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This study investigated the role of a therapeutic presence in metaverse counseling, considering the growing interest in virtual reality psychotherapy. To examine the relationship between therapeutic presence and working alliance over time in metaverse counseling, we conducted a multilevel analysis with sessions at level 1, clients at level 2, and therapists at level 3. The dataset consisted of 75 sessions, nested within 25 clients and seven therapists. The study revealed that therapeutic presence positively affected the working alliance, at the between-sessions (within individual clients) and between-clients levels (across different clients). The findings also indicated that, during the early stages of treatment, a higher level of therapeutic presence in a session was associated with a stronger working alliance for that particular session. The final model explained approximately 45% of the working alliance variance. The implication for the potential influence of a therapeutic presence was discussed particularly during the initial sessions of metaverse counseling.
Im et al. (Mon,) studied this question.