Therapist-youth agreement on alliance change predicts long-term outcome in CBT for anxiety disorders

Therapist's effect on children's therapeutic alliance: A naturalistic study

OBJECTIVES

The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA.

METHODS

The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q).

RESULTS

Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients).

CONCLUSION

We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.

Therapeutic Alliance, Attendance, and Outcomes in Youths Receiving CBT or Client-Centered Therapy for Anxiety

OBJECTIVE

Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (N = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety.

METHOD

We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time.

RESULTS

Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance.

CONCLUSIONS

Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.

A Three-level Meta-analysis on the Alliance-Outcome Association in Child and Adolescent Psychotherapy

Previous meta-analyses have found small to moderate associations between child-therapist alliance and treatment outcomes. However, these meta-analyses have not taken into account changes in alliance (i.e., alliance shifts), alliance agreement (i.e., congruence or discrepancies between child-therapist ratings), and the role of alliance as a moderator in relation to treatment outcomes (i.e., an interaction effect of alliance and treatment condition on treatment outcomes). A series of multilevel meta-analyses of 99 studies was conducted to investigate several types of alliance-outcome associations in child and adolescent psychotherapy. Associations between child-therapist alliance and child outcomes (r = 0.17), changes in child-therapist alliance and child outcomes (r = 0.19), child-therapist alliance as a moderator of outcomes (r = 0.09), and parent-therapist alliance and child outcomes (r = 0.13) were small. Associations between child-therapist alliance agreement and outcomes (r = 0.21) and between parent-therapist alliance and parent outcomes (r = 0.24) were small to moderate. This meta-analysis provides the most updated and comprehensive overview of the alliance-outcome association in child and adolescent psychotherapy, showing that the alliance continues to show impact on treatment outcomes. Alliance research in youth psychotherapy has increasingly focused on several complex aspects of the alliance-outcome association, such as the role of changes in alliance, alliance discrepancies, client and therapist variability, and the reciprocal association between alliance and prior symptom change in relation to treatment outcomes. Implications for future research and clinical practice are discussed.

A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy

OBJECTIVE

The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy.

METHODS

A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy.

RESULTS

Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively).

CONCLUSIONS

It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.

Conceptual, methodological, and measurement factors that disqualify use of measurement invariance techniques to detect informant discrepancies in youth mental health assessments

On page 1 of his classic text, Millsap (2011) states, "Measurement invariance is built on the notion that a measuring device should function the same way across varied conditions, so long as those varied conditions are irrelevant [emphasis added] to the attribute being measured." By construction, measurement invariance techniques require not only detecting varied conditions but also ruling out that these conditions inform our understanding of measured domains (i.e., conditions that do not contain domain-relevant information). In fact, measurement invariance techniques possess great utility when theory and research inform their application to specific, varied conditions (e.g., cultural, ethnic, or racial background of test respondents) that, if not detected, introduce measurement biases, and, thus, depress measurement validity (e.g., academic achievement and intelligence). Yet, we see emerging bodies of work where scholars have "put the cart before the horse" when it comes to measurement invariance, and they apply these techniques to varied conditions that, in fact, may reflect domain-relevant information. These bodies of work highlight a larger problem in measurement that likely cuts across many areas of scholarship. In one such area, youth mental health, researchers commonly encounter a set of conditions that nullify the use of measurement invariance, namely discrepancies between survey reports completed by multiple informants, such as parents, teachers, and youth themselves (i.e., informant discrepancies). In this paper, we provide an overview of conceptual, methodological, and measurement factors that should prevent researchers from applying measurement invariance techniques to detect informant discrepancies. Along the way, we cite evidence from the last 15 years indicating that informant discrepancies reflect domain-relevant information. We also apply this evidence to recent uses of measurement invariance techniques in youth mental health. Based on prior evidence, we highlight the implications of applying these techniques to multi-informant data, when the informant discrepancies observed within these data might reflect domain-relevant information. We close by calling for a moratorium on applying measurement invariance techniques to detect informant discrepancies in youth mental health assessments. In doing so, we describe how the state of the science would need to fundamentally "flip" to justify applying these techniques to detect informant discrepancies in this area of work.

What if children with psychiatric problems disagree with their clinicians on the need for care? Factors explaining discordance and clinical directions

BACKGROUND

Children and adolescents in mental healthcare often perceive their care needs and necessary treatment differently from their clinicians. As such discordance between young patients and clinicians may obstruct treatment adherence and compromise treatment outcomes, it is important to understand the factors associated with it. We therefore investigated the factors associated with patient-clinician discordance with regard to care needs in various areas of functioning.

