This is something that I’ve been wondering about for a while, and something that has come up in conversation with a few friends in recovery lately. I get the feeling that this is something that people are perhaps hesitant to talk about because we don’t want to be seen as judging others based on body size, etc. I know that’s the case for me anyway.
But, if I’m being totally honest, the body types of my treatment providers DO matter. Obviously they are not the be-all and end-all determinant of whether or not I’ll work with someone. Much more important to me is the level of mutual respect I feel w/ my team members, how easily I am able to trust them, whether or not I connect with them, their views about e.d.’s and treatment, etc. But, at first, their body type IS quite important to me. In therapists, I want someone who is “average,” or even perhaps a little bit above “average.” B/c my set point is a bit on the higher side of normal, I prefer to have a therapist who has experienced what it’s like to move through a thin-obsessed society with a body that is, well, not thin. If I have to go through a weight gain process, I also tend to be less self-conscious doing that with a therapist who is not particularly thin.
Dietitians, however, are another matter. I hate to say it, but, at least when my e.d. is active, it would be a struggle for me to work with a dietitian who was not slender. My first RD was very small (she was clearly just built that way), and that was a bit hard for me because I felt so big in comparison. My current RD is thin, not skinny; she looks like she is a very healthy weight for her frame. Slender, but clearly not disordered. This appeases my e.d. a bit, and it encourages me that one can nourish oneself and not be overweight (something that I absolutely believe in regard to other people, but I have trouble applying to myself). And frustratingly, these kinds of standards, expectations, etc. based on size are in direct opposition to what I believe in my daily life about size, etc. I’m actually a firm believer in HAES (health at every size) and a proponent of body diversity. Yet, when it comes to my treatment team, I have preferences.
What about you? Does the weight/size/body type of your treatment providers matter? If you’re a treatment provider, is this something you’ve considered? Is it something you’ve talked about with clients?
I know this can be a sensitive subject, but in my conversations with others, it seems like it’s something that can be important to people and should be open for discussion. And I’d like to think this blog can be a forum where we can all discuss these matters honestly and without judgment. π
18 comments
Comments feed for this article
October 9, 2009 at 10:58 pm
Julie
As a treatment provider this is something I have thought about before and even discussed with women during the recovery process. I will openly admit that at times it has concerned me that some therapists in eating disorder programs have appeared to my eyes to be painfully thin. It has been difficult to know how to process this or even what to do without of course wanting to cause harm in any way.
I have also heard of some women I have counselled say that when they first met me they felt somewhat “put off” by the fact that I am not naturally thin. This was something they have told me honestly made them want to turn away from me, but stuck with it and later realised it was not at all important – in fact – helpful – to see someone considerably larger than them being happy and fulfilled.
It’s a really delicate area and I congratulate you on raising it. I think it’s something that few people talk about but probably should.
October 10, 2009 at 8:42 am
sayhealth
Thank you for such an honest and open response. π It’s wonderful to hear that this is something that you can discuss with women in recovery. And, yes, there are definitely a number of eating disordered e.d. treatment providers out there. I’m know a few people who have struggled with that as clients; for example, I had a friend who’s RD didn’t eat with clients. I think it’s so important for clinicians to be models of realistically healthy behavior, if that makes sense.
I think it speaks volumes to the trust that clients must have for you that they can talk about this directly with you! If you don’t mind me asking, how is it for *you* when they say things like that?
October 10, 2009 at 9:35 pm
Julie
I don’t mind you asking at all. Probably important for me to clarify that no person has ever raised such things early in the stages of us working together. It has only come about at a much later stage when trust was well established.
It has only been raised 3 times I can recall ie. about a client being “put off” initially about my shape/size. On two of these occasions it did not come as a surprise to me – I sensed very strongly that was something they felt, but I chose to ignore it and see if it was something that was going to bother them so much they would end our therapy – or choose to forge on. Both did forge on and by the time they said it out loud, both stated it was a relief and so I felt fine. They came to realise it was a silly judgment and that it had no bearing on their drive to recover.
