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. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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联盟与早期治疗症状之间的相互关系：两阶段的个体参与者数据荟萃分析。

目的尽管已经证明早期的联盟能够强有力地预测治疗后的结局，但联盟导致症状减轻还是症状减轻导致更好的联盟的问题仍未解决。为了在治疗早期更好地了解联盟与症状之间的关系，我们对第1到第7阶段对联盟和症状在患者中的逐期治疗效果进行了荟萃分析。分析方法。根据来自9个国家/地区的5350名参与者的17项主要研究的数据集，我们首先计算了每次会议的标准化患者内系数。其次，我们使用随机效应模型对这些系数进行荟萃分析，以计算整个研究的综合效应。结果与以前的荟萃分析一致，我们发现早期联盟可以预测治疗后的结局。我们在前7个疗程中发现联盟与症状之间存在显着的互惠性。跨级别的交互作用表明，较高的联盟和较低的症状在随后的会议中积极影响联盟与症状之间的关系。结论这些发现提供了经验证据，即在治疗的早期，症状和联盟相互之间是相互相关的，通常导致较高联盟/较低症状的正螺旋上升，预示随后的疗程中较高联盟/较低症状。两阶段的个人参与者数据荟萃分析有可能通过生成和链接可重复复制的基于过程的知识来推动该领域向前发展。（PsycInfo数据库记录（c）2020 APA，