Maternal Depression Mediates the Link Between Therapeutic Alliance and Improvements in Adolescent Externalizing Behavior

The current study: (1) examined the relation between therapeutic alliance and changes in adolescent externalizing behavior in Multisystemic Therapy; (2) tested whether maternal depression mediates this relation; and (3) determined whether mothers' and clinicians' perceptions of the alliance differentially predicted outcomes. Alliance was rated near the end of the first month of treatment. At pre-, mid- and posttreatment, maternal depression and adolescents' externalizing behavior were assessed via mother reports, and by clinicians at pre- and posttreatment only. Mediational analyses showed that therapist-rated alliance was related to improvements in maternal depression, which, in turn, was associated with reductions in adolescent externalizing behavior as rated by mothers. There was no association between mothers' and therapists' perceptions of the therapeutic alliance.