Maladherence is the most important factor in the prevention of neurotoxic and demoralizing relapses in schizophrenia. Empirical evidence is presented and organized in a conceptual four-level framework to address maladherence more effectively and to prevent the demoralizing role classical insight plays in its neglect of the underlying motivational processes in routine care. The four-level framework to address maladherence encompasses (a) functional analysis of (mal-) adherence as an instrumental goal-oriented behaviour, (b) addressing dysfunctional attitudes in relation to disorder and treatment, (c) techniques to strengthen the therapeutic bond and, finally, (d) focusing on the obstacles undermining an ability to adhere.