GUIDELlNES FOR THERAPISTS
WHO TREAT FAT CLIENTSThere are several assumptions, based on myth and prejudice rather than fact, which many members of our culture (including psychotherapists) believe to be true about fat people. These assumptions affect how therapists view and work with fat people in their practice. It is imperative that therapists recognize and clear out misinformation and bias in order to be most supportive and effective with their clients. Good sources of information include Big Fat Lies, available through Gurze Books, 1-800-756-7533.
Myth #1: You can determine what people are doing about eating and exercise, just by looking at them.
Info: People naturally come in all sizes and shapes. On average, fat people eat no more (and often less) than thin people.* Some fat people are extremely active; some thin people are extremely inactive.
*Garner and Wooley, 1991, Clinical Psychology Review
Myth #2: Emotional issues cause body size, and once the issues are resolved, the person will get to the right weight.
Info: While some people undereat or overeat due to emotional issues, body size is largely determined by genetics, and influenced by people's eating, dieting, and movement habits. Some people may normalize their weight by healing emotional issues; however, assuming weight normalization with healing emotional issues is akin to assuming height normalization with healing emotional issues. The “right” or natural weight for each person can be anywhere on the weight continuum.
Myth #3: If a person is distressed and fat, weight loss is the solution.
Info: Being the target of weight prejudice can be cause for profound distress; however, the solution to prejudice is to address the prejudice, not the weight. What would we do for a thin person in similar distress?
Myth #4: Large body size indicates sexual abuse, or a defense against sexuality.
Info: Fat children and their parents have been increasingly ostracized in a culture that equates body size with personal value. Children often gain extra weight before a growth spurt. Enforcing weight-loss dieting and competitive exercise can lead to rebellion against both. Children of all sizes can be harmed by learning eating disordered attitudes and behaviors from parents, as well as from classmates, teachers, or doctors. Ellyn Satter (www.EllynSatter.com) is a very good resource for information about children and weight
The Ideal Office
The ideal office for a fat client includes:
- Handicapped accessibility
- Wide doors
- Large restrooms
- Sturdy, armless chairs or couches
- Adequate air conditioning
- Fat-positive publications ( Fat!So? or The Obesity Myth)
The fatter the person, the more likely s/he has faced socially sanctioned abuse in daily life. The abuse may come in the form of insults from strangers, family, educators, and acquaintances; denial of insurance or of medical treatment, or insistence by medical professionals that weight loss is required for good health and/or for healing any and all presenting complaints; restricted access to jobs, promotions, or advanced education; denial of opportunities to adopt a child; lack of access to adequate seating in theaters, public transportation, restaurants, and even restrooms.As with other victims of abuse, the fat person may have internalized the abuse, with such consequences as low self-esteem, depression, social isolation, passivity, or self-hatred. These can be vital areas for therapeutic intervention.
Barbara Altman Bruno, Ph.D., ACSW, and Debora Burgard, Ph.D.
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