METHODS

A cross-sectional study involving 244 children/adolescents aged 6-18 participating with their clinicians in treatment at a specialized mental healthcare center. As a previous study conducted by our research group had found the greatest patient-clinician discordance in three CANSAS care needs-"mental health problems," "information regarding diagnosis and/or treatment," and "making and/or keeping friends"-we used univariable and multivariable statistics to investigate the factors associated with discordance regarding these three care needs.

RESULTS

patient-clinician discordance on the three CANSAS items was associated with child, parent, and family/social-context factors. Three variables were significant in each of the three final multivariable models: dangerous behavior towards self (child level); severity of psychiatric problems of the parent (parent level); and growing up in a single-parent household (family/social-context level).

CONCLUSIONS

To deliver treatment most effectively and to prevent drop-out, it is important during diagnostic assessment and treatment planning to address the patient's care needs at all three levels: child, parent and family/social context.

Therapeutic Alliance in Cognitive Behavioural Therapy in Child and Adolescent Mental Health-Current Trends and Future Challenges

This extended literature review proposes to present the trends in the therapeutic alliance, outcomes, and measures in the last decade within the premises of individual cognitive behaviour therapy (CBT) and its innovations, used as an interventional measure in the context of child and adolescent mental health setting. A brief background of the rationale for conducting this literature search is presented at the start. This is followed by the methodology and design which incorporates the inclusion and exclusion criteria and the basis for the same. The critical appraisal of the primary studies is presented in the literature review section with a brief description of the summary features of the studies in the study tables followed by the results and discussion of the study findings. To summarise, the literature review of primary studies conducted in the last decade demonstrates the need for further research to be conducted both in the field of CBT in children and therapeutic alliance, competence, and therapy outcomes, integrating perspectives in child development, carer alliance, and the social construct theory in children, to allow for further innovations in CBT in the context of increasing challenges in the current times of exponentially developing technology and its utility without compromising the quality of therapy. In conclusion, recommendations are made as a guideline for future studies and research in this field.

Four perspectives on traumatized youths' therapeutic alliance: Correspondence and outcome predictions

OBJECTIVE

Does the rater-perspective of youths' therapeutic alliance matter? To answer this, we evaluated the relationships between four perspectives of youths' alliance, then, we examined whether each perspective and potential discordance between the perspectives predicted outcomes.

METHOD

Participants were 65 youth (M age = 15.11, SD = 2.14; 76.9% girls) undergoing trauma-focused cognitive behavioral therapy (TF-CBT) and their therapists (n = 24). Youths' alliance was rated by youth, therapists and parents using the Therapeutic Alliance Scale for Children-revised and by observers using the Therapy Process Observational Coding System-Alliance scale. Posttraumatic stress symptoms (PTSS) were assessed with the Child PTSD Symptom Scale (CPSS) and the Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA).

RESULTS

The alliance ratings by youth-parent, parent-therapist, and therapist-observer significantly correlated. Only a higher youth-rated alliance significantly predicted fewer PTSS. Furthermore, a higher therapist-rated than youth-rated alliance significantly predicted higher scores on CPSS and CAPS-CA, and a higher parent-rated than youth-rated alliance predicted significantly higher CPSS score.

CONCLUSION

Therapists should explicitly check in with youth clients about the alliance; because only youths' evaluation of their alliance predicted the outcome and an overestimation of their alliance by therapists and parents predicted more PTSS.Trial registration: ClinicalTrials.gov identifier: NCT00635752..

Longitudinal trajectory and predictors of change in family accommodation during exposure therapy for pediatric OCD

Family accommodation (FA) is key in the maintenance of OCD. However, most studies are cross-sectional, and have not identified long-term trajectories and correlates of FA changes over treatment. This study investigated changes in clinician-rated FA over 10 sessions of cognitive behavioral therapy (CBT) for 142 children with OCD, as well as several key predictors/correlates: (a) clinician-rated OCD symptom severity, (b) child- and parent-rated functional impairment, (c) parent-rated treatment expectancies, and (d) child- and parent-rated therapeutic alliance. Multi-level models indicated that FA changed significantly during treatment, with gains maintained over 6-months. Baseline clinician-rated OCD severity did not predict changes in FA. Significant interactions indicated that children with higher child- and parent-rated impairment exhibited greater FA improvements over treatment (versus children with lower impairment). Child- and parent-rated therapeutic alliance and parent-rated expectancies did not predict FA changes. Finally, FA mediated the relationship between OCD severity and parent- (but not child-) rated impairment. Reverse mediation models were also significant. Findings indicate that CBT can successfully reduce FA (a) even if children experience high OCD severity and interference in school, relationships, and family life, and (b) regardless of non-specific factors like treatment expectancies and alliance. FA reductions are an important mechanism mediating treatment response.

