Adherence, Self-Efficacy and the Person of the Therapist
Adherence, Self-Efficacy and the Person of the Therapist
Quite the snappy title, huh? ;-}
Organisational Psychotherapy is still in its infancy but we can accelerate its development by borrowing from decades of science and research into individuals’ therapy and related fields.
Some concepts in the “borrow” bag today are: Adherence, Concordance, Self-efficacy and the person of the therapist.
Adherence
In medicine – including therapy – patient compliance (also called adherence or capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to medical device use, self care, self-directed exercises, or therapy sessions.
Patient adherence, or rather its flip-side, non-adherence, costs the US alone around $300 Billion per annum.
In treatment of individuals, an estimated half of those for whom treatment regimens are prescribed do not follow them as directed.
In Organisational Psychotherapy I propose we use the term adherence only slightly differently:
Client adherence describes the degree to which a client organisation follows (implements) its own resolutions.
The term encapsulates the behaviours we see in almost ever organisation – where the organisation, having made some kind of resolution about behaving differently, rows-back on that resolution.
Barriers to Adherence
The World Health Organization (WHO) groups barriers to medication adherence into five categories:
- Health care team and system-related factors
- Social and economic factors
- Condition-related factors
- Therapy-related factors
- Patient-related factors
Common barriers include:
| Barrier | Category |
| Poor Patient-provider Relationship | Health Care Team and System |
| Inadequate Access to Health Services | Health Care Team and System |
| High Medication Cost | Social and Economic |
| Cultural Beliefs | Social and Economic |
| Level of Symptom Severity | Condition |
| Availability of Effective Treatments | Condition |
| Immediacy of Beneficial Effects | Therapy |
| Side Effects | Therapy |
| Stigma Surrounding Disease | Patient |
| Inadequate Knowledge of Treatment | Patient |
Barriers to Organisational Psychotherapy Adherence
As far as Organisational Psychotherapy goes, we might similarly categorise and group barriers to adherence.
Concordance
The related term concordance has been used to refer to situations where the patient is involved in the treatment process, often to help improve adherence. In this context, the patient is informed about their condition and treatment options, involved in the decision as to which course of action to take, and takes partial responsibility for monitoring and reporting their condition, adherence, etc., back to the team.
Concordance has been used to refer specifically to patient adherence to a treatment regimen which the physician sets up collaboratively with the patient, to differentiate from adherence to a physician-only prescribed treatment regimen
Self-efficacy
Self-efficacy refers to an individual’s belief in their capacity to execute behaviours necessary to produce specific performance attainments. In other words, their belief in their ability to “do the necessary”.
In the Organisational Psychotherapy context, by determining the beliefs a client organisation holds regarding their power to affect their situation, self-efficacy strongly influences both the power an organisation actually has to face challenges competently, and the choices the organisation is most likely to make.
A strong sense of self-efficacy promotes accomplishment and the well-being of the organisation. An organisation with high self-efficacy views challenges as things to be mastered rather than threats to avoid. These organisations are able to recover from failure faster and are more likely to attribute failure to a lack of motivation. They approach threatening situations with the belief that they can overcome them. These views have been linked to lower levels of stress and a lower vulnerability to depression.
In contrast, organisations with a low sense of self-efficacy view difficulties as threats and shy away from them. Difficulties lead such organisations to look at the skills they lack rather than the ones they have. It is easier for them to lose faith in their own abilities after a failure. Low self-efficacy can be linked to higher levels of stress and depression.
The Person of the Therapist
Much research has shown that the person of the therapist is the single most influential factor in the success of therapy for individuals. I hold the same is likely true in the context of organisational psychotherapy.
– Bob
Further Reading
Smith, E.W.L. (2003). The Person of the Therapist. Mcfarland & Co.
Think Different
I’m interested in the concept of ‘Adherence’ here.
How does this work in practice when the senior officers of an organisation make a policy decision (and announce it widely, and get kudos for it), but the grass roots managers roll back on that policy because it’s organisationally inconvenient for them, and their middle managers collude with that roll-back?
Your postulated scenario sounds akin to non-adherence in e.g. schizophrenic individuals?
When treating organizations as if they were individuals, I think that we would be quite safe in assuming schizophrenia. And only considering its possible absence should we observe considerable compelling evidence.
Schizophrenic organisations are almost without doubt a Thing.
In the case I have in mind, a friend of mine had considerable caring responsibilities for her elderly mother, who had dementia. Her employer, a red-brick university, had what was considered a highly enlightened set of “family-friendly” personnel policies. Yet when it came to actually applying those policies in the real world, there always seemed to be some impediment against making them work in the way they were supposed to; and it was always local managers who said “No, we can’t let you do that” and always their middle managers who backed them up, even to the point of commencing efficiency measures against my friend when she was forced to put her mother first in emergencies.
I think that in the current case of the Metropolitan Police, we are almost certainly seeing another schizophrenic organization.
I have regularly seen folks block the purpose of their organisation based on their own assumptions, beliefs and mores. For example, one client had a admin person who, despite repeated requests from myself and their CEO both, failed to acquire needed equipment in the name of “saving money”.