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.

The current study evaluated cognitive-behavioral therapy (CBT) for adolescent depression delivered in health clinics and counseling centers in four high schools. Outcomes were benchmarked to results from prior efficacy trials. Fifty adolescents diagnosed with depressive disorders were treated by eight doctoral-level psychologists who followed a manual-guided, 12-session, individual CBT protocol. Referred adolescents presented with high rates of comorbidity, traumatic experiences, and prior suicide attempts. Posttreatment response to school-based CBT (64%) was comparable to results obtained in efficacy trials. On average, symptom reduction in this school-based study was similar to prior efficacy trials, exceeded results from an efficacy trial using the original manual, and exceeded results from a prior school-based CBT trial. Examination of predictors of symptom change and treatment response showed that life stress, trauma history, and depressive symptom severity were negatively associated with outcomes. Results suggest that school-based CBT is a relatively robust treatment for adolescent depression across gender, age, and ethnic groups as well as for adolescents with varied patterns of comorbidity.