title: Alliance and outcome in cognitive-behavioral therapy for adolescent depression.
abstract: This study examined predictive relations between therapeutic alliance and treatment outcomes in manual-guided, cognitive-behavioral therapy for adolescent depression. Fifty-four adolescents met criteria for a depressive disorder and were treated in school-based clinics. Alliance was measured after the third session from both therapist and adolescent perspectives, and change in depressive symptoms was assessed by structured interview and self-report. Two models of alliance-outcome relations were assessed, one direct and one through treatment participation. Results showed significant associations between adolescent-reported alliance and change in depressive symptoms, even after controlling for number of sessions completed. Therapist-reported alliance was only marginally related to outcomes but was predictive of number of sessions completed. On average, alliance showed a modest relation with outcomes (r = .26). Results are discussed in the context of differential alliance-outcome relations in prior studies of cognitive-behavioral compared to nonbehavioral therapy with children and adolescents.
authors.affiliation: Department of Psychology, University of Denver, Denver, CO 80210, USA. sshirk@du.edu
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Shirk
authors.forename: Gretchen
authors.initials: G
authors.lastname: Gudmundsen
authors.forename: Heather Crisp
authors.initials: HC
authors.lastname: Kaplinski
authors.forename: Dana L
authors.initials: DL
authors.lastname: McMakin
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010555:Personality Inventory; D011369:Professional-Patient Relations