On being a fat therapist

on being a fat therapist

on being a fat therapistWhen I was 18 and in college I had a terrific women’s studies teacher who was addressing media representations of women and the tyranny of thinness. In my reaction paper I wrote something about how every woman I knew wanted to lose weight and my professor wrote next to this in the margin, “Not me!” And I didn’t believe her because she was fat. Not just heavy (the euphemism my friends and I used to describe the not-skinny among us, which seems to have been replaced by “bigger girl” these days) but actually fat. Like the kind of fat we were scared of, the kind of fat we were all running from. I couldn’t think of anything worse than being that fat. But her words in the margin set me thinking. They came back to me through the years as my own body shifted and changed as I met other women who were able to accept their bodies and the bodies of the women around them.

Now I am fat myself, the kind of fat that used to scare me, and although I am sometimes a little thinner and sometimes a little heavier, I am pretty much fat no matter what I’m eating (or not eating) or how much I’m exercising (or not exercising). Which means that I am and will likely remain a fat therapist and in the same way that I assumed I knew something about my women’s studies professor just by looking at her so I know that my clients assume they know something about me just by looking at me.

I have talked to other fat therapists about this because we are all aware that there are some clients who quite simply won’t be comfortable having a therapist who is overweight. They may assume that I don’t know what I’m doing because they believe fat people couldn’t have it together (otherwise they wouldn’t be fat). They may assume that I myself have low self-esteem or cannot control my eating or don’t understand the value of exercise or a thousand other ideas that many of us have about fat people and these things may get in the way of them being able to feel comfortable working with me.

So what do I think about that?

Well, I don’t think anyone ought to work with a therapist who they cannot trust so I understand that I’m not everyone’s cup of tea (that’s why there are lots of different counselors in the world — to meet the needs of lots of different people). If someone comes to me and doesn’t feel comfortable with me for any reason (because I am fat or because they don’t like my office decor or because they don’t like the music I play in the waiting room) then I will help them find another therapist. It’s why I have a rolodex. If I can’t help someone who needs help, I don’t want to leave them hanging.

But I also think that there is a lot of opportunity in being a fat therapist. I think we need more fat role models who are happy and healthy and loved so I am proud to model the acceptance of bodily diversity in my acceptance of my own body. My personal and professional philosophy is one of Health at Every Size.

I’m writing about this because I think it’s important that we talk explicitly about our experiences in a world that has a limited view of how a woman (and increasingly how a man) should look and so I try to talk about my experience. I also bring it up as a way to let clients and potential clients know that this is a discussion we can have together. I am happily and willingly opening that door.

35 Comments on “On being a fat therapist”

  1. This is interesting to me, because my long-term therapist is very thin and I have found it difficult to talk about weight issues with her because it is easy to assume she can’t relate. But, she does have the redeeming feature of being poor with her time (running late, etc) and I like that about her because it is easy to think she has it all together. And who does. It’s funny to be writing this because I haven’t seen her in over a year, but I met with her every week for 3 years, so I definitely still consider her *my* therapist.

  2. Thank you for this! As a therapist whose body tends to be on the thin side, I find that my clients assume (rightly, sometimes) that I won’t understand their experiences with their bodies. I have a number of go-to articles on body acceptance that I refer people too, and this is now one of them!

    1. Christine, I would love to hear your thoughts as a thin therapist who may be working with fat clients in regards to Margaret’s comment above. Maybe you could do a blog post and leave the link here?

  3. I found her comment ,”I don’t want to leave them hanging” kind of distasteful when talking about clients seeing a therapist–am I too sensitive to this or does anyone else see a possible suicide reference in that statement? Most likely not intentional–still, kind of weird to me.

    1. Thanks for your feedback. It was certainly not intentional but I appreciate you letting me know that some people might find this offensive. I will be more mindful of that in the future.

