Sign Up Submit Enquiry

Exploring the Discourse Attributes of Referential Process in Emotion Focused and Cognitive Behavioral Therapies for Depression

Home Exploring the Discourse Attributes of Referential Process in Emotion Focused and Cognitive Behavioral Therapies for Depression

Related Articles

Contact us

Article Content

Abstract

Referential process (RP) refers to how nonverbal experiences are translated into verbal forms, and it has been proposed as a foundational framework for understanding psychotherapeutic change (Bucci, 1993; Bucci, Maskit, & Murphy, 2016; Bucci, 2013). While most of the prior research has examined RP in the context of psychodynamic psychotherapy and single-case designs, the current study examined RP in Cognitive Behavioral Therapy (CBT) and Emotion Focused Therapy (EFT) for 40 depressed clients. The Discourse Attributes Analysis Program (DAAP; Maskit, Bucci, & Murphy, 2012) was employed to evaluate discourse attributes within 80 session transcripts. Generalized Estimating Equation (GEE) was used to analyze the data. There was a higher occurrence of affect words in EFT transcripts and a higher occurrence of reflection words in CBT transcripts reflecting each approach’s theory of change. The results of the study highlighted the therapists’ ability to effectively connect to their experiences and articulate themselves clearly to clients. Among the highest client-rated sessions, therapists of good outcome clients used more concrete, imagistic, specific, and clear language compared to therapists of poor outcome clients. Therapists of the good outcome group had higher WRADM (weighted referential activity mean) scores ((β =.018, p =.006) and WRADHP (weighted referential activity high proportion) scores (β =.059, p =.008). Moreover, clients’ session ratings increased as therapists’ WRADM (β = 15.08, p =.017) and WRADHP (β = 4.12, p =.032) increased. Contrary to the hypotheses, clients’ WRADM, WRADHP, and WRAD/WRRL did not differ between highest and lowest-rated sessions, nor did they predict clients’ session ratings. Clients in the two outcome groups also did not differ in terms of how much they symbolized and then reflected on their experiences. Clinical, theoretical, and measurement implications, limitations, and directions for future research are discussed.

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

  • Communication Psychology
  • Discourse Research
  • Discourse Analysis
  • Person-Centered Psychotherapy
  • Pragmatics
  • Psychodynamics

Data Availability

Due to the sensitive nature of the data (e.g., client privacy), the datasets are not publicly available but may be available from the corresponding author on reasonable request.

References

  • Anderson, T., & Patterson, C. (2013). Facilitative interpersonal skill task and rating method revised. Unpublished manuscript, Department of Psychology, Ohio University.

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571.

    Article PubMed Google Scholar

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford.

  • Ben-Meir, M., & Adelphi University. (2005). The nature of language in anorexia nervosa: a multiple code account (Doctoral dissertation, 2006). Dissertation Abstracts International: Section B: The Sciences and Engineering, 66(11-B), 6260.

  • Borkovec, T. D., Roemer, L., & Kinyon, J. (1995). Disclosure and worry: Opposite sides of the emotional processing coin. In D. M. Wegner, & J. W. Pennebaker (Eds.), Handbook of mental control (pp. 340–365). Prentice-Hall.

  • Bucci, W. (1985). Dual coding: A cognitive model for psychoanalytic research. Journal of the American Psychoanalytic Association, 33(3), 571–607. https://doi.org/10.1177/000306518503300305

    Article PubMed Google Scholar

  • Bucci, W. (1993). The development of emotional meaning in free association: A multiple code theory. In A. Wilson, & J. E. Gedo (Eds.), Hierarchical conceptions in psychoanalysis (pp. 3–47). Guilford.

  • Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory. Guilford Press.

  • Bucci, W. (2002). The referential process, consciousness, and the sense of self. Psychoanalytic Inquiry, 22(5), 766–793. https://doi.org/10.1080/07351692209349017

    Article Google Scholar

  • Bucci, W. (2011). The role of embodied communication in therapeutic change: A multiple code perspective. In W. Tschacher, & C. Bergomi (Eds.), The implications of embodiment: Cognition and communication (pp. 209–228). Imprint Academic.

  • Bucci, W. (2013). The referential process as a common factor across treatment modalities. Research in Psychotherapy: Psychopathology Process and Outcome, 16(1), 16. https://doi.org/10.4081/ripppo.2013.86

    Article Google Scholar

  • Bucci, W., & Freedman, N. (1981). The Language of depression. Bulletin of the Menninger Clinic, 45, 334–358.

