Therapy News

This week on Say More About That I talked to Hilary Kinavy, a therapist who is an expert on Health at Every Size. It was an amazing conversation and you should probably stop reading this article and just listen to the podcast episode right now. As a therapist, I felt inspired in a way I haven’t since I finished grad school. Body shaming of people in bigger bodies happens in so many ways and is still widely accepted in our country. Therapists that don’t know about Health at Every Size may be doing damage to their clients. It’s horrible and it needs to stop. I promise to get training in being body positive and learn about intuitive eating. Not only does it feel important, but it sounds so interesting. I bet you’ll feel just as pumped after you listen to my conversation. Click play below or listen on Apple Podcasts or Spotify.

In this article, I want to discuss what prompted me to contact Hilary, what messages we receive from our families and our culture about body size and how it could be effecting our clients.

I described a client as “fat” on facebook

About four weeks ago, I posted an article about a podcast episode in a therapist Facebook group. The client I talked to on the episode described herself as “black, poly and fat”. She talked briefly about wanting to find a therapist that can say the word “fat” and not feel uncomfortable about it. If you don’t know, the word “fat” is being used in the body positive community as a purely descriptive word that doesn’t have any negative connotation associated with it. That being said, many people use the word as derogatory and as a way to shame people in bigger bodies. There is still a lot of work that needs to be done in order to strip the word of the negativity associated with it. But really, “fat” is just a descriptive word about bodies that shouldn’t carry much meaning. It’s just like using the word “tall” to describe someone. “Tall” doesn’t need to be good or bad or ugly or attractive. “Tall” just means tall. “Fat” just means fat.

A handful of therapists had negative reactions to me using the same words that the client used to describe herself. They said it was incredibly inappropriate of me to describe the client as fat and that I should never use that word. Me and other therapists tried to educate them on the body positive movement but the comments quickly devolved into ugliness, as is common in Facebook groups. I invited the therapists that had a problem with the word to discuss their feelings on the podcast but they declined. After feeling a bit shaken and unsure all of a sudden on whether or not it’s okay for me to use the word “fat,” I contacted Hilary, a local therapist celebrity in the Portland community, to set the record straight. Among other things, we talked about using the word “fat” and the movement behind it on the episode. We talk about the word “fat” at 30:48 if you want to skip ahead in the episode.

Personally, I blame MTV. But it’s so much more.

If you were born in America in the last 100 years, you are probably unconsciously (or consciously) biased against bigger bodies — unless you have already deliberately educated yourself. The media and the health industry are constantly bombarding us with this message. For example, I was born in 1980, which just happens to be the best year to be born, and which also means I was raised by MTV. In the 90’s, I fell in love with all the girls I saw in music videos, most of whom fit the mold reinforced by the greater culture. I grew up in Los Angeles in a family of women who worked incredibly hard to hold onto their petite figures. I don’t remember receiving any messages that bigger bodies were attractive or even acceptable. I was told that fat people were either unattractive or funny looking, that fat was a moral and character weakness. Fat jokes were all the rage in the 90’s. “Yo momma’s so fat” was really peaking when I was in high school.

I went to grad school at the University of Southern California in 2003. There was zero mention of body positivity in the marriage and family therapy program. I moved to Portland in 2005 and soon after started my private practice. It wasn’t until around 2010 that I started to hear about Health at Every Size.

All this to say that I imagine my experience is not to far off from many Americans. Did I contribute negatively to harmful stereotypes about body size? I hope not. But did I do anything positive to help. No.

Was it my fault that I didn’t educate myself about Health at Every Size sooner than 2010? Yes, 100% it was my fault. It’s my responsibility as a therapist to be educated in all possible ways when it comes to understanding my biases, trying to rid myself of them, and making sure my biases don’t do any harm to my clients. And while I don’t think I have ever deliberately made my clients that are in bigger bodies feel bad about themselves, I do imagine I have done some damage. However, I probably shouldn’t take all the blame. It’s our culture, it’s Hollywood, it’s our doctors that focus too much on weight and body size and it’s the messages we receive from our families.

How can our unconscious bias harm our clients?

If I don’t check my body size bias what happens when a client in a bigger body sits on my couch? What might our unconscious bias influence our subconscious to think?

• Maybe they are in therapy because they are fat.
• Maybe if they just lost weight they'd be happier.
• Their fat is probably protecting them from trauma.
• They are probably emotional eaters.
• Maybe they should try to go on a diet.
• Have they talked to a doctor about being "overweight”?
• It’s probably hard for them to find a partner.
• There is a skinny person inside of them that’s dying to get out.
• They don’t seem very disciplined.
• They must not exercise at all.
• They probably come from a fat family that didn’t teach them about nutrition.
• They probably feel horrible about their body.
• They’ve been judged and ridiculed about their body all their lives.

This list is off the top of my head. It can be much longer. I am sure I have an unconscious bias against fat people. You most likely do as well. I have been conditioned to think there is something wrong, unhealthy and unattractive about bigger bodies. And what happens if a client brings up their body size in therapy? Will my comments make them feel ashamed and send them the message that they should change their body? Or will my therapy positively impact their relationship with their body? What happens if they talk about dieting, which is just an exercise in restricting foods. Will I tell them they should do it? With all my biases going unchecked, I imagine I would. But dieting can be extremely psychologically harmful in many ways.

What should therapists do?

In this week’s podcast, Hillary said something that really inspired me: we can change all this in one generation. And it starts with health practitioners. So let’s take the lead. Find educational courses on Health at Every Size. I would highly recommend Hilary’s training that can be found at benourished.org. Even if you don’t specialize in Health at Every Size, sign up for therapist directories that allow clients to easily filter for therapists that have specialized experience with body positivity. Might I recommend TherapyDen? Every therapist that signs up for a profile with TherapyDen increases our exposure, moves us up the search ranks and allows clients to find a therapist who’s truly a good match.

And even if you don’t jump into a training right now, start Googling Health at Every Size. Buy a book about intuitive eating. Start pointing out to colleagues, friends, family members and yes, even well meaning, but totally uniformed, facebook “friends” that there is a better relationship we can have with fat bodies and how we think of them. The word “fat” doesn’t have to be a loaded word. It never should have been and we need to do something to de-stigmatize it.