Reconciling Different Voices—Developing as an

Integrative Scientist Practitioner

Jeanne C. Watson
Ontario Institute for Studies in Education, University of Toronto

This paper provides an overview of my development as an integrative scientist-

practitioner. Starting with the early life experiences that shaped my moti-
vation to become a counselor, I trace my progress through graduate school
to my current position at the University of Toronto. I have identified the
important influences on my thinking and development that prompted me to
integrate client-centered, gestalt, interpersonal, and cognitive interventions as
part of my repertoire as a predominantly emotionally-focused psycho-
therapist working with individuals and couples. The integrative focus that
characterizes my practice is also evident in my development as a researcher.
In my work as a predominantly process-oriented researcher, I have struggled
to combine both quantitative and qualitative approaches to the study of
psychotherapy. Most recently I have shifted my research focus from studying
clinical process to implementing clinical trials to determine the effective-
ness of experiential and client-centered psychotherapy in the treatment of
depression.

THE EARLY YEARS—MOTIVATION

I left South Africa when I was 21, still uncertain about what I would do
with my life but curious about the world and its peoples. As a teenager I
had imagined I would study law or political economy because these were
most relevant in a South African context, characterized by oppression and
exploitation. However, after obtaining a B.A. in English literature and
political studies, I immigrated to Canada, where I became involved in
setting up an import company. Although challenging, it did not fit my view
of myself, but I had yet to find a focus. It was Simone de Beauvoir’s novel
The Mandarins that first gave me the idea to pursue a career in psychology.

Correspondence concerning this article should be addressed to Jeanne C. Watson,

Department of Adult Eduction and Counseling Psychology, OISE/University of Toronto, 252
Bloor Street W, Toronto, Ontario, M5S 1V6, Canada. E-mail: jewatson@oise.utoronto.ca

20
Journal of Psychotherapy Integration Copyright 2006 by the American Psychological Association
2006, Vol. 16, No. 1, 20 –35 1053-0479/06/$12.00 DOI: 10.1037/1053-0479.16.1.20
Developing as an Integrative Scientist Practitioner 21

One of the main characters, a psychiatrist was working with survivors of

World War II. The work of analysis as described by de Beauvoir captured
my attention and resonated deeply with me.
So I began to explore my options. I looked into social work and then
psychology. I remembered the advice of a guidance counselor, before
leaving high school, that one way to find your career path was to look at the
activities that you pursued in your free time. At 16 her words had per-
plexed me because it seemed that none of my hobbies were related to work
or career options. However, when I began to consider psychotherapy as an
option, I recalled that much of my free time as a teenager had been spent
listening to my mother bemoan the conditions of her life, as I tried
unwittingly to moderate her erratic mood swings.
To further explore my interest in psychology, I volunteered at a
Behavior Therapy Clinic where I received training in relaxation tech-
niques, systematic desensitization, and the work of Albert Ellis to treat
patients with agorapbobia. This experience convinced me to do a make-up
year of psychology undergraduate courses before applying to graduate
school. During this period I met Laura Rice, who became my mentor.
Laura taught a course in client-centered therapy that fit with my view of the
world and limited experience of counseling. Laura’s theoretical framework
at that time was heavily influenced by information processing theories and
the work of cognitive theorists like Ulric Neisser. Her view of the change
process as well as her praxis made sense to me and meshed with my
understanding and beliefs about both. I remember the 1st time I was
introduced to systematic evocative unfolding as a technique. I felt so
present, so alive, as my client and I searched out the clue that would shed
light on her problematic reaction. I was thrilled at how natural it felt. After
completing the undergraduate courses, I was accepted to the graduate
program in psychology at York to work with Laura as my research and
clinical supervisor.
With Laura’s teaching I learned to listen, to probe, and to seek an
understanding of each client’s unique perspective, resources, and life
course. I learned to walk with clients as they searched for the answers to
their problems; I discovered how to shine a spotlight in places that they
may have overlooked, but I never allowed myself to think I had the
answers to resolve their own special set of life problems.
I had learned early that advising people in specific courses of action
was pointless. As a young adolescent, I recall listening intently as my
mother shared her memories and current discontents. I remember ear-
nestly trying to help her find solutions, urging her to particular courses of
action, none of which she ever followed. In retrospect, I saw that my
solutions addressed the tip of the iceberg. But I was too young and naı̈ve
at the time to realize the extent of her problems. She did not have the
22 Watson

