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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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Semi\u2010structured interviews were conducted with sixteen female clients (in age range of 18\u201349) and six therapists; topic guides explored perceptions of client change processes. Thematic analysis was conducted on the data by two researchers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two themes and six sub\u2010themes were developed from the data. These were: \u201cthe impact on the eating disorder,\u201d \u201cchange processes\u201d (\u201cemotional change\u201d and \u201cchanging the self\u201d), and \u201cfacilitators of and barriers to change processes\u201d (\u201ctherapeutic relationship,\u201d \u201cclients\u2019 emotional engagement,\u201d \u201conline delivery,\u201d and \u201ctherapist lacking flexibility\u201d). \u201cEmotional change\u201d involved an enhanced capacity for clients to tune\u2010in more, acknowledge, listen to, and express how they felt, and \u201cChanging the self\u201d represented a shift in how clients related to themselves, particularly the more vulnerable parts of themselves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>The study was registered according to the guidelines of the International Standard Randomized Controlled Trial Number Register (ISRCTN No. 11778891).<\/jats:p><\/jats:sec>","DOI":"10.1002\/jclp.23769","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T17:24:47Z","timestamp":1736789087000},"page":"298-310","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["\u201cIt's OK for Me to Cry\u201d: Client and Therapist Perspectives on Change Processes in SPEAKS Therapy for Anorexia Nervosa"],"prefix":"10.1002","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3055-5301","authenticated-orcid":false,"given":"Cat Papastavrou","family":"Brooks","sequence":"first","affiliation":[{"name":"SPIRED Clinic Sussex Partnership NHS Foundation Trust Worthing West Sussex UK"},{"name":"Population Health Science, Bristol Medical School University of Bristol Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail","family":"Rennick","sequence":"additional","affiliation":[{"name":"Kent and Medway All Age Eating Disorders Service North East London NHS Foundation Trust Maidstone Kent UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6497-2253","authenticated-orcid":false,"given":"Randeep Singh","family":"Basra","sequence":"additional","affiliation":[{"name":"Health in Mind Sussex Partnership NHS Foundation Trust Worthing West Sussex UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Lavender","sequence":"additional","affiliation":[{"name":"Salomons Institute for Applied Psychology Canterbury Christ Church University Canterbury Kent UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"Startup","sequence":"additional","affiliation":[{"name":"Schema Therapy School and Brighton Psychology Service London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Oldershaw","sequence":"additional","affiliation":[{"name":"Salomons Institute for Applied Psychology Canterbury Christ Church University Canterbury Kent UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503301003705871"},{"volume-title":"Diagnostic and Statistical Manual of Mental Disorders: DSM\u20105TM","year":"2013","author":"APA","key":"e_1_2_9_3_1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2020.101921"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03327569"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12198"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-017-0322-5"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.01062"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-10-5251-4_103"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1754470X14000105"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.22177"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20367"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/13561820.2017.1356809"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000289028"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-017-0549-4"},{"key":"e_1_2_9_18_1","unstructured":"Craig P. 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