What do fat women want? An exploratory investigation of the influences of psychotherapy on the process by which fat women work toward acceptance of their size and weight

This study explores the process by which a selected group of fat women work toward a positive acceptance of their size and weight and on the experiences and perspectives of these women as participants in psychotherapy. Research questions focused on participants\u27 childhood, adolescent and adult experiences as large women prior to choosing to emphasize accepting, rather than changing their bodies; on the factors that influenced their decision to make that choice; and on participants\u27 experiences as clients in psychotherapy. Psychotherapy experiences were examined to determine what role they may play in a woman\u27s process of working toward acceptance of size and weight. Participants were asked to describe therapist characteristics necessary to their being effective with clients who are fat women. In-depth phenomenological interviewing served as the primary method of data collection. Each participant was interviewed twice individually in sessions lasting from ninety minutes to two hours each. The study employed reflective and interactive components. Participants were given copies of the transcriptions of their individual interviews for review and comment and invited to take part in a focus group interview. The data are organized into four areas: childhood and family of origin, adulthood and independence, working toward acceptance of size and weight, and experiences in therapy. Findings indicate that the negative sequalae of participants (a) being shamed for their size and (b) blamed for not controlling their size, continued well into adulthood. Adult experiences of prejudice and discrimination based on size confirmed and recapitulated attributions of unattractiveness and inadequacy. The journey toward acceptance of size and weight is life-long, nonlinear and involves embracing an alternative paradigm of assumptions concerning the origins of fatness, prevailing cultural standards of beauty, and the tendency to regard fatness as an indicator of compromised physical and mental health. In order to conduct effective therapy with fat women, psychotherapists need to understand the biological bases of fatness and the exacerbating effects of dieting; examine their own biases concerning size and weight; educate themselves regarding issues that fat women face; and remain aware of dynamic considerations specific to conducting therapy with fat women as clients