psychological or material resources to implement my suggestions. Later on,

reflecting on what I had done, I came to realize that helping others did not
mean giving them advice. Perhaps the best gift of all was my rapt attention
and struggle to understand their fears and concerns. The possibility of
being blind to what others really need and feel was driven home once again
during my first internship. A young client was experiencing considerable
distress in her relationship with her boyfriend. She complained bitterly
about him, saying that he had disappointed her and was quite unsuitable.
I was certain that she would choose to end the relationship. Yet after
returning from a brief vacation, she informed me that she was going to
marry him. Once again I had only glimpsed a part of the picture. Her
positive feelings were submerged by the weight of the negative. In my
practice I came to concentrate not only on that which was shared but that
which was hidden.
After reading Carl Rogers and working with Laura, I became a firm
adherent to a client-centered/humanistic philosophy of practice. However
I was always keenly aware of attachment issues and my clients’ develop-
mental histories. This focus together with the need to understand the
change process more fully, and a strong interest in family functioning,
prompted me to explore and try to integrate other approaches.
While in practice I was client-centered, theoretically I was influenced
by a number of different theorists. Harry Stack Sullivan (1953) and Karen
Horney (1950) provided me with an alternative framework for understand-
ing personality development. The writings of Murray Bowen (1960), Carl
Whittaker (1978), Virginia Satir (1983) and Salvador Minuchin (1974)
illuminated the inner workings of the family and helped me form a more
systemic perspective of my clients’ difficulties. The work of George Kelly,
Albert Bandura, and Seymour Epstein (1980) provided me with a cognitive
framework, whereas the writings of Lev Vygotsky (1962) and Charles
Taylor (1990) highlighted the important relationship between language and
reflection in guiding behavior and promoting change in psychotherapy.
Finally John Bowlby (1971) and his work on attachment was seminal to my
understanding of pathology and my theory of affect regulation. By inte-
grating the writings of these scholars, I began to develop an integrative
theoretical framework with which to understand people and their devel-
opment and functioning that I could use to inform my thinking and
formulations of clients’ difficulties.
As my theoretical framework broadened, I began to experiment with
other approaches in practice. One of my internships was with a psychody-
namic practitioner. I was nervous, uncertain about whether I would be able
to accurately interpret people’s conflicts or work with transference issues.
I was sure that my approach would be criticized as unsophisticated. How-
ever, to my surprise and relief, I learned that empathic conjectures were
Developing as an Integrative Scientist Practitioner 23