    PubMed Google Scholar

  • Bucci, W., & Maskit, B. (2007). A weighted dictionary for referential activity. https://doi.org/10.1007/1-4020-4120-0-6

  • Bucci, W., Maskit, B., & Murphy, S. (2016). Connecting emotions and words: The referential process. Phenomenology and the Cognitive Sciences, 15(3), 359–383.

    Article Google Scholar

  • Derogatis, L. R., Rickels, K., & Roch, A. F. (1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. The British Journal of Psychiatry, 128(3), 280–289. https://doi.org/10.1192/bjp.128.3.280

    Article PubMed Google Scholar

  • Elliott, R., Watson, J. C., Goldman, R., & Greenberg, L. S. (2004). Learning emotionally focused therapy: The process experiential approach to change. APA Books.

  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.

    Article PubMed Google Scholar

  • Greenberg, L. S., & Foerster, F. S. (1996). Task analysis exemplified: The process of resolving unfinished business. Journal of Consulting and Clinical Psychology, 64, 439–446.

    Article PubMed Google Scholar

  • Greenberg, L. S., & Paivio, S. C. (1997). Working with emotions in psychotherapy. Guilford Press.

  • Greenberg, L. S., & Pascual-Leone, A. (2006). Emotion in psychotherapy: A practice-friendly research review. Journal of Clinical Psychology, 62(5), 611–630. https://doi.org/10.1002/jclp.20252

    Article PubMed Google Scholar

  • Greenberg, L. S., & Watson, J. C. (2006). Emotion-focused therapy for depression. American Psychological Association. https://doi.org/10.1037/11286-000

  • Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment-by- moment process. Guilford Press.

  • Greenberg, L. S., Watson, J. C., & Lietaer, G. (1998). Handbook of experiential psychotherapy: Foundations and differential treatment. Guilford.

  • Greenberger, D., & Padesky, C. (1995). Mind over mood: A cognitive therapy treatment manual for clients. Guilford Press.

  • Hanley, J. A., Negassa, A., Forrester, J. E., & Edwardes, M. D. (2003). Statistical analysis of correlated data using generalized estimating equations: An orientation. American Journal of Epidemiology, 157(4), 364–375. https://doi.org/10.1093/aje/kwf215

    Article PubMed Google Scholar

  • Homish, G. G., Edwards, E. P., Eiden, R. D., & Leonard, K. E. (2010). Analyzing family data: A GEE approach for substance use researchers. Addictive Behaviors, 35(6), 558–563. https://doi.org/10.1016/j.addbeh.2010.01.002

    Article PubMed PubMed Central Google Scholar

  • Hong, J., & Watson, J. C. (2018). Examining the Relations among Autobiographical Memory Recall Types, Quality of Descriptions, and Emotional Arousal (Unpublished master’s thesis). University of Toronto, Toronto, Ontario.

  • Horowitz, L. M., Rosenberg, S. E., Baer, B. A., Ureño, G., & Villaseñor, V. S. (1988). Inventory of interpersonal problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology, 56(6), 885–892. https://doi.org/10.1037/0022-006X.56.6.885

    Article PubMed Google Scholar

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/0022-006X.59.1.12

    Article PubMed Google Scholar

  • Jennings, L., & Skovholt, T. M. (1999). The cognitive, emotional, and relational characteristics of master therapists. Journal of Counseling Psychology, 46(1), 3–11.

    Article Google Scholar

  • Josefowitz, N. (2017). Incorporating imagery into thought records: Increasing engagement in balanced thoughts. Cognitive and Behavioral Practice, 24(1), 90–100. https://doi.org/10.1016/j.cbpra.2016.03.005

    Article Google Scholar

  • Kennedy-Moore, E., & Watson, J. C. (1999). Expressing emotion: Myths, realities, and therapeutic strategies. Guilford Press.

  • Kingsley, G. (2010). The clinical validation of measures of the referential process. (Doctoral dissertation). Retrieved from ProQuest. (AAT 3377938).

  • Liang, K. Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73(1), 13–22.

    Article Google Scholar

  • Maskit, B. (2021). Overview of computer measures of the referential process. Journal of Psycholinguistic Research, 50(1), 29–49. https://doi.org/10.1007/s10936-021-09761-8

    Article PubMed Google Scholar

  • Maskit, B., Bucci, W., & Murphy, S. (2012). Computerized language measures. Retrieved from https://sites.google.com/site/referentialprocess/dictionary-measures-and-computer-programs

  • Okiishi, J., Lambert, M. J., Nielsen, S. L., & Ogles, B. M. (2003). Waiting for supershrink: An empirical analysis of therapist effects. Clinical Psychology and Psychotherapy, 10, 361–373.