  4. I love this because its so wonderfully transparent and that’s only helpful for all of us. It also made me think about the women’s studies prof who taught me about body image/dismorphia/hatred and eating disorders and ultimately had a big effect on my healing. Seriously, someone should conduct a study to see how many women have been positively influenced by a women’s studies instructor in terms of how they view their bodies. I’m guessing a lot.

    1. I would love to see a study like that, too. And I wish I could go back and talk to my classmates then and see if they had the same epiphany that I did there.

  5. I appreciated reading this and it mirrors my own concerns. I spent the last 8 years as an addictions counselor and often wondered if my patients would find me less effective because I was overweight. Applying the same recovery concepts to my eating patterns as I was teaching them to apply toward addictions did help me lose some weight, but as you say, I am pretty much fat anyway. I’ve come to the same conclusion that you have, in that our patients can benefit from seeing an overweight person happy with their lives.

    1. Thanks for your thoughts, Vicki, and I know that *I* always appreciate fat & happy role models so I’m glad you are out there doing good work in the world. 🙂

  6. I’m sorry, but the words “fat” and “healthy” do not co-exist. If you are fat, you are unhealthy. “Denial” and “fat” co-exist quite well.

    1. Hi Melissa — you are certainly NOT the only person who belives that a person can’t be fat and healthy but the research bears it out. Weight is just one way that a person’s body lives out genetic heritage, lifestyle, diet and fitness so none of us can know just by looking at someone which of these aspects are most at play. I appreciate your concern and hope that concern will lead you to look beyond the headlines to the scientific research. It’s interesting stuff!

  7. I have been thinking about this subject a lot lately, as I’m going back to school to become a therapist. So glad to read someone else’s thoughts on it. It’s very reassuring.

  8. I love this article and your attitude! I am a year away from graduating with my counseling degree & think about this topic often. I am a plus size woman, short and fat– and often worry how clients will perceive my overall health (mental/emotion&physical). What I am finding in my intern experience is that people in crisis or needing guidance judge me based on my centeredness, knowledge and willingness to help. I think my own issues with my size are more my issue than that of the clients I work with..

  9. I really liked reading this article but from a patient viewpoint I have been very scared/ nervous to talk about my problems with bulimia and how I feel about my weight to my therapist who is plus size. I don’t want it to be awkward nor hurt her feelings.

    1. Rosemarie, I totally understand. And probably it would feel awkward because we’re conditioned to be sensitive to weight discussions. But this isn’t a casual conversation you’re having; it’s therapy and therapy is a place to throw out conventions and get real. While I can’t speak for your therapist I can tell you that I wouldn’t feel hurt by a client who wanted to be thinner than I am or needed to be able to say that a certain body type (like the one I possess) is not attractive to her. I very much understand that my client’s lives are THEIR lives and my life is mine. I would no more be hurt by that discussion than hearing from a client that to practice a certain religion (that I might practice) or vote a certain way (that I might vote) feels wrong to her. I hope that you are able to feel safe bringing it up because you deserve to have whole hearted, full support and not feel that certain topics are off-limits in your counseling sessions.

  10. Hi, and thank you for this. I am also about a year away from graduation, and am about to begin seeing my first clients as an MFT trainee. I am a big guy, and while it is high on my list of priorities to lose this weight, I am currently a little terrified of how my new clients will react to sitting down across the room from their big, fat, new therapist. I found this piece somewhat fortifying, and while I realize it is essentially nothing I did not already know, it was very reassuring to find I am not the only one who worries about this. The weight really bugs me though. If I could shed these pounds I would feel a whole lot better.


