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Cognitive Therapy and Research, Vol. 14, No. 5, 1990, pp. 469-482 Determinants of Change in Cognitive Therapy for Depression 1 Robert J. DeRubeis 2 and Michael Feeley University of Pennsylvania We explored the processes of change in cognitive therapy of depression in a sample of 25 adult outpatients. Raters blind to treatment outcome listened to audiotapes of sessions and rated items that pertained to (a) the therapist-offered facilitative conditions (warmth, empathy, etc.); (b) the patient-therapist rela- tionship (the helping alliance); and (c) the therapist's adherence to the methods of cognitive therapy. Adherence separated into two factors in a factor analysis. One factor, representing "concrete," symptom-focused methods of cognitive therapy, predicted subsequent symptom reduction when assessed early in treat- ment, but not later. The other factor, representing less focused, more "abstract" discussions, did not predict improvement. Neither did facilitative conditions nor the helping alliance predict change that occurred after the rated session. How- ever, later in treatment, the helping alliance was predicted by prior symptom reduction. Methods used to discern the temporal relations of in-session behavior to outcome are highlighted. KEY WORDS: cognitive therapy; depression; therapy process; adherence; helping alliance. A number of studies have shown that cognitive therapy is an effective treatment for depression (see Dobson, 1989, for a review). On the assumption 1We wish to thank Aaron T. Beck and the therapists, staff, and patients at the Center for Cognitive Therapy, without whose cooperation this project would not have been possible. Portions of this paper were presented at the 21st Annual AABT Convention, Boston, November 1987, and at the 19th annual meeting of the Society for Psychotherapy Research, Santa Fe, New Mexico, June 1988. This research was supported in part by a grant from the Biomedical Research Foundation of the University of Pennsylvania, and by the Foundation for Cognitive Therapy and Research. 2Address all correspondence to Robert J. DeRubeis at the Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania 19104. 469 0147-5916190]1000-046956.00[0 © 1990 Plenum Publishing Corporation