The other time it was raised, it was done in a more hurtful manner and I felt that sting more. In saying that, this particular woman was very sick and therefore the way I wrestled with her comment was not so much that it was her actually saying that to me, rather it was her very negative eating disorder that had considerable control of her mind. I tried to see it as the illness saying that to me and not the actual person, which did help. It also made me ‘dig in’ harder with her and not let her go, as to me it seemed like her eating disorder was trying to get me to give up on her by being negative/cruel. I didn’t want to do that, so we moved on. She never raised it again and did make great progress, until she and her husband moved interstate and I could no longer see her. I am not sure where things are at for her now but I certainly hope she is well.
All up I guess it can be hurtful, but I think as someone who works with people who have eating disorders and even other mental illnesses, it’s really important to keep in mind that a negative mind set can be the greatest part of someone’s illness and therefore what they may say to you might not even be their true selves.
It’s hard to know if this has been an issue for the many other people I have seen but have never said so. For some it may be, but for others I don’t think it even registered. It all has to do with people’s filters of course. To some people I could be seen as being very fat or obese, but to others I am just curvaceous. I certainly have never seen myself as anyone who was really large – in fact – I know I’m not. In our media saturated culture of ‘thin’ however, if Glamour ever knocked on my door – I would be in the plus sized spread!
October 14, 2009 at 6:20 am
sayhealth
“tβs really important to keep in mind that a negative mind set can be the greatest part of someoneβs illness and therefore what they may say to you might not even be their true selves.”
I think that this is such an important statement! Thank you for pointing it out. In regard to eating disorders specifically, people with active eating disorders are often more judgmental of the bodies around them (and obviously their own) than they might be otherwise. I think that it’s important for people with eating disorders to be exposed to a diversity of healthy body types. And I’m glad there’s people in the field like you who are willing to talk about this – even with clients themselves!
October 9, 2009 at 11:11 pm
Michelle
I completely relate to this post. Over the years, I have seen three therapists for my disordered eating (which has often teetered into ED territory), and all three were thin (one of them I actually questioned to myself whether she had overcome her eating disorder because she was so thin). It’s hard for me not to think “well, sure, it’s easy for you to be happy with your body … after all, it meets the ideal”. I love my current therapist, but I have to admit, I might find it helpful to be working with someone who has overcome all the same issues I have dealt with and ended up at a size that is above the ideal in our society, while still living a healthy lifestyle and maintaining a healthy body image.
Thank you for bringing this subject out into the open. I am interested in what others have to say on the topic.
October 14, 2009 at 6:21 am
sayhealth
Thank *you* for sharing your comments and experience! π
October 10, 2009 at 6:48 am
David
I get it. The ED therapist I’m seeing now is, to me painfully thin. I know that she doesn’t have an ED it’s just she’s a woman that is 5’2″. I’m a man and would look at her arm’s and and leg’s and wonder why mine, 41 year old 5’10” man, could not be that skinny. At first when I saw her I thought that it was ok because she couldn’t do anything to hurt me (I’ve got some trauma issues) now her strenght of character and self assurance is a great comfort to me. And we’ve talked about body image issues and BDD a lot.
My first RD was a normal sized person, second was very tiny but she ran like 6 marathons a year (can you say psycho?), the one I’m seeing now is normal sized for her height. The one thing they all were though is happy with their bodies. I think that can come out at any weight and seeing it really helps me.
October 14, 2009 at 6:23 am
sayhealth
SIX marathons a year?? Wow . . . .
“The one thing they all were though is happy with their bodies.”
Yes. That’s so important! And I definitely understand what you’re talking about here. And I think it’s crucial to see that being happy with one’s body is not contingent upon shape or size.
