Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Cortney S. Warren

Second Committee Member

Marta Meana

Third Committee Member

Jason Holland

Fourth Committee Member

Lori Olafson

Number of Pages



A large body of research demonstrates the existence of weight bias in healthcare professionals, including physicians, nurses, and dietitians (Budd, Mariotti, Graff, & Falkenstein, 2011). Very few published studies examine mental health providers' attitudes toward obese clients, but a small body of existing data suggests that mental health providers attribute more negative personal attributes to fictional obese clients and rate them as having more severe symptoms than their average weight counterparts (Agell & Rothblum, 1991; Hassel, Amici, Thurston, & Gorsuch, 2001; Young & Powell, 1985). Given these findings, it is important to understand whether obese clients experience mental health professionals as stigmatizing and, if so, how this impacts clients and the therapeutic work. Consequently, this study explored obese women's experiences with weight-related microaggressions (subtle, perhaps unintentional communications of weight bias) in psychotherapy. Fifteen obese women (mean BMI = 41.52) who were currently attending therapy participated in semi-structured interviews inquiring about general therapy experiences and experiences with weight stigma in psychotherapy. Data were coded using a general inductive approach to identify themes emerging from participants' experiences. Overall, participants reported very few weight-related microaggressions in therapy. Other key findings included participants' responses regarding whether and how their weight impacts therapy sessions, with an emerging theme of being less forthcoming or more evasive in therapy due to weight. Many participants also reported reactions (often negative and rarely discussed in therapy) to their therapist's body size or appearance. Participants also offered advice to therapists working with overweight clients. They suggested allowing clients to initiate and direct conversations about weight in therapy, but advice otherwise tended to focus on general, non-weight-related interventions. Implications for clinical practice and training and future research are discussed.


Aggressiveness; Discrimination against overweight women; Discrimination in mental health services; Microaggressions; Obesity; Obesity in women; Psychotherapy; Weight Bias; Weight Stigma


Clinical Psychology

File Format


Degree Grantor

University of Nevada, Las Vegas




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