Magazine article Clinical Psychiatry News

Tackle Noncompliance with Persistent, Critical Eye

Magazine article Clinical Psychiatry News

Tackle Noncompliance with Persistent, Critical Eye

Article excerpt

NEW ORLEANS -- When patients fail to take their medications properly, a number of psychodynamic concepts could be at play, Dr. Elizabeth S. Robinson said at the annual meeting of the American Academy of Psychoanalysis.

For example, issues of transference and countertransference can have a dramatic impact on a patient's willingness or ability to comply with prescribed treatment, or a medication could be serving as a transitional object for the patient, said Dr. Robinson of Harvard University in Boston.

In deciphering the problem of noncompliance with an individual patient, one should first recognize that taking medication can have any number of meanings. Societal rules governing ingestion in general and religious symbolism involving ingestion and reminding a patient of suffering and oppression can affect compliance.

The problem is complex-and extensive; noncompliance among patients with chronic illness is about 50%. Approximately one-third of patients never fill their prescriptions, and as many as 60% don't take them properly once they are filled, results of studies show.

In evaluating the problem from a psychodynamic perspective, consider issues of alliance and resistance, Dr. Robinson said.

Therapists are aware of the impact that alliance has on other aspects of care, but the effect on compliance may be overlooked. When a problem with compliance is identified, alliance building, though time consuming, is a good way to address it. It is important to find a way to agree that there is a problem, and to work together to solve the problem.

Resistance, or the conscious and unconscious psychological forces that work against a patient's desire to get better, can be a significant factor in noncompliance. Signs that resistance may be a problem include missing appointments, misunderstanding instructions, failing to fill prescriptions, and altering the treatment regimen, she noted. …

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