy, trust, collaboration, and mutual respect. By employing these strategies, therapists can create a supportive and conducive environment that facilitates patients’ healing and personal development.

Evidence of therapeutic alliance’s impact on medication adherence

Several studies have provided evidence for a positive link between therapeutic alliance and medication adherence. For example:

A systematic review by Desta et al. (2022) found that interventions centered around the therapeutic alliance have proven to be effective in enhancing medication adherence in black patients with diabetes and hypertension¹⁰.
A research paper by Chang et al. (2019)reported that presence of a favorable therapeutic alliance is linked with medication adherence in schizophrenia. To improve adherence further, patients are required to treat in an open and authentic manner¹¹.
In a meta-analysis study by Zolnierek et al. (2009) stated that effective communication in medical care is strongly correlated with improved patient adherence⁷.

Conclusion

Developing a strong therapeutic alliance is vital for healthcare professionals looking to improve medication adherence in their patients. By enhancing communication, trust, and patient empowerment, therapeutic alliance creates a collaborative and supportive environment that fosters adherence to treatment plans. Implementing strategies such as active listening, empathy, shared decision-making, and individualized treatment plans can lead to stronger therapeutic alliances and, ultimately, better health outcomes for patients.

By recognizing the significance of therapeutic alliance and investing time and effort into building and nurturing this relationship, healthcare professionals can make a positive impact on their patients’ lives, helping them effectively manage their conditions and improve their overall quality of life.

“Success as a therapist is not found in doing something for the client, but rather in being someone for the client”
– Ili Rivera Walter