Compliance can represent a poor outcome and, as a concept places medication at the center of therapeutic action. Compliance implies submission to the authority of the prescriber and invites or reenforces an adversarial approach to the doctor-patient relationship. It is that relationship which is properly viewed as central to all therapies. The multiple meanings that medications have for everyone in our society, whether we are in the role of patient, doctor, or simply a member of the community, effects treatment adherence and outcomes. The promotion of a collaborative therapeutic relationship requires sensitivity to these meanings and roles as well as to cultural contexts in which the therapeutic relationship is embedded. Examples of some of the factors in patients, psychiatrists, and the rest of the world that militate for and against effective treatment are given.