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This study investigated mathematical visualization supported by an alternating problem-posing and problem-solving process, as well as the differences/connections of visualization at different stages of that process with 85 United States and Chinese prospective elementary teachers. The findings demonstrated the effectiveness of visualization on preservice teachers’ understanding of mathematical concepts and the associations among those concepts. In the meantime, prospective teachers’ visualization has specific features at different stages of that process, and they showed better performance in visualization and problem posing after engaging in problem solving. Instructional implications and future directions of research are discussed at the end.