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What is SPEAKS Therapy?
SPEAKS was co-developed by Dr Anna Oldershaw, Dr Helen Startup and Professor Tony Lavender. SPEAKS developed out of recognition that difficulties with emotion and emotion processing may underpin and maintain anorexia nervosa and that emotion focused interventions may be beneficial.
Emotion processing (i.e. how emotion productively changes) is a common therapeutic process across therapies, including Emotion Focused Therapy (EFT), Schema Therapy (ST), Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and psychodynamic psychotherapy (Pascual-Leone, 2018). Models differ in the way they may target emotional change, but these methods are all thought to represent subtypes of emotion processing which include aspects of: awareness, affective arousal, down regulation, cognitive reflection on emotion and emotion transformation. Mapping out emotional change (understanding key emotional states and productive transitions between them) enables building of causal models of how people can get better, and which methods might best facilitate such changes. A lack of focus upon the process of change for anorexia, including emotional change, has been argued to be a barrier to better treatments being delivered, and therefore this approach was considered valuable in developing SPEAKS.
In a 5 year research program funded by the National Institute for Health and Care Research, SPEAKS sought to consult with a range of people with lived experience, families and therapists to better understand what changes in emotion may be linked to recovery and how those changes may best be facilitated in therapy. By developing a theory of anorexia as a ‘lost emotional self’ arrived at through a persistent lack of connection with good emotional information to guide people in their lives, SPEAKS highlighted a target for therapy of a reconfigured, resilient and integrated sense of self that demonstrates acceptance of and connection with emotion, and can act with self-agency and self-efficacy in using that good emotional information to get needs met in healthy ways. This was further elaborated on in work with people recovered from anorexia who described this self as “The Real Me.”
Based on this, we ‘mapped out’ a hypothesised sequential emotion change process to help support people to find and connect with “The Real Me”, drawing on emotion change theory developed in the field of Emotion Focused Therapy.
At its heart therefore, SPEAKS has a causal and sequential model of emotion change leading to self-efficacy and self-agency. The next step was to consider which therapeutic approaches and methods may best facilitate such change. The result is an integrated therapeutic intervention, with suggested tasks and techniques drawing most heavily on elements of psychological practice from Emotion Focused Therapy and Schema Therapy, but also elements of CBT and psychodynamic psychotherapy. These are flexibly and sensitively used by therapists in a phased approach that both ‘follows and guides’ the client. Therapists move between tasks with a more emotional, cognitive or behavioural basis where appropriate, seeking to support ‘meaning bridges’ between emotional and cognitive change. This approach also recognises that tolerance for emotion work will vary, with clients accessing emotional processing in different ways and some more deeply or experientially than others.
SPEAKS is organised into five phases of therapy, each with associated change processes and suggested useful therapeutic ‘tasks’ identified. These are to be flexibly used by therapists with recognition that clients may move backwards and forwards between phases. The available SPEAKS Foundations training provides an overview of the change process and skills training in some of the key tasks/techniques. SPEAKS was written into a guidebook for therapists which we hope will be available soon.
Emotion Speaks is the professional website of Dr Anna Oldershaw, clinical psychologist, Director of Emotion Focused Therapy Institute of England and co-developer of SPEAKS.
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