good interpretations. I did not have to alter my style much at all. Through-
out graduate school, I remained committed to a client-centered approach,
with additional training in family therapy, specifically systemic and strate-
gic approaches.
Laura was not only my clinical mentor but my research supervisor as
well. She introduced me to psychotherapy process research. Initially I
worked within the task analytic paradigm described by Rice and Green-
berg (1984) to develop models of micro change events in psychotherapy.
The objective was to identify productive periods in therapy when clients
seemed to effect changes or shifts in their cognitive-affective processing
and to determine whether these contributed to successful outcome. I tested
a model describing clients’ and therapists’ performances in the exploration
of problematic reactions in client-centered therapy. The model attempted
to explicate therapists’ tacit knowledge and to describe their actual in-
session behaviors as they worked with clients to gain an understanding of
and facilitate changes in the reactions that clients experienced as problem-
atic or puzzling in some way. Successful resolution of the micro change
event or problematic reaction was then related to therapy outcome.
This study provided the building blocks for my dissertation, in which I
sought to examine the links between clients’ affective arousal and memory
of problematic events during psychotherapy and the use of vivid language
by both clients and therapists (Watson & Rennie, 1994; Watson & Green-
berg, 1994; Watson, Goldman & Greenberg, 1996; Watson, 1996; Watson &
Greenberg, 1996). The study added to the growing literature from other
modalities of the role of expressive language in therapy and its relationship
to affect, memory and emotional arousal in facilitating change in clients’
functioning (Angus, Hardtke, Pederson & Marziali, 1991; Bucci, 1985).
The 2nd objective of my dissertation was to extend the task analytic
paradigm by using qualitative research strategies. Task analysis served to
illuminate therapists’ tacit knowledge and effectively described clients’ and
therapists’ processes from therapy transcripts; however, this approach did
not take full account of clients’ agency and their more covert processes
within the therapeutic encounter (Bohart, & Tallman, 1999; Rennie, 1992).
I therefore began to investigate clients’ subjective experience during the
exploration of specific tasks to amplify our understanding of the processes
that led to successful resolution. This work led to the development of a
cognitive-affective model of clients’ inner processes that emphasized the
role of the symbolization of their inner and outer experience in words,
emotional arousal and reflection in the change process (Watson & Rennie,
1994; Watson & Greenberg, 1994).
Symbolization and reflection, are generic to problem solving in a
variety of different tasks (Dewey, 1933). The one that is more unique to
psychotherapy is the symbolization and arousal of affect. That it is impor-
24 Watson

tant to problem solving in psychotherapy is not surprising given that we are

concerned with interpersonal processes, socialization, and affect regula-
tion. From an integrative perspective these 3 activities are facilitated across
different modalities albeit that each modality may emphasize the role and
importance of one or more over the others. All psychotherapies promote
the symbolization of experience usually in words but also by means of
dramatic enactments, music, and other forms of expressive art. Some
schools emphasize emotional arousal and symbolization, for example ex-
periential and psychodynamic approaches, while others, like cognitive-
behavioral, emphasizes people’s reflexivity and cognitive abilities to eval-
uate their experience. Mergenthaler’s (1996) research shows that while
clients in different therapies engage in these three activities, each approach
shows a different patterning over a session and over the course of therapy.
There are also different patterns in successful and unsuccessful cases in
experiential and psychodynamic psychotherapy.
Numerous scholars see our ability to use language as one of the
distinguishing features of human beings (Dewey, 1933; Taylor, 1975; Vy-
gotsky, 1962). Our capacity to represent our experience in words mediates
our interactions with the environment. It is this ability that allows us to
represent our experience in consciousness, to observe it, analyze it, and
problem solve. This capacity is activated in psychotherapy to facilitate
clients’ regulation of their cognitive, behavioral, and affective functioning
with respect to their environment at large and their interpersonal transac-
tions more specifically. The objective in most approaches to psychotherapy
is to facilitate clients’ representation of their experience whether the focus
is on their cognitions, their affect or their behavior.
In addition to helping clients to represent their experience, scientist-
practitioners from the different schools acknowledge the important role of
affect in facilitating access to important material and in representing it so
that change can be effected. We assist clients to access their feelings and
label them so that they can understand and obtain a certain cognitive
distance from events. Knowing how they feel informs them of their needs
and goals. Once these are in awareness, psychotherapy helps clients reflect
on their behavior and actions in order to develop alternative ways of
perceiving, feeling, and behaving that are more personally satisfying while
still remaining cognizant of the impact of these behaviors on others. There
are multiple ways of facilitating clients cognitive, affective, and behavioral
repertoires so that they are able to effectively regulate their inner affective
experiences and its expression in behavior. Alternative ways of responding
can be facilitated didactically through role play, making suggestions, pre-
scribing the symptom, working with the transference, by modeling other
ways of treating the self and others, and through developing new skills like
assertiveness either through cognitive-behavioral skills training or the use
Developing as an Integrative Scientist Practitioner 25

