Weight Stigma in Clinical Psychology: a Critical Discursive Psychology Analysis with Trainees

Abstract

Background Weight stigma is defined as negative attitudes towards and beliefs about others because of their weight (Andreyeva, Puhl, & Brownell, 2008). Biased views of fat individuals by professionals in physical healthcare and the stigmatising impact this can have on the quality of care they receive has been well documented (Phelan, et al., 2015). Mental health professionals ascribe more negative personal attributes to fat clients (Hassel, Amici, Thurston, & Gorsuch, 2001), rate fat clients as having more severe symptoms than thin clients (Hassel, Amici, Thurston, & Gorsuch, 2001; Young & Powell, 1985) and predict worse treatment prognosis and contribute less effort towards treatment of fat clients (Davis-Coelho, 2000). Although weight stigma has recently been studied in American Clinical Psychology training institutions and qualified professionals (Brochu, 2019, 2020) the topic has received little published research attention within the profession of Clinical Psychology in the UK. Method The current study used Critical Discursive Psychology (Edley & Wetherell, 2001, Wetherell, 1998) analysis to consider the way in which 12 UK trainee clinical psychologists constructed weight, bodies, and fatness during online focus groups; how they drew on and resisted existing repertoires, positioning themselves and others in relation to these; and the implications of this, clinically, professionally and in broader social and political ways. Findings Findings highlighted a disjuncture between trainees’ reflections about ‘fat-talk’ with family and friends in their personal lives compared to talk in professional settings, including training programmes, clinical work and supervision. They offered enthusiastic and detailed accounts of conversations about weight and body size in their personal lives, but reported limited and awkward talk in professional settings, and when speaking ‘as professionals’. Trainees drew on multiple repertoires to discuss weight, bodies and fatness, including weight as something that is controllable and should be managed (either by individuals or society), weight as a physical health issue, weight as a mental health issue, and weight as measure of worth. While showing some awareness of the impact of negative stereotypes, they were not immune to perpetuating, at times, powerful negative societal positionings of fat people in comparison to others, and in ways that underplayed the relevance of fat stigma. Further, their apparent awareness of how their internalisation of stereotypes was as odds with their values as trainee clinical psychologists appeared to have the paradoxical effect of closing down open discussion needed for learning and reflexive clinical work and supervision. Conclusion & Implications Trainees are in a powerful position to challenge weight bias, but to challenge it they must first be made more aware of it and the detrimental impact it can have on all people, but especially those in fat and marginalised bodies. Clinical implications are discussed to consider how trainees might be better supported to acknowledge and challenge their own biases about weight and fat individuals, including addressing weight stigma in their training and how supervisors might better support trainees to actively reflect on their own and other bodies.