Clin Psychopharmacol Neurosci 2019; 17(2): 273-278  
Association between Therapeutic Alliance and Adherence in Outpatient Schizophrenia Patients
Jhin Goo Chang1,4, Daeyoung Roh2, Chan-Hyung Kim3,4
1Department of Psychiatry, Myongi Hospital, Hanyang University College of Medicine, Goyang, 2Department of Psychiatry, Hallym University College of Medicine, Chuncheon, 3Institute of Behavioral Science in Medicine and 4Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: Chan-Hyung Kim, MD, PhD
Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722,
Tel: +82-2-2228-1620, Fax: +82-2-313-0891, E-mail:
Received: June 15, 2018; Revised: October 29, 2018; Accepted: November 15, 2018; Published online: May 31, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective: Although various clinical factors that affect medication adherence in schizophrenia have been studied, the role of the therapeutic alliance has not been studied in detail. Accordingly, we investigated the association between medication adherence and therapeutic alliance in patients with schizophrenia treated in a community outpatient clinic in Korea.
Methods: In this cross-sectional study, 81 outpatients who met the DSM-IV-TR criteria for schizophrenia were analyzed. Therapeutic alliance was measured via patient-self-report questionnaires consisting of 12 questions, which evaluate both “affective bond” and “collaborative bond” of alliance. We investigated the relationship between medication adherence and therapeutic alliance through correlation and regression analyses.
Results: Overall therapeutic alliance was weakly associated with medication adherence (r=0.268, p<0.05). Among two factors of therapeutic alliance, “affective bond” was associated with adherence (r=0.302, p<0.05), but collaborative was not. Regression analysis showed that therapeutic alliance significantly predicted medication adherence even after adjustment for duration of treatment, insight, and symptom severity.
Conclusion: Maintaining a favorable therapeutic alliance is associated with medication adherence in schizophrenia. Further, treating patients in a frank and genuine manner might be important to improve adherence.
Keywords: Schizophrenia; Physician-patient relations; Medication adherence.

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