Two important theoretical assumptions of family therapy were examined: (a) Child behavior problems are associated with cross-generational coalitions, and (b) treatment of these coalitions using family therapy leads to decreases in individual symptomatology. Ss were 45 delinquent adolescents assigned to multisystemic therapy (MST) or individual therapy and 16 well-adjusted adolescents. Pretreatment and posttreatment assessments included measures of observed family relations and self-reported symptoms. Cross-generational coalitions were more evident in families of delinquents vs. families of well-adjusted adolescents. In addition, changes in adolescent and paternal symptoms in the MST group were linked with changes in marital relations. Implications for systemic conceptualizations of symptom maintenance and change are highlighted.