    1. Congratulations on being so close to graduating, Matt! I think sometimes when we are understandably nervous about something new (clients!) that we can go right to our weight because it’s a familiar place on which to hang our anxieties. The truth is, your clients will not be sitting down across the room from their “big fat new therapist.” They will be sitting across the room from YOU, their compassionate, prepared new therapist — who is feeling a little nervous. I would also like to share the Fat Nutritionist’s site with you: http://www.fatnutritionist.com/ There is so much terrific information there and I hope you will find it encouraging and if you haven’t clicked the Health At Every Size link above, I hope you will here: http://www.haescommunity.org/. Weightloss may or may not be part of your future but right now at this very moment you are just fine and you will be a blessing to your clients. We therapists don’t have to be perfect — far better that we’re not, I think. And as we become better at our own self-acceptance and self-love, the more we can bring that to our clients in every session. I will be thinking of you — let me know how it all goes! 🙂

      1. Hi Dawn. Just a follow-up: I am now seeing clients as trainee, and I am reasonably sure the only one who is uncomfortable with my weight in the room is me. 🙂


  11. Thanks Dawn. The resources you provided were great. I am just beginning this awesome journey (been in school for a decade though), and I’m grateful I stumbled across your site. 🙂

  12. Hello, I know this post is old but I would like to know how you help peopl with weight problems? My therapist is overweight and trying to loose weight, he tells me during our session what he is doing but how he cheats also or dont go to they gym. So can he really help me in my struggle to loose weight because of my emotional eating? He is 60+, divorced i think and overweight, can he be a good therapist? Even asked me if I have cute friends to introduce him…..I think I need to change therapist but I feel I will make him feel bad…

    1. Hey Cici — I don’t know anything about helping people lose weight because it’s not a focus in my therapeutic practice but this guy sounds like he has some *really* bad boundaries. Ethical therapists don’t joke with their clients about their clients fixing them up with “cute friends” or talk about their weight struggles. As far as making him feel bad, you are employing him and if he’s not helping you than you’re not getting your time and money’s worth. It’s not your job to make your therapist feel good. Please please please see about getting another therapist who specializes in disordered eating (if in fact you feel your eating is disordered). If you contact me via my form and tell me where you live I’d be happy to scare up a referral for you.

  13. I have struggled with my weight since I hit puberty. When I am not looking at a picture of myself, I often feel pretty and even confident, however, whenever I am around my parents, I get criticized for my weight and have been since I started gaining weight at around 12 years of age. It is getting really old and is very hurtful when your own parents tell you that “no one will hire you after college because of the way you look”. I am 25 years old and on my way to getting my degree in counseling psychology. I am academically very successful, have a husband who loves me… and a family who does not accept me for me.
    I was wondering how hard it is for “real-life, big professionals” to get hired and if there really is the overall perception that, since a therapist/counselor is part of the health care system, fat professionals can not advocate (mental) health in the eyes of employers? I know that it shouldn’t matter too much how my parents are trying to make me feel “because of their worries”, but obviously I do and I am simply wondering if they have a legitimate point or not. Personally, I never really thought of my body weight to have too much of an impact on my future career. I do not need a wheelchair to move around, I can still fit on a standard airplane seat and I haven’t recognized any impairment of my skills or knowledge by my plus-sized body (*sarcasm).
    Thank you very much for this post of yours and doing what you are doing!

    1. Juli, I am really sorry that your parents have such a limited view and that they visit it on you. Obviously I can’t speak for every fat therapist but I have not had an issue with 1) getting internships/jobs; or 2) getting and keeping clients. I do see fat bias within the counseling community (just look at all the counselors who specialize in “weightloss”) and in the wellness community (ditto); I don’t deny that but I think it makes the work that we do that much more important. And I’ll add that even working within the wellness community (i.e., practitioners whose brand of health & wellness includes weight stigma and a push to diet) I’ve been able to work well with colleagues. I am sure that you will do great work when you graduate and that your clients will be grateful to have an advocate for self-acceptance to turn to!!!!

  14. I just started seeing a therapist who is overweight. I’m not. I’m super into helping ppl love their greens. In reading this article, I realized it’s not her weight that is the problem. It’s her lack of confidence in herself. Or am I judgementally assuming she is insecure because of her weight? What ever it is, it definitely creates an initial barrier. Is it okay to acknowledge the elephant?