of chair tasks in experiential psychotherapy where clients learn how to

negotiate with self and others.
Irrespective of focus it is unlikely that these different activities occur
independently of each other and probably the activation of one promotes
the activation of the others. However, there are possibly qualitative differ-
ences in how clients engage in each of these activities that can be enhanced
or facilitated in psychotherapy. Research indicates that vivid concrete
description of events is related to successful outcome in psychodynamic
psychotherapy and the successful resolution of in-session tasks and out-
come in experiential psychotherapy (Buccie, 1985; Watson, Goldman &
Greenberg, 1996; Watson & Rennie, 1994). This would suggest that there
are types of storytelling or descriptions of events that are likely to be more
productive than others. Similarly it is possible that there are optimal levels
of emotional arousal to facilitate clients’ reprocessing of traumatic and
problematic experiences (Rimé et al., 1991). The experiencing scale (Klein,
Mathieu-Coughlan, & Kiesler, 1986) suggests that productive process in
therapy not only requires clients to be able to represent what is happening
in the outside world but this also needs to be integrated with their own
subjective world view including their interpretations, feelings, values, and
goals in order for clients to achieve shifts in their experience of themselves,
others, and their environments. The experiencing scale provides a model of
meta-cognitive processing that facilitates clients’ resolution of problematic
aspects of their experience and the way in which clients reflexively examine
it. Thought records facilitate similar processes in cognitive-behavioral psy-
chotherapy. Awareness of how to facilitate each of these processes effec-
tively within each approach will enhance our practice and contribute to the
development of an integrative model.
My doctoral work laid the conceptual and methodological foundations
for my subsequent work; more specifically it provided the framework for an
integrative treatment model combining cognitive-behavioral and process-
experiential interventions that has been presented in the book I have
coauthored with Kennedy-Moore (1999). Thus my development as an
integrative scientist-practitioner was spawned early by my interest in pan-
theoretical aspects of counseling including psychotherapy research and the
role of the therapeutic relationship. My integrative learnings were fostered
by Laura, who encouraged her students to participate as volunteers at one
of the first meetings of the Society for Exploration of Psychotherapy
Integration (SEPI) held in Toronto in 1986. However, my membership
lapsed during those early years as I struggled to find my own voice. It was
only after I completed my dissertation that an integrative vision coalesced
for me and made membership of SEPI an important part of my profes-
sional development. This participation and involvement has been sup-
26 Watson

ported and encouraged by Marvin Goldfried, Art Bohart, Leslie Green-

berg, and Franz Caspar.

THE MIDDLE YEARS

Toward the end of my graduate training, my purist approach to client-

centered practice was challenged when I became involved in the depression
project funded by the National Institute of Mental Health at York Uni-
versity with Laura Rice and Les Greenberg. The objective of the research
was to compare the efficacy of both client-centered and experiential psy-
chotherapy in the treatment of depression. Process-experiential therapy
combines gestalt and client-centered techniques. I was recruited as both a
research associate and therapist. Throughout my training I had been skep-
tical of gestalt approaches. I viewed them as too challenging, too confron-
tational with clients. Gestalt therapy seemed to lack the respect and
empathic attunement that I so prized in client-centered therapy. However,
I was aware that Leslie Greenberg had worked to integrate a client-
centered relationship philosophy with more emotionally focused gestalt
techniques. Together he, Laura Rice, and Robert Elliott (1993) had devel-
oped a marker-guided approach to therapy and started training their
students. However, as a result of my doctoral research and my changing
understanding of the functions of different types of symbolic representa-
tion and affective arousal, I began to see the potential of the other
techniques to facilitate clients’ access to their emotional experience during
the session. As long as I remained empathically attuned to my client, I felt
I could use these techniques to enhance my therapeutic approach. Initially,
I struggled, I was nervous of taking over a session, of losing my listening
ear. It was not easy to deliberately take charge and steer the session in a
particular direction. I knew how to focus a client with reflections but to ask
them to change chairs and engage in activities that they did not initiate was
very foreign to me at first. Gradually it became easier, as I developed a
map, and was no longer concerned about what to do at every little curve in
the road.
While on the York Depression Project, I was hired to a faculty position
at the University of Windsor. During this period I extended the examina-
tion of clients’ cognitive-affective processes to the study of 2 other change
events: the resolution of unfinished business and conflict splits. This work
sought to illuminate the relationship between clients’ internal processes
and specific therapeutic interventions. More specifically in this work we
began to articulate more clearly the relationship between process and
outcome and to identify the steps that clients need to perform for success-
ful resolution of specific in-session tasks and post therapy outcome in
Developing as an Integrative Scientist Practitioner 27

