With this conceptualization of the trusted leadership advisor (TLA), a senior practitioner provides an in-depth view of the role transition from executive coach in short-term engagements to the TLA in long-term consulting relationships with corporate level and other senior business leaders. Emphasis is placed on the integration of business knowledge with an insight-oriented approach, and the nature of the TLA’s presence as the core factor in the success and perpetuation of these relationships. Three specific albeit discontinuous states of presence are offered as a mental framework for informing how the practitioner “meets” clients for sustained impact. Further, four dimensions of the TLA role are presented as guidance for specific actions in client meetings. Taken together, these TLA states of presence and role dimensions provide a model that can contribute to the development of those who aspire to work with top business leaders, as well as enrich the practice of other senior practitioners already engaged in this work.