Alliance-Outcome Associations in a Community-Based Social Skills Intervention for Youth With Autism Spectrum Disorder

Although the alliance is a consistent predictor of treatment outcomes in psychosocial interventions, few studies have examined this association among youth with autism spectrum disorder (ASD). In particular, youth-therapist alliance has never been examined in social skills interventions (SSIs), a common modality for this population. In this study, thirty-four youth with ASD (M_age = 12.41; 79% male) participated in a community-delivered, group-based SSI in a summer camp format led by eight Head Therapists (M_age = 32.12; 50% male). Early alliance and change in alliance over the course of the treatment were assessed via self- and observer-reported measures. Both self- and observer-rated alliance were associated with positive treatment outcomes as reported by parents (decreased problem behaviors) and other peers in the group (reciprocated friendship and social preference). These results provide the first evidence of the role of the alliance in an SSI for youth with ASD and add to the growing body of literature that demonstrates the importance of assessing and addressing the alliance in treatment for this population.

Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders

OBJECTIVE

The alliance influences outcomes in CBT for youth anxiety disorders. Thus, knowledge about how therapists can enhance the alliance is needed.

METHOD

Seventy-three youth with anxiety diagnoses (M age = 11.5 years, SD = 2.2; range 8 to 15 years; 47.9% boys; 90.4% white-European) participated in 10-session cognitive behavioral therapy in community clinics. Therapist alliance-building behaviors in session 2 was reliably coded with the observer-rated Adolescent Alliance-Building Behavior Scale (Revised) (AABS(R)). Alliance was measured as youth- and therapist-rated alliance, and youth-therapist alliance discrepancy in session 3. Outcomes were diagnostic recovery and anxiety symptom reduction at post-treatment and one-year follow-up, and treatment dropout. We examined the direct effects of alliance-building on alliance, alliance on outcomes, and alliance-building on outcomes in multilevel mediation models, and between- versus within-therapist variance across these effects.

RESULTS

The alliance-building behaviors collaborate, present treatment model, and explore motivation positively predicted alliance, whereas actively structuring the session (i.e., dominating) negatively predicted alliance. The alliance-building behaviors attend to experience, collaborate, explore motivation, praise, and support positively predicted outcomes. The alliance-building behaviors present treatment model, express positive expectations, explore cognitions, and support negatively predicted outcomes. The effect of collaborate on symptom reduction was mediated by youth-therapist alliance discrepancy. There was almost zero between-therapist variance in alliance-building, and considerable within-therapist variance.

CONCLUSION

Therapist alliance-building behaviors were directly (positively and negatively) associated with alliance and/or outcomes, with only one effect mediated by alliance. Alliance-building behaviors varied far more within therapists (i.e., across clients) than between therapists.

A dual perspective on first-session therapeutic alliance: strong predictor of youth mental health and addiction treatment outcome

We investigated the potential role of first-session therapeutic alliance ratings to serve as an early marker of treatment outcome in youth mental health and addiction treatment. The present study is among the first to incorporate both a youths' and a therapists' perspective of the therapeutic alliance in order to maximize predictive value of the alliance for treatment outcome. One hundred and twenty-seven adolescents participated in a multi-site prospective naturalistic clinical cohort study, with assessments at baseline and at 4 months post-baseline. Main outcome measure was favorable or unfavorable treatment outcome status at 4-month follow-up. Early therapeutic alliance had a medium and robust association with treatment outcome for youth' (b = 1.29) and therapist' (b = 1.12) perspectives and treatment setting. Based on the two alliance perspectives four subgroups were distinguished. Incorporating the alliance-ratings from both perspectives provided a stronger predictor of treatment outcome than using one perspective. Youth with a strong alliance according to both perspectives had an eightfold odds of favorable treatment outcome compared with youth with a weak alliance according to both perspectives. The association between therapeutic alliance and treatment outcome in youth mental health and addiction treatment may be substantially stronger than earlier assumed when both a youths' and therapists' perspective on alliance is considered.