process-experiential psychotherapy (Watson & Greenberg, 1996; Green-

berg & Watson, 1998a; Watson & Greenberg, 1995).
My research into clients’ subjective experiences was furthered by data
I collected on the York Depression Project, partially funded by a small
scale Social Sciences and Humanities Research Council of Canada
(SSHRC) grant while I was at the University of Windsor. In this study I
examined clients’ subjective experiences of resolving other change events
specifically empty chair work to resolve unfinished business with significant
others. The preliminary model that I developed illuminates the specific
cognitive-affective client processes involved in the resolution of an empty
chair task (Watson, 1996). The model of clients’ cognitive-affective pro-
cesses, in the resolution of unfinished business tasks, extends the findings
from my dissertation research. Together they begin to illuminate the
differential client processes that are facilitated by specific therapeutic
interventions. In addition, I have investigated the relationship between
clients’ affective expression and reflexivity in client-centered and process-
experiential psychotherapy with outcome (Watson, 1999). The models
have been very useful in guiding revisions to theory and practice and it is
hoped will begin to provide the theoretical framework for an informed
eclecticism and integrative practice. This work has been developed further
in the book I wrote on the role of emotional expression in psychotherapy
(Kennedy-Moore & Watson, 1999). The models have been incorporated
into the integrative treatment model to facilitate clients’ processing and
expression of emotion in the session.
My interest in psychotherapy process and the variables that contribute
to its success or failure include an examination of the interpersonal pro-
cesses between clients and therapists. This focus has resulted in a number
of chapters and articles on the therapeutic alliance and therapists’ expres-
sion of empathy in therapy (Watson & Greenberg, 1994, 1995, 1998, 2000;
Watson, Goldman & Vanaerschot, 1998; Watson, 2001, Watson & Gelker,
2005). My interest in the alliance was rooted in Rogers’ relationship
conditions and fostered by my research into clients’ subjective experiences
in psychotherapy, spurred by Dr. David Rennie’s (1992) work on clients’
deference during therapy sessions. The important role of the alliance in
facilitating clients’ resolution of problematic reactions became clear in my
dissertation research and prompted a revision of the model of therapist
operations. This work resulted in a greater emphasis on metacommunica-
tion by therapists to facilitate agreement with clients on the tasks and goals
of therapy and to establish a collaborative bond between the participants.
More recently, I have analyzed clients’ and therapists’ behaviors from
therapy transcripts using Lorna Benjamin’s (1974) model for the Structural
Analysis of Social Behavior. This work was funded by a small scale SSHRC
grant at Ontario Institute for Studies in Education, University of Toronto
28 Watson

