The purpose of this study is to identify and evaluate therapist behaviors that affect how well and how long adolescent patients stay in treatment for depression.

Early patient drop out, sporadic attendance, and minimal participation have hindered the development and administration of effective treatments for adolescent depression. Adolescents who do not receive adequate exposure to active treatment are unlikely to benefit from experimentally supported treatments. Certain therapist behaviors may influence the attendance, drop-out, and overall participation of adolescents with depression. This study will evaluate the effect of engagement interventions and alliance on attendance, participation, completion, and outcome in depressed adolescents.

Participants in this study will have 12 weekly sessions of cognitive behavioral therapy (CBT) at a school-based health clinic. Audio recordings from the completed CBT sessions will be replayed and evaluated to identify therapist engagement interventions, therapy alliance, and treatment participation.

Inclusion Criteria:

• Major depression or dysthymic disorder
• Referred by school

Exclusion Criteria:

• Comorbid psychosis, bipolar disorder, or mental retardation