“我可以哭”：客户与治疗师对神经性厌食症言语治疗中改变过程的看法
"It's OK for Me to Cry": Client and Therapist Perspectives on Change Processes in SPEAKS Therapy for Anorexia Nervosa.
作者信息
Brooks Cat Papastavrou, Rennick Abigail, Basra Randeep Singh, Lavender Tony, Startup Helen, Oldershaw Anna
机构信息
SPIRED Clinic, Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK.
Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
出版信息
J Clin Psychol. 2025 May;81(5):298-310. doi: 10.1002/jclp.23769. Epub 2025 Jan 13.
INTRODUCTION AND AIMS
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.
METHOD
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.
RESULTS
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.
DISCUSSION
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.
CLINICAL TRIAL REGISTRATION
The study was registered according to the guidelines of the International Standard Randomized Controlled Trial Number Register (ISRCTN No. 11778891).
引言与目的
神经性厌食症（AN）的现有疗法效果有限，因此需要开发新的疗法和干预措施。在治疗中假设并针对明确的改变机制提供了改进治疗的潜在机会。“SPEAKS”项目旨在开发、试验和评估一种针对已知与神经性厌食症的发生和维持相关的关键情感和社会因素的疗法。本研究的目的是探讨治疗师和客户在“SPEAKS”干预过程中对改变过程的体验，以及哪些因素促进或阻碍了这些改变。
方法
对16名年龄在18 - 49岁之间的女性客户和6名治疗师进行了半结构化访谈；主题指南探讨了对客户改变过程的看法。两名研究人员对数据进行了主题分析。
结果
从数据中得出了两个主题和六个子主题。它们分别是：“对饮食失调的影响”、“改变过程”（“情感改变”和“自我改变”）以及“改变过程的促进因素和障碍”（“治疗关系”、“客户的情感投入”、“在线交付”和“治疗师缺乏灵活性”）。“情感改变”包括客户增强了更多地调整、承认、倾听和表达自己感受的能力，“自我改变”代表了客户与自己的关系发生了转变，特别是与自己更脆弱部分的关系。
讨论
本研究的结果为“SPEAKS”治疗方法中固有的假设改变机制提供了支持。这支持了该干预措施的稳健性和有效性，并为进一步研究其有效性提供了支持。
临床试验注册
该研究已按照国际标准随机对照试验编号注册指南进行注册（国际标准随机对照试验编号：ISRCTN No. 11778891）。
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