(OISE⶿UT). The primary objective was to isolate specific therapist behav-

iors that are related to good outcome in therapy and those that are related
to poor outcome using data from the York Depression Study (Watson,
Enright, Kalogerakos, & Greenberg, 1998; Watson & Greenberg, 1998).
My developing integrative perspective and examination of pan-theo-
retical processes in psychotherapy as well as my allegiance to humanistic-
experiential therapies prompted me to turn my attention to the role of
therapist empathy in facilitating client changes in therapy. I have elabo-
rated the work of Drs. Greenberg and Elliott (1997) to identify different
types of empathic responses and the specific client markers or statements
at which these can be applied, in order to enhance teaching, research, and
practice (Watson, Goldman & Vanaerschot, 1998; Watson, 2001). More
recently after a review of the existing measures of empathy and the poor
relationship between client and external observer’s ratings of empathy, I
constructed a process measure of therapist-expressed empathy that shows
a positive relationship with the Barrett-Lennard Relationship Inventory, a
client self-report measure (Watson, 1999; Watson & Prosser, 2002).
My research interests provide the backbone to my teaching practice.
The 2 work together synergistically to extend and inform the other. My
research and scholarship serve to invigorate and support my teaching,
while the latter serves to challenge and push me to further explicate my
ideas as I share them with students and explore with them their own
diverse and unique perspectives. First at the University of Windsor and
then the University of Toronto, I have taught at both the undergraduate
and graduate level. At the undergraduate level I have taught introductory
courses in psychology as well as courses in abnormal psychology and
personality. At the graduate level I have taught courses in process-expe-
riential psychotherapy, clinical research design, theories and techniques of
counseling, and a practicum course.
Since joining the Department of Adult Education, Community Devel-
opment and Counseling Psychology at OISE/UT, I have designed and am
continuing to develop an integrative advanced level graduate course. Ini-
tially the course was on process-experiential theory and practice. However,
along with my thinking and the interests of my students, it evolved to have
more of an integrative focus. Currently the course provides a metatheo-
retical perspective of counseling theories and techniques. There is an
emphasis on clients’ cognitive-affective processes in psychotherapy as stu-
dents are exposed to a number of advanced counseling techniques. The aim
is to provide students with the opportunity to develop a metacognitive
perspective for their work so that they can incorporate and apply tech-
niques from different therapeutic modalities into a rational treatment plan.
In addition they are encouraged to explore how they might incorporate
emotionally focused techniques into their repertoire.
Developing as an Integrative Scientist Practitioner 29

Another course that I offer is Theories and Techniques of Counseling,

which covers different approaches to individual and family psychotherapy
including, humanistic, psycho-dynamic, cognitive-behavioral, systemic, and
constructivist among others. The course is a blend of lecture and seminar
formats. One of the primary objectives is to examine and integrate theory
and practice. Students are encouraged to think critically about the different
theories and carefully examine consistencies and inconsistencies between
theory and practice. In this way the course attempts to have students begin
to focus on clinical process and the factors that are important in therapy
irrespective of modality. To facilitate this learning students are encouraged
as part of their seminar presentations to present videos of therapists
working in the modality that they are reviewing. These presentations form
the basis of class discussion.
In keeping with APA requirements and the tenets of the Boulder
Model, I am committed to the development of scientist-practitioners. My
work in terms of graduate supervision thus encompasses both research and
clinical supervision. In each of these areas my primary intent is to help
students find their own voices and to develop to their fullest potential. I see
the tension in the scientist-practitioner divide best resolved with students
doing research in the area of clinical practice that most interests them. I am
thus committed to developing a group of researchers who are keen and
competent process-outcome researchers.
The development of clinical researchers is currently taking place in the
context of my Social Sciences and Humanities Research Council of Canada
grant. Over the past 2 years, a total of 9 graduate assistants worked with me
on the project. During this time they gained experience in research design
and implementation, including subject selection, clinical assessment, treat-
ment, administration and scoring of outcome measures, application of
process measures, and statistical analysis, and presenting papers at inter-
national conferences. Three students have collected data on the project for
their dissertations, which they are in the final stages of writing up, and
another five are developing dissertation proposals from the database.
My integrative perspective to teaching extends to the training of my
students in the use and application of psychotherapy process measures,
including Structural Analysis of Social Behavior (Benjamin, 1974); Verbal
Response Modes (Hill, 1982); and Clients’ Expressive Stance (Rice,
Watson & Greenberg, 1993), Measure of Expressed Empathy (Watson,
1999), the Experiencing Scale (Klein, Mathieu-Coughlan, Wagstaff, &
Kiesler, 1986), and Client Vocal Quality (Rice, Koke, Greenberg & Wag-
staff, 1979). These measures have been used for various research projects.
Training in psychotherapy process measures is an intensive, time-consum-
ing, and difficult endeavor. This type of in-depth analysis of psychotherapy
process is useful for the development of students clinical and research skills
30 Watson

and an important adjunct to the other types of learning experiences that

they receive.

