Cultural Competency: 10 tough steps to become a fat-friendly therapist, counselor, or psychologist by Dr. Abi Weissman at Waves, A Psychological Corporation

The more time I live in Southern California, the more I realize that life here is not meant for the average fat person or even average sized person at that. It can be hard to be fat in Southern California. Therefore, I think that it is time or really, past time, to talk about the ways that our therapy offices can be more fat friendly for our clients and our colleagues.  In this article, I will describe ways that you and your office can become more fat-friendly. Take these tips and resources with you as you continue to rock your therapy practice.

A note on language: I use the term, “fat” to describe a person who is not thin. This definition leaves a lot up to the person reading this post to define what “fat” is and what “thin” is. I truly feel that bodies come in all shapes and sizes and that the diversity of bodies is wonderful. I loathe the term, “obese.” When I hear it, I know that most likely the person using it is not a fan of the many different types of bodies out there but instead, privilege those who have thin bodies over heavier ones.

The plethora on obesity research worries me (Here is a list of some National Institutes of Health press releases showcasing the large amount of research in the last several years https://obesityresearch.nih.gov/news/  ) as studies often assume that being fat means being unhealthy. Instead, I support the idea that healthy is different for each person and one can be healthy at any and every size. This post showcases some ways to be a fat-friendly therapist. While not exhaustive nor fully research-based, I am writing to help therapists see the world from the viewpoint of a fat person and work to make changes in their office set up and/or therapy practice. This post does not intend to describe the viewpoints of all fat people.  

Tips to make your office fat-friendly:

1)    Have chairs that can easily fit people’s hips

a.    I once sat in a chair at an interview, only to get up and have the chair come with me. I did get the job, but oh my goodness, I was so embarrassed when I had to turn back to the chair and push it off my bottom. It was hard to get into a “winning” and confident mindset when I wanted to crawl under a rock and never leave rather than face the interviewer.

2)    Have chairs that do not have spindly legs; it’s hard enough to go to a therapist without worrying that your chair legs will break

a.     I often think of seating at weddings. I ask myself, "Will I break the chair?" Everyone is focused on the brides or grooms and I can’t stop focusing my attention on shifting my weight to my legs and off the chair itself. I’d much rather sit back and enjoy the ceremony.

b.     I like having different chairs in my office. I have a couch to sit on, a ball chair for those clients who like to bounce and/or balance, and a chair with high arms that one can use to push off to get up from the chair into a standing position. I also invite clients to stretch during session or sit on the floor if they are more comfortable that way.  

3)    Have offices that fit people of size. Is there room for a client’s flesh to fit or will it overlap with the therapist’s body or other furniture? Can Clients walk into the room with their larger than thin bodies and make it to their seat without tripping over a table? Please leave extra space for clients to walk through your office.  

4)    Can fat people walk up your tight staircase or fit easily into your tiny bathroom?

a.     Folding oneself into a tiny bathroom stall is something one could live without. Please design/advocate for an office bathroom where you could imagine a tall basketball player or a wide football player or a fat person being able to pee in peace.

5)    Please provide information about ACCESSIBILITY of your office on your web page. Letting your prospective clients know that you have an elevator to your office or, in turn, that you work out of a four- story walk-up can be of interest to people of any size. Be aware that many people would like to know if her/his/their therapist’s office is accessible to them.

Tips to make your psychology practice fat-friendly:

6)    Please do not assume that people who are fat are trying to lose weight. It’s hard enough to be fat in Southern California without being presented with many images showing fat people who are sad until they lose weight and become happy (that they have lost weight).

 a. There are so many posters and advertisements about weight loss here in SoCal. I remember living in the Inland Empire, California and seeing billboards on a major highway every few hundred feet about weight loss surgeries. This did not make me want to have a surgery. It made me want to go home and cry. I felt so sad after driving along that highway.

7)    Or are lazy or slow or have mental difficulties

a. I mean, if I’m at a therapist office, and I’m the client not the therapist, I’m probably suffering in some way. My suffering might not be about my weight at all. Please don’t add to the suffering and assume that people who are fat, for instance, hate their bodies. Here’s one older article (from 2004) describing stereotypes of fat people. I also appreciate the introduction for its researchers’ explanation about where the stereotypes about fat people can be found in daily life. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2530916/

8)    Please don’t think that fat people don’t love to exercise. Fat people can be healthy too. Please see information about Healthy at Every Size at https://haescommunity.com/ or author and activist, Linda Bacon, and her book(s) at https://lindabacon.org/ .

a.     Exercise is a wonderful thing. It can reduce stress and decrease depressive and anxious feelings. Running, walking, cardio, weight lifting, swimming, and other exercises can bring about wonderful health benefits (Please see your medical doctor before trying any exercise. I’m not that kind of doctor and it is out of my scope of practice to suggest (any) physical exercise for you.) For an American Psychological Association article on the positive effects of exercise on mental health, please see http://www.apa.org/news/press/releases/stress/2013/exercise.aspx

9)    There is such a thing as weight discrimination. It happens. Recently, I’ve been hearing more and more about fat people being less likely to get jobs or housing based on their size. Please don’t be one of those people who are fat phobic or discriminate against people based on their size. Please hire people who will be good assets to your company, regardless of size. For more information about how weight discrimination can impact all of us, regardless of size, please see articles including https://www.nationaleatingdisorders.org/can-you-tell-anything-persons-weight and http://www.obesityaction.org/educational-resources/resource-articles-2/weight-bias/weight-discrimination-a-socially-acceptable-injustice

10) Read the book FAT!SO? : Because You Don't Have to Apologize for Your Size (http://www.fatso.com/) and have it in your bookshelves. Learn about the Yay scale. While the Yay scales are out of stock, they can be a great tool to talk about separating self-worth from numbers on a scale. Here’s an article showcasing how one was used to do just that. https://healthateverysizeblog.org/2012/06/12/the-haes-files-using-the-yay-scale-at-work-a-social-experiment-in-changing-attitudes/ Support clients in their search for mental health in a fat-friendly way.  Feel free to buy the book from Amazon by clicking on the link below. For more information about the books I suggest on my website, please click here. 

Thank you for reading Dr. Abi Weissman’s 10 tips for having a fat-friendly office and therapy practice. If you have any questions about making your office fat friendly or if you want to consult on these and other issues, please contact Dr. Abi Weissman (PSY 27497) at info@doctorabi.com or (619) 403-5578. If instead, you are looking for a fat-friendly therapist and live or work in Poway, CA or Hillcrest, San Diego, CA, please contact Dr. Abi Weissman through email at info@doctorabi.com or on the phone at (619) 403-5578. Both offices have elevators and comfortable couches for client use. As always, this post does not signify a therapeutic relationship with Dr. Abi Weissman and is meant to share general information. Should you need individual information about your situation, please contact your local licensed counselor, therapist, or psychologist.

In solidarity,

Abi Weissman, Psy.D.

PSY 27497

Waves, A Psychological Corporation