Details

Autor(en) / Beteiligte

• Flückiger, Christoph
• Rubel, Julian
• Del Re, A. C
• Horvath, Adam O
• Wampold, Bruce E
• Crits-Christoph, Paul
• Atzil-Slonim, Dana
• Compare, Angelo
• Falkenström, Fredrik
• Ekeblad, Annika
• Errázuriz, Paula
• Fisher, Hadar
• Hoffart, Asle
• Huppert, Jonathan D
• Kivity, Yogev
• Kumar, Manasi
• Lutz, Wolfgang
• Muran, John Christopher
• Strunk, Daniel R
• Tasca, Giorgio A
• Vîslă, Andreea
• Voderholzer, Ulrich
• Webb, Christian A
• Xu, Hui
• Zilcha-Mano, Sigal
• Barber, Jacques P
• Davila, Joanne

Titel

The Reciprocal Relationship Between Alliance and Early Treatment Symptoms: A Two-Stage Individual Participant Data Meta-Analysis

Ist Teil von

• Journal of consulting and clinical psychology, 2020-09, Vol.88 (9), p.829-843

Ort / Verlag

United States: American Psychological Association

Erscheinungsjahr

2020

Quelle

Applied Social Sciences Index & Abstracts (ASSIA)

Beschreibungen/Notizen

• 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. What is the public health significance of this article? Improvements in the quality of the patient-rated alliance are associated with subsequent symptom reduction early in psychotherapy, and symptom reduction is associated with further improvement in the subsequent alliance. This meta-analysis provides empirical evidence for good clinical wisdom that collaborative qualities within the therapist-patient relationship and early distress remediation go "hand-in-hand." These results underscore the relevance of respectful, collaborative, and ethically sound care for mental health patients to positively impact therapy outcomes.