TY - JOUR
T1 - The reciprocal relationship between alliance and early treatment symptoms
T2 - A two-stage individual participant data meta-analysis
AU - Flückiger, Christoph
AU - Rubel, Julian
AU - Del Re, A. C.
AU - Horvath, Adam O.
AU - Wampold, Bruce E.
AU - Crits-Christoph, Paul
AU - Atzil-Slonim, Dana
AU - Compare, Angelo
AU - Falkenström, Fredrik
AU - Ekeblad, Annika
AU - Errázuriz, Paula
AU - Fisher, Hadar
AU - Hoffart, Asle
AU - Huppert, Jonathan D.
AU - Kivity, Yogev
AU - Kumar, Manasi
AU - Lutz, Wolfgang
AU - Muran, John Christopher
AU - Strunk, Daniel R.
AU - Tasca, Giorgio A.
AU - Vîslă, Andreea
AU - Voderholzer, Ulrich
AU - Webb, Christian A.
AU - Xu, Hui
AU - Zilcha-Mano, Sigal
AU - Barber, Jacques P.
N1 - Publisher Copyright:
© 2020 American Psychological Association.
PY - 2020/9
Y1 - 2020/9
N2 - Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.
AB - Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.
KW - Early response
KW - Individual participant data meta-analysis
KW - Process-based therapy
KW - Within-patient effects
KW - Working alliance
UR - http://www.scopus.com/inward/record.url?scp=85089170506&partnerID=8YFLogxK
U2 - 10.1037/ccp0000594
DO - 10.1037/ccp0000594
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C2 - 32757587
AN - SCOPUS:85089170506
SN - 0022-006X
VL - 88
SP - 829
EP - 843
JO - Journal of Consulting and Clinical Psychology
JF - Journal of Consulting and Clinical Psychology
IS - 9
ER -