    Article Google Scholar

  • Pos, A. E., Greenberg, L. S., Goldman, R. N., & Korman, L. M. (2003). Emotional processing during experiential treatment of depression. Journal of Consulting and Clinical Psychology, 71(6), 1007–1016. https://doi.org/10.1037/0022-006X.71.6.1007

    Article PubMed Google Scholar

  • Rice, L. N. (1974). The evocation function of the therapist. In D. Wexler, & L. N. Rice (Eds.), Innovations in client-centered therapy (pp. 289–312). Wiley Interscience.

  • Rice, L. N., & Saperia, E. (1984). A task analysis of the resolution of problematic reaction. In L. N. Rice, & L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapy process (pp. 29–66). Guilford Press.

  • Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive behavioral treatment for generalized anxiety disorder: From science to practice (2nd ed.). Routledge/Taylor & Francis Group. https://doi.org/10.4324/9781315709741

  • Rosenberg, M. (1965). Society and the adolescent self-image. Princeton University Press.

  • Watson, J. C., & Greenberg, L. S. (1996). Emotion and cognition in experiential therapy: A dialectical constructivist perspective. In H. Rosen, & K. T. Keuhlwein (Eds.), Constructing realities: Meaning making perspectives for psychotherapists (pp. 253–274). Jossey-Bass.

  • Watson, J. C., & Rennie, D. L. (1994). Qualitative analysis of clients’ subjective experience of significant moments during the exploration of problematic reactions. Journal of Counseling Psychology, 41(4), 500–509. https://doi.org/10.1037/0022-0167.41.4.500

    Article Google Scholar

  • Watson, J. C., Greenberg, L. S., Rice, L. N., & Gordon, L. B. (1999). Client task-specific measure- revised. Unpublished manuscript, Department of Adult Education and Counselling Psychology, OISE/University of Toronto.

  • Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the 275 treatment of depression. Journal of Consulting and Clinical Psychology, 71(4), 773–781. https://doi.org/10.1037/0022-006X.71.4.773

    Article PubMed Google Scholar

  • Watson, J. C., & Bedard, D. L. (2006). Clients’ emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies. Journal of Consulting and Clinical Psychology, 74(1), 152–159. https://doi.org/10.1037/0022-006X.74.1.152

  • Watson, J. C., Schein, J., & McMullen, E. (2010). An examination of clients’ in-session changes and their relationship to the working alliance and outcome. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 20(2), 224–233. https://doi.org/10.1080/10503300903311285

  • Weissman, A. N., & Beck, A. T. (1978). Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Paper presented at the meeting of the Association for the Advancement of Behavior Therapy, Chicago, IL.

  • Zhou, Y., Maskit, B., Bucci, W., Fishman, A., & Murphy, S. (2021). Development of WRRL: A new computerized measure of the reflecting/reorganizing function. Journal of Psycholinguistic Research, 50(1), 51–64. https://doi.org/10.1007/s10936-021-09762-7

    Article PubMed Google Scholar

Author information

Authors and Affiliations

  1. University of Toronto, Toronto, Canada

    Jinny Hong & Jeanne C. Watson

Corresponding author

Correspondence to Jinny Hong.

Ethics declarations

Declarations

The authors of this paper declare that this paper is an authentic and original representation of their work, and collaborative efforts have been duly acknowledged and referenced. The authors adhered to ethical protocols and guidelines for research conducted at the University of Toronto and ensured the protection and responsible handling of sensitive data. This article is based primarily on the first author’s dissertation. The second author acted as the first author’s research supervisor, and both authors contributed to the study’s conception and design. Jinny Hong wrote the first draft of the manuscript and the second author commented on the previous versions. Both authors read and approved the final manuscript.

Competing Interests

The authors have no competing interests to declare relevant to this article’s content.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Cite this article

Hong, J., Watson, J.C. Exploring the Discourse Attributes of Referential Process in Emotion Focused and Cognitive Behavioral Therapies for Depression. J Psycholinguist Res 54, 39 (2025). https://doi.org/10.1007/s10936-025-10151-7

  • Accepted
  • Published
  • DOI  https://doi.org/10.1007/s10936-025-10151-7

Keywords

  • Referential Process
  • Referential Activity
  • Depression
  • Emotion Focused Therapy
  • Cognitive Behavioral Therapy

Copyright © All rights reserved Designed and Developed by Digital Flavers

WhatsApp