Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed outpatients randomized to the combined condition of a clinical trial, we examined ratings of adherence and alliance as predictors of subsequent session-to-session symptom change across early CT sessions. Results: Both adherence to Behavioral Methods/Homework and the therapeutic alliance significantly predicted session-to-session symptom change. In models in which patients' medication regimen and prior symptom change were covaried, only Behavioral Methods/Homework remained a significant predictor of subsequent symptom change. Conclusions: Our findings highlight the utility of Behavioral Methods/Homework in combined treatment for promoting early session-to-session symptom change. (Contains 1 figure, 2 tables, and 4 footnotes.)