    1. How do you know she lacks confidence, Sunny? How do you know she doesn’t love her greens? If you find her weight is an issue for you, it’s certainly ok to bring it up especially because you’re experiencing it as a barrier. It does sound like you’re carrying some assumptions because of her weight and if those get in the way of your therapeutic relationship with her then you definitely need to talk about it for the sake of your counseling progress. And for what it’s worth, I’m a secure person who loves and eats veggies. I’m still fat. 🙂

      1. If you truly LOVED greens, you wouldn’t be fat or calling yourself fat. Other than that, it sounds like we are saying the same thing as far as my judgments are concerned and am looking forward to some honest therapy this week!

        1. Sunny, there’s no connection between loving greens and being fat or calling yourself fat. Fat is a descriptor and it describes what my body is like. You might want to check out Ragen Chastain’s impressive size-acceptance work — it will really challenge some of your assumptions! 🙂 http://danceswithfat.wordpress.com/

  15. Thank you. I know you posted this article so long ago, but I just found it today. I am a 42-year old student Mental Health Counselor and had my first “practice” session with a volunteer client last night. I am short and fat, and I found my own insecurities to be the third “person” in the room. Instead of focusing on her, I worried about how * I * was presenting. This was noticed and commented on during our critique afterward. I’m not comfortable in my own skin (though I have been overweight all my adult and most of my adolescent life). What would you suggest is the best way (I almost typed “weigh”) to learn to “forget” the self and focus entirely on the client? Thanks!

  16. Thank you for the opportunity to comment and be candid. I was shocked to meet my latest therapist ‘in the flesh’ as she has a very high bmi and is definitely obese. I find this increasingly problematic. She has stated to me once that she ‘doesnt do exercise’ as she had to walk quite a short distance to get to the session when her car broke down and she was out of breath etc. Whereas I value health and fitness. Moreover, I just wonder how much of the ‘padding’ is emotional insulation. I wonder how ‘deeply’ she has entered into her own difficult emotional states and what she is using food for in her life. This is relevant as I have used food to escape difficult feelings in the past, but now I need help and support to ‘go there’. Well no easy answers, but very helpful to air thoughts.

    1. Jodie, if you feel that your therapist’s weight is a barrier for you to feel comfortable in your relationship with her, I encourage you to bring it up. I will say, however, that she may not “do exercise” but that doesn’t necessarily mean that she will not support you as someone who DOES “do exercise.” Therapists see a wide variety of people with different religious beliefs, political values and life goals; exercise is surely just one place where the two of you may differ so it may not be the barrier to her understanding you as you think it might be. Also I think it’s really important to stress that we cannot look at anyone and assume to know their emotional relationship to food. There are fat people who overeat and fat people who don’t and also people overeat for a wide variety of reasons, not always because they are using food as a crutch. But it does sound like it is triggering some introspection on your part re., your past issues and that deserves attention and discussion.

  17. Thank you for opening this up for discussion. For me, it depends on how overweight the person is. I’m studying to be a Clinical Mental Health Counselor and I’m about 20 pounds overweight. I’m working hard with my own therapist to deal with my issues so that I can stop using food to make myself feel better during stressful times.
    I know of a woman who is studying to become a LCSW. She is 5’5″ and weighs at least 300 pounds. To me, there is a difference between someone who is 20 pounds overweight and someone who is 300. Yes, there are extremely obese people who have physiological issues, but they’re much rarer than we want to believe. I personally wouldn’t see a therapist who is that much overweight. I wouldn’t trust her to have her own emotional self in order enough to help me. If I’m being honest, 50 pounds overweight is about as high as I would accept in my therapist.

    1. Hi Tracy, thank you for commenting! It sounds like you have some ingrained biases and misunderstandings about weight. I would encourage you to read Health At Every Size by Linda Bacon (to understand more about how weight is not necessarily an indicator of physical or mental health) and Body of Truth by Harriet Brown (to learn about the research around weight and what it really says). I think you’ll find it really interesting and give you lots to consider as you figure out your own counseling orientation and head into practice.

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