October 10, 2009 at 10:41 am
700stories
This is interesting. I’ve only had two therapists, the first was thin but not “skinny”… just average slender size. She was also very pretty (I feel like a vain asshole saying this, but that matters to me too) My most recent one is tall and slender and at first I was like “shit she’s got my ideal body”. Not body for me, cause I physically could never look like that, but it’s the body type I am most drawn to, that my ED thinks is “the best”. Very ballerina-esque. But I was glad for the challenge of not letting that intimidate me, and it didn’t. I also preferred that to the opposite, someone more my size or larger. That would make me uncomfortable. (Or my ED uncomfortable?)
I know why this is, I don’t want to be “complaining” about my size or appearance to anyone I think society would consider “worse” than me. Even if I don’t personally, I am always thinking about how “others” judge other people. So it’s easy to complain about myself to someone who is “obviously” more attractive than I am.
Wow that’s weird haha. And I used a lot of quotations.
As for an RD, it’s funny even though I haven’t been to one I would prefer a NOT thin one. Because I’d want someone who understands my body type and the fact that even when I am healthiest I am not thin. The woman I met at the conference who I really liked was tall and muscular. She was also very natural and had long dreads… I liked that she was alternative. That shows open-mindedness in general.
October 14, 2009 at 6:28 am
sayhealth
You’re not a vain asshole. I promise. π I think how a therapist looks (and that includes being pretty) is probably important to a lot of people, even boyond the world of eating disorders.
My current therapist is bigger than me (just, bigger all around – tall, muscular, etc.), and it did make me uncomfortable at first. I definitely know what you’re talking about. But then I realized, “WAIT a minute. She’s happier in her body than I am, her body’s healthier than mine is . . . . Intriguing!” It was an eye-opening moment for me. So I think the experience of having a therapist who’s larger than me – even though it initially made me uncomfortable – has been a good one.
That RD sounds pretty cool, I must say! I like that she appeared alternative too, for the reason you mentioned!
October 10, 2009 at 7:00 pm
The_Timekeeper
I think it is essential for any professional working with clients who have eating disorders to model emotional and physical balance … and should not have disordered eating or destructive habits themselves. However, patients with eating disorders, though expert at spotting fellow sufferers, also are notorious for suspecting everyone has an eating disorder, especially is someone is fit and/or thin.
It’s a double-edged sword for clinicians: If they’re not “just-right average”/perfectly however-the-client-might-imagine is a “good weight” and … then the client may be less likely to follow advice for fear they might get as “fat” as the clinician. If the provider is too thin, in the client’s eyes, the patient may not want to follow advice b/c they don’t want to bigger than the clinician or might feel in competition with the clincian: “Why should I gain weight if she gets to be thin? … Why should I eat when it doesn’t look like she does? Why should I moderate my exercise when she exercises every day?”
So, I think the most important thing is less about the size, shape and pathology (or not) of the clinician and the conversation between therapist/RD and patient about the issue. People who have a healthy diet and self-concept, whether treatment providers or not, will come across that way. Likewise, those with a problem, even if all looks OK on the surface, will come across that way. I think it helps if clients admire/respect a treater’s health/lifestyle, just as it does to build on other traits.
I have noticed many of the nurses/staff in hospitals where I have been an inpatient are often heavier than what is probably the BMI range the patients are given as healthy. Patients don’t seem to mind this, as this seems a better alternative than stick-think people telling ’em to eat and sit on their behinds so they gain weight. Yet, I think many patients don’t feel understood or maybe belittled or “dislked” by overweight staff.
There also have been instances where patients have spoken up about this issue (comparing bodies/habits with that of staff), with the reply from staff being: “The difference between you and me/patient and staff … is that your weight has become so problematic that it interferes with your life. It’s not so much the weight as what the weight brings to bear.”
I have been in programs both where staff eat with patients and where they don’t, and I think it’s better when staff don’t eat with the patients. It keeps the patients focused on themselves, their program, their meal-plan, their table habits.
