A clarification on the use of the term “compliance”

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A clarification on the use of the term

“compliance”

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MINERVA PSICHIATRICA · JUNE 2014

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Alberto Stefana

University of Verona

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SEE PROFILE Available from: Alberto Stefana Retrieved on: 16 February 2016

Vol. 55 - No. 2 MINERVA PSICHIATRICA 105 ce, or the working alliance between physician and patient, representing the other side, the clinical side, of compliance.

The therapeutic alliance is an operational con-cept that embodies a process, an evolution — a bond built over time that goes through the normal break-ups and repairs that occur within the diagno-stic/therapeutic course of treatment, and on which the clinician works together with the patient. This partnership is thus the result of a process of con-tinuous negotiation between the therapist and the patient, in which the subconscious dynamics of the pair have great importance.

The quality of the doctor-patient relationship de-pends largely on the quality of their communica-tion. It is the clinician’s job to facilitate the progress of communication. Out of this interaction there may arise a whole set of individual, family, and environ-mental variables that can affect and influence the therapeutic alliance – goals and aims, expectations, perplexities, setbacks, and anxieties over the thera-peutic project, as well as a possible mistrust of and/ or impatience with the doctor. All this can lead to theories and ideas on the illness, reasons behind the cure, and newly-acquired perceptions of the family and social support. Throughout this, the doctor ke-eps the patient abreast of the technical aspects of the therapy, providing information on the nature of the illness or disorder afflicting him/her, explaining the usefulness and necessity of therapy, reassuring him/her that all difficulties will be considered and discussed together. Compliance therefore comes from a good therapeutic alliance, from the quali-ty of the therapeutic relationship that the doctor is able to establish with the patient, and is the result of a multi-dimensional process, in which the focus cannot only be on “which” therapy to prescribe, but must also be on “how” to prescribe it.

A. STEFANA

Libero professionista, Brescia, Italia alberto.stefana@email.it

MINERVA PSICHIATR 2014;55:105

T

O THE EDITOR: There exists today a rather common usage, in terms of some internatio-nal scientific literature on psychology or clinical psychiatry, of the concept of “compliance”. To my mind, this usage is not only incorrect but also non-beneficial to practitioners in both the research and clinical fields. I thus feel it necessary to clarify the matter.

The term compliance has its roots in pharmaco-logical research: originally it referred to a patient’s observance of pharmacological prescriptions – his/ her willingness to take the medications prescribed by the treating doctor, and also to accept the ge-neral conditions of dosage, procedure, and times of intake, regardless of the possible onset of side effects. Subsequently the meaning of the term was extended to include a patient’s observance of non-pharmacological aspects of treatment, those that concern diet, life-style, periodical check-ups etc. (In current medical literature the term “adherence” is often used as a synonym of compliance).

In time, the term compliance was adopted in are-as related to cognitive behavioural therapy (CBT). Why did cognitive-behavioural psychologists begin to use this term? The answer lies within the ab-sence of suitable vocabulary for describing a pa-tient’s adherence to prescribed psychotherapeutic recommendations. CBT psychologists could have chosen more appropriate linguistic expressions, but perhaps out of the fear of losing their own theoreti-cal and clinitheoreti-cal identity, they preferred not to resort to the classical terminology of dynamic psychology. The concept of compliance hence acquired a clini-cal significance (from Greek klinē; implying a per-sonalized and unique relationship between patient and doctor).

As is well-known, compliance, or non-adherence, is among those factors that can most compromise the clinical effectiveness of therapies. The difficulty is that the available research on com-pliance has limited usefulness for clinical practice (that is not what is required of it) Undoubtedly of greater value is the work on the therapeutic

allian-Anno: 2014 Mese: June Volume: 55 No: 2

Rivista: MINERVA PSICHIATRICA Cod Rivista: MINERVA PSICHIATR

Lavoro: 1850-MPSI titolo breve:

primo autore: CORRESPONDENCE pagine: 105

CORRESPONDENCE

A clarification on the use

of the term “compliance”

MINERVA PSICHIATR 2014;55:105

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