SPEAKS EXPLAINED

SPEAKS Therapy for Anorexia Nervosa

SPEAKS (Specialist Psychotherapy with Emotion for Anorexia) is a longer-term, integrative psychotherapy developed specifically for adults with anorexia nervosa who feel emotionally stuck, ambivalent about change, or unable to benefit fully from first-line eating disorder treatments.

At The London Centre for Eating Disorders and Body Image, SPEAKS is offered as a specialist intervention, delivered by SPEAKS trained clinicians who have advanced training in emotion-focused and schema-informed psychotherapy.

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SPEAKS EXPLAINED

What Is SPEAKS?

SPEAKS is an emotion-focused, process-based psychotherapy that targets emotion as the core mechanism of change, rather than focusing primarily on eating-disorder behaviours.

It integrates Emotion-Focused Therapy (EFT) and Schema Therapy (ST) to help individuals identify, access, and transform long-standing emotional patterns that maintain anorexia nervosa.

SPEAKS was developed by Anna Oldershaw, Helen Startup, and Tony Lavender, in response to evidence that many individuals with anorexia remain unwell despite receiving evidence-based first-line treatments.

SPEAKS explained

Why was SPEAKS developed?

While specialist eating-disorder therapies are effective for many people, outcomes are more limited for those with:

  • Longer illness duration
  • Multiple prior treatments
  • High emotional avoidance or emotional over-control

Research suggests that behaviour change cannot be sustained when the eating disorder continues to serve an emotional function. For many individuals, anorexia helps regulate, suppress, or communicate distress, making behavioural change feel unsafe or impossible.

SPEAKS was developed to go beyond symptom management, focusing instead on:

  • Resolving stuck emotional patterns
  • Processing core emotional pain
  • Supporting deeper psychological change
speaks explained

Who Is SPEAKS Suitable For?

SPEAKS is designed for adults with:

  • Anorexia nervosa
  • Anorexia-type OSFED

It may be particularly helpful if you:

  • Have had limited benefit from first-line therapies
  • Have a longer illness history or multiple previous treatments
  • Experience significant ambivalence, emotional detachment, or feeling “stuck”
  • Have co-occurring difficulties such as anxiety, depression, trauma, or personality traits
  • Are neurodivergent, including autistic or ADHD traits, and find emotion-based work challenging but necessary

Within NHS services, SPEAKS is increasingly used as a second-line treatment pathway for complex or enduring anorexia presentations.

How We Support you

How Does SPEAKS Works?

SPEAKS is typically delivered over longer-term treatment (often around one year), within a multidisciplinary framework where medical risk, dietetic input, and psychiatric care are held alongside psychotherapy.

Key features include:

  • Weekly individual psychotherapy sessions
  • A structured, goal-oriented approach that includes, but goes beyond, eating-disorder symptoms
  • Weighing and physical monitoring held outside the therapy session
  • A strong emphasis on emotional safety, collaboration, and therapeutic relationship

Eating-disorder behaviours are understood to reduce naturally as emotional needs are identified, processed, and met in healthier ways.

The core theory behind SPEAKS

SPEAKS is based on the understanding that Underlying difficulties with emotion contribute to the development and maintenance of anorexia nervosa.

When emotions are avoided, suppressed, or experienced as dangerous, anorexia can become a powerful coping strategy providing control, numbing, safety, or a way of expressing distress without words.

SPEAKS focuses on:

  • Identifying different types of emotion (primary adaptive, primary maladaptive, secondary)
  • Working with different parts of self (e.g. inner critic, coping modes, eating-disorder part)
  • Transforming maladaptive emotional responses so that adaptive emotions can emerge
  • Understanding unmet emotional needs

Emotional difficulties are a well-recognised core feature of anorexia nervosa, including:

  • Over-control or avoidance of emotion
  • Difficulty recognising or naming feelings
  • Beliefs that emotions are dangerous, weak, or unacceptable
  • Use of starvation to suppress emotional experience
  • Using the body and weight loss to communicate distress non-verbally

SPEAKS helps individuals safely reconnect with emotion, understand what it is communicating, and respond with care rather than control.

Why focus on emotion in anorexia?

SPEAKS

The Five Phases of SPEAKS Therapy

Phase 1: Engagement and Formulation
Building safety, trust, and a shared emotional formulation. Therapy focuses on mapping emotional parts, introducing emotion as information, and establishing collaborative goals.

Phase 2: Seeing Through the Façade
Reducing the dominance of the eating-disorder part, building emotional language, and strengthening motivation for change.

Phase 3: Deepening to Core Pain
Carefully accessing and staying with core emotional pain linked to unmet developmental needs, while strengthening emotional regulation and tolerance.

Phase 4: Resolving Core Pain
Transforming maladaptive emotions through imagery, chair work, and rescripting, allowing new meaning, compassion, and adaptive emotion to emerge.

Phase 5: Emergence of the “Real Me”
Consolidating change, strengthening identity beyond the eating disorder, grieving the loss of the illness, and preparing for ending therapy.

What is the aim of SPEAKS?

The aim of SPEAKS is not simply symptom reduction, but the emergence of an authentic, emotionally connected sense of self, sometimes described as the “real me”.
As emotional needs are recognised and met:

  • The eating disorder becomes less necessary
  • Emotional resilience increases
  • Identity expands beyond illness
  • Recovery becomes more sustainable

At The London Centre for Eating Disorders and Body Image, SPEAKS is delivered by clinicians with specialist expertise in:

  • Eating-disorder psychology
  • Emotion-focused psychotherapy
  • Schema-informed approaches
  • Complex and enduring presentations

Treatment is always individualised, carefully risk-managed, and integrated within a broader multidisciplinary plan where needed.

SPEAKS at The London Centre

Start your journey

Considering SPEAKS Therapy?

If you feel stuck, ambivalent, or emotionally disconnected in your recovery from anorexia nervosa, SPEAKS may offer a different way forward.

Contact our team to discuss whether SPEAKS therapy is suitable for you, or to arrange an initial specialist assessment.

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