Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.

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Dealing with the psychological issues involved in perinatal loss exposes the medical, nursing, and midwifery staff not only to parents' distress but also their own feelings of impotence and frustration. This often leads to inadequate management of the situation, which may have long–term deleterious effects on parents and affect staff personally and professionally. Thus, mental health professionals should not only address their interventions to parents, but to staff as well, potentiating the latter's role as mental health providers. The skills needed for this kind of task involve creativity and flexibility, as well as the capacity to adapt traditional training to the active participation needed in dealing with perinatal loss. The present paper is based upon the author's 15 years' experience in consultatiodliaison in this field and describes the work carried out based on case discussion, group work, and, specially, video–recorded interviews with parents and staff accompanied by written material providing guidelines for management.

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