Therapist presence and client session and symptom outcomes: A longitudinal examination of their reciprocal...

The aim of this study was to explore how therapeutic presence predicted psychotherapy session quality (SQ) and client symptom (CS) reduction at both between-person and within-person between-session levels. The sample included 14,316 sessions involving 1,916 clients and their 173 trainee therapists in a master's level mental health counseling training program in China. Before each session, the client rated their symptom level. After every session, the therapist reported their level of therapeutic presence in the session, while the client rated their perception of the quality of the session. Analyses using latent curve model with structured residuals showed that, at the between-person level, higher therapist rating of first-session therapeutic presence predicted better initial SQ rated by the client. Further, sustained increasing presence over time was associated with continued CS relief during treatment. At the within-person between-session level, therapeutic presence led to better SQ for the session and lower CSs before the next session. Significant fluctuations (i.e., the lack of an autoregressive effect) for therapeutic presence at the session level were also found. We discussed implications for research and training, especially in the Chinese cultural context. (PsycInfo Database Record (c) 2026 APA, all rights reserved).