Predicting Alliance for Depressed and Suicidal Adolescents: The Role of Perceived Attachment to Mothers

Abstract

ABSTRACTAlthough therapeutic alliance is a robust predictor of treatment outcomes in child and adolescent psychotherapy, less is known about relational factors, such as youth’s attachment, to mothers and fathers. The current study investigated anxious or avoidant attachment to mothers or fathers as predictors of early formation of the therapeutic alliance in a high-risk sample of depressed and suicidal adolescents. Changes in adolescents’ alliance ratings between the 1st and 4th treatment sessions were examined in a comparative efficacy trial (N = 115) of attachment-based family therapy and family-enhanced nondirective supportive therapy for suicidal and depressed adolescents. Multilevel regression analysis accounted for nested data by therapist and treatment condition. After accounting for significant random effects in our multilevel model associated with therapist to treatment condition, results revealed a significant effect of perceived insecurity to mothers leading to lower levels of therapeutic alliance at Session 4 (β = −0.49, p < .05). The quality of adolescents’ attachments to parents may play an important role in adolescents’ ability to form strong working relationships with a therapist. Findings suggested that adolescents with avoidant attachment styles may be more difficult to engage in treatment and could benefit from specific interventions focused on alliance-building.