Alliance not compliance: a philosophy of outpatient care

Over the last decade, our clinical research team has evolved effective methods for forming a strong treatment alliance with mood disorder patients. These methods, in turn, have been associated with very low rates of patient dropout (< 10%) and high rates of objectively measured medication compliance (> 85%) over multiyear treatment trials. We have every reason to believe that our technique for alliance building would be equally effective in general clinical practice. The cornerstones of our methods are education of, information for, and active participation by the patient in the treatment process. We begin by educating the patient about his or her disorder and its treatment, giving patients as much information as their clinical condition will allow them to absorb. As patients begin to improve, we provide additional information. We continuously inform patients about what to expect in treatment and when, both with respect to amelioration of symptoms and with respect to the medication side effects they may experience. We present the treatment experience as an experiment in which clinician and patient are coinvestigators, each with his or her own expertise. The clinician is the expert on the disorder and its treatment in general; the patient is the expert on his or her own disorder and his or her own experience of the treatment. We try to keep the experiment interesting and, whenever possible, to inject some humor into it. We work to engage family members as adjunct members of the experimental team by educating them as well and keeping them informed throughout the treatment process.(ABSTRACT TRUNCATED AT 250 WORDS)