Urban pseudo and reality human settlements (PHSs and RHSs) are important components of the human–land relationship regional system. To explore the coupling and coordination relationship and principle among them is an important approach to high-quality coordinated urban development. Based on the three-dimensional development of human settlements, the theoretical system of a “three states” dynamic frame diagram is constructed. The spatio-temporal heterogeneity and driving principle of coupling coordination among PHSs and RHSs in 34 prefecture-level cities in northeast China from 2011 to 2019 were explained by using the coupling coordination degree, spatial trend surface analysis and geographic detector techniques, and the evolution principle of spatio-temporal coordination was revealed. The results show that: (1) in the temporal dimension, the coupling coordination degree among PHSs and RHSs in the three provinces shows a smooth growth from “slight disadjustment” to “near disadjustment”; (2) With Shenyang, Dalian, Changchun and Harbin as the center, the coordination degree shows a circular pattern decreasing from the transition area to peripheral area. In the direction of south and north, the spatial evolution trend shows a gradual change from a “—” shape to “U” shape. There is spatio-temporal variation of the trend surface from an inverted “U” shape to “—” shape in the east–west direction; (3) The socioeconomic situation is an important driving factor, and the tool system is a new driving system for the coupling and coordinated development of urban PHSs and RHSs.