First-session pathways to the working alliance in cognitive-behavioral therapy for adolescent depression

In the current study of cognitive-behavioral therapy for 54 depressed adolescents, chained p-technique was applied to 14 therapist behaviors that were rated in each 10-min segment of Session 1 provided by eight female therapists. Four underlying factors were identified: experiential socialization, therapist responsiveness, therapist lapse, and remoralization. Analysis of changes in the prominence of these factors revealed significant Factor X Session Segment trends. Therapist responsiveness and remoralization growth curves across Session 1 accounted for significant variance in Session 3 therapist-rated alliance. Experiential socialization growth curves across Session 1 also accounted for significant variance in Session 3 adolescent-rated alliance. Results are discussed in terms of the importance of Session 1 therapist behaviors for adolescent alliance formation.