CURRENT AND FUTURE PLANS

Today I easily blend client-centered and experiential techniques; a

more recent change has been a greater use of myself in the session,
especially humor and the use of emotionally focused therapy with couples.
My work has been influenced by my ongoing research into psychotherapy
process first with Les Greenebrg and subsequently with my own research
team as well as the research of Germain Lietaer (1998), Marvin Goldfried
(1980), Louis Castonguay (1990), Jeremy Safran (1990), David Rennie
(1992), Clara Hill (1986), Robert Elliott (1993), Lorna Benjamin (1986),
William Henry (1990), and Art Bohart (1999). Thiese influences have given
my work a more interpersonal flavor as I have learned to be more attentive
to the working alliance and especially sensitive to ruptures or times when
my clients seem resistant. However, I still always try to follow their lead. I
have found SASB to be an invaluable tool that has helped me to pull
together my earlier readings in psychodynamic theory. It has proven useful
in my clinical practice, research, and teaching. As a result of my research
I am now more aware of my clients cognitive-affective processing and
continue to search for ways to facilitate their affect regulation. Although I
continue to emphasize empathy and the therapeutic relationship in my
teaching and practice, I am aware of incorporating a variety of different
ways of being with my clients including empathic confrontation, empathic
challenges, relaxation training, a greater focus on the alliance, cultivating
self-soothing strategies in my clients, and alternative ways of regulating
their affect. I also share more observations about their functioning and
more teaching about how I see therapy working as well as my understand-
ing of what might be contributing to their current problems. I continue to
be challenged by my clients. There are times when my clients are reluctant
to do experiential tasks. Some feel that the tasks interfere with their own
processing style. When clients are resistant, I use more supportive tech-
niques like empathic responding and focusing techniques (Beutler et al.,
1991). However, I remain alert for times when experiential markers are
highly salient and will suggest an experiential task to my clients when these
appear. If clients are open to working with experiential tasks, and these can
be seamlessly woven into the fabric of the therapy, and we have a good
working alliance, then we do. In spite of my growth and development, I am
very aware of my limitations, and that there are many things I do not do
well and for which it is better to refer clients to people with more expertise
than I.
Developing as an Integrative Scientist Practitioner 31

