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The smoothness advantage: Session quality and symptom change in a training clinic
1Department of Psychology, TOBB Economy and Technology University.
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While both emotional depth and relational smoothness are considered therapeutic, their relative contributions to symptom change remain debated. This study disentangles the within-person (state) and between-person (trait) effects of client-rated session depth and smoothness on symptom trajectories in a university training clinic. Utilizing longitudinal data from 84 clients (1,338 session observations) treated by 33 novice therapists, this study employed multilevel modeling with two complementary specifications: an autoregressive model testing immediate session-to-session effects and a baseline-adjusted model testing cumulative change from pretreatment levels. Findings revealed distinct pathways for immediate versus cumulative change. Within-person fluctuations in session depth were associated with cumulative symptom reduction (b = -0.06, p = .015), suggesting that sessions deeper than a client's average provide incremental long-term benefits. Conversely, within-person smoothness was associated with a slight increase in next-session symptoms in the autoregressive model (b = 0.05, p = .001), potentially reflecting regression effects or the temporary disruption that accompanies productive therapeutic work. However, the most robust finding across both models was the between-person smoothness effect (bAR = -.34, bBase = -.36, p < .001); clients who generally experienced smoother, more comfortable therapeutic interactions demonstrated significantly better overall symptom trajectories. Findings challenge the "no pain, no gain" assumption in short-term psychotherapy and counseling with young adults. While depth contributes to cumulative change, establishing a consistent "smoothness advantage," a comfortable and safe relational foundation, appears critical for symptom relief in this population. For novice therapists, prioritizing relational safety over premature depth may optimize outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
