Date of Award


Document Type


Degree Name


Organizational Unit

Morgridge College of Education

First Advisor

Maria Riva, Ph.D.

Second Advisor

Stephen Shirk

Third Advisor

Karen Riley

Fourth Advisor

Jeff Jenson


Adolescence, Cognitive-behavioral therapy, Depression, Interpersonal trauma, Therapeutic alliance


Childhood trauma is a risk factor for a wide range of psychopathology and other damaging outcomes later in life (Cohen, Mannarino, Murray, & Igleman, 2006; Saunders, 2003). Among the many treatment models developed for maltreated youth and their families, both specific and non-specific therapeutic factors such as developing a trauma narrative (e.g., trauma self-disclosure) and forming a strong therapeutic alliance have been identified as ―active ingredients‖ that contribute to positive treatment outcome (Cohen & Mannarino, 1996a, 1998a; Friedrich, 1990). The current study used data from the Aurora-Adolescent Mood Project, a community based randomized controlled trial, which evaluated the effectiveness of a manualized cognitive behavioral treatment for adolescents with depression and prior interpersonal trauma experience. This study used the same participants from the Aurora-Adolescent Mood Project to evaluate an observational coding system (Trauma Involvement Rating scale - TIRS) for trauma-focused involvement within therapy sessions. The sample consisted of 29 participants between the ages of 12 and 18 with a primary diagnosis of a depressive disorder (Major Depressive Disorder (n = 23), Dysthymic Disorder (n = 2), or Depressive Disorder - Not Otherwise Specified (n=4). 142 segments that were flagged as having trauma-focused discussion from 29 cases were evaluated for level of involvement. It was hypothesized that the association between pre-treatment PTSD-Avoidance symptoms and trauma-focused involvement in therapy would be moderated by the therapeutic alliance. Hierarchical regression did not reveal a significant interaction between PTSD-Avoidance symptoms and therapeutic alliance in predicting mean trauma-focused involvement. In order to further explore adolescents' involvement in trauma-focused discussion separate from the therapist contribution, TIRS item one (Does the adolescent initiate discussion or introduce topics related to his or her trauma experience) was examined individually. Using linear regression, the Beck Depression Inventory (BDI) and PTSD-Avoidance symptoms significantly predicted adolescent initiation of trauma-focused discussion. These results indicate that the higher level of symptomatology and distress present at pre-treatment the more frequently adolescents are going to initiate discussion about interpersonal trauma they have experienced. Overall, this study was the first to investigate trauma-focused involvement using an observational coding system with a community sample of depressed adolescents who had experienced interpersonal trauma. Future research should continue to utilize observational coding methods to analyze trauma-focused involvement with a larger sample of youths who have experienced interpersonal trauma.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Tess Siler Simpson


Received from ProQuest

File Format




File Size

94 p.


Counseling psychology