It keeps someone from saying, “I don’t know why I have to finish my meal when “staff” didn’t finish his/hers … I mean, if she’s full or thinks it sucks and doesn’t want to finish, why should I finish?” People with eating disorders seem to love to focus on other people, other people’s food, how other people eat, drink or don’t, etc.
I think supervision and oversight can take care of truly problematic situations … and, frankly, the patients will probably sort it out themselves, recognizing that this clinician is not helpful in whatever way, for whatever reason.
October 14, 2009 at 11:09 pm
Sayhealth
I agree. I think that the most important thing is that treatment providers – regardless of size – model healthy behavior and attitudes in regard to body/weight/food, etc. I think it’s ideal if the treatment staff portray a diversity of bodies, like that in the real world! I think it can show patients that health and happiness are not based on shape or size but on a person giving her/his body what it needs and enjoying the process – and that health looks different on different people, and that’s okay!
For me, I actually prefer when treatment staff will eat with patients. I’ve eaten with both my nutritionist (in a group) and my therapist (one on one) and it’s been incredibly helpful. It made me feel less in the spotlight with them eating too. I do think it needs to be done with tact, however! Like you said, if clients are being asked to eat a certain amount, I think it’s reasonable to expect staff to as well. I think what makes it work is that, for example, when eating with my RD, it’s clear that she is eating something that would meet one of her own meal plans, so it feels fair.
October 12, 2009 at 6:13 am
aquana
I could never work with a therapist who is overweight. (My current therapist is a severely underweight man, if it matters.) I could never, ever trust them not to make me fat.
October 14, 2009 at 11:11 pm
Sayhealth
That’s my feeling about an RD. AND, I know logically that different bodies are healthy at different sizes, and a lot of treatment providers can recognize and act on that in a rational, reasonable way, regardless of their size.
October 12, 2009 at 2:18 pm
ihatetoweightandmore
interesting answers. i’m disappointed to confess that i want a healthy weight therapist — not too thin, not too fat. yikes, i sound like goldilocks.
my regular therapist is a very, nice average weight. i like to think she has very healthy, natural eating habits. i don’t really want to know, actually.
my addiction therapist (for drugs and alcohol) was really thin, and i would not have wanted her to be my ED counselor. however, she seemed solidly clean and sober, so that worked for me in that area.
i couldn’t even tell you about my regular doctors. i don’t really care what they weigh, i think. as long as they’re gentle with pap smears, needles, breast exams, etc., i’m good.
with medical doctors, i don’t think they need to be healthy themselves in order to keep me healthy, as long as they know what’s right. with mental health professionals, a different story, i guess.
October 14, 2009 at 11:12 pm
Sayhealth
lol “Not to thin. Not too fat. Juuuuuuuust right.”
I don’t think you need to be disappointed in yourself. We all have opinions on this! No need to judge it. π
October 17, 2009 at 8:18 pm
Nichole
I have thought about this a lot. Oddly enough, I thought for a lot of people recovering from an ED it might be easier to have thin practitioners so that they didn’t have this idea of, “OMG if I recover, I’m going to look like that?!?” My “natural weight” is high; my therapist is thinner than I was at my thinnest. Probably by at least three dress sizes. When I first started working with her the thought kept cropping up, “She must think its a joke for someone as fat as me to have an eating disorder.” My nutritionist is above average in size, but healthy. I still am battling thoughts about the nasty things Ed says she is thinking about me when she reads my food logs…
October 17, 2009 at 9:05 pm
Michelle
It seems to me, judging the comments, a lot depends on what type of eating disorder or disordered eating the patient has. Though I have been a life-long chronic disordered eater, my emotional eating has always outweighed my controlled eating behaviors, and therefore I have never been the “ideal” weight I always was seeking. So seeing a therapist that has achieved a healthy body image at a weight that I see as ideal is sometimes unsettling to me. But if my disordered eating had ever fully succumbed to ED, I can see how seeing a heavier therapist (i.e. someone my size or bigger) I can see how that would bother me too.