In our review, we noted that high rates of medication adherence were common in efficacy studies and, hence, that "this requirement may make it difficult to detect an increase in adherence" (p. 1661). Mr. Hogarty reinforces this point in his efforts to maximize medication adherence across groups to assess the effects of personal therapy and thus questions whether this therapy would additionally improve medication adherence. While ceiling effects limit opportunities to achieve group differences, we would like to inquire whether the interventions studied yield additional benefits for adherence. Efficacy studies are important, but a large gap remains between efficacy studies under controlled conditions and effectiveness studies in practice, where multifaceted intervention strategies must be evaluated against usual care. The literature also makes an increasingly compelling case that in achieving specifically desired outcomes, such as medication adherence or employment, targeted efforts are more effective than more diffuse ones (1). Psychoeducational efforts might usefully incorporate specific interventions directed at medication adherence. This was, in fact, what Mr. Hogarty and his colleagues did across conditions to optimize adherence (Hogarty et al., 1997).