The unbearable lightness of laughting: a reflexive thematic analysis of smiles and laughter in five psychotherapy training processes.

Objective: This study explored how smiles and laughter unfolded in five psychotherapy training processes, comprising two psychodynamic, two metacognitive, and one integrative. Methods: Using a multimodal approach, video observations from naturalistic therapy and supervision sessions served as a springboard for Interpersonal Process Recall interviews with therapists, clients, and supervisors. Transcripts from supervision sessions and interviews were analyzed with Reflexive Thematic Analysis. Findings: The analysis yielded four themes: 1. Smiles and laughter sometimes served to strengthen the therapeutic alliance, while at other times they functioned as emotion-regulating strategies or carried profound personal significance; 2. The therapists intuitively tended to downregulate their responses to clients' expressions of laughter, to modulate and contain the clients' underlying emotions; 3. The way therapists handled laughter and smiles in the therapeutic setting seemed to be related to their degree of security and the quality of the therapeutic relationship; and 4. In supervision, smiles and laughter were not explicitly addressed as a distinct theme but occasionally surfaced spontaneously during sessions. Conclusion: By showing how clinical practice unfolds on observable and inferred emotional levels, the study highlights the importance of empirical grounding and the difficulty of verbalizing subtle nonverbal processes.