SPEAK Clinical Guidebook

Transforming Emotional Pain and Rediscovering the Self in Anorexia Nervosa:
A Clinical Guide

Authors: Dr. Anna Oldershaw, Dr. Helen Startup, and Dr. Tony Lavender
Publisher: Routledge (2025)
ISBN: 9781032741727

Transforming Emotional Pain and Rediscovering the Self in Anorexia Nervosa introduces the SPEAKS approach—an innovative, integrative treatment model for adults with anorexia nervosa. Rooted in Emotion-Focused Therapy (EFT) and Schema Therapy, and integrating learnings from client lived experience, it describes a clear model of change linked to recovery from anorexia that addresses its emotional underpinnings. This model shifts the therapeutic focus from solely addressing eating disorder symptomatic eating thoughts and behaviours to exploring and healing underlying emotional difficulties.

The book provides a clear rationale for the centrality of emotion in understanding anorexia, detailing the blocks to emotional experiencing and how these contribute to the development and maintenance of the disorder. It offers practical guidance for clinicians, including detailed interventions and case examples, to facilitate emotional processing, emotional healing and self-reconnection and growth in clients.

  • SPEAKS Model: The SPEAKS structured, phased treatment approach integrating EFT and Schema Therapy techniques is outlined clearly, including aims of each phase, techniques to facilitate these therapeutic aims and guidance on when moving to a new phase is indicated.
  • Focus on Emotional Processing: Using clear theory and research, it argues for and emphasises the importance of addressing emotional avoidance and transforming ‘stuck’ emotion experiences (such as shame) during treatment.
  • Practical Interventions: The therapy includes techniques like chairwork, guided imagery and memory work. Each technique is explained in the book with detailed step-by-step instructions for therapists, including suggested adaptations for neurodivergent clients.
  • Case Examples: Throughout the book, readers follow a case example through her treatment and her change, illustrating application of the model in clinical practice.

Wow! This guidebook on SPEAKS, a new and evidence-based theory and treatment for adults with anorexia nervosa is a triumph. It takes therapeutic understanding and working with emotion to a whole new level. In accessible prose and via helpful diagrams the reader is shown very practically, how to help patients find, use and strengthen their emotional selves to facilitate change and recovery. Whatever your therapeutic orientation, this book will be an extremely useful resource. I learnt so much from it.

Ulrike Schmidt OBE, Professor of Eating Disorders, King’s College London and Consultant Psychiatrist, Maudsley Hospital

Here is a book that is simultaneously scientifically rigorous, theoretically rich and highly practical. It provides the reader with everything one needs to know to apply this approach. It offers a novel emotion based theory based on the facilitation of the experience of emotion and emotional vulnerability to regain a lost sense of an emotional self. It doesn’t stop here but offers a highly detailed treatment manual, tested it in a feasibility trial based on connecting with and resolving core pain by transforming emotion with new adaptive emotions. This is a must read for anyone interested in the treatment of Anorexia Nervosa and would be an interesting, clinically, and theoretically rich, worthwhile read for practitioners of all persuasions.

Leslie Greenberg, Distinguished Research Professor Emeritus, Dept. of Psychology, York University, Toronto, Ontario, Canada

This book presents a guide that has been needed for a long time: an integrated treatment (Emotion Focused Therapy and Schema Therapy) for one of the most severe and difficult to treat mental health presentations, Anorexia Nervosa. Instead of primarily targeting the over control of weight, this new treatment focuses on the underlying emotional issues, which in most treatments to date are not seriously addressed. An absolute must for any clinicians working in this field!

Arnoud Arntz, professor emeritus, University of Amsterdam

The first line treatments for anorexia nervosa have been established for over fifty years. However, the second step for those with a more complex form of illness including forms of neurodiversity has been uncertain. SPEAKS fills this gap by combining strategies developed to shift unhelpful beliefs and emotional reactions that lead development to become stuck and entangled with the eating disorder. This book provides clear illustrations and guidance derived from clinical expertise and research wisdom.

Janet Treasure, OBE PhD FRCP FRCPsych, Professor of Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London

This clinical guide is essential for:

  • Eating Disorder Therapists – Psychologists, counsellors, and therapists seeking effective methods for treating eating disorders, especially where presentations are complex, longstanding or include neurodivergence.
  • Therapists with an interest in chairwork, Emotion Focused Therapy and Schema Therapy – Any psychologists, counsellors, and therapists looking for clear and practical resources for delivering and integrating these therapeutic interventions and techniques.
  • Clinical Researchers: Researchers and supervisors who have an interest in emotion theory and its application in clinical practice.

Transforming Emotional Pain and Rediscovering the Self in Anorexia Nervosa: A Clinical Guide is available through major booksellers, including: