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We've been passing on your details to our developers and they have already rolled out several improvements to fix the experience reported.
While the number of new reports seems to have dropped significantly since updates to both the Spotify app and watchOS in the last couple of months, we are aware that some users do still experience issues streaming directly from their Apple Watch, but our tech teams weren't able to reproduce it and this seems to be affecting specific devices or setups, so we're unable to find a solution remotely.
A common solution that we see has been reported working is to do a factory reset on the Apple Watch and add it back as a new watch vs. restoring a backup.
Also, keep in mind that the built-in speaker in the watch cannot be used for music playback by Spotify and you’ll need to have headphones connected to the watch via Bluetooth.
We hope this helps. If you still need a hand, you can start a new topic in the relevant help board, including all the steps you've tried so far and the outcome, and we'll take it from there.