Presence before alliance? Longitudinal evidence from psychotherapy trainees in China.

Abstract

This study examined the longitudinal associations and temporal precedence between therapeutic presence and working alliance in psychotherapy. The data set comprised 14,498 sessions conducted by 208 master's-level trainee therapists with 1,587 clients in China. After each session, both therapists and clients completed standardized measures of therapeutic presence and working alliance. Results from random-intercept cross-lagged panel modeling indicated that, at the between-person level, therapist-client dyads that reported higher average therapeutic presence also tended to report higher average working alliance based on both client and therapist ratings. At the within-person, between-session level, a unidirectional temporal pathway was identified: From both client and therapist perspectives, higher therapeutic presence in a session consistently predicted higher subsequent working alliance across the course of treatment, whereas working alliance did not significantly predict subsequent therapeutic presence. These findings underscore the pivotal role of therapeutic presence as a precursor to a strong working alliance, highlighting its importance in fostering effective therapeutic relationships and positive treatment processes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).