A primary objective of the York Depression Project was to determine

whether client-centered or process-experiential therapy was more effective
in treating depression. In keeping with most other research studies on the
differential effectiveness of specific treatments (Dobson, 1989; Elkin et al.,
1989; Hollon, DeRubeis, & Evans, 1996; Jacobson et al., 1996; Lambert &
Bergin, 1994; Shapiro & Firth, 1987), we did not find differences between
the 2 approaches on measures of symptom reduction. Both approaches
were effective in reducing clients’ depressive symptoms. Although clients
did respond more quickly to the process-experiential treatment than the
client-centered, these differences were not significant at follow-up
(Watson, Goldman & Greenberg, 1996; Greenberg & Watson, 1998a,
1998b, 1998c Watson & Greenberg, 1996).
The success of the 2 approaches in treating depression prompted me to
investigate the comparative efficacy of experiential therapy with cognitive-
behavioral therapy. The latter has a proven track record in the treatment
of depression. It was important to replicate the findings from the York
Depression Study with a new sample and a more stringent comparison
group to demonstrate that an alternative humanistic approach can also be
successful in treating depression. To this end, I was awarded a SSHRC
grant in 1997 for 4 years to examine clients’ cognitive-affective processes in
psychotherapy beyond the process-experiential paradigm by comparing the
latter with cognitive-behavioral approaches. The results of the randomized
clinical trial were published in The Journal of Consulting and Clinical
Psychology in 2003 (Watson, Gordon, Stermac, Steckley, & Kalogogera-
kos, 2003). In this work I hope to illuminate the role of emotion in the
change process in 2 different therapeutic approaches so as to identify
similarities and differences within each. A primary objective of the re-
search is to examine the differential role of emotional arousal and expres-
sion in the change process (Watson & Bedard, 2006).
A 2nd goal of the study is to illuminate and explicate clients’ and
therapists’ in-session processes in cognitive-behavioral psychotherapy, as
these have not received much attention in the literature (Castonguay,
Goldfried, Wiser, Raue, & Hayes, 1996). It is anticipated that a comparison
and examination of the 2 approaches will enhance our understanding of the
differential effectiveness of the 2 therapies and will provide the framework
for an integrative approach that will incorporate the active ingredients of
each. This objective is in keeping with the strong trend toward integration
that is emerging in the field of psychotherapy. It is expected that this work
will further the development of the integrative treatment perspective, that
I began to formulate in the book I coauthored with Kennedy-Moore
(1999).
Clients’ interpersonal processes are being investigated further in my
3-year SSHRC grant with the examination of the role of clients’ childhood
32 Watson

attachment histories in the etiology of depression, and its relationship to

the maintenance and development of the therapeutic alliance, clients’
cognitive-affective processes and therapeutic outcome. To amplify my
integrative treatment perspective the specific interpersonal processes rel-
evant to cognitive-behavioral and process-experiential therapies will be
explicated.
In addition my students and I hope to further extend our understand-
ing of the change process by examining clients’ subjective experiences
during the resolution of conflict splits and specific periods of in-session
change in cognitive– behavioral therapy. Currently my doctoral students
are using qualitative methods to investigate therapists’ metacognitive strat-
egies in therapy, clients’ experience of connection in the therapeutic rela-
tionship, and the resolution of unfinished business.

GOALS FOR SEPI

As may be apparent from the direction of my work thus far, I think it

is important for us to work toward a unifying theory of human functioning
that will enable clinicians to practice an informed eclecticism (Lazarus &
Messer, 1991). Ideally, I envision the development of a taxonomy of
markers, or client statements, that indicate that clients are working on
specific issues or are stuck at particular points in their cognitive-affective
functioning, that would indicate the appropriate use of different techniques
from different schools. To this end I see the need for more intensive study
of specific change events in every modality as well as the continued
investigation of clients’ and therapist’ subjective experience to augment
our understanding as researchers and observers of the change process
(Bohart & Tallman, 1999; Toukmanian & Rennie, 1992). I continue to
believe as proposed by Goldfried (1980) that it is important for us not only
to work from the top down in developing theoretical models but that if we
are to inform practice and fully understand the uniqueness and similarities
of different therapeutic approaches we need to pay careful attention to
what therapists do in practice. To this end I think it is important to
encourage more intensive analysis of psychotherapy process (Jones &
Pulos, 1996; Wiser & Goldfried, 1993, 1998; Castonguay, Goldfried, Wiser,
Raue, & Hayes, 1996). Understanding at this level will serve to enhance
practice and facilitate the development of integrative treatment models
that can only serve to enhance our research and teaching as well.
As we continue to listen to the plurality of voices in psychotherapy I
am certain a unified integrative framework will emerge. This trend is
already evident in diverse practioner-scientists conception and formulation
Developing as an Integrative Scientist Practitioner 33

of optimal functioning (Rogers, 1959; Mahoney, 1991; Lazarus, 1997), I

have no doubt that it will continue to grow as we develop a unifying theory
to inform our technical eclecticism, even as we adhere to particular phi-
losophies and ways of being that allow us to use our own unique person-
hood as part of the therapeutic encounter.

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