Background <p>This study expands the understanding of congruence, or the level of agreement, between therapists and patients regarding therapy progress perception during psychotherapy for distressing persistent somatic symptoms (PSS).</p> Method <p>We completed a Grid Sequence Analysis of 174 patient-therapist dyads completing cognitive behavior therapy (CBT) to explore congruence patterns regarding therapy progress perceptions, assess baseline characteristic associations with congruence patterns, and investigate whether these patterns are associated with treatment outcomes.</p> Results <p>A notable majority of dyads (91.4%) were able to reach strong positive congruence by the end of treatment. No baseline characteristics were associated with congruence patterns, except for baseline depression, which was related to a congruence pattern in which the patient underestimated therapeutic progress relative to their therapist. Strong positive congruence was associated with decreased symptom severity at the end of treatment, but no association with disability was found.</p> Conclusion <p>Overall, it appears that congruence is an important factor in the treatment of PSS. Our results demonstrate that patients can develop strong positive congruence with their therapists regardless of what baseline characteristics they present with. Thus, therapists should aim to develop positive congruence with their patients early in treatment.</p>