"It's OK for Me to Cry": Client and Therapist Perspectives on Change Processes in SPEAKS Therapy for Anorexia Nervosa

Existing therapies for Anorexia Nervosa (AN) have limited effectiveness, necessitating the development of novel therapies and interventions. Hypothesizing and targeting clear mechanisms of change within treatment offer potential opportunities to improve them. The SPEAKS program aimed to develop, trial, and evaluate a therapy which targets key emotional and social factors known to be relevant in the development and maintenance of AN. The aim of the present study is to explore therapist and client experiences of change processes during the SPEAKS intervention, and what supported or inhibited these.

Semi-structured interviews were conducted with sixteen female clients (in age range of 18-49) and six therapists; topic guides explored perceptions of client change processes. Thematic analysis was conducted on the data by two researchers.

Two themes and six sub-themes were developed from the data. These were: "the impact on the eating disorder," "change processes" ("emotional change" and "changing the self"), and "facilitators of and barriers to change processes" ("therapeutic relationship," "clients' emotional engagement," "online delivery," and "therapist lacking flexibility"). "Emotional change" involved an enhanced capacity for clients to tune-in more, acknowledge, listen to, and express how they felt, and "Changing the self" represented a shift in how clients related to themselves, particularly the more vulnerable parts of themselves.

The findings of the present study provide support for the hypothesized mechanisms of change inherent within the SPEAKS therapy approach. This supports the robustness and validity of the intervention and lends support for further investigation of its effectiveness.

The study was registered according to the guidelines of the International Standard Randomized Controlled Trial Number Register (ISRCTN No. 11778891).