Do caregivers' perspectives matter? Working alliances and treatment outcomes in trauma-focused cognitive behavioural therapy with children and adolescents

Background: Caregivers play a key role in the success of trauma-focused cognitive behavioural therapy (TF-CBT). Yet, the effect of their alliance on treatment outcomes besides the other parties in treatment has hardly been studied. Objective: This study examined the working alliance (WA) of therapists, patients and caregivers in TF-CBT and its contribution on treatment outcome over time. Methods: N = 76 children and adolescents (mean age = 12.66 years, range 7-17, M/F ratio: .43) participated in the TF-CBT arm of a randomized controlled trial. The WA was assessed with the Working Alliance Inventory Short Version (WAI-S) at two measurement points, while symptom level of posttraumatic stress symptoms (PTSS) was assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Paired sample t-tests, intraclass correlations (ICC), and mixed-effects regression models for longitudinal data were performed. Results: The alliance rating was high across all informants, with caregivers achieving the highest rating. The average level of cross-informant agreement on the alliance was low between therapists and caregivers (ICC = .26) and moderate between therapists and patients (ICC =.65). A significant contribution of an alliance improvement to the reduction of PTSS over time was found in each of the two tested models: therapists with patients model (b = .682) and therapists with caregivers model (b = .807). However, these effects were not detected with all four perspectives in one comprehensive model. Conclusion: In summary, the potential of caregivers' views should receive more attention in the therapeutic process of trauma-focused therapy.

Alexithymia - Not autism - is associated with frequency of social interactions in adults

OBJECTIVE

While much is known about the quality of social behavior among neurotypical individuals and those with autism spectrum disorder (ASD), little work has evaluated quantity of social interactions. This study used ecological momentary assessment (EMA) to quantify in vivo daily patterns of social interaction in adults as a function of demographic and clinical factors.

METHOD

Adults with and without ASD (N_ASD = 23, N_Neurotypical = 52) were trained in an EMA protocol to report their social interactions via smartphone over one week. Participants completed measures of IQ, ASD symptom severity and alexithymia symptom severity.

RESULTS

Cyclical multilevel models were used to account for nesting of observations. Results suggest a daily cyclical pattern of social interaction that was robust to ASD and alexithymia symptoms. Adults with ASD did not have fewer social interactions than neurotypical peers; however, severity of alexithymia symptoms predicted fewer social interactions regardless of ASD status.

CONCLUSIONS

These findings suggest that alexithymia, not ASD severity, may drive social isolation and highlight the need to reevaluate previously accepted notions regarding differences in social behavior utilizing modern methods.

Do Immediate Gains Predict Long-Term Symptom Change? Findings from a Randomized Trial of a Single-Session Intervention for Youth Anxiety and Depression

Single-session interventions (SSIs) can help reduce youth psychopathology, but SSIs may benefit some youths more than others. Identifying predictors of SSIs' effectiveness may clarify youths' likelihoods of benefitting from an SSI alone, versus requiring further treatment. We tested whether pre-to-post-SSI shifts in hypothesized symptom change mechanisms predicted subsequent reductions in youth internalizing symptoms. Data were from a trial evaluating whether an SSI teaching growth mindset (the belief that personality is malleable) reduced youth anxiety and depression. Youths (N = 96, ages 12-15) self-reported growth mindsets, perceived primary control, and perceived secondary control pre- and immediately post-intervention. They self-reported depression and anxiety symptoms at pre-intervention and 3, 6, and 9-month follow-ups. Larger immediate increases in primary control predicted steeper depressive symptoms declines across the follow-up; larger immediate increases in secondary control predicted steeper anxiety symptoms declines. Immediate shifts in proximal intervention "targets" may predict longer-term response to an SSI for youth internalizing distress. CLINICAL TRIALS: Clinicaltrials.gov registration: NCT03132298.

Improving Interpretability of Subjective Assessments About Psychological Phenomena: A Review and Cross-Cultural Meta-Analysis

