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It is an area that has attracted little systematic study, despite the available evidence suggesting that it plays a measurable role in clinical outcomes.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> A literature search was undertaken using Medline, Ovid, Psychinfo and Science Direct from 1975 to 2004. The following key words were used: bipolar disorder, patient adherence, non\u2010adherence to medication, compliance, doctor\u2013patient relationship, doctor\u2013patient communication, treatment alliance, therapeutic alliance, chronic illness management, collaborative care, self\u2010management, health beliefs, self\u2010efficacy, self\u2010determination, autonomy support, motivational interviewing.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> Psychosocial interventions have demonstrated positive effects on adherence problems. Studies of the impact of the treatment alliance on outcomes in mental illness highlight the possibilities of fruitful research in this area in bipolar disorder. Different theoretical models of changing health related behaviour may inform approaches to the treatment alliance.<\/jats:p><jats:p><jats:bold>Conclusions:\u2002<\/jats:bold> Results suggest the usefulness of a collaborative approach to the treatment alliance. Attention needs to be given to developing intervention models that target modifiable risk factors for non\u2010adherence and address patient, clinician and illness related variables to enhance medication adherence in the treatment alliance. 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