Conversational pursuit of medication compliance in a Therapeutic Community for persons diagnosed with mental disorders*

PURPOSE In this article, we contribute to the debate on medication compliance by exploring the conversational "technologies" entailed in the process of promoting clients' adherence to psychopharmacological prescriptions. Using a case study approach, we explore how medication-related problems are dealt with in conversational interaction between the staff members and the clients of a mental health Therapeutic Community (TC) in Italy. METHOD Four meetings between two staff members (Barbara and Massimo) and the clients of the TC were audio-recorded. The data were transcribed and analyzed using the method of Conversation Analysis. RESULTS Barbara and Massimo recur to practices of topic articulation to promote talk that references the clients' failure to take the medications. Through these practices they deal with the practical problem of mobilizing the clients' cooperation in courses of action that fit into the institutional agenda of fostering medication adherence. CONCLUSIONS Barbara and Massimo's conversational practices appear to reflect the assumption that medication-related problems can be reduced to compliance problems. This assumption works to make the clients accountable for their failure to take the medications while shaping a conversational environment that is unreceptive to their complaints about side effects. Implications for the understanding of mental health rehabilitation practice in TCs are discussed. Implications of Rehabilitation Therapeutic community staff members should be aware of the challenges and blocks in communicating with their clients. Therapeutic communities can promote staff members' awareness of communication challenges through reflective workshops in which they can jointly view and comment on interaction with their clients. Reflective workshops can be used to raise awareness of the presuppositions underlying therapeutic community staff members' communication practices.