Attempts to understand subjectivity have historically involved distinguishing the strengths of subjective methods (e.g., survey ratings from informants) from those of alternative methods (e.g., observational/performance-based tasks). Yet a movement is underway in Psychology that considers the merits of intersubjectivity: Understanding the space between two or more informant’s subjective impressions of a common person or phenomenon. In mental health research, understanding differences between subjective impressions have less to do with informants’ characteristics and more to do with the social environments or contexts germane to the people or phenomena examined. Our article focuses on one relatively understudied social environment: the cultural context. We draw from seminal work on psychological universals, as well as emerging work on cultural norms (i.e., cultural tightness) to understand intersubjectivity effects through a cross-cultural lens. We report a meta-analysis of 314 studies of intersubjectivity effects in mental health, revealing that (a) this work involves independent research teams in more than 30 countries, (b) informants rating a target person’s mental health (e.g., parent and teacher ratings of a child’s behavior) commonly provide diverging estimates of that person’s mental health, and (c) greater convergence between subjective reports relates to a “tighter” or more norms-bound culture. Our article illustrates strategies for understanding divergence between subjective reports. In particular, we highlight theoretical and methodological frameworks for examining patterns of divergence between subjective reports in relation to data from nonsubjective methods. We also describe how research on intersubjectivity informs efforts to improve the interpretability of subjective assessments in multiple subdisciplines in Psychology.

Comparing Alliance in Two Cognitive-Behavioural Therapies for Adolescents With ADHD Using a Randomized Controlled Trial

Alliance is defined as the client-therapist bond and their ability to collaborate on therapeutic activities. Treatment for adolescents with ADHD is rarely studied in terms of alliance. In this study, two cognitive-behavioral treatments (CBT; one structured treatment aimed at planning skills and one less-structured solution-focused treatment, both delivered in the style of Motivational Interviewing) were compared with regard to alliance and alliance-outcome association. The influence of therapist competence on this alliance-outcome association was also evaluated. The alliance between 69 adolescents diagnosed with ADHD and their therapists was measured early in treatment, using the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale. Observer-rated therapist competence was measured using the Motivational Interviewing Treatment Integrity scale (version 3.1.1.). Outcome variables were the adolescents' reduction in planning problems and ADHD symptoms. The alliance, and, more specifically, collaboration on therapeutic activities, was significantly higher for the more structured CBT (p = .04; moderate effect size). Alliance was not related to outcome in the more structured CBT, while the alliance was positively related to the reduction in planning problems in the less structured CBT. Finally, alliance was a significant mediator between therapist competence and treatment outcome for the less-structured CBT. The clarity and structure of CBT may help facilitate alliance formation for adolescents with ADHD who often have difficulty implementing structure themselves. Therapists may need to invest more in alliance formation in less structured CBT as the alliance affects outcome. Moreover, enhancing therapist competence in less structured CBT may help improve outcomes in less structured CBT, as therapist competence may impact outcome through alliance.

Child social and emotion functioning as predictors of therapeutic alliance in cognitive-behavioral therapy for anxiety

OBJECTIVE

This study examined baseline child social and emotional functioning as predictors of therapeutic alliance during a cognitive-behavioral therapy (CBT) program for children with anxiety disorders. It was hypothesized that better social and emotional functioning at baseline would be related to stronger alliance initially and over the course of treatment.

METHOD

Ninety-two anxious youth, ages 7-11 years (M age = 8.93 years, SD = 1.64; 42% female) participated. Children, caregivers, and teachers completed measures of child social and emotional functioning. Therapeutic alliance was measured using therapist-rated and observer-coded reports.

RESULTS

Receiving prosocial support from peers and emotion regulation (ER) were both related to initial rating and slope of alliance.

CONCLUSIONS

Child social and emotional functioning enhances our understanding of how the alliance is formed and in identifying children who might be at risk for difficulties in developing a strong therapeutic relationship.

Introduction to the Special Issue: Discrepancies in Adolescent-Parent Perceptions of the Family and Adolescent Adjustment

Researchers commonly rely on adolescents' and parents' reports to assess family functioning (e.g., conflict, parental monitoring, parenting practices, relationship quality). Recent work indicates that these reports may vary as to whether they converge or diverge in estimates of family functioning. Further, patterns of converging or diverging reports may yield important information about adolescent adjustment and family functioning. This work is part of a larger literature seeking to understand and interpret multi-informant assessments of psychological phenomena, namely mental health. In fact, recent innovations in conceptualizing, measuring, and analyzing multi-informant mental health assessments might meaningfully inform efforts to understand multi-informant assessments of family functioning. Therefore, in this Special Issue we address three aims. First, we provide a guiding framework for using and interpreting multi-informant assessments of family functioning, informed by recent theoretical work focused on using and interpreting multi-informant mental health assessments. Second, we report research on adolescents' and parents' reports of family functioning that leverages the latest methods for measuring and analyzing patterns of convergence and divergence between informants' reports. Third, we report research on measurement invariance and its role in interpreting adolescents' and parents' reports of family functioning. Research and theory reported in this Special Issue have important implications for improving our understanding of the links between multi-informant assessments of family functioning and adolescent adjustment.