Weight-Based Microaggressions Experienced by Obese Women in Psychotherapy

A large body of research demonstrates the existence of weight bias in healthcare professionals, including physicians, nurses, and dietitians (Budd, Mariotti, Graff, & Falkenstein, 2011). Very few published studies examine mental health providers\u27 attitudes toward obese clients, but a small body of existing data suggests that mental health providers attribute more negative personal attributes to fictional obese clients and rate them as having more severe symptoms than their average weight counterparts (Agell & Rothblum, 1991; Hassel, Amici, Thurston, & Gorsuch, 2001; Young & Powell, 1985). Given these findings, it is important to understand whether obese clients experience mental health professionals as stigmatizing and, if so, how this impacts clients and the therapeutic work. Consequently, this study explored obese women\u27s experiences with weight-related microaggressions (subtle, perhaps unintentional communications of weight bias) in psychotherapy. Fifteen obese women (mean BMI = 41.52) who were currently attending therapy participated in semi-structured interviews inquiring about general therapy experiences and experiences with weight stigma in psychotherapy. Data were coded using a general inductive approach to identify themes emerging from participants\u27 experiences. Overall, participants reported very few weight-related microaggressions in therapy. Other key findings included participants\u27 responses regarding whether and how their weight impacts therapy sessions, with an emerging theme of being less forthcoming or more evasive in therapy due to weight. Many participants also reported reactions (often negative and rarely discussed in therapy) to their therapist\u27s body size or appearance. Participants also offered advice to therapists working with overweight clients. They suggested allowing clients to initiate and direct conversations about weight in therapy, but advice otherwise tended to focus on general, non-weight-related interventions. Implications for clinical practice and training and future research are discussed