Female eating disorder clients’ beliefs about female therapists’ body size and eating behaviours: An exploration using thematic analysis

Although people with an eating disorder are known to observe and assess body related stimuli, research has yet to explore these behaviours in the therapy room. Consequently, little is known about clients’ feelings about, and responses to, a therapist’s body, or the potential for a therapist’s body to have an impact upon the process and outcome of treatment. This lack of knowledge is problematic given client preferences and expectations can affect their willingness to engage in, and be influenced by, their therapist and the therapy process, and the fact that a fundamental part of the intra- and interpersonal experience of people with an ED is that of feeling invisible, unheard and worthless. It is also problematic given the poor recovery rates and high levels of drop out in eating disorders treatment and the fact that clinical guidance providers, researchers in the eating disorders (ED) field and individuals who have recovered from AN, all advocate psychological interventions as part of AN treatment.This study begins the process of redressing this omission by exploring ED clients’ beliefs regarding what is important about an ED therapist’s body weight and shape, eating behaviours and relationship with food. Twelve women who self-identified as recovered or on the road to recovery from AN, and had received counselling for their ED from a female therapist, participated in semi-structured interviews. Thematic analysis was used to analyse the data and three overarching themes were developed. The first theme – “Wearing Eating Disorder Glasses” – described the women’s observational tendencies. The second theme – “You’re Making All Sorts of Assumptions as a Client” – illustrated the women’s tendency to place great emphasis on body-related visual information when forming their opinions of, and beliefs about, a therapist. And the third theme – Appearance Matters – demonstrated the ways in which the women’s observation-based assumptions seemed to have potentially far-reaching implications for their attitude towards the therapeutic endeavour.Accordingly, the analysis offers preliminary evidence of a potentially important process taking place in the therapy room; namely, ED clients’ tendency to both observe their therapist’s body and eating behaviours, and make assumptions and judgements based on what they have seen. The analysis also suggests that ED clients’ assumptions and judgements may influence both their beliefs about their therapist’s ability to help them, and their willingness to engage in the therapeutic endeavour. Possible limitations of this study, areas for future research, and implications for practitioners in general and for counselling psychology and counselling psychologists in particular, are also discussed