Publication Date


Document Type

Masters Thesis


School for Social Work


Overweight women-Mental health services, Psychotherapist and patient, Countertransference (Psychology), Psychotherapists-Attitudes, Physical-appearance-based bias, Fat, Size, Bias, Size positive, Fat positive, Managing negative countertransference, Mental health clinicians, Psychotherapy, Fat women, Women of size, Size acceptance


This qualitative study was conducted to explore mental health clinicians' possible countertransference with clients who are women of size. This study intends to contribute to the growing clinical literature on size bias in psychotherapy by focusing on clinicians' countertransference in depth. Twelve clinicians participated in this study, from various mental health backgrounds and degrees from licensed clinical social workers to clinical psychologists. The data in this study suggests that clinicians experience intense, and often negative, countertransference with their clients who are women of size. Some clinicians were aware of their fat bias and prejudice out in the world, yet were not as aware of how this bias made its way into the countertransference with their fat female clients. Clinicians' narratives also suggest that cultural reinforcement of body aesthetics plays a significant role in countertransference, via an emphasis on health, disordered eating, and weight. Ambivalence was an overarching theme categorizing clinicians' experiences of their thoughts and feelings toward women of size. Other findings included affective reactions such as devaluation, fear, shame, and confusion around the topic of fat women, which can manifest in the form of microaggressions. This researcher concludes that size acceptance can be used as a way to manage clinicians' negative countertransference with women of size and can also be useful in treating fat women in psychotherapy.




iv, 89 p. Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. Includes bibliographical references (p. 86-87)