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:

  1. 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.
  2. 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.
  3. 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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 care1,3.
  7. 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.
  8. Transparency and boundaries: Therapists should openly communicate about their therapeutic approach and limitations. Establishing clear boundaries ensures a professional relationship is maintained8.
  9. 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.
  10. 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:

  1. 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.
  2. 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.
  3. In a meta-analysis study by Zolnierek et al. (2009) stated that effective communication in medical care is strongly correlated with improved patient adherence7.


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


1. Ardito RB, Rabellino D. Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Front Psychol. 2011;2:270. doi:10.3389/fpsyg.2011.00270

2. Hsieh WL, Yeh ST, Liu WI, Li IH, Lee SK, Chien WT. Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model. Patient Prefer Adherence. 2022;16:1017-1026. doi:10.2147/PPA.S351848

3. Horvath AO, Luborsky L. The role of the therapeutic alliance in psychotherapy. J Consult Clin Psychol. Aug 1993;61(4):561-73. doi:10.1037//0022-006x.61.4.561

4. Tessier A, Boyer L, Husky M, Bayle F, Llorca PM, Misdrahi D. Medication adherence in schizophrenia: The role of insight, therapeutic alliance and perceived trauma associated with psychiatric care. Psychiatry Res. Nov 2017;257:315-321. doi:10.1016/j.psychres.2017.07.063

5. Thompson SJ, Bender K, Lantry J, Flynn PM. Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families. Contemp Fam Ther. Jun 2007;29(1-2):39-55. doi:10.1007/s10591-007-9030-6

6. Weiss M, Kivity Y, Huppert JD. How does the therapeutic alliance develop throughout cognitive behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization. Psychother Res. 2014;24(3):407-18. doi:10.1080/10503307.2013.868947

7. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. Aug 2009;47(8):826-34. doi:10.1097/MLR.0b013e31819a5acc

8. Connolly P. Instability and Uncertainty Are Critical for Psychotherapy: How the Therapeutic Alliance Opens Us Up. Front Psychol. 2021;12:784295. doi:10.3389/fpsyg.2021.784295

9. Street RL, Jr., Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. Mar 2009;74(3):295-301. doi:10.1016/j.pec.2008.11.015

10. Desta R, Blumrosen C, Laferriere HE, et al. Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review. Patient Prefer Adherence. 2022;16:3095-3110. doi:10.2147/PPA.S371162

11. Chang JG, Roh D, Kim CH. Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients. Clin Psychopharmacol Neurosci. May 31 2019;17(2):273-278. doi:10.